NewsChannel 5.com - Nashville, Tennessee - Cervical & Ovarian Cancer -- Dr. Brent Boles -- February 26, 2007
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MEDICAL MONDAY - Cervical and Ovarian Cancer
Brent Boles, M.D. gynecologist
Middle Tennessee Medical Center
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Medical Monday - Cervical & Ovarian Cancer
What causes cervical cancer?
The cervix is made up of two kinds of cells: columnar cells and squamous cells. Columnar cells constantly change into squamous cells in an area of the cervix called the transformation zone. As a result of this natural process of change, some cervical cells can become abnormal. Infection can also cause abnormal cervical cell changes. When abnormal cell changes persist over time (years) and become severe, these cells may develop into cervical cancer.
What are the symptoms?
Since abnormal cervical cell changes rarely cause symptoms, it is important for you to have regular Pap test screening. If untreated cervical cell changes progress to cervical cancer, symptoms may develop. Symptoms of cervical cancer may include:
What increases my risk for cervical cancer?
Abnormal cervical cell changes are often the result of high-risk sexual behaviors years earlier. These behaviors include having unprotected sex (not using condoms), having multiple sex partners, or having a partner who has had multiple partners. These behaviors increase your risk of infections and sexually transmitted diseases (STDs). The most common cause of cervical cancer is infection with a high-risk type of the human papillomavirus (HPV). A past HPV infection in you or your partner can cause abnormal cervical cell changes later since the virus may remain in the body for life. Low-risk types of HPV cause genital warts, but other types may not cause any symptoms so you may not know you have had it.
Smoking (or a history of smoking) or having an impaired immune system may also increase your risk for cervical cell changes. The use of birth control pills for more than 5 years may be a risk factor related to infection with HPV.2
How is cervical cancer diagnosed?
As part of your routine gynecological exam, you should have a Pap test. If a Pap test indicates abnormal cell changes, further tests, such as a colposcopy or cervical biopsy, will be done to diagnose whether there are precancerous or cancerous changes present on your cervix.
You may also be diagnosed because of your specific symptoms, such as abnormal bleeding after sexual intercourse, but a biopsy will still be needed.
If cervical cancer is present, your doctor will determine the stage of your cancer by gathering information from a variety of tests, including blood tests, bone scans, and X-rays. The stage of your cancer, which identifies its size and how much it has spread, is one of the most important factors in selecting the treatment option that is right for you.
How is it treated?
Cervical cancer in its early stages can be cured with treatment and close follow-up. Your treatment choices depend on:
Treatment for later stages of cervical cancer is more extensive to remove the cancer and will likely take away your ability to have children. More extensive treatment may include:
A combination of these treatments or a specific sequence, such as surgery before radiation or chemotherapy along with radiation, may be recommended as the most effective treatment for the best possible outcome.
Women with human immunodeficiency virus (HIV) will usually have cervical cell changes that have progressed to a more advanced stage of cervical cancer.
Advisory Committee Wants Girls Age 11 and Up to Get New Cervical Cancer Vaccine
June 29, 2006 - A government panel today recommended that girls as young as 11 routinely get a new vaccine against cervical cancercervical cancer.
The Advisory Committee on Immunization Practices, which advises the government on vaccine policies, unanimously backed widespread use of the vaccine in preadolescent girls in hopes of protecting them before most become sexually active.
The vaccine, known as Gardasil, prevents infection with human papillomavirus (HPV), a sexually transmitted virus known to cause most cervical cancers and genital wartsgenital warts.
If the panel's recommendation is approved by the Bush administration, Gardasil would join vaccines against measlesmeasles, whooping coughwhooping cough, chicken pox, and other diseases on the list of routine shots for all American children.
Such approval would also qualify Gardasil for inclusion in a federal program that provides free vaccines for low-income children.
"This is a huge breakthrough for women's health and for prevention and for cancercancer prevention," said Anne Schuchat, MD, director of the National Center for Infectious Diseases at the CDC.
The vaccine received the unanimous consent of an FDA panel earlier this month after the drug company Merck showed it was nearly 100% effective in preventing HPV infections.
Early Vaccinations
But the vaccine is only effective in preventing -- not treating -- HPV infections in women, which are highly common. Public health experts urged early vaccinations, before girls become sexually active, to maximize its benefits.
"It was important for the committee that their recommendations offer the vaccine before most girls would have the onset of sexual activity," Schuchat said. "To have the maximum preventative impact, the decision was to target 11- and 12-year-olds."
The committee said the vaccine could be safely given to girls as young as 9, at the discretion of parents and doctors.
Invasive cervical cancer is expected to be diagnosed in more than 9,700 American women this year, and to kill roughly 3,700, according to the American Cancer Society.
Today's recommendation met with praise from women's health groups.
But early vaccination troubles some conservative groups, who worry it might encourage girls to become sexually active.
Charmaine Yoest, a spokeswoman for the conservative Family Research Council, says the group "welcomes" today's vote. But she also says the group opposes putting Gardasil on the list of childhood vaccines required as a condition of attending school.
"This isn't something you get from a sneeze in a classroom, so there is no need to make it mandatory," she tells WebMD.
Pricing Worries
The vaccine contains four HPV subtypes. Two cause most cervical cancers; the other two cause most genital wartswarts. It's designed to be given in a series of three shots.
Multiple vaccine shots are not uncommon, but some health experts worry the vaccine's $120-per-shot cost could limit widespread access.
"Vaccine financing is an enormous issue," Schuchat said.
Inclusion on CDC's routine immunization schedule would qualify Gardasil for the federal Vaccines for Children Program, which provides free vaccines to youngsters who are uninsured or who are Medicaid recipients, Native Americans, or Alaska Natives.
Most, but not all, private insurance companies also use the CDC schedule to decide which vaccines they will cover.
Emily Stewart, a policy analyst with the Planned Parenthood Federation of American, praised the vaccine in a statement before the committee today. She called the panel's recommendation critical to guaranteeing coverage by insurance companies and the government.
"Access to the vaccine should be a public health priority," she said.
HPV, Cervical Cancer Vaccine: 15 FAQs
Here's what you need to know about Gardasil.
Gardasil, the new vaccine against human papilloma virus (HPV) -- which causes cervical cancer and genital warts -- is now available nationwide.
Here is what you need to know now about this new vaccine.
1. What is Gardasil?
Gardasil is a vaccine, licensed for use in June 2006, by the FDA. It targets four strains of human papillomavirus (HPV) -- HPV-6, 11, 16, and 18. HPV-16 and HPV-18 account for about 70% of all cervical cancers. HPV-6 and -11 cause about 90% of genital warts. HPV is also linked to anal cancer.
2. How does HPV spread?
Sexual activity spreads the virus, a very common one. It's one of the most common sexually transmitted diseases (STDs) in the country, according to the CDC, with more than 20 million people currently infected and another 6.2 million contracting the virus each year.
About half of those with HPV are aged 15 to 24. Surveys suggest 3.7% of U.S. girls have sex by age 13, and 62.4% have had sex by the 12th grade.
3. Who should get the vaccine?
Gardasil is approved by the FDA for girls and women ages 9 to 26. The CDC and the American Academy of Pediatrics recommend that the vaccine be given routinely to girls at age 11 to 12 years old, although doctors may choose to vaccinate girls as young as 9. The CDC also recommends the vaccine for women age 13 to 26 who did not receive the vaccine at an earlier age.
However, if a girl or woman is already infected with HPV, the vaccine will not prevent that strain of HPV from causing disease. It will protect against new infections with other strains of HPV included in the vaccine.
The vaccine is also being studied in women up to age 45, although that group may be targeted for the vaccine later.
The vaccine is being studied in males, too. Men can get HPV infections and can pass the virus to their sex partners. HPV causes genital warts and is associated with rare cases of cancer of the penis. Particularly in gay men, HPV is linked to anal cancers. Merck is currently testing Gardasil in men, including gay men.
4. What is the best way to talk to my daughter about this?
Emphasize that the primary goal is to help prevent cervical cancer. If you, as a parent, are worried this will give your child a false sense of security that she can't catch a sexually transmitted infection from sexual activity, you can also emphasize that the vaccine only protects against certain strains of HPV -- not against any of the many other types of sexually transmitted infections.
5. Does Gardasil protect against all cervical cancers?
No. The vaccine does protect against the strains of HPV most likely to cause cancer. But it does not protect against all HPV strains.
However, recent reports suggest that the vaccine may give wider protection than originally thought. There is preliminary evidence it may offer some protection against other HPV strains, which cause 8% or 9% of cervical cancers.
6. How effective is the new vaccine?
Studies have shown it is 100% effective in the prevention of cervical precancers and noninvasive cervical cancers caused by HPV-16 and 18 in those not already exposed to those strains, according to Merck & Co. Inc., which makes Gardasil. Merck is a WebMD sponsor.
7. If someone is already sexually active, will this vaccine still work?
If a person has been infected with any of the four strains the vaccine protects against, the vaccine won't provide protection against that type. But it will prevent infection from the other three.
8. How long is Gardasil effective?
Research suggests the vaccine lasts at least four years. Long-term results are not yet certain. The protection might last longer.
9. Does the vaccine actually contain HPV or any live virus?
No. It has a virus-like particle but not the actual virus.
10. Is Gardasil safe?
Clinical trial data have found it is safe.
11. What does the vaccine cost? Will insurance cover it?
The "list" price is about $120 per dose, and three doses are needed. But that is the price your doctor pays to the manufacturer. It does not include the cost of an office visit or other charges, so the cost to individuals could be higher. The federal Vaccines for Children Program will provide free vaccines to those under age 19 who qualify. More information on that program is on the CDC web site, www.cdc.gov. A number of insurers say they plan to cover the costs.
12. Is it available everywhere in the U.S.?
Supplies have been shipped nationwide, according to Merck, although your individual doctor's office or clinic may not have ordered it.
13. Will the new vaccine make cervical cancer screens such as the Pap test passé?
No. Screening with a Pap test is still needed, since the vaccine does not protect against all cervical cancer.
14. Is this the only vaccine for cervical cancer?
There's a second vaccine in the works: Cervarix, from GlaxoSmithKline. Cervarix targets two HPV strains, HPV-16 and HPV-18. GSK says it plans to seek FDA approval for Cervarix by the end of the year. Early studies find that this vaccine, like Gardasil, is extremely safe and effective. GlaxoSmithKline is a WebMD sponsor.
15. How common is cervical cancer and how deadly?
The American Cancer Society predicts that in 2007, there will be about 11,150 new U.S. cases of invasive cervical cancer, and 3,670 cervical-cancer deaths.
Cervical cancer is the second most common cancer in women worldwide. There are about 500 000 new cases, and 250,000 cervical-cancer deaths each year. According to the World Health Organization, nearly 80% of cases occur in low-income countries, where cervical cancer is the most common cancer in women
Ovarian Cancer
Topic Overview
What is ovarian cancer?
Ovarian cancer happens when cells that are not normal grow in one or both of your ovaries . This topic is about epithelial ovarian cancer, the most common type.
This cancer is often cured when it is caught early. But most of the time, the cancer has already spread by the time it is found.
It is frightening to hear that you or someone you love may have ovarian cancer. It may help to talk with your doctor or join a support group to deal with your feelings.
What causes ovarian cancer?
The cause of ovarian cancer is not known. Genetics are a risk factor for some women. A family history of ovarian cancer is found in 10% to 20% of women with ovarian cancer.
Women who inherit changes (genetic mutations) in the BRCA1 and BRCA2 genes have a higher chance of developing ovarian cancer and breast cancer. Most women with BRCA gene changes have a first-degree female relative, such as a sister or mother, or several second-degree female relatives, such as an aunt or grandmother, who have had breast or ovarian cancer, especially at an early age (before 50).1
You have a higher chance of developing ovarian cancer if you:
If you have a strong family history of ovarian cancer, you may want to talk with your doctor or a genetic counselor about having a blood test to look for BRCA1 and BRCA2 gene changes. Women who inherit these changes in one or both of these genes have a higher chance of developing ovarian cancer.
Symptoms
Ovarian cancer does not cause many symptoms in its early stages. This is why 75% to 80% of cases are not found until the cancer has spread. Most women do have symptoms in the 6 to 12 months before ovarian cancer is found. Symptoms that occur in later stages are most likely caused by the pressure of the growing cancer. These symptoms include:
What Happens
Ovarian cancer spreads when cancerous (malignant) cells enter the abdominal cavity. The cancer cells then grow on the peritoneal lining of the abdomen and other abdominal organs. In its advanced stage, ovarian cancer usually spreads to the lymph nodes and to other organs in the pelvis. This may cause kidney and bowel problems. Cancer may also spread to other organs in the body, such as the liver and lungs.
Cancer from other areas of the body can also spread to the ovaries. This most commonly occurs in cancers that involve the breast, stomach, colon, and the lining of the uterus (endometrium).3
Ovarian cancer usually is not found in its early stages because it causes few, if any, symptoms. Laparotomy surgery is done to confirm that cancer is present, to provide initial treatment, and to stage the cancer with biopsies of abdominal tissue, peritoneal fluid, and lymph nodes. The long-term outcome (prognosis) depends on the stage of your ovarian cancer.
What Increases Your Risk
Risk factors for ovarian cancer include:
What Increases Your Risk
More research is needed to confirm if certain other factors can increase a woman's chances of getting ovarian cancer, such as:
When To Call a Doctor
Ovarian cancer does not cause many symptoms in its early stages. Having symptoms not always mean you have cancer. These symptoms may be caused by other problems. It is important to talk to your doctor if you have any new symptoms, such as:
There are no reliable screening tests for ovarian cancer. Ovarian cancer is confirmed and staged by biopsies that are taken during laparotomy surgery.
Some initial exams and tests are done before surgery if ovarian cancer is suspected. These tests include:
Treatment Overview
The choice of treatment and the long-term outcome (prognosis) for women who have ovarian cancer depends on the type and stage of cancer. Your age, overall health, quality of life, and desire to have children (preserve fertility) must also be considered.
Initial treatment
The goal of the initial surgery is to remove all visible cancer. The type of surgery you will need depends on the stage of your cancer and if you want to be able to have children after having the surgery.
If you have early-stage (stage I and low-grade [grade 1]) cancer and you wish to have children, your surgery may include:
Your uterus and the healthy ovary will remain, so it may be possible for you to become pregnant.
If you have a more advanced stage (stage II, III, or IV) of cancer or you have stage I and do not want to have children, your surgery may include:
Because this surgery removes all the reproductive organs, you will not be able to become pregnant after having it.
Chemotherapy is recommended after surgery for most women. The current standard of treatment is 6 cycles of paclitaxel (Taxol) and carboplatin or cisplatin. Each chemotherapy cycle is scheduled every 3 to 4 weeks, so chemotherapy may last 4 to 6 months. Studies are looking at delivering chemotherapy directly into the belly (intraperitoneal chemotherapy). One study compared women with stage III ovarian cancer who had already had surgery. In that study, one group had treatment with paclitaxel delivered into a vein (intravenous) followed by intravenous cisplatin; the other group had treatment with intravenous paclitaxel followed by intraperitoneal cisplatin and paclitaxel. Although the intraperitoneal group had more side effects, overall survival was better than for the intravenous group.12
Home treatment measures may help relieve some of the common side effects of cancer treatment, such as nausea, vomiting, fatigue, hair loss, stress, or sleep problems.
If both of your ovaries are removed, you are likely to experience menopausal symptoms after surgery. Home treatment measures may relieve some of these symptoms. If home treatment does not help your menopausal symptoms, talk to your doctor about other ways to manage your symptoms.
If you have recently been diagnosed with ovarian cancer, you may experience a wide variety of emotions in reaction to having cancer. Most women feel some denial, anger, and grief. There is no "normal" or "right" way to react to having cancer. You can take steps, though, to manage your emotional reactions to learning that you have ovarian cancer. Some women find that talking with family and friends is comforting, while others may need to spend time alone to understand their feelings about their cancer.
If your emotions are interfering with your ability to make decisions about your health and to move forward with your life, it is important to talk with your doctor. Your cancer treatment center may offer counseling services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other women who have had similar feelings after having cancer such as yours can help you accept and deal with your cancer.
Prevention
Ovarian cancer cannot be prevented, but you may be able to reduce some of your chances for developing it.
Studies have found that the use of a combined estrogen and progestin birth control pill for more than 5 years reduces a woman's risk by 40%.2 Women who have a family history of ovarian cancer may also lower their risk by using birth control pills. The results are not clear from studies on the use of birth control pills in women who have BRCA gene changes.
Having surgery to close or tie off your fallopian tubes (bilateral tubal ligation) will lower your chances of developing ovarian cancer. However, you will not be able to become pregnant after having this surgery. Talk to your doctor about whether this choice is right for you.9
Having a baby lowers your chances for ovarian cancer. Having more than one baby lowers your chances even more. Breast-feeding also lowers your chances.
A small number of women with ovarian cancer have a first-degree female relative, such as a sister or mother, or a second-degree female relative, such as an aunt or grandmother, who has had ovarian cancer. Changes (mutations) in two major genes, BRCA1 and BRCA2, are most closely related to a higher lifetime chance of 15% to 40% for ovarian cancer in these families. You may consider a BRCA gene test if you have a family history of ovarian cancer. Most experts recommend that women with known BRCA mutations have their uterus, ovaries, and fallopian tubes removed while these organs are still healthy to reduce their lifetime chance of developing ovarian cancer. You will not be able to become pregnant but studies have shown that this surgery lowers your chance of getting ovarian cancer by more than 95%.
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