Symptoms of Cervical Cancer

Early cervix cancer generally produces no signs or symptoms. But, as the cancer grows, symptoms may include :
- Abnormal bleeding.
- Unusual heavy discharge : It may be foul smelling, watery, thick, or contain mucus. It varies from woman to woman.
- Bleeding after sexual intercourse, douching, or a pelvic exam.
- Menstrual periods that last longer and are heavier than before.
- Pelvic pain and pain during sex.
- Pain during urination.
- Bleeding between regular menstrual periods.

Types of Cervical Cancer

There are two types of cervical cancer :
- Squamous cell carcinoma : These cancers are from the squamous cells that cover the surface of the exocervix. Under the microscope, this type of cancer is made up of cells that are like squamous cells. Squamous cell carcinomas most often begin where the exocervix joins the endocervix.
- Adenocarcinoma : This develops mucus-producing glandular cells of the endocervix, the part of the cervix next to the body.

Risks Involved in Mammography

- There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk.
- The effective radiation dose from a mammogram is about 0.7 mSv, which is about the same as the average person receives from background radiation in three months. Federal mammography guidelines require that each unit be checked by a medical physicist every year to ensure that the unit operates correctly. See the Safety page for more information about radiation dose.
- False Positive Mammograms. Five percent to 15 percent of screening mammograms require more testing such as additional mammograms or ultrasound. Most of these tests turn out to be normal. If there is an abnormal finding, a follow-up or biopsy may have to be performed. Most of the biopsies confirm that no cancer was present. It is estimated that a woman who has yearly mammograms between ages 40 and 49 has about a 30 percent chance of having a false-positive mammogram at some point in that decade and about a 7 percent to 8 percent chance of having a breast biopsy within the 10-year period.
- Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. See the Safety page for more information about pregnancy and x-rays.

- A mammogram is an x-ray of the breast. Mammograms can be used to check for breast cancer in women who have no signs or symptoms of the disease. This type of mammogram is called a screening mammogram. Screening mammograms usually involve two x-rays of each breast. They make it possible to detect tumors that cannot be felt.

- Mammograms can also be used to check for breast cancer after a lump or other sign or symptom of breast cancer has been found. This type of mammogram is called a diagnostic mammogram.

- Women age 40 and older should have mammograms every 1 to 2 years.

- Women who are at higher than average risk of breast cancer should talk with their health care providers about whether to have mammograms before age 40 and how often to have them.

- Mammograms are quick and easy. You stand in front of an X-ray machine. The person who takes the X-rays places your breast between two plastic plates. The plates press your breast and make it flat. This may be uncomfortable, but it helps get a clear picture. You will have an X-ray of each breast.

Local treatment

It is used to treat a tumor without affecting the rest of the body. Surgery and radiation are examples of local treatment.

1. Surgery

The main mode of treatment for breast cancer is surgery, especially so when the tumor is localized.
- Breast conserving surgery: An operation to remove the cancer but not the breast is called breast-sparing surgery.
- Lumpectomy: The surgeon removes the breast cancer and some normal tissue around it.
- Segmental mastectomy: The surgeon removes the cancer and a larger area of normal breast tissue around it. Occasionally, some of the lining over the chest muscles below the tumor is removed as well. Some lymph nodes under the arm may also be removed.
- Total mastectomy: The surgeon removes the whole breast. Some lymph nodes under the arm may also be removed.
- Radical mastectomy: The surgeon removes the breast, both chest muscles, all of the lymph nodes under the arm, and some additional fat and skin.
- Axillary Lymph node dissection: Removing some or all of the lymph nodes in the arm pit. Usually 10 to 20 lymph nodes in the arm pit are removed.

2. Radiation Therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

Systemic treatment

This treatment is given into the bloodstream or by mouth and goes throughout the body to reach cancer cells that may have spread beyond the breast. Chemotherapy, hormone therapy, and targeted therapy are systemic treatments.

1. Chemotherapy

Chemotherapy uses anticancer drugs to kill cancer cells. There are many different kinds of chemotherapy drugs. Often they are used in combination called regimens. The prime target for such medicines is cancer cells that are actively growing and dividing. Unfortunately, anticancer medicines are not able to recognize cancer cells specifically and they also kill normally dividing cells such as the blood and hair cells.

2.Hormone therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow.
- Hormone therapy with tamoxifen is often given to patients with early stages of breast cancer and those with metastatic breast cancer.
- Hormone therapy with tamoxifen or estrogens can act on cells all over the body and may increase the chance of developing endometrial cancer.
- Hormone therapy with an aromatase inhibitor is given to some postmenopausal women who have hormone-dependent breast cancer.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.
- Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow.
- Tyrosine kinase inhibitors are targeted therapy drugs that block signals needed for tumors to grow. Tyrosine kinase inhibitors may be used in combination with other anticancer drugs as adjuvant therapy.

Stage 0 is Carcinoma in situ

- It is used to describe non-invasive breast cancers, such as DCIS and LCIS.
- It occurs when abnormal cells have appeared inside the linings of the breast ducts. They have not spread yet.

Stage 1 Early stage invasive breast cancer

- The tumor measures up to 2 centimeters.
- No lymph nodes are involved.
- It has not spread to other parts of the body.

Stage 2(a) Breast Cancer

- Cancer is found in auxillary lymph nodes but there is no tumor found in the breast; or
- The tumor is 2 centimeters or smaller and has spread to the axillary lymph nodes; or
- The tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes.

Stage 2(b) Breast Cancer

- The tumor is larger than 2 but no larger than 5 centimeters and has spread to the axillary lymph nodes, OR
- tTe tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes.

Stage 3 Breast Cancer

- In stage 3(a) the tumor is larger than two centimeters but smaller than five centimeters and has spread to up to nine auxiliary underarm lymph nodes.
- In stage 3(b) the cancer has spread to tissues near the breast including the skin, chest wall, ribs, muscles, or lymph nodes in the chest wall or above the collarbone.

Stage 4 Breast Cancer

It represents a full spreading of the cancer to the other organs of the body, including the bones, liver, lungs, or the brain.

Self Breast Exam

Changes in the breast can occur because of aging, your menstrual cycle, pregnancy, menopause, or taking birth control pills or other hormones. Breast self-exams cannot replace regular screening mammograms and clinical breast exams.

Mammographic Screening

The first diagnostic tool to identify breast cancer is Mammogram. It is an X-ray of the breast that can show the presence of abnormal growth lumps in the breast area.

Ultra-Sonography

Use of high frequency sound waves often identifies whether the lump is filled with liquid or solid for further investigation.

Clinical Breast Exam

During a clinical breast exam, your health care provider checks your breasts. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips. The skin of your breasts is checked for a rash, dimpling, or other abnormal signs. Your nipples may be squeezed to check for fluid. A thorough clinical check up takes about 10 min.

Aspiration

Fine needle is inserted in the lump to take the tissue or liquid out from the lump and then a biopsy is performed to test for carcinoma.

Surgical Biopsy

Surgical biopsy removes a small part of lump by surgery and then the lump is tested for further diagnosis.

Ductal Breast Cancer

About 80-90% of all breast cancers are ductal in origin. The ducts in the breasts carry milk from the lobules or glands of the breast to the nipples. There are two types of Ductal Cancers:
- DCIS – Ductal Carcinoma In Situ : It is the most common type of non-invasive breast cancer. Ductal means that the cancer starts inside the milk ducts, carcinoma refers to any cancer that begins in the skin or other tissues (including breast tissue) that cover or line the internal organs, and in situ means “in its original place.” DCIS is called “non-invasive” because it hasn’t spread beyond the milk duct.
- IDC – Invasive Ductal Carcinoma : It refers to cancer that has broken through the wall of the milk duct and begun to invade the tissues of the breast. Over time, invasive ductal carcinoma can spread to the lymph nodes and possibly to other areas of the body.

Lobular Breast Cancer

Lobular breast cancer is a type of cancer which originates in the lobules or milk-producing glands of the breasts.
- LCIS – Lobular Carcinoma In Situ : Lobular means that the abnormal cells start growing in the lobules, the milk-producing glands at the end of breast ducts. Carcinoma refers to any cancer that begins in the skin or other tissues that cover internal organs — such as breast tissue. In situ or “in its original place”.
- ILC – Invasive Lobular Carcinoma : It refers to cancer that has broken through the wall of the lobule and begun to invade the tissues of the breast. Over time, invasive lobular carcinoma can spread to the lymph nodes and possibly to other areas of the body.

Inflammatory Breast Cancer

Inflammatory breast cancer is a very aggressive form of cancer. It starts out in the breast ducts and then quickly invades the surrounding tissue. It does not form a lump but the breast can become enlarged and tender with engorged veins, similar to an infection or inflammation of the breast.

Paget’s Disease of the Nipple

Paget’s disease is a cancer of the skin cells of the nipples and/or the areola. It may be due to spread from an underlying invasive breast cancer or may be a spontaneous change of the skin cells.

Causes of Breast Cancer

The exact cause of breast cancer is not known but some causes associated with breast cancer are :
- Age : As the person gets older, chances of having breast cancer increases.
- Family history : Any close relative diagnosed with breast cancer increases the risk factor.
- Early start onset of menses and early menopause are also associated with breast cancer.
- Exposure to chemicals.
- Exposure to radioactive rays increases the chances of breast cancer.
- Late childbearing increases the risk of breast cancer.

Symptoms of Breast Cancer

Initially, breast cancer may not cause any symptoms. A lump may be too small for you to feel or to cause any unusual changes you can notice on your own.
* swelling of all or part of the breast.
* skin irritation or dimpling.
* breast pain.
* nipple pain or the nipple turning inward.
* redness, scaliness, or thickening of the nipple or breast skin.
* a nipple discharge other than breast milk.
* a lump in the underarm area.
These changes also can be signs of less serious conditions that are not cancerous, such as an infection or a cyst. It’s important to get any breast changes checked out promptly by a doctor.

- A flat or raised growth of black or brown color, often mixed with blue, red, or white parts, from 6 mm to few cm in size, may appear anywhere on the skin, in men mostly on the trunk, in women on the back and legs, and parts of the skin that are usually hidden from the sun, but were exposed to intense sunlight for short periods.
- Melanoma may show one or more of typical ABCDE characteristics: Asymmetry: one part of the tumor differs from other parts; Border of the tumor is irregular; Color: tumor may be of different colors, often several colors are present in one tumor; Diameter above 6 mm (in most cases), Evolving: lesion growths and changes color and appearance with time.

Melanoma Subtypes :
- Superficially spreading melanoma grows relatively slowly.
- Nodular melanoma grows rapidly – weeks to months. It tends to ulcerate and bleed.
- Acral lentiginous melanoma appears in dark skinned people (Afro-American, Asian, and Hispanic), mostly on their palms, soles, and under nails.
- Lentigo maligna melanoma. A macule grows slowly (years) as a patch, over 1-3 cm in size. It does not spread to other organs.

Treatment :
- Chemotherapy is often used to treat melanoma that has returned or spread.
- Medications such as interferon or interleukin, which boost the immune system to fight the cancer, may be useful in addition to chemotherapy and surgery. This kind of treatment is called immunotherapy. However, interferon has many side effects and can be difficult to tolerate.
- Radiation treatments may be used to relieve pain or discomfort caused by cancer that has spread.
- Cancer that has spread elsewhere in the body is sometimes removed with surgery to relieve pain or discomfort.