CERVICAL CANCER

CERVICAL CANCER

     Cervical cancer or cancer of the cervix is a major concern for many women. the cervix is a ring of muscle at the top of the vagina. it is the entrance to the womb. the cervix is the opening of the uterus connected to the upper vagina and known as the neck of the uterus.

     the surface layer of the cervix is made up of two different types of cells, flat cells called squamous cells and tall column-like gland cells called columnar cells. This produces a mucous membrane, but the mucous membrane of the cervix is smooth. the place where squamous and columnar cells meet is known as the transformation zone and this is the area of the cervix where cancer most commonly arises.

     Cervical cancer forms in the interior lining of the cervix, the junction of the vagina and uterus. the development of cervical cancer is slow and occurs over a period of years. the cancer cells may be present in the cervix for 4-10 years before becoming invasive, affecting the deeper tissues and giving rise to symptoms. even when the cancer is invasive, there is an 80% chance of successful cure. but once it spreads through the pelvic to the vagina, uterus, bladder it is much more difficult to cure.

CAUSES:

Although the exact cause of cervix cancer are unknown but several risk factors appear o be linked with the disease such as-

1.   Infection HPV virus:

More than 90% of women with cervical cancer are infected with the Human Papilloma Virus (HPV). HPV is the single most important cause for cervical cancer and usually causes warts in the genital area. the viruses are passed from one person to another during unprotected sex. Because HPV is spread mainly through sex, women who start having sex at a young age, who have multiple sexual partners.

Early sexual activity is one of the causes because the cells lining the cervix do not fully mature until the age of 18 and this increases the risk of HPV and cervical cancer.other sexually transmitted diseases (STDs) and sexually transmitted infections (STIs) including Gonorrhea, HIV/AIDS are also increases the risk of HPV.Long term use of oral contraceptives.Cigarette smokers also develop the chances of cervix cancer.

SYMPTOMS:

Early cervical cancer generally produces no symptoms but as the cancer grows symptoms may include-

Abnormal vaginal bleedingAn unusual vaginal heavy white dischargeVaginal bleeding after the menopauseDiscomfort during sexual intercourseBladder pain during urinationBleeding from vagina between regular menstrual periods and after sexual intercourseIn advanced stages it causes symptoms like pelvic pain, vaginal leakage of urine, anorexia, weight loss and anemia.

TYPES:

          there are mainly two types of cervical cancer. the most common types of cervical cancer is called Squamous cell carcinoma. it develops from the flat cells which cover the outer surface of the cervix at the top of the vagina. About 85% of cervical cancers are squamous cell cancer

          the other type is called Adeno carcinoma and is less common. it develops mucus producing glandular cells of the endo-cervix.

About 3-5% of cervical cancers have characteristics of both squamous and adenocarcinomas and are called Adenosquamous carcinomas.

DIAGNOSIS:

          Cervical cancer is most often diagnosed in middle aged women between the ages of 35-55. it is very rarely seen in women less than 20 years of age but 20% of cases occur in women over 65 years. there are several different tests that can be used to determine a cervical cancer.

1.   Pap Smear Test:

Pre cancerous changes in the cervix can be detected in a screening test known as pap smear test.

2.   Colposcopy:

An instrument called a colposcope is used to take a close detailed look at the cervix and vagina.

3.   Biopsy:

Cervical biopsy is a test in which a protein of tissue sample is taken from the cervix for microscopic examination.

4.   Cone Biopsy:

Cone biopsy, in it a cone shaped samples of cervical tissues are removed for examination.

5.   Conization:

Sometimes a large cone shaped biopsy specimen may have to be taken and this procedure is known as conization.

 6.   Loop-electro surgical excision procedure (LEEP):

In this biopsy method there is an electrical wire which is used to slice off a thin, round piece of tissue for laboratory analysis.

7.   Endo cervical curettage (ECC):

In this a small spoon shaped instrument called a curette to scrape tissue from inside the cervical opening and examined for cancer cells.

8.   CT scan:

A computerized tomography scan involves taking X-rays at different angles to build up a 3-dimensional image of the body.

STAGES:

          the chances of cure are determined by the stages of the cancer at the time of diagnosis for better treatment.

Stage – 1:

          this stage is an invasive cancer with cancer confined to the cervix only and probability of cure is 85-90%.

Stage – 2:

          this stage describes the cancer that has spread beyond the cervix but is still limited to the pelvic area. the probability of cure is 75-80%.

Stage – 3:

          the cancer has extension beyond the cervix but not to the pelvic reason. the cancer may be blocking the uterus. the probability of cure is 50%.

Stage – 4:

          this stage includes cancer that has spread to the bladder and the probability of cure is 30%.

TREATMENT:

          Treatment for cervical cancer depends on the tumor size, its location, disease stages and the patient’s age and overall health. Cervical cancer is curable by removing or destroying the pre-cancerous tissue. Cervix cancer most often treated with one or a combination of treatments like surgery, radiation and chemo-therapy.

1)  Surgery:

Surgery is the primary treatment for cancer of the cervix in the early stage.

     i.        Hysterectomy – this surgical procedure is used to remove the cervix and uterus.

   ii.        Bilateral salpingo oophorectomy – this surgical procedure is used to remove the ovaries and fallopian tubes.

  iii.        Pelvic extension – it is a surgical procedure used to remove the cervix, vagina, ovaries, lower colon, rectum, and bladder and nearby lymph nodes. Artificial openings are made for urine and stool to flow from the body.

  iv.        Cry-O-surgery – this surgery technique uses an instrument to freeze and destroy abnormal tissue.

    v.        Laser surgery – A surgical procedure that uses a laser beam as a knife to make bloodless cut in tissue to remove a small piece of tissue.

  vi.        Loop electrosurgical excision procedure (LEEP) -  A treatment that uses electrical current passed through a thin wire loop as a knife to cutting out the abnormal cells.

2)  Radiation Therapy:

If the tumor has spread more than a small amount beyond the cervix, then radiotherapy is the usual treatment. Radiation therapy uses X-rays or other high energy particles to kill cancer cells. Treatment is concentrated on a specific area. the most common type of radiation is called External beam radiation which is radiation given from a machine outside the body. Patient may receive both internal and external radiation.

3)  Chemotherapy:

Chemotherapy, the use drugs to kill cancer cells. it is used to destroy cancer remaining after surgery, slow the tumors growth or reduce symptoms.

WAYS TO REDUCE CERVICAL CANCER:

1)   Girls less than 18 years of age should avoid sexual activity.

2)   Have fewer sexual partners and make sure your partner is having sex only with you.

3)   Use condom, which may help prevent the transmission of HPV.

4)   Annual pelvic examinations, including a pap smear should begin when a woman becomes sexually active.

5)   All women over the age of 20 should have a cervical screen test at least every five years.

     Menstrual cycle is a natural process is done in every girl. A girl has gifted by the God to become a mother. as we have this capacity, the possibility is there to have some problem. Now-a-days cervix cancer is a common disease for women as most of the girls have many menstrual problems from the starting. so, if we have some problems then it is not the time to become worried about and do not be hesitate to discuss it with your parents or spouse and gynecologists. Because “A stitch in time saves nine.”

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2010 ? 12 ? 01 ?

congenital disease of the lung is a rare congenital lung abnormalities. Comparison of the pathological classification and naming confusion, disagreement, in the past referred to congenital lung cyst, more consistent now known as congenital disease of the lung, including bronchial cyst (lung cysts), pulmonary cysts, lung large leaf gas swelling (bullae), and congenital cystic adenomatoid malformation of the cystic bronchiectasis and so on.

embryonic development, because of the trachea, bronchial abnormalities caused by abnormal development of the bud or branch. Lesions can occur in different parts of bronchial branches and display different developmental stages. Multilocular cyst often pregnant, but also for a single room of. Multi-wall structure of the bronchial wall with a small, inner ciliated columnar epithelium, the outer scattered in small pieces of cartilage, smooth muscle wall can be seen within the bundles and fibrous tissue. Cystic lesions of the inner structure can be seen different Pip cells, columnar, cuboidal and round epithelial cells, which showed incomplete development of the bronchial tree branches of different levels. some columnar cells with mucus secretion, cavity filled with mucus.

small bronchogenic cyst is not showing clinical symptoms, only the chest X-ray examination or autopsy only to be found. once the communication between cystic lesions and small bronchi, causing secondary infection or produce tension gas cyst, cyst fluid, cyst fluid or gas pressure such as tension pneumothorax lung, heart, mediastinal and tracheal shift, can be symptoms.

(a) of the infants of tension bronchogenic cyst, pulmonary emphysema and lung bullae large leaves were more common. Frequent clinical presentation of intrathoracic pressure symptoms of tension, manifested as shortness of breath, cyanosis or respiratory distress and other symptoms. See contralateral tracheal shift examination, the affected side drum percussion sounds, breath sounds decreased or disappeared. Chest radiograph shows cystic lesions caused by ipsilateral lung atelectasis, mediastinum, tracheal shift, and may show ipsilateral mediastinal hernia and atelectasis in critical condition, not timely diagnosis and treatment, died of respiratory failure can be.

(b) were more common for childhood bronchial cyst. Clinical manifestations of recurrent pulmonary infections. Patients often fever, cough, chest pain treatment. Symptoms similar to bronchial pneumonia.

(c) more common in adult acquired secondary pulmonary bulla and bronchial cyst. Clinical symptoms are due to secondary infection such as fever, cough, purulent sputum, hemoptysis, chest tightness, asthma-like episodes, exertional dyspnea and recurrent pneumothorax and other symptoms. Need and lung abscess, empyema, bronchiectasis, tuberculosis, lung tumor cavity and identification.

congenital bronchial cyst is common in children’s cases, the cyst is located within the interstitial lung or mediastinum. about 70% in the lung, 30% in the mediastinum. As can be single or multiple cysts containing different amount of gas or liquid, which can be in the X-ray showed different performance:

1. a single liquid, the most common cysts, cysts of different sizes, we can see circular thin-walled cysts containing liquid. Wall of such cysts are characterized by meager, no inflammatory infiltration in lung tissue adjacent to lesions, fibrosis small, need and lung abscess, pulmonary tuberculosis and lung hydatid cyst cavity identification. X-line performance of thick abscess wall, surrounded by significant inflammation, tuberculosis is a long history of empty, surrounded by satellite lesions of tuberculosis. Epidemiology of pulmonary hydatid cyst in the regional characteristics, life history and occupational history, blood like, skin test and other help to identify.

2. a single gas cyst lateral chest radiograph shows pulmonary disease gas cyst, giant gas cyst may occupy the side of the chest, oppression, lung, trachea, mediastinum, heart, need to identify and pneumothorax. Pneumothorax is characterized by a decline toward the lung hilum, while the gas cysts in the lungs of air, often carefully observed in the apical and ribs can be seen every corner of the lung tissue.

3. Multiple gas cysts are often seen on chest X-ray showed multiple sizes, missing the edge of the gas cysts, need to identify with multiple bullae. especially in children, often accompanied by pneumonia, pulmonary bulla in the X line to translucent and circular thin-walled bleb size, number, shape characterized by volatility. Each follow-up in the short term changes to see more, and sometimes can be rapidly increased, the formation of pneumothorax or rupture. once the lung inflammation subsided, bullae and sometimes self-shrink or disappear.

4. Multiple liquid, gas cysts visible on chest X-ray multiple sizes of the liquid, gas chamber. in particular, lesions in the left side, the need to identify with congenital diaphragmatic hernia, which can also be present for more than one fluid level, if necessary, or the diluted barium oral iodized oil, in the chest to see if the contrast agent into the gastrointestinal tract, was diaphragmatic hernia.

generally clear diagnosis, in the absence of acute inflammatory situations, early surgery should be. Cyst easy because secondary infection, drug treatment not only can not cure, on the contrary, due to multiple infection inflammation around the wall, causing extensive pleural adhesions, caused by surgery more difficult, prone to complications. Young age is not an absolute contraindication to surgery. in particular, in the event of hypoxia, cyanosis, respiratory distress, and even more should be early surgery, and even emergency surgery to save lives.

surgical approach should be based on lesion location, size, infection may be: isolated subpleural cyst is not infected, can be used as a simple cyst; confined to the lung edge part of the cyst, can be used for wedge resection of lung surgery; cyst infection Erzhi around or near the bronchiectasis will be used for adhesion or resection of lung lobe. Bilateral lesions, there are surgical indications in the premise, first as a disease can be serious side. Children to try to retain the principle of normal lung tissue.

clinically diagnosed when the disease should be avoided as thoracentesis, chest infection or to avoid occurrence of tension pneumothorax. Only in individual cases, the performance of severe respiratory distress syndrome, cyanosis, severe hypoxia, and unconditional for emergency surgery, cyst puncture and drainage can be to achieve temporary relief, the lifting of respiratory distress, as a temporary emergency preoperative measures. General removal of cysts or lung disease, the prognosis is good.

adult patients before surgery if a lot of sputum, surgical anesthesia required for the double-lumen endotracheal intubation to avoid sputum back to the contralateral side. Children can be affected side of the low low chest prone position, after the first ligation of thoracic bronchopulmonary disease.

such lesions are too extensive, serious decline in lung function or a combination of serious heart, liver, kidney and other organic disorder, then the taboo surgery.