- The most important examination at the early stage is plain chest x-ray.
- Other tests include the endoscopic studies
- CT scan of the chest
- MRI of the chest
- Tissue biopsy ( done during the endoscopy)
- Flexible fiberoptic bronchoscopy
- A transbronchial needle aspiration: done via a special needle passed through the bronchoscope. This technique can be used to sample out mediastinal masses or paratracheal lymph nodes
- Transthoracic fine-needle aspiration biopsy with fluoroscopic or CT scan guidance
- Pleural biopsy in patients with pleural effusion
- Thoracentesis of pleural effusion and cytologic evaluation of the obtained fluid
Read Cervical Cancer First.
Treatment of cervical cancers depends on the staging and the depth of invasion. For example for invasion of less than 3 mm (stage IA-1) treatment includes a hysterectomy or the option of cervical conization in women who wish to preserve fertility. The staging of cervical cancer involves the following:
The International Federation of Obstetrics and Gynecology (FIGO). It permits assessment through biopsy, physical examination, cystoscopy, proctoscopy, excretory urography (intravenous pyelography or IVP), and plain film x-ray of the chest and skeletal system. The American Joint Cancer Committee staging is also involved.
Staging in cervical cancer
Read lung cancer first.
The early symptoms of lung cancer and their prevalence include:
- Cough or altered cough in 60% of patients.
- Coughing blood( Haemoptysis) in 27% of cases
- Chest pain in 34%.
- Difficulty in breathing (Dyspnea) in 46% of cases.
- Loss of appetite
- Weight loss 56%.
On examination of the patients
Cervical cancer is uncontrolled growth of abnormal cells and tissue within the cervix (the neck of the uterus). The uterus is the womb where babies are grown. There is then an abnormal growth of cells presenting with hypertrophy (increase of cell size), hyperplasia (the increase of the numbers of cervical cells), anaplasia (formation of atypical shapes of cervical cell shape), and poor cervical cell function.The increasing cell size and numbers lead to an increase in the size of the surrounding tissues with the invasion of more abnormal cells from the cervix.
The cells are so aggressive and invade the surrounding tissues by competing for blood supply to the tissues. These cells are easily detected by a Pap smear test as they are shed from the.
Cervical cancer causes
There are several know causes of cervical cancer. The main cause of cervical cancer is an infection with Human papilloma virus (HPV) serotypes 16, 18, 31, 33, 45, and 56 which account for more than 80% of all invasive cervical cancers.
However most of the causes are associated with specific risk factors that women face. A regular Pap smear tests is important as a screening tool and a preventive measure for cervical cancer among women.
What are the risk factors for cervical cancer?
- Associated risk factors include
- Having multiple sexual partners
- Women living in lower socioeconomic status
- Cigarette smoking
- A history of sexually transmitted diseases such as chlamydia, HPV infection
- Oral contraceptive use.
- Certain types of sexual behavior such as
- Women who have sex at an early age
- Women who have multiple sexual partners
- Women who have partners who have many other sex partners
- Women who have sex with uncircumcised men
- Smoking or nicotine
- Infections with Human immunodeficiency virus (HIV)
- Diet with increased levels of homocysteine has been associated with increased risk of having cervical cancer. Vitamin deficiency has also been implicated in development of cervical cancer. Lack of
- Prolonged use of oral contraceptives (birth control pills)
- Women who have multiple pregnancies
- Women living in low socioeconomic status
- Injection with diethylstilbestrol (DES) drugs
- Women who have relatives who had cervical cancer
- Exposure to radiation of any type especially these on treatment for other cancers
- Exposure to compounds that may affect nuclear genetic material such as benzene
- Prolonged stressful conditions
Screening for cervical cancer
From the evidence obtained from large control studies, it is recommended that:
Screening for cervical cancer with a Pap smear test can achieve an 80% reduction in death rates from the cancer in the target population of women aged between 25 to 60 years.
It is also recommended that women have a screening interval of one year with conventional Pap smear tests or every 2 years using liquid-based cytology.
After the age of 30, women who have had three consecutive, technically satisfactory screening results may be screened every 2-3 years.
The American Cancer society recommend that cervical cancer screening should begin 3 years after the onset of vaginal intercourse and no later than age 21 years of age
Women who are age 70 years or older with an intact cervix and who have had 3 or more documented satisfactory cervical screening test results within the 10-yr period before age 70 may cease to have the routine cervical cancer screening tests
Those who have had uterus removal (with removal of the cervix need not undergo screening tests.
Cervical cancer epidemiology
Although cervical cancer is the third most common gynecologic cancer in the United States, it is the most common malignancy worldwide.
Cervical cancer is the second most common cancer in women in the world, with an estimated 500,000 cases in 2003.
Screening for cervical cancer with follow up and treatment has helped reduce the incidences of cancer. How ever this may not be true in some countries or regions such as the Latin America, the Caribbean, and Africa, where cervical cancer is the most common cause of cancer-related death in women
The incidences are high among the whites in the United States with an estimated 8.1 new cases per 100,000 each year as compared with 11 per 100,000 in African-American women and 14.4 per 100,000 in Hispanic populations.
Symptoms of cervical cancer
- There are no symptoms in those in precancerous stage
- There is an unusual vaginal bleeding, particularly after sex
- A vaginal discharge with odor
- Early invasive cancers may also present with no symptoms although some women will notice postcoital (after sex), between menses, or postmenopausal spotting.
- Some women will present with malodorous vaginal discharge
- Painful coitus (dyspareunia)
- Cramping pelvic pain from uterine contractions
- Chronic blood loss may result in symptoms of anemia in some patients
- There may be pelvic pain
- In advanced stages, there may b lower limb swelling (from occlusion of pelvic lymph vessels or thrombosis of the external iliac vein)
- Advanced stages of disease may lead to anorexia, dysgeusia and unintentional weight loss
Diagnosing cervical cancer
- The following tests may be performed to help in diagnosis of cervical cancer.
- The healthcare provider will perform a detailed history and physical examination
- Pelvic examination which includes examination of the vagina, cervical and related organs
- Pap smear test.
- Test for human papilloma virus (HPV) DNA. There is a high sensitivity for the detection of cervical intraepithelial neoplasia with these tests. This test helps to reduce the incidence of grade 2 or 3 cervical intraepithelial neoplasia (CIN) or cancer detected by subsequent screening examinations.
- Colposcopy The method of examining the vagina and by means of a binocular instrument known as the colposcope, to screen for cancer of the cervix. The clinician may also use this test to do biopsy and endocervical curettage.
- Complete blood count
- A squamous cell carcinoma (SCC) antigen test
- Carcinoembryonic antigen (CEA)
- Chest x-ray examination
Continue reading about Treatment of Cervical cancer.
This is primary lung malignancy that arises from the lung tissue. There are several types of primary cancer of the lung including squamous cell carcinoma, adenocarcinoma, small cell carcinoma, and large cell carcinoma. Here are some of the listed types
Adenocarcinomas: These types of cancers are common in North America and Japan. They tend to occur among smokers, although nonsmokers are more likely to develop adenocarcinoma than other lung cancer types. On radiological examination, they are found more peripherally, but can occur almost anywhere, and can be multifocal. They have been known to fill the entire lobe of the lung tissue. Other x-ray findings show that they are associated with solid opacities, ground-glass opacities, or mixed patterns. Epidemiologically, Adenocarcinomas represent 35%-40% of lung carcinomas. The variants of adenocarcinomas include types such as signet ring, clear cell, mucinous, and fetal adenocarcinomas
Squamous cell (Epidermoid): This type of cancer tends to occur centrally and is highly associated a history of smoking. It’s a malignancy that shows squamous differentiation 20% to 30% of lung cancers. It spreads by locally invading the surrounding tissues and forms cavities in the lungs. The differential diagnosis includes reactive processes that may result in squamous metaplasia with reactive atypia as seen during infections or radiation-induced injury