Pap test. Why? Few more words about Cervical Cancer.

Considering the high interest in the post about PAP test, I would like to add few more words about cervical cancer.

Cervical cancer is a type of cancer that occurs in the cells of the cervix — the lower part of the uterus that connects to the vagina. Various strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cases of cervical cancer. When exposed to HPV, a woman's immune system typically prevents the virus from doing harm. In a small group of women, however, the virus survives for years, contributing to the process that causes some cells on the surface of the cervix to become cancer cell.

What causes cervical cancer isn't clear. However, it's certain that the sexually transmitted infection called human papillomavirus (HPV) plays a role. Evidence of HPV is found in nearly all cervical cancers. However, HPV is a very common virus and most women with HPV never develop cervical cancer. This means other risk factors, such as your genetic makeup, your environment or your lifestyle choices, also determine whether you'll develop cervical cancer.

Types of cervical cancer

The type of cell where the initial genetic mutation occurred determines the type of cervical cancer you have. The type of cervical cancer you have helps determine your prognosis and treatment. The main types of cervical cancer are:

• Squamous cell carcinomas. These begin in the thin, flat cells that line the bottom of the cervix (squamous cells). This type accounts for the great majority of cervical cancers.
• Adenocarcinomas. These occur in the glandular cells that line the cervical canal. These cancers make up a smaller portion of cervical cancers.

Sometimes both types of cells are involved in cervical cancer. Very rare cancers can occur in other cells in the cervix.

Diagnosis

• A Pap test can detect abnormal cells in the cervix, including cancer cells and cells that show changes (dysplasia) that increase the risk of cervical cancer.
• HPV DNA test is used to determine whether you are infected with any of the types of HPV that are most likely to lead to cervical cancer. Like the Pap test, the HPV DNA test involves collecting cells from the cervix for lab testing.

The HPV DNA test isn't a substitute for regular Pap screening, and it's not used to screen women younger than 30 with normal Pap results. Most HPV infections in women of this age group clear up on their own and aren't associated with cervical cancer.

While the pap smear is an effective screening test, confirmation of the diagnosis of cervical cancer or pre-cancer requires a biopsy of the cervix. This is often done through colposcopy, a magnified visual inspection of the cervix aided by using a dilute acetic acid (e.g. vinegar) solution to highlight abnormal cells on the surface of the cervix.

Further diagnostic and treatment procedures are loop electrical excision procedure (LEEP) and conization, in which the inner lining of the cervix is removed to be examined pathologically. These are carried out if the biopsy confirms severe cervical intraepithelial neoplasia.

Sometimes the diagnosis can be really confusing. There are too many words and acronyms. Here I will try to simplify the results that you may see in your medical papers.

These terms are related since they represent the three steps of the progression toward cancer:

• • Dysplasia is the earliest form of pre-cancerous lesion recognizable in a biopsy by a pathologist. Dysplasia can be low grade or high grade . The risk of low-grade dysplasia transforming into cancer is low.
  • Carcinoma in situ is synonymous with high-grade dysplasia in most organs. The risk of transforming into cancer is high.
  • Invasive carcinoma, commonly called cancer, is the final step in this sequence. It is a disease that, if left untreated, will invade and spread to surrounding tissues and structures of the host (hence its name), and may eventually be lethal.
  Biopsy results....
  Cervical biopsies allow to diagnose Cervical intraepithelial neoplasia, the potential precursor to cervical cancer. For premalignant dysplastic changes, the CIN (cervical intraepithelial neoplasia) grading is used.
  It classifies mild dysplasia as CIN1, moderate dysplasia as CIN2, and severe dysplasia and CIS as CIN3. More recently, CIN2 and CIN3 have been combined into CIN2/3. These results are what a pathologist might report from a biopsy.
  
  
  Pap Test results...
  This clssification should not be confused with the Bethesda System terms used for Pap smear (cytology) results. Among the Bethesda results we can find : Low-grade Squamous Intraepithelial Lesion (LSIL) and High-grade Squamous Intraepithelial Lesion (HSIL). An LSIL Pap may correspond to CIN1, and HSIL may correspond to CIN2 and CIN3, however they are results of different tests, and the Pap smear results need not match the histologic findings.

If your doctor determines that you have cervical cancer, you'll undergo further tests to determine whether your cancer has spread and to what extent — a process called staging. Your cancer's stage is a key factor in deciding on your treatment. Staging exams include:

• Imaging tests. Tests such as X-rays, computerized tomography (CT) scans and magnetic resonance imaging (MRI) help your doctor determine whether your cancer has spread beyond your cervix.
• Visual examination of your bladder and rectum. Your doctor may use special scopes to see inside your bladder (cystoscopy) and rectum (proctoscopy).

Your doctor then assigns your cancer a stage — typically a Roman numeral. Stages of cervical cancer include:

• Stage I. Cancer is confined to the cervix.
• Stage II. Cancer at this stage includes the cervix and uterus, but hasn't spread to the pelvic wall or the lower portion of the vagina.
• Stage III. Cancer at this stage has moved beyond the cervix and uterus to the pelvic wall or the lower portion of the vagina.
• Stage IV. At this stage, cancer has spread to nearby organs, such as the bladder or rectum, or it has spread to other areas of the body, such as the lungs, liver or bones.

The treatment really depends on the staging. During the treatment is really inportant to find the right support to better cope with this situation. Alternative and complementary medicine can offer a great variety of options that can be really helpful to go through it.