Cervical cancer is cancer that starts in the cervix, the lower part of the uterus (womb) that opens

at the top of the vagina. Cervical cancer remains to be one of the leading malignancies among Filipino women. High-risk human papillomavirus (HPV) types, such as 16 and 18, are consistently identified in Filipino women with cervical cancer.

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.

Most of the time, early cervical cancer has no symptoms. Symptoms that may occur can include: Continuous vaginal discharge, which may be pale, watery, pink, brown, bloody, or foulsmelling Abnormal vaginal bleeding between periods, after intercourse, or after menopause Periods become heavier and last longer than usual Any bleeding after menopause

Symptoms of advanced cervical cancer may include: Loss of appetite Weight loss Fatigue Pelvic pain Back pain Leg pain Single swollen leg Heavy bleeding from the vagina Leaking of urine or feces from the vagina Bone fractures

According to the Filipino cancer registry 2005 annual report, the incidence of cervical cancer remained stable from 1980 to 2005, with an annual age-standardized incidence rate of 22.5 cases per 100,000 women. In 2005, there were 7,277 new cases of cervical cancer, with 3,807 reported deaths. The overall 5-year survival rate was 44% and mortality rate was 1 per 10,000 women.

The high mortality rate was attributed to the fact that 75% of women were diagnosed at late stage disease with treatment being frequently unavailable, inaccessible or non-affordable.

The Philippine General Hospital (PGH) has been the country's government tertiary center reporting the highest number of new cervical cancer cases.

In 2006, 466 new cases were reported, of which 68% were squamous cell carcinoma, 21% adenocarcinoma, 3% adenosquamous and 8% of other histology. Among these cases, more than half (52%) were diagnosed as stage III

The development of cervical cancer is usually 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. Most women that are diagnosed with cervical cancer today have not had regular Pap smears or they have not followed up on abnormal results.

Undetected, pre-cancerous changes can develop into cervical cancer and spread to the bladder, intestines, lungs, and liver. It can take years for pre-cancerous changes to turn into cervical cancer. Patients with cervical cancer do not usually have problems until the cancer is advanced and has spread.

Almost all cervical cancers are caused by HPV (human papilloma virus). HPV is a common virus that is spread through sexual intercourse. There are many different types of HPV, and many do not cause problems. However, only certain strains of HPV actually lead to cervical cancer.

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 1960s to prevent miscarriage Weakened immune system Poor economic status (may not be able to afford regular Pap smears)

Pre-cancerous changes of the cervix and cervical cancer can not be seen with the naked eye. Special tests and tools are needed to spot such conditions. Pap smears screen for pre-cancers and cancer, but do not offer the final diagnosis. If abnormal changes are found, the cervix is usually examined under magnification. This is called colposcopy. Pieces of tissue are surgically removed (biopsied) during this procedure and sent to a laboratory for examination.

Other tests may include: Endocervical curettage (ECC) to examine the opening of the cervix Cone biopsy

If the woman is diagnosed with cervical cancer, the health care provider will order more tests to determine how far the cancer has spread. This is called staging. Tests may include: CT scan Cystoscopy MRI Chest x-ray Intravenous pyelogram (IVP)

The ectocervix is covered by stratified squamous epithelium. The canal of the cervix is lined by columnar epithelium . point where these two epithelia meet is called the squamocolumnar Junction . It lies just at the external os, but as the cervix increases in volume during puberty and also pregnancy, the SCJ is said to roll out onto the ectocervix.

The delicate columnar epithelium exposed to the acid environment of the vagina undergoes a process of metaplasia whereby it becomes squamous epithelium. The transformation zone is that part of the cervix that extends from the widest part of skin that was originally columnar epithelium into the current SCJ.

The most widely used treatments for cervical cancer are surgery and radiation therapy. Chemotherapy or biological therapy is sometimes used. Treatment for invasive cervical cancer usually involves a team of specialists. The team generally includes a gynecologic oncologist and a radiation oncologist. These doctors may decide to use one treatment method or a combination of methods.

Cancerous cells typically invade surrounding tissues. If a biopsy shows that cancerous cells have invaded through a layer called the basement membrane, which separates the surface layers of the cervix from other underlying layers, surgery is usually required. The extent of the surgery varies, depending on the stage of the cancer.

Radiation therapy (also called radiotherapy) is also used to fight cervical cancer at some stages. Radiation therapy uses high-energy rays to damage cancer cells and stop them from growing. Like surgery, radiation therapy is local therapy; the radiation affects cancer cells only in the treated area. Radiation may be applied externally or internally. Some women receive both kinds.

External radiation treatments usually are given 5 days a week for 5-6 weeks. At the end of that time, an extra dose of radiation called a "boost" may be applied to the tumor site. Each treatment takes only a few minutes. Because of safety concerns and expense of equipment, radiation therapy generally is offered only at certain large medical centers or hospitals.

Internal or implant radiation comes from a capsule containing radioactive material which is placed directly in the cervix. The implant puts cancer-killing rays close to the tumor while sparing most of the healthy tissue around it. It is usually left in place for 1-3 days, and the treatment may be repeated several times over the course of 1-2 weeks. Patient stays in the hospital while the implants are in place.

Chemotherapy is the use of powerful drugs to kill cancer cells. In cervical cancer, it is used most often when the cancer has spread to other parts of the body. Just one drug or a combination of drugs may be given. Anticancer drugs used to treat cervical cancer may be given via an IV line or by mouth. Either way, chemotherapy is systemic treatment, meaning that the drugs flow through the body in the bloodstream. They can kill cancer cells anywhere in the body.

Chemotherapy is given in cycles: each cycle comprises a period of intensive treatment followed by a recovery period. Treatment usually consists of several cycles. Most patients have chemotherapy as an outpatient (in an outpatient clinic at the hospital, at the doctor's office, or at home). Depending on which drugs are given and the general health, however, patient may need to stay in the hospital during treatment.

Total hysterectomy removal of the uterus, cervix, and ovaries Radical hysterectomy removal of the uterus, ovaries, fallopian tubes, proximal vagina, and bilateral lymph nodes through an abdominal incision Radical vaginal hysterectomy - removal of the uterus, ovaries, fallopian tubes and proximal vagina Bilateral pelvic lymphadenectomy removal of the common iliac, external iliac, hypogastric, and obturator lymphatic vessels and nodes

Pelvic exenteration removal of the pelvic organs, including the bladder or rectum and pelvic lumph nodes, and construction of diversional conduit, colostomy, and vagina Radical trachelectomy removal of the cervix and selected nodes to preserve childbearing capacity in a woman of reproductive age with cervical cancer.

Brunner & Suddarths Medical-Surgical Nursing pp. 1429-1433 http://en.wikipedia.org/wiki/Cervical_cancer#V isual_inspection_to_detect_precancer_or_canc er http://www.nlm.nih.gov/medlineplus/ency/arti cle/000893.htm http://www.ncbi.nlm.nih.gov/pmc/articles/PM C2676501/ http://www.emedicinehealth.com/cervical_can cer/article_em.htm