Cervical Cancer

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Cervical Cancer

NIH - Medical Encyclopedia Cervical Cancer

"Cervical cancer is cancer that starts in the cervix, the lower part of the uterus (womb) that opens at the top of the vagina. … Worldwide, cervical cancer is the third most common type of cancer in women. … Cervical cancers start in the cells on the surface of the cervix. There are two types of cells on the cervix's surface: squamous and columnar. The majority of cervical cancers are from squamous cells. The development of cervical cancer is very slow. It starts as a pre-cancerous condition called dysplasia. This pre-cancerous condition can be detected by a Pap smear and is 100% treatable. That is why it is so important for women to get regular Pap smears … Undetected, pre-cancerous changes can develop into cervical cancer and spread to the bladder, intestines, lungs, and liver. … Almost all cervical cancers are caused by HPV (human papillomavirus). … Other risk factors for cervical cancer include: • Having sex at an early age • Multiple sexual partners • Sexual partners who have multiple partners or who participate in high-risk sexual activities • Women whose mothers took the drug DES (diethylstilbestrol) during pregnancy in the early 1970s to prevent miscarriage • Long-term use of birth control pills (more than 5 years) • Weakened immune system • Infections with genital herpes or chronic chlamydia infections • Poor economic status (may not be able to afford regular Pap smears)."

Highlighted Article

Prevalence of HPV Infection Among Females in the United States (JAMA. 2007)

"Results The overall HPV prevalence was 26.8% … among US females aged 14 to 59 years … HPV prevalence was 24.5% (19.6%-30.5%) among females aged 14 to 19 years, 44.8% (36.3%-55.3%) among women aged 20 to 24 years, 27.4% (21.9%-34.2%) among women aged 25 to 29 years, 27.5% (20.8%-36.4%) among women aged 30 to 39 years, 25.2% (19.7%-32.2%) among women aged 40 to 49 years, and 19.6% (14.3%-26.8%) among women aged 50 to 59 years. There was a statistically significant trend for increasing HPV prevalence with each year of age from 14 to 24 years … followed by a gradual decline in prevalence through 59 years … HPV is common among females in the United States. Our data indicate that the burden of prevalent HPV infection among females was greater than previous estimates and was highest among those aged 20 to 24 years."

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Cervical Cancer

Diagnosis, Imaging, and Screening

NEWS:

HPV Beats Pap as Cervical Cancer Test: HPV Test 40% Better at Detecting Precancerous Cells "In a head-to-head comparison study from Canada, DNA testing for human papillomavirus (HPV) was found to be far more accurate than traditional Pap smear testing for detecting precancerous lesions. The HPV test was nearly 40% better at detecting these lesions than the Pap test. "

PET Scans Can Spot Cervical Cancer's Return "Whole-body positron emission tomography (PET) scans three months after cervical cancer patients have completed therapy can help determine whether they're cancer-free or require further treatment, U.S. researchers say."

Simple Method Detects Cervical Cancer "The visual screening test is done by a nurse or trained health care worker who washes a woman's cervix with vinegar and gauze using a speculum to hold it open. After one minute, any pre-cancerous lesions turn very white and can be seen with the naked eye under a halogen lamp. … Previous research has shown visual screening is almost as effective in catching cancer as Pap smears, a more expensive technique used in the West, which involves scraping cells from the cervix to be examined under a microscope in a laboratory. "This is the final proof that with an extremely simple test, we can have a dramatic impact on cervical cancer rates," Sanghvi said. … Still, the test isn't perfect. It can produce many false positives, so health care workers giving the test must be properly trained. Also, the test cannot be used in post-menopausal women or in women who have had more than two or three children, since pre-cancerous lesions in those women develop in parts of the cervix not normally visible. "

Study Shows HPV Test Is Better Predictor of Cervical Cancer in Older Women " For more than 60 years the Pap smear has been the screening method of choice for cervical cancer , but it is not the best approach for assessing risk in older women, new research suggests. Findings from a large, Danish study provide compelling evidence that testing for human papillomavirus (HPV) is more effective for identifying older women with a high risk of developing cervical cancer."

ARTICLES:

JOURNAL ARTICLES:

[Are analyses of cytological cervix smears from young women more harmful than beneficial?] (Tidsskr Nor Laegeforen. 2007) "INTERPRETATION: Most lesions in young women regress spontaneously. By not collecting smears from young women, many lesions that would anyway regress spontaneously, would not be discovered and follow-up could be avoided. Prospective follow-up studies of viral processes and oncogeneses indicate that it takes many years for normal cervix cells in the uterus to develop into cancer. For most young women it makes no difference whether low grade lesions or lesions that require treatment are diagnosed at age 23, 24 or shortly after 25. With reference to data from the Norwegian Cancer Registry and international literature, we conclude that analysis of cytological cervix smears from young women is more harmful than beneficial."

Cervical cancer screening in Serbia. (Coll Antropol. 2007) "Compared with other European countries, the incidence of cervical cancer in Central Serbia is the highest."

Cervical screening in the UK and laboratory quality control in the context of the 2007 European guidelines. (Coll Antropol. 2007)

Comparative study of four candidate strategies to detect cervical cancer in different health care settings. (J Obstet Gynaecol Res. 2007)

Contribution of the sentinel node procedure to tailoring the radicality of hysterectomy for cervical cancer. (Gynecol Oncol. 2007)

High-risk HPV may indicate cytologically false negative smears. An analysis of "normal" smears preceding CIN2/3. (J Clin Pathol. 2007)

Frequency and prognostic significance of HPV DNA in sentinel lymph nodes of patients with cervical cancer. (Ann Oncol. 2007) "CONCLUSION: In women with cervical cancer, HPV DNA screening of sentinel nodes might help to identify patients at risk of lymph node metastases and recurrence."

High-risk human papillomavirus DNA testing and high-grade cervical intraepithelial lesions. (Aust N Z J Obstet Gynaecol. 2007) "Conclusion: HPV DNA testing is a useful indicator in the management of patients with ASC-US and plays an important role in the evaluation of risk for CIN 2,3 and cervical cancer."

HPV status in sentinel nodes might be a prognostic factor in cervical cancer. (Gynecol Oncol. 2007) "CONCLUSION.: Our results suggested the possibility that sentinel-node HPV typing could play a supportive role to reduce the false-negative rate of the sentinel-node biopsy. All of five patients with recurrence had HPV infection in the sentinel nodes. Absence of HPV in sentinel nodes showed reliable negative predictive value for lymph node metastasis and recurrence. Additional study will be needed to confirm the clinical application of the sentinel-node procedure and to determine whether there is a correlation of HPV status of sentinel nodes to lymph node metastasis and recurrence in cervical cancer patients."

HPV triage for low grade (L-SIL) cytology is appropriate for women over 35 in mass cervical cancer screening using liquid based cytology. (Eur J Cancer. 2007) "In conclusion, triaging by HPV testing performed better in women aged over 35 years than those younger. For older women, HPV triaging should also be considered for managing those with LSIL cytology."

Human papillomavirus genotype in cervical cancer: A population-based study. (Int J Cancer. 2007)

Human papillomavirus testing for precancerous lesions of the cervix. (N C Med J. 2007)

Is it rational to start population-based cervical cancer screening at or soon after age 20? Analysis of time trends in preinvasive and invasive diseases. (Eur J Cancer. 2007) " The study confirms an increasing rate of preinvasive and invasive disease among younger women and indicates the benefit of starting organised screening at 2-3 year intervals soon after age 20."

[MRI findings of uterine cervical cancer and value of MRI in preoperative staging] (Nan Fang Yi Ke Da Xue Xue Bao. 2007) "CONCLUSION: MRI can accurately describe the size and invasion of uterine cervical cancer, especially useful in detecting parametrial invasion, but for diagnosis of IA uterine cervical cancer, MRI findings are not sufficient without considerations of clinical findings and cellular examination."

Papanicolaou smear history in women with low-grade cytology before cervical cancer diagnosis. (Cancer. 2007)

Positron emission tomography imaging for gynecologic malignancy. (Curr Opin Obstet Gynecol. 2007)

Prognostic value of histopathology and trends in cervical cancer: a SEER population study. (BMC Cancer. 2007) "CONCLUSIONS: Small cell carcinoma and adenocarcinomas were associated with poorer survival. The incidental observation of increasing numbers of adenocarcinomas despite a general decline suggests the inefficiency of conventional screening for these tumors. Increased incidence of adenocarcinomas, their adverse prognosis, and the young age at diagnosis indicate the need to identify women who are at risk."

Risk of high-grade cervical intra-epithelial neoplasia based on cytology and high-risk HPV testing at baseline and at 6-months. (Int J Cancer. 2007)

Screening and management of women and girls with human papillomavirus infection. (Gynecol Oncol. 2007)

Sentinel lymph node biopsy improves staging in early cervical cancer. (Gynecol Oncol. 2007) "CONCLUSION: SLN detection ensures the identification of SLNs in unusual locations in 36% of patients. SLN disease was found in 8% of our patients. Thus, SLN biopsy improves staging in patients with early cervical cancer. Studies in larger patient populations are needed to evaluate the clinical impact of SLN biopsy."

Sentinel lymph nodes in early stage cervical cancer. (Gynecol Oncol. 2007) "OBJECTIVES.: Lymph node status is the most important prognostic factor in cervical cancer. Sentinel lymph node (SLN) procedures have been purported to reduce peri- and postoperative morbidity and operative time"

The performance of magnetic resonance imaging in early cervical carcinoma: a long-term experience. (Int J Gynecol Cancer. 2007) "Our study confirms MRI is highly accurate in localizing cervical tumor, excluding parametrial invasion, confirming myometrial and internal os invasion. MRI is therefore useful in selecting patients for surgery and mandatory in patients for fertility-preserving surgery. Using accepted size criteria for nodal involvement, MRI is insensitive and currently will not avoid need for pelvic lymphadenectomy."

Therapeutic value of pretherapeutic extraperitoneal laparoscopic staging of locally advanced cervical carcinoma. (Gynecol Oncol. 2007)

Where to look for the sentinel lymph node in cervical cancer. (Am J Obstet Gynecol. 2007)

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