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Microinvasive cervical cancer
(stage IA) is usually treated by hysterectomy
(removal of the whole uterus including part
of the vagina). For stage IA2 cervical
cancer, the
lymph
nodes are removed as well. An alternative
for cervical cancer patients who desire to maintain
fertility is a local surgical procedure such
as a LEEP or cone biopsy.
Early stages of
cervical
cancer (IB1 and IIA
less than 4cm) can be treated with radical
hysterectomy with removal of the
lymph nodes
or radiation therapy. Radiation therapy is
given as external beam radiotherapy to the
pelvis and brachytherapy (internal
radiation). For cervical cancer patients treated with
surgery who have high risk features found on
pathologic examination, radiation therapy
with or without chemotherapy is given in
order to reduce the risk of relapse.
Larger early stage
cervical tumors (IB2 and IIA more than 4cm) may be treated with radiation
therapy and cisplatin-based chemotherapy,
hysterectomy (which then usually requires adjuvant
radiation therapy), or cisplatin chemotherapy
followed by hysterectomy.
Advanced stage cervical tumors (IIB-IVA) are treated with
radiation therapy and cisplatin-based chemotherapy.
Epidemiology of
Cervical Cancer
Worldwide,
cervical cancer is the
second most common cancer in women (after
breast
cancer) and is the third leading killer (behind
breast cancer and
lung cancer).
Cervical cancer affects about 16 per
100,000 women per year and causes death in about 9
per 100,000 per year.
In the United States, however,
cervical cancer is only the 8th most common
cancer
of women. About 12,800 women in the United States
are diagnosed with cervical cancer and about 4,800
die each year (Canavan & Doshi, 2000). Among
gynecological cancers it ranks behind endometrial
cancer and ovarian cancer. The incidence and
mortality figure of cervical cancer for the U.S. are about half that of
the rest of the world, a difference which can be
attributed in part to the success of screening with
the Pap smear.
In Great Britain the incidence of
cervical cancer has reached alarming proportions in
that the mortality in England and Wales in women
younger than 35 years rose three-fold from 1967 to
1987. In a study published in 2004 (Peto J et al)
scientists from the London School of Hygiene and
Tropical Medicine found that had it not been for
effective cervical screening, one in 65 of all
British women born since 1950 would have died from
cervical cancer.
A study published in 2002 (Castellsagué
et al) reports that
male circumcision can reduce the
risk of penile human papillomavirus (HPV) infection
in the man, and as a result that of cervical cancer
in his female partner. The authors do state that "it
would not make sense to promote circumcision as a
way to control cervical cancer in the United States,
where Pap smears usually detect it at a treatable
stage". In contrast to this claim, Menczer (2004)
quotes research that male circumcision probably does
not contribute to a lower incidence of cervical
cancer in Jewish populations.
History of Cervical Cancer
Epidemiologists working in
the early 20th century noted that:
1. Cervical cancer was
common in female sex workers.
2. Cervical cancer was rare in nuns,
except for those who had been sexually
active before entering the convent.
3. Cervical cancer was more common in
the second wives of men whose first wives
had died from cervical cancer.
4. Cervical cancer was rare in Jewish
women.
This led to the deduction
that cervical cancer could be caused by a
sexually transmitted agent. Initial research
in the 1950s and 1960s put the blame on
smegma (e.g. Heins et al 1958), but it
wasn't until the 1970s that human
papillomavirus (HPV) was identified. It has
since been demonstrated that
HPV is
implicated in over 90% of cervical cancers.
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