so what happens to you if you get cervical cancer?

[xchrom]

while compiling data on the expense of cancer treatments -- uh -- they're really expensive but more on that another day -- i began to see information about the treatments for cervical cancer.

at first i ignored it -- i was focused on gardasil -- i'm for it -- and yes i'm for for mandates.

but really -- what was i ignoring?

i mean that's what this really boils down to if you are one of the 4,000 women each year who gets it -- or if your dysplasia is persistant enough to warrant an hysterectomy.

Cervical Cancer

Cervical cancer is a disease in which cancer cells develop in the lower, narrow portion of the uterus. The American Cancer Society estimates that there will be over 9,700 new cases of cervical cancer and 3,700 deaths from this disease in the United States in 2006. Most of these cancers develop over an extended period of time, as cells gradually begin to appear abnormal and then become malignant. The most common cause of cervical cancer is Human papillomavirus (HPV). Regular gynecologic examinations are important because early cervical cancer may cause no symptoms and PAP smears can help in the early detection and successful treatment of the disease. Cervical cancer that is more advanced may cause abnormal vaginal discharge or bleeding, pelvic pain or painful intercourse. These cancers can spread into the tissues surrounding the cervix, lymph nodes or other areas of the body.

The chance of successfully treating a cervical cancer is determined by the stage, size and type of cancer. Early cervical cancers are usually treated with surgery, but can also be treated effectively with radiotherapy. More advanced cervical cancer is usually treated with radiation therapy given at the same time as a low dose of chemotherapy to sensitize the cancer cells to the radiation.

Conventional radiation therapy uses high-energy x-rays to damage and kill cancer cells. These x-rays must travel through normal tissues and organs such as the bladder and rectum to reach the cervix. This radiation may cause damage to these normal tissues producing treatment side effects such as temporary or occasionally permanent urinary, gastrointestinal, or sexual dysfunction.

The two most common methods of delivering radiation are conventional external beam radiation therapy and internal radiation or brachytherapy. Both methods use X-rays as a source of radiation. X-rays are very lightweight packets of energy that pass through tissue creating damage along their paths. External beam radiation is delivered by a machine called a linear accelerator that gives a daily dose of radiation to the patient over several weeks.

Internal radiation, or brachytherapy, is done by placing holders for radiation sources into the uterus and upper vagina or by placing catheters to hold radiation seeds into the tissues around the cervix. This placement of holders is usually done in the operating room under anesthesia. The radioactive sources release their radiation into the cervix and surrounding tissues while they are in place, usually for two days or less. It is common to use more than one brachytherapy procedure in a course of treatment for locally advanced cervical cancer. The combination of external and internal radiation is effective at killing cancer cells and curing patients, but treatment side effects sometimes limit the dose needed for the best chance of cure.

http://www.ufscc.ufl.edu/Patient/content.aspx?section=ufscc&id=685

External Beam Radiation Therapy

External beam radiation therapy (EBRT) for cervical cancer is administered on an outpatient basis, 5 days a week for several weeks. EBRT begins with a planning session, or simulation, where marks are placed on the body and measurements are taken in order to line up the radiation beam in the correct position for each treatment. A program of daily treatments is then begun where the patient lies on a couch and is treated with radiation from multiple directions to the pelvis. External beam radiation therapy for cervical cancer is administered on an outpatient basis for approximately 4 to 6 weeks.

A combination of external beam radiation therapy and implant radiation is used to increase the dose of radiation administered to the cancer. Implant or internal radiation is further described in the section below. When these two methods are combined, the external beam radiation therapy is given for 4-6 weeks, and the final "boost" of radiation to the cervix is given with the implant radiation.

Although patients do not feel anything while receiving radiation treatment, the effects of radiation gradually build up over time. Many patients become tired as treatment continues. It is also common for patients to experience loose stools or diarrhea. Urination may become more frequent or uncomfortable. Some patients may experience loss of pubic hair or irritation of the skin. After the radiation therapy is completed, the vagina can become narrower and less flexible. This can make sexual relations painful and make future pelvic examinations difficult. Patients are often taught how to use a dilator to maintain the pliability of the vagina. Finally, radiation therapy to the pelvis can stop the ovaries from functioning, thereby causing younger women to enter menopause early.

Implant Radiation Therapy

Implant radiation, sometimes referred to as brachytherapy, refers to treatment where radioactive material is placed directly into the cervix. Placing the radiation in this manner allows a high radiation dose to be delivered directly to the cancer, while reducing radiation to surrounding normal organs, such as the rectum and bladder. During a procedure in the operating room, a small device is placed into the cervix and vagina. This device is later "loaded" with the radiation capsules while the patient is in a lead-shielded hospital room. The radioactive material is left in place for 1-3 days. This procedure may be performed once or twice during the course of treatment. The patient is discharged from the hospital once the device is removed from the cervix.

Many centers are administering the implant radiation on an outpatient basis using a slightly different technique called "high-dose rate (HDR) brachytherapy." With this procedure, a device is inserted into the cervix and vagina in the radiation therapy department and the patient remains with the radiation for only 30 minutes to one hour. This procedure is generally repeated weekly, approximately 3 to 5 times during the course of treatment. HDR brachytherapy is a newer technique and is not yet widely available. The results from early experience demonstrate that HDR brachytherapy appears to be just as effective as traditional implant radiation, but avoids a hospital stay.

A less commonly used method of brachytherapy is interstitial (into the tissue) implant. With this method, the patient is placed under general anesthesia and fine tube like needles are placed into the cancer and immediate tissue around it in a manner to fit the shape of the cancer. The tube-like needles are later "loaded" with the radioactive seeds and the remaining steps are similar to what is done with implants.

In implant radiation therapy, the positioning of the device is critical to the effectiveness and safety of the treatment. Although the cervical cancer receives the highest radiation dose, the surrounding organs, such as the rectum and bladder, are also exposed to some radiation. Radiation injury to the rectum, bladder or bowel can occur and may cause pain or bleeding with urination or passage of stools. Less commonly, some patients will develop a fistula, which is an abnormal connection between the rectum or bladder and the vagina. At times, additional surgery may be necessary for repair of fistulas or other radiation injury.

http://www.ufscc.ufl.edu/Patient/cancernews.aspx?section=cancernews&id=35366
sexual side effects for stage 1 cervical cancer patient

Treatment with radiation therapy was associated with worse long-term sexual function:
* There was no difference between the radiation therapy group and the surgery group in level of sexual desire, but other measures of sexual function and the overall sexual function score were worse in women who had been treated with radiation therapy.
* Other factors that influenced sexual function were marital status (married women reported better sexual functioning) and menopausal symptom score (menopausal symptoms were associated with worse sexual functioning).
* The difference in sexual function between the radiation therapy group and the surgery group persisted even after accounting for tumor size, histology, and grade.
* There was no significant different in sexual functioning between the women treated with surgery and the women without cancer.

The researchers conclude that stage I cervical cancer patients who are treated with radiation therapy have more problems with sexual function than women treated with hysterectomy and lymph node dissection. Women treated with hysterectomy can expect to have long-term levels of sexual function that are similar to women who have not had cancer.

Reference: Frumovitz M, Sun CC, Schover LR et al. Quality of Life and Sexual Functioning in Cervical Cancer Survivors. Journal of Clinical Oncology. 2005;23:7428-7436.

http://patient.cancerconsultants.com/CancerTips.aspx?DocumentId=38033

Given that cervical cancer screening (Pap tests) has greatly reduced the occurrence of the disease, why is the vaccine so important?

In addition to reducing the risk of cervical cancer, the vaccine will reduce the risk of precancerous changes to the cervix known as cervical intraepithelial neoplasia (CIN). High-grade CIN requires treatment follow-up, which causes anxiety and expense. The vaccine will also have a large impact in parts of the world where cervical cancer screening and follow-up are less available.

i.e. irregularities make for greater emotional discomfort -- and THE COST GOES UP JUST TO KEEP AN EYE ON YOU.

http://patient.cancerconsultants.com/CancerTips.aspx?DocumentId=210

Radiation is a common form of therapy in the treatment of cervical cancer. The potential short-term side effects may cause varying degrees of discomfort that can be managed by you and your doctor. Potential long-term effects such as early induced menopause, infertility, vaginal stenosis and bowel problems are reportedly the most difficult for patients to deal with emotionally and physically. Support groups, family support or professional support may help patients cope with these side effects. To understand the specific kind of radiation you will receive and the expected side effects, ask questions and use sources including your medical team, books, the Internet and other people with your disease. Before undergoing any treatment you should understand your responsibility, your medical team’s role, explore treatment options and get a second opinion(s).

http://patient.cancerconsultants.com/CancerTips.aspx?DocumentId=38539

anorexia is a possible side affect when looking at combo radiation and chemotherapy

http://www.sciencedaily.com/releases/2006/11/061108154922.htm

there are some advances in radiation

"We found that by using extended-field IMRT and chemotherapy, we were able to effectively reduce the toxic effects of treatment," said Sushil Beriwal, M.D., principal investigator and assistant professor at the University of Pittsburgh School of Medicine and medical director of radiation oncology at Magee-Womens Hospital of UPMC. "This is important because it means there are less treatment interruptions and more patients are able to complete the treatment within the prescribed time period. This, in turn, increases the efficacy of treatment, giving us encouraging evidence that these cervical cancer patients can benefit from IMRT."
Unlike standard radiation therapy, IMRT administers a radiation field that consists of several hundred small beams of varying intensities that pass through normal tissue without doing significant damage but converge to give a precise dose of radiation at the tumor site. IMRT can potentially limit the adverse side effects from radiation while increasing the intensity of doses that can be given to effectively destroy cancer cells.
Co-authors of the study include Greg Gan, Joseph L. Kelley, M.D., and Robert P. Edwards, M.D., all with the University of Pittsburgh School of Medicine.
Note: This story has been adapted from a news release issued by University of Pittsburgh Medical Center.

http://www.umm.edu/patiented/articles/what_specific_treatments_invasive_cervical_cancer_000046_12.htm

hysterectomies are also common with cervical cancers but they have side effects as well

A radical hysterectomy removes not only the uterus and the cervix but also the parametrium, the supporting ligaments, the upper vagina, and some or all of the local lymph nodes (a procedure called lymphadenectomy).

If the cancerous tumor recurs within the pelvis after primary treatment, a more extreme procedure may be performed called a pelvic exenteration, which combines radical hysterectomy with removal of the bladder and rectum. (In such cases, plastic surgery may be needed afterward to recreate an artificial vagina.) Patients undergoing this procedure are physically and psychologically screened in advance to determine whether it is an appropriate choice. The success rate for pelvic exenteration in halting the progression of the disease is approximately 25% to 45%.

Any form of hysterectomy is major surgery and requires at least a three to five day hospital stay. Although hysterectomy typically uses a wide abdominal incision, less invasive techniques that allow shorter recovery time may be possible for some women with early stage cancers if performed by experienced surgeons.

Side effects include difficulty emptying the bladder or bowels and a painful lower abdomen. Urinary tract infections are very common. Complications include fistulas (abnormal channels within the pelvis, which in this case are a result of surgery), bladder dysfunctions, and cysts.

Normal activity, including intercourse, can be resumed in about four to eight weeks. Once the uterus is removed, menstruation will cease. If the ovaries are removed, the symptoms of menopause will begin. These symptoms are likely to be more severe in surgical menopause than in the course of a natural passage to menopause. Hormone replacement therapy should be considered.

Trachelectomy. An experimental procedure called trachelectomy is being investigated for preserving fertility in certain women with early stage cancer, but it is highly controversial and appropriate in only about 5% of cervical cancer patients. In the procedure, only the cancerous portion of the cervix is removed, while the uterus and the rest of the cervix are left intact. The cervix is closed with a suture.

Small, early studies suggest this procedure may be effective for early stage 1 patients with no risk factors for aggressive cancer. In two small 1999 and 2000 studies, conception rates were between 27% and 37%, and survival rates after two years were more than 95%. The procedure is primarily performed outside the US, and few surgeons in this country are skilled in this surgery at this time. Throughout the world, in fact, only about a few hundred of these procedures have been performed to date. Women should also realize that conception rates are still lower than normal. And even if they can get pregnant, there is a very high risk for miscarriage because the cervix is weakened. Larger and longer-term studies are needed to confirm its long-term safety.



i have to post what happens in two parts --

but if you are concerned about what happens to girls and women -- this should bloody well concern you.

i've been through chemo -- and there simply is no describing how sick you will be --

now imagine that and radiation in your vagina, pelvis, maybe through to your rectum.

imagine having to pee with all that going on -- or combating leukemia and having diarhea?