DEFINITIONS
Cervix Cancer (Cervical Cancer) is a malignant tumor that grows in the neck of the uterus / cervix (the lowest part of the uterus attached to the top of the vagina.
Cervical cancer usually attacks women aged 35-55 years.
90% of the cervical cancer derived from squamous cells lining the cervix and the remaining 10% comes from mucus-producing gland cells in the cervical canal leading into the womb.
CAUSE
Cervical cancer occurs when cervical cells become abnormal and divide by an uncontrollable.
If the cervical cells continue to divide it will form a tissue mass called a tumor may be benign or malignant. If the tumor is malignant, then the condition is called cervical cancer.
Cause of the abnormalities in cervical cells is not known with certainty, but there are several risk factors that influence the occurrence of cervical cancer:
- HPV (human papillomavirus)
- Smoke Tobacco damage the immune system and affect the body's ability to fight HPV infection in the cervix.
- First sexual intercourse at an early age performed
- Changing sexual partners
- Husband / partner first sexual intercourse at age under 18 years old, have multiple sexual partners and had been married to women who suffer from cervical cancer
- The use of DES (diethylstilbestrol) in pregnant women to prevent miscarriage (widely used in the year 1940 to 1970)
- Impaired immune system
- Pill Use
- Infections genital herpes or chronic chlamydia infections
- Economically weak groups (for not being able to do Pap smears on a regular basis)
Cells on the surface of the cervix sometimes appear abnormal but not malignant.
Scientists believe that some abnormal changes in cervical cells is the first step in a series of slow changes, a few years later, can cause cancer.
Because of that some abnormal changes are precancerous condition, which can turn into cancer.
We have used a different term for abnormal changes to cells on the surface of the cervix, one of whom is squamous intraepithelial lesions (mean lesion tissue disorder, intraepithelial means that abnormal cells are found only in the surface layer).
Changes in these cells can be divided into two groups:
- Low-level lesions: an early change in the size, shape and number of cells that form the surface of the cervix. Some low-level lesions disappear by itself. But others grow up to be bigger and more abnormal, forming a high-level lesions. Low-level lesion also called mild dysplasia or cervical intraepithelial neoplasia 1 (NIS 1). Low-level lesions most often found in women aged 25-35 years, but can also occur in all age groups.
- High level lesions: found a large number of precancerous cells that look very different from normal cells,These precancerous changes occur only in cells on the surface of the cervix. For months, even years, these cells will not become malignant and will not penetrate into the deeper layers of the cervix. High-level lesion dysplasia is also called secondary or severe dysplasia, NIS 2 or 3, or carcinoma High level lesions most often found in women aged 30-40 years.
Cervical cancer is most commonly found in over 40 years of age.
SYMPTOMS
Precancerous changes in the cervix usually do not cause symptoms and this change was not detected except if the woman underwent a pelvic examination and Pap smear.
Symptoms usually only appear when abnormal cervical cells become malignant and infiltrate into surrounding tissue. At this time the following symptoms occur:
- Abnormal vaginal bleeding, especially between the two periods, after sexual intercourse and after menopause
- Menstrual abnormalities (longer and more)
- Leucorrhea who settled, with a watery liquid, pink, brown, contains blood or black and smelly.
Symptoms of advanced cervical cancer:
- Decreased appetite, weight loss, fatigue
- Pelvic pain, back or leg
- From the pussy out of urine or faeces
- Broken bones (fractures).
DIAGNOSIS
Diagnosis based on symptoms and examination results of the following:
1. Pap smear
Pap smears can detect up to 90% of cervical cancer cases are accurately and at a cost that is not too expensive. Consequently servikspun number of cancer deaths decreased by more than 50%.
Every woman who has been sexually active or have reached age 18 years, should undergo regular Pap smear is a time / year. If over three times in a row showed normal results, Pap smears can be done one kali/2-3tahun.
Pap smear results indicate stages of cervical cancer:
- Normal
- Mild Dysplasia (early changes are not yet malignant)
- Dysplasia weight (a change-up which is not malignant)
- Carcinoma in situ (cancer confined to the outermost layer of the cervix)
- Invasive cancer (cancer has spread to the deeper layers of the cervix or to other organs).
2. Biopsy
Biopsy was performed if the pelvic exam seemed a growth or lesion on the cervix, or if the Pap smears show an abnormality or cancer.
3. Colposcopy (cervical examination with a magnifying lens)
4. Test Schiller
Cervical lauran smeared with iodine, a healthy cell will change to brown color, whereas the abnormal cells turn white or yellow color
To help determine the stage of the cancer, conducted some examination follows:
- Cystoscopy
- Chest X-ray
- Intravenous urography
- Sigmoidoscopy
- Skening bone and liver
- Barium enema.
TREATMENT
Treatment of precancerous lesions
Treatment of precancerous lesions of the cervix depends on several factors:
- The level of lesion (whether low level or high level)
- Patient plans to become pregnant again
- Age and general condition of patient.
Low-level lesions usually do not require further treatment, especially if an abnormal area has been fully lifted at the time of biopsy examination. But the patient should undergo Pap smears and pelvic examinations regularly.
- Treatment of precancerous lesions can be: Kriosurgeri (freezing)
- Cauterization (burning, also called diathermy)
- Surgical laser to destroy abnormal cells without harming surrounding healthy tissue
- LEEP (loop electrosurgical excision procedure) or konisasi.
After treatment, patients may feel cramping or other pain, bleeding or watery discharge from the vagina.
In some cases, may require a hysterectomy (removal of the womb), particularly if abnormal cells are found in the cervical opening. Hysterectomies performed if the patient has no plans to get pregnant again.
Treatment for cervical cancer
Selection of treatment for cervical cancer depends on the location and size of tumor, disease stage, age, general condition of the patient and the patient plans to become pregnant again.
- Surgery
- Radiation therapy
- Chemotherapy
- Biologic therapy
There are two ways to prevent cervical cancer:
1. Preventing HPV infection
2. Pap smears regularly.
Pap smear (Papanicolau test) is a microscopic examination of cells obtained from cervical smear.
In the Pap smear, cervical cell samples obtained with the aid of a spatula made of wood or plastic (which is applied to the outside of the cervix) and a small brush (which is inserted into the cervical canal).
Cervical cells are then smeared on glass objects and then given a preservative and sent to the laboratory for examination.
24 hours before undergoing a Pap smear, should not perform vaginal washing or rinsing, no sex, no baths and do not use tampons.
Pap smears are very effective in detecting precancerous changes in the cervix.
If the results of a Pap smear shows dysplasia or cervical looks abnormal, colposcopy and biopsy is usually performed
-Recommendation for doing Pap smears on a regular basis: Every year for women aged over 35 years
- Every year for women who have multiple sexual partners or have suffered sexual or genital warts HPV infection
- Every year for women who use oral contraceptives
- Each 2-3 years for women aged over 35 years if the Pap smear test three times in a row show negative results or to women who had undergone hysterectomy was not due to cancer
- As often as possible if the results showed an abnormal Pap smear
- As often as possible after the assessment and treatment of precancerous or cervical cancer.
To reduce the possibility of cervical cancer should be:
- Children of women under the age of 18 years did not have sexual relations.
- Do not have sexual relations with patients with genital warts or use condoms to prevent transmission of genital warts
- Do not keep changing sexual partners
- Stop smoking.
Pelvic exam every year (including Pap smear) should be started when a woman begins an active sexual intercourse or at age 20 years. Any abnormal results should be followed with colposcopy and biopsy.
Some researchers have shown that vitamin A berpertan in stopping or preventing malignant changes in cells, as happens on the surface of the cervix.
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