CAUSES: Cervical cancer is one of the leading types of cancer in women ... it occurs typically between 40 and 50 years of age (sometimes seen in women under the age of 18) ... it's cause is unknown.

RISK FACTORS: Although the cause of cervical cancer is unknown there are some risk factors which have been identified: 1. Multiple sex partners. 2. Early childbearing. 3. Sexual relations at a young age. 4. Genital herpes. 5. HIV infection. 6. Genital warts (human papilloma virus). 7. Women exposed to the drug DES (once thought to prevent miscarriages).

DEVELOPMENTAL STAGES: This type of cancer may take years to develop and starts with almost imperceptible changes in the cervical cells. As these changes continue to mount up they cause the cells to alter shape, size and organization (at this time the cells are not malignant). With time these cells may develop into preinvasive cancer which affects only the outer cells of the cervix. If allowed to continue, the cancer then invades the deeper cells and eventually the organs of the pelvis.

SYMPTOMS: The early stages of cervical cancer displays no outward symptoms. The sufferer notes problems when small blood vessels of the cervix are affected by the invasive cancer ... vaginal bleeding following intercourse, between periods, after menopause. A vaginal discharge is typically present which may be streaked with blood or pink.

If the disease is allowed to progress the symptoms typically include weight loss, loss of appetite, back pain, leg pain. Also, an abnormal passage (called a "fistula") may develop between the vagina and bladder (or rectum). This passage can result in urine and rectal contents to appear in the vagina.

SIGNS AND TESTS: A physical examination shows a normal cervix in the early stages of the disease, however, Pap smears are effective at detecting the abnormal cells. An examination of the cervix and vagina by means of a coloscope (a device used to inspect for abnormal tissue and cells) will pinpoint areas of concern.

STAGE RATINGS:

Stage 0: Abnormal cells which affect superficial tissue of the cervix ... non- invasive.

Stage 1a: The tumor penetrates to a depth of no more than 3 mm.

Stage 1b: The tumor does not affect any areas other than the uterus and cervix.

Stage 2: The tumor affects structure of the uterus and the upper area of the vagina.

Stage 3: Tumor has spread to the wall of the pelvis.

Stage 4: The tumor has spread to rectum, bladder and /or distant areas of the body.

SURVIVAL RATE: At the early stages 80% + women are saved. However, the survival rate drops dramatically if the cancer has been allowed to spread to the pelvic organs. In the year 2000 the survival rate for women undergoing radiation therapy was approximately 50%.

In those with untreated or unresponsive cervical cancer, death typically occurs within two years from the beginning of the symptoms.

TREATMENT: The choice of treatment is very much dependent upon the stage of the cancer, age of patient, health of the patient, desire to bear children in the future.

If the cancer is localized (and in the earlier stages) a cone biopsy may be performed to remove the malignant cells. Another option is :cryosurgery which destroys the diseased tissue by freezing it. If the cancer has become invasive then a radical hysterectomy which removes the uterus and lymph nodes in the general area.

When the cancer has spread to the lymph nodes of the pelvis then more aggressive treatment is advised ... radiation therapy (in conjunction with surgery), chemotherapy, hysterectomy.

Note that women who choose cryosurgery or a cone biopsy are at high risk of recurrence.

In 1999 the National Cancer Institute announced that people with later stage cervical cancer have a much survival rate with a combination of cisplatin (a drug), chemotherapy and radiation therapy. Up until that time radiation therapy alone was the standard treatment. Overall, the risks of death is decreased by 30-50 percent (versus radiation alone).

It is not known why this combination therapy works, however, it has been theorized that the drug makes the cancer more vulnerable to the radiation therapy.

The side-effects are severe but manageable and include nausea, vomiting and a low white blood cell count.

THE CONNECTION BETWEEN HUMAN PAPILLOMA VIRUS AND CERVICAL DYSPLASIA.

Studies show that women with mild dysplasia associated with HPV can be observed over a period of time in routine screening programs because the great majority will convert over to a non-dysplastic state with time.

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