Emphasis on Cancer of the Female Reproductive System

CANCER OF THE FEMALE REPRODUCTIVE SYSTEM

Music to accompany this page:
Out Here on My Own, by Irene Cara

Over 46,000 women will be diagnosed with endometrial or cervical cancer in the next year. Female

reproductive organ cancers affect fewer women than breast, lung and colorectal cancers. But there is no comfort in that fact if you happen to be on of the women diagnosed with cervical, uterine (endometrial) or ovarian cancer.

The uterus is about three inches long and shaped like an upside-down pear. The wider upper portion forms the main body of the uterus which is lined with a layer of cells called the endometrium.

Cancer of the uterus usually affects the endometrium, the inner lining of the main body of the uterus itself. Cancer of the cervix refers to the lower portion of the uterus which opens to the vagina.

UTERINE CANCER

Cancer of the uterus, or endometrial cancer, is the sixth leading cancer among American women. Fortunately, early detection and advancements in treatments have reduced the death rate from uterine cancer, by more than 70% over the last forty years.
Uterian cancer can be diagnosed in its early stages, which often allows for a cure to be rendered. But when abnormal symptoms are ignored, or yearly pelvic examinations are avoided, uterine cancers can grow and invade surrounding tissues and organs, such as the bladder and rectum. Once tumor cells spread through the body the chances of survival are dramatically cut.

As with the majority of cancers, the cause of uterine cancer is unknown. There have been inconclusive suspicions that the hormone estrogen plays a role. Women who are subject to a condition known as "unopposed estrogen" have a greater incidence rate for uterian cancer. During normal menstruation, the stimulation of estrogen is relieved by the hormone progesterone, which is produced monthly following ovulation. Irregular menstrual periods and infrequent ovulation do not result in the release of progesterone, hence the term "unopposed estrogen." Higher levels of estrogen also are present in women who have a late menopause, which prolongs the years of estrogen stimulation.
Most uterine tumors occur in women after menopause, with a very small percentage (5%) occurring in women below the age of 40.
Women who are at highest risk for this cancer have:

	never borne children			irregular periods
	a history of infertility			obesity in the post-menopausal years
	menopause that began after age 50			had breast, colo-rectal or ovarian cancer
	a history of diabetes mellitus

The use of continuous and prolonged estrogen replacement therapy for menopausal estrogen deficiency has been associated with an increased risk of endometrial cancer. Intermittent low-dose estrogen in conjunction with progesterone, however, has been found to reduce the risk. Birth control pills today combine both estrogen and progesterone and may in fact protect against uterine cancer.
To improve the survival odds, women who fall into one of the above listed risk groups should discuss a screening program with their physician to allow detection of the cancer in it's earliest stage.

Symptoms The easiest way to look at the symptoms is to categorize them according to the period of menopause that a women is currently in:
Pre-Menopause	The most common symptom of uterian cancer is unusual vaginal bleeding. In pre-menopausal women, this may include excessive or prolonged menstruation or bleeding between menstrual periods. This symptom occurs in more than 90% of pre-menopausal women, and is usually caused by some other factor. It should not be ignored however, and you should alert your physician if abnormal bleeding occurs.
Menopause	During menopause, bleeding that is heavier or more frequent than usual is considered abnormal. The normal course of events is less frequent menstrual periods and a lighter menstrual flow. Since skipping menstrual periods and a lessening of low are not unusual during menopause, abnormal vaginal bleeding can be difficult to recognise.
Post-Menopause	After menopause, any vaginal bleeding, even scant spotting, is considered abnormal. So, too, is a menstrual period that resumes after six months to a year's time without periods. Post-menopausal vaginal discharge of clear fluid after heavy exertion or straining may also be a symptom. It can proceed abnormal bleeding.
Although the above symptoms in pre-menopausal, menopausal and post-menopausal women can be caused by conditions other than cancer, play it safe and notify your physician if they appear.

Diagnosis Prompt diagnosis is in order whenever uterine cancer is suspected. A tissue specimen is taken to provide an accurate diagnosis. The favored methods to rule out the presence of cancer or to confirm its spread are either dilation and curettage (D&C) or the cervical canal or an endometrial biopsy. The results of the cell and tissue analysis, combined with the stage of the cancer's development, determine the recommended course of treatment. Tumors are "staged" according to the maturity of the cancer cells, their extent and aggressiveness.
Stage 1:	The cancer is confined to the body of the uterus.
Stage 2:	Signifies the cancer involves the cervix but still is confined to the uterus.
Stage 3:	The cancer has spread aggressively to adjacent tissue and organs.
Stage 4:	The cancer has spread aggressively to adjacent tissue and organs.

Treatment In addition to the stage, location and aggressiveness of the cancer, the woman's general health influences upon the type of treatment recommended. These factors must be weighed on an individual bases for the physician and the patient to arrive at the most beneficial form of treatment.
Surgery	Surgery is the primary method for treating uterine cancer. Fore very early cancers with a low risk of recurrence, surgery alone is sufficient to cure endometrial cancer. However, patients with a more advanced cancer have a greater likelihood of tumor recurrence following surgery.
		Hysterectomy - This is the minimal surgical procedure in treatment of uterine cancer and involves the removal of the uterus.
		Bilateral saplingo-oophorectomy - Involves removal of the ovaries and the Fallopian tubes as well. Parts of the vagina may be removed as well.
		Lymphadenectomy - A procedure that is conducted, in which lymph nodes within the abdominal area are also removed to confirm whether the cancer has spread.
		Radical Hysterectomy - Involves removal of the uterus, Fallopian tubes, ovaries, the upper third of the vagina, adjacent connective tissues and lymph nodes.
		Pelvic Exenteration - Used for locally recurrent cervical cancer, and involves removal of the bladder, connective tissues, urethra and rectum along with the tissues and organs removed in a radical hysterectomy.
Radiation		For more advanced case, radiation is used in combination with surgery. Radioactive implants or external radiation therapy is used either before or after surgery when the cancer is fairly developed to reduce the chances of cancer cells spreading elsewhere. A radioactive source inserted temporarily in the uterus and/or vagina often has the effect of killing or disabling any tumor cells present.
Hormone Therapy		In certain high-risk, advanced recurrent cancer, hormone therapy may be used to treat the tumors. Some cancers are sensitive to changes in hormone levels. By adding, removing, or limiting the activity of a certain hormone, doctors can slow the growth.
Chemotherapy		In certain high-risk advanced recurrent cancer, chemotherapy may be used to treat the tumors. Chemotherapy can affect any rapidly growing cells in the body, and include normal as well as cancer cells. The normal cells most likely to be affected are the blood-producing cells in the bone, cells lining the digestive tract and reproductive organs, and hair follicles. The normal cells are able to replace themselves while the cancer cells cannot.

CERVICAL CANCER

Cancer of the cervix refers to the lower portion of the uterus which opens to the vagina. Its incidence of detection and cure is on the rise. This increase is due in part to the fact that this cancer is now being detected at an earlier stage than was previously possible thanks to the widespread use of the Pap smear. As a consequence of this screening test, the incidence and death rates for invasive cervical cancer have actually declined over the years.
Most authorities believe cervical cancer develops very slowly and in stages. The first stage is thought to be cervical dysplasia, a precancerous condition marked by abnormal cell development within the cervix. In actuality, only 30% to 50% of women with dysplasia ultimately will develop cancer if the condition is left untreated. The percentage is great enough for most authorities, however, to consider dysplasia the first step in the slow progression of abnormal cellular changes leading to carcinoma in situ, the earliest stage of cancer.
This "cancer that is in place" can, in turn, progress to an invasive cancer. Current practice holds that if there is dysplasia, a biopsy must be done for confirmation and if verified, treatment ensue.'Early stage O cancer - carcinoma in situ - appears more frequently in women in their 30's who have had children. Invasive cervical cancer is found more frequently in women in their 40's.

Symptoms
Warning symptoms usually are absent. The most common sign - bleeding, between menstrual periods or after intercourse - occurs in only about one-third of women with cervical carcinoma in situ. A constant light vaginal discharge may be present in the cancer's early stages. The cervix may also appear abnormal upon examination, but since abnormalities are common among women who have borne children, observed changes may not be related to cancer. The Pap smear remains the primary method of early detection.
In advanced stages of cervical cancer, the vaginal discharge is more pronounced odorous, bleeding more profuse, there may be lower back pain, pelvic pain and there may be weight loss, and possible urinary and bowel problems. But again, these symptoms are often not present. Because the menstrual cycle is not affected, bleeding, when it does occur, is between periods and in most cases, very slight or spotting. Because the average age of women with invasive cancer of the cervix is 48 - about the time of menopause - bleeding irregularities may be mistaken for menopause.

Diagnosis A diagnosis of cancer cannot be made without a tissue biopsy. The preferred diagnostic instrument is the colposcope. The colposcope is a magnifying lens which permits the physician to exam the cervix from the outside and take a biopsy of suspicious tissue. An endocervical curettage, or cervical canal scraping, is done to detect spread of cancer up the cervical canal. In certain instances, a procedure called a conization may be necessary following the initial biopsy. This entails the removal of a cone of tissue from the cervix. A dilation and curettage (D & C) may also be done. In the past, the accepted treatment following diagnosis of abnormal cells in the cervix, or evidence of cancer in situ, was a cervical conization or more frequently, the removal of the uterus. This combination of early detection and surgical removal is estimated to have saved hundred of thousands of women from progressive cervical cancer. Newer examination and treatment methods, such as use of the colposcope, now make possible more subtle discrimination of the nature and extent of abnormal changes. A conization, or now more often cryosurgery (freezing) or laser beam surgery of the affected tissue sometimes allows preservation of the uterus. In the event of invasive cervical cancer, the extent of the cancer's spread will dictate the resulting treatment program. The extent is "staged" as follows:
Stage 1:	Confined to the cervix and usually treated by radiation. Cancer may also be treated effectively by surgery depending on teh individual patient's circumstances. Five-year survival rates for this stage average around 75%.
Stage 2:	Extending beyond the cervix, but not to the pelvic wall. This stage of cancer is usually treated with radiation, because the cancer is too widespread for surgical removal. Five-year survival rates for this stage average around 50%.
Stage 3:	Invasion of the pelvic wall and/or lower third of the vagina. It is usually treated with radiation, because the cancer is too widespread for surgical removal. Five-year survival rates for this stage average around 30%.
Stage 4:	Extends beyond the pelvis and invading the bladder or rectum. It is usually treated with radiation as well, although there are exceptions where surgery may be preferred. Five-year survival rates for this stage average around 8%.

Treatment In addition to the stage, location and aggressiveness of the cancer, the woman's general health influences upon the type of treatment recommended. These factors must be weighed on an individual bases for the physician and the patient to arrive at the most beneficial form of treatment.
LEETZ or LEEP	LEETZ is a rather new procedure for the diagnosis and treatment of cervical cancer. The technique treats the condition by removing the affected tissue through excision. The specimen is then sent to the pathology lab for further evaluation.
Surgery	Various types of surgery are available for the treatment of cervical cancer, dependent on the extent of the cancer and the physical condition of the patient.
		Hysterectomy - This is the minimal surgical procedure in treatment of cervical cancer and involves the removal of the uterus.
		Lymphadenectomy - A procedure in which lymph nodes within the abdominal area are also removed to confirm whether the cancer has spread.
		Radical Hysterectomy - Involves removal of the uterus, Fallopian tubes, ovaries, the upper third of the vagina, adjacent connective tissues and lymph nodes.
		Pelvic Exenteration - Used for locally recurrent cervical cancer, and involves removal of the bladder, connective tissues, urethra and rectum alon with the tissues and organs removed in a radical hysterectomy.
Radiation	For more advanced case, radiation is used in combination with surgery. Radioactive implants or external radiation therapy is used either before or after surgery when the cancer is fairly developed to reduce the chances of cancer cells spreading elsewhere. A radioactive source inserted temporarily in the uterus and/or vagina often has the effect of killing or disabling any tumor cells present.

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