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Cervical cancer refers to cancer of the narrowed entry to the uterus (cervix). Cervical cancer is categorized into stages 0 through IV. Stage 0 refers to cancer limited to only the cells on the surface layer of the cervix (carcinoma in situ, or preinvasive cancer). Stage IV refers to cancer that has spread beyond the pelvis and involves the bladder, rectum, or distant organs.
There are two types of cervical cancer: squamous cell carcinomas and adenocarcinomas. If the cancer has signs of both types, it is called mixed carcinoma. Cervical cancer is often associated with a sexually transmitted human papillomavirus (HPV). Certain types of HPVs are considered "high-risk," and infection by one may cause abnormal (precancerous) cells to form on the cervix. These cells may lead to cancer if not treated.
Women who have regular Pap smears rarely present with advanced cervical cancer.
The American Cancer Society recommends that all women begin having Pap smears when they initiate sexual activity or before they are 21 years old. Smear tests should be done every year, or liquid tests should be done every 2 years. From age 30 on, women who have had three normal test results in a row and have no other risk factors can reduce frequency of testing to once every 2 to 3 years.
Risk: The most commonly noted risk factors for cervical cancer include beginning sexual intercourse at 16 years or younger; having a history of multiple sexual partners, genital HPV infections, chlamydia infections, or other sexually transmitted diseases; having sex with an uncircumcised male, and being diagnosed with a previous precancerous cervical lesion.
Women who have had many children and those who are long-term users of oral contraceptives (5 or more years) are considered to have increased risks of cervical cancer. Women with HIV or a family history of the disease are also at higher risk. Other factors include smoking, exposure to secondhand smoke, and being overweight. Being the daughter of a mother who was prescribed diethylstilbestrol (DES) to prevent miscarriages may also slightly increase the risk of cervical cancer.
Half the women diagnosed with cervical cancer are between the ages of 35 to 55. Slightly more than 20% of women with cervical cancer are diagnosed when they are older than 65 years ("Detailed Guide"). Incidence and Prevalence: Cancer of the cervix is the fourth most common malignancy in women in the US. The disease is more common in Hispanic, black, and Native American women than in white women (Garcia). An estimated 10,520 cases of invasive cervical cancer ("Detailed Guide") and more than 50,000 cases of carcinoma in situ will be diagnosed in the US in 2004 (Garcia). The death rate for cervical cancer declines by approximately 2% each year due to the increasing use of the Pap test ("Detailed Guide"). More than 500,000 new cases of cervical cancer are diagnosed around the world each year (Garcia). In many developing countries where women do not have routine Pap tests, cervical cancer is the leading cause of cancer death. |
Source: Medical Disability Advisor
| History: Women often have no symptoms of early cervical cancer. If the cancer has become invasive, some women may report a bloody discharge between menstrual periods or after sexual intercourse, or a vaginal discharge with or without odor. Physical exam: Carcinoma in situ will not be seen on routine pelvic examination. Women with invasive cervical cancer may have an abnormal growth visible on the cervix that can be detected during a routine pelvic exam. Tests: The Pap smear is the best method to detect cervical cancer, particularly in its early stage. The Pap smear identifies all stages of cervical cancer. An abnormal Pap smear often requires a repeat test within several months or a more detailed examination of the cervix through colposcopy, in which a magnifying instrument called a colposcope is used to examine the cervix. If suspicious tissue is seen, a piece of tissue may be removed (biopsy) and sent to the laboratory for examination. Endocervical curettage may also be performed. In this procedure, tissue is scraped from the inside of the cervix. Like a biopsy, it is sent to the laboratory for examination. A cone biopsy is the removal and examination of a larger piece of tissue, usually cone- or cylinder-shaped.
ThinPrep (liquid-based) Pap testing may be conducted on the cervical cell sample, which is placed in a special solution for examination. Computer analysis (Autopap) also may be done of cell samples. DNA analysis through polymerase chain reaction (PCR) testing may be conducted to identify the human papilloma virus (HPV).
If there is evidence that the cancer has spread, x-rays, CT, or MRI may be needed. Examination of the bladder or rectum may be done with an endoscopy procedure in which a thin tube with a camera is inserted into the ureter or rectum.
Positron emission tomography (PET) imaging may be used to monitor individuals diagnosed with cervical cancer. |
Source: Medical Disability Advisor
| In stage 0 (surface tissue only), carcinoma in situ, treatment may include cone biopsy, laser vaporization or excision, cryosurgery, or simple hysterectomy, in which only the uterus with cervix is removed. Frequently, both diagnosis and treatment for stage 0, carcinoma in situ, can be achieved through the use of the loop electrosurgical excision procedure (LEEP).
For stage IA cancer visible by microscope, treatment is often a simple hysterectomy. For women with superficial tumor invasion who want to have additional children, cold-knife conization treatment may be considered.
In stages IB and IIA (tumors that are visible and/or have penetrated surrounding tissue), treatment is often a radical hysterectomy with removal of the uterus, ovaries, upper portion of the vagina and pelvic lymph nodes. Radiation therapy may also be used as the sole treatment for invasive cervical cancer or in combination with hysterectomy. In stage IIB where cancer has spread into tissue near the cervix, a combined internal and external radiation therapy may be used, sometimes with chemotherapy. For women with advanced cervical cancer, stages III and IVA (tumor has spread into areas such as the vagina and/or organs such as the bladder), the combination of radiation therapy and chemotherapy, possibly along with other drugs, is now recommended. Stage IVB cancer found in areas far removed from the cervix is considered incurable. |
Source: Medical Disability Advisor
| Specific survival rates vary according to the stage. When the cancer is caught at the earliest stage of invasive cervical cancer, the 5-year survival rate is 92%. The overall 5-year survival rate (all stages combined) is about 71% ("Detailed Guide"). |
Source: Medical Disability Advisor
| Untreated cervical cancer may result in massive and acute vaginal bleeding. It also may spread to other body sites, including the bladder, rectum, lymph nodes, and central nervous system.
Complications associated with the treatment of stage 0 (carcinoma in situ) are usually limited to bleeding after the surgical treatment. However, women who have been treated with one or more of the nonsurgical interventions may develop subsequent problems maintaining a full-term pregnancy due to the fact that the cervix has become incompetent or weakened and possibly scarred as a result of the treatments.
Radiation therapy for invasive cervical cancer may result in complications such as damage to the rectum, urinary incontinence, and scarring that can interfere with sexual intercourse. Psychological reactions such as depression, irritability, feelings of sexual inadequacy, and guilt can accompany this disease. |
Source: Medical Disability Advisor
| Women treated nonsurgically for stage 0 (carcinoma in situ) should not require special accommodations or work restrictions. Women treated surgically with either a simple or radical hysterectomy and those undergoing radiation therapy may benefit from having a place at the work site where they may periodically rest. Work responsibilities for these women may need to be primarily sedentary. Return to work may start with part-time hours, with a slow transition to full-time. Women undergoing radiation therapy may require leave from work to complete their treatments. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Was diagnosis of cervical cancer confirmed?
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Were conditions with similar symptoms ruled out?
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Has individual experienced psychological reactions such as depression, irritability, feelings of sexual inadequacy, and guilt that can accompany this disease?
Regarding treatment:
- What stage is the cancer?
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With what procedure was it treated (cone biopsy, laser vaporization, excision, cryosurgery, or loop electrosurgical excision procedure)?
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Was all the cancerous tissue removed?
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Was a hysterectomy performed?
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Is radiation being used as sole treatment or in combination with hysterectomy?
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If the cancer is advanced, to what body sites has it spread?
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Were lymph nodes removed?
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Would individual also benefit from chemotherapy?
Regarding prognosis:
- At what stage was cancer diagnosed?
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Was initial treatment successful? Was additional treatment required?
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Does individual have an underlying condition such as pregnancy that may complicate treatment or delay recovery?
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Has individual experienced any complications as a result of the cancer or treatment for the cancer?
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Since treatment options such as the addition of radiation or chemotherapy may extend recovery time by several months, was adequate time allotted for recovery?
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If disability has extended past expected duration, what are the extenuating circumstances?
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Since most women report feeling a loss of self-esteem, decrease in or total loss of sexuality, fears about dying, general feelings of anxiety, sadness, anger, irritability, difficulty with concentration, and changes in sleep and eating patterns, is the psychological impact of this disease being addressed? Was referral made for counseling?
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Source: Medical Disability Advisor
| "Detailed Guide: Cervical Cancer." American Cancer Society. 17 Sep. 2004 <http://www.cancer.org>.Garcia, Agustin A., and Jia Bi. "Cervical Cancer." eMedicine. Eds. John J. Kavanagh, et al. 17 Dec. 2004. Medscape. 17 Sep. 2004 <http://emedicine.com/med/topic324.htm>. |
Source: Medical Disability Advisor
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