Detection and diagnosis

Symptoms

Early cervical cancers usually don't cause symptoms. When the cancer grows larger, women may notice one or more of these symptoms:

    * Abnormal vaginal bleeding
          o Bleeding that occurs between regular menstrual periods
         o Bleeding after sexual intercourse, douching, or a pelvic exam
          o Menstrual periods that last longer and are heavier than before
          o Bleeding after going through menopause

    * Increased vaginal discharge
          o Pelvic pain
          o Pain during sex

Infections or other health problems may also cause these symptoms. Only a doctor can tell for sure. A woman with any of these symptoms should tell her doctor so that problems can be diagnosed and treated as early as possible.

Detection and diagnosis

Doctors recommend that women help reduce their risk of cervical cancer by having regular Pap tests. A Pap test (sometimes called Pap smear or cervical smear) is a simple test used to look at cervical cells. Pap tests can find cervical cancer or abnormal cells that can lead to cervical cancer.

Finding and treating abnormal cells can prevent most cervical cancer. Also, the Pap test can help find cancer early, when treatment is more likely to be effective.

For most women, the Pap test is not painful. It's done in a doctor's office or clinic during a pelvic exam. The doctor or nurse scrapes a sample of cells from the cervix. A lab checks the cells under a microscope for cell changes. Most often, abnormal cells found by a Pap test are not cancerous. The same sample of cells may be tested for HPV infection.

If you have abnormal Pap or HPV test results, your doctor will suggest other tests to make a diagnosis:

    * Colposcopy: The doctor uses a colposcope to look at the cervix. The colposcope combines a bright light with a magnifying lens to make tissue easier to see. It is not inserted into the vagina. A colposcopy is usually done in the doctor's office or clinic.


    * Biopsy: Most women have tissue removed in the doctor's office with local anesthesia. A pathologist checks the tissue under a microscope for abnormal cells.


          o Punch biopsy: The doctor uses a sharp tool to pinch off small samples of cervical tissue.


          o LEEP: The doctor uses an electric wire loop to slice off a thin, round piece of cervical tissue.


          o Endocervical curettage: The doctor uses a curette (a small, spoon-shaped instrument) to scrape a small sample of tissue from the cervix. Some doctors may use a thin, soft brush instead of a curette.


          o Conization: The doctor removes a cone-shaped sample of tissue. A conization, or cone biopsy, lets the pathologist see if abnormal cells are in the tissue beneath the surface of the cervix. The doctor may do this test in the hospital under general anesthesia.

Removing tissue from the cervix may cause some bleeding or other discharge. The area usually heals quickly. Some women also feel some pain similar to menstrual cramps. Your doctor can suggest medicine that will help relieve your pain.

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Who Should Get the HPV Vaccine?

Human papillomavirus (HPV) infection of the cervix can lead to cervical cancer. A vaccine designed to prevent cervical cancer and other diseases caused by infection with HPVs was approved for use in the U.S. in June 2006. This is the first vaccine to be developed against a known risk factor for the development of a cancer.

While some HPV types infect the skin and cause benign warts and other lesions, about 40 types of HPVs can infect the genital tract. Genital HPV infection is very common in the general population; estimates suggest that up to 50% of all sexually active people will be infected at some point in their lives. In the majority of cases, the infection does not cause any symptoms, but in some women, HPV infection can progress to cause precancerous and cancerous lesions of the uterine cervix. HPVs that infect the genital area are also associated with other less common genital cancers in men and women such as cancers of the anus, vagina, penis, and vulva. HPV infection also causes genital warts in both men and women.

The most common HPV types that infect the genital area are HPV types 6, 11, 16, and 18. Among these, HPV types 6 and 11 are most commonly associated with benign lesions, such as genital warts and mild precancerous changes of the cervix. In contrast, HPV types 16 and 18 are the types found in the majority of cancers as well as in severe precancerous changes of the cervix. The vaccine, called Gardasil, targets these four common HPV types.

Gardasil, developed by Merck & Co., has been shown to be safe and 100% effective in preventing infection by these four common HPV types in young people who have not been previously infected with HPV. Its effectiveness is lessened for those who have already been exposed to the viruses.

The FDA has approved Gardasil for males and females aged 9-26. Another vaccine directed at HPV types 16 and 18 (the two HPV types most commonly associated with cervical cancer), known as Cervarix, manufactured by GlaxoSmithKline, has been approved for use in females aged 10-15. Ideally, vaccination should occur before youth become sexually active, since those who have not yet been infected with any HPV types will get the full benefit of the vaccine. However, it can also be useful in people who are already sexually active, since they may not be infected with HPV or may not be infected by all four HPV types covered by the vaccine.

Research is ongoing to determine whether the vaccine has any beneficial effects in older women, and its safety for use in pregnant women has not yet been determined. It is also not known if the vaccine confers lifelong immunity, since long-term study results are not yet available.

Since Gardasil only targets the four major types of HPV that infect the genital tract, it cannot protect against all causes of HPV. HPV types 16 and 18 are the causes of about 70% of all cervical cancers, and HPV types 6 and 11 cause about 90% of genital warts. All women, even those who have received the vaccine, should still undergo regular cervical cancer screenings.

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Cervical Cancer

Second opinion

Before starting treatment, you might want a second opinion about your diagnosis and treatment plan. Some people worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it.

If you get a second opinion, the doctor may agree with your first doctor's diagnosis and treatment plan. Or the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at your options.

It may take some time and effort to gather your medical records and see another doctor. In most cases, it's not a problem to take several weeks to get a second opinion. The delay in starting treatment usually will not make treatment less effective. To make sure, you should discuss this delay with your doctor.

There are many ways to find a doctor for a second opinion. You can ask your doctor, a local or state medical society, a nearby hospital, or a medical school for names of specialists.

Nutrition and physical activity

It's important for you to take care of yourself by eating well and staying as active as you can.

You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.

However, you may not feel like eating during or soon after treatment. You may be uncomfortable or tired. You may find that foods don't taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth sores) can make it hard to eat well. Your doctor, a registered dietitian, or another health care provider can suggest ways to cope with these problems.

Research shows that people with cancer feel better when they stay active. Walking, yoga, swimming, and other activities can keep you strong and increase your energy. Exercise may reduce nausea and pain and make treatment easier to handle. It also can help relieve stress. Whatever physical activity you choose, be sure to talk to your doctor before you start. Also, if your activity causes you pain or other problems, be sure to let your doctor or nurse know about it.

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Prevent Cervical Cancer by HPV Vaccine

Except pap smears, measures to Prevent Emergence of cervical cancer in women is by Vaccination. Current Efforts to combat the growing problem of cervical cancer vaccine is ameliorated by the presence of Human papilloma virus (HPV), the which was introduced into the community.
HPV Vaccination Should Be done since the age of 9-26 years in both boys and girls. Also Because men tend to pass on cervical cancer.

"Unfortunately for HPV vaccine price to be paid every time you make a vaccine is very expensive around Rp1, 3 million. But price is not comparable to suffer from cervical cancer," said dr. Rachmawati on the sidelines of Teaching Science for Society Layman Dharmais Cervical Cancer Early Detection Cancer Hospital in Jakarta, Tuesday (8 / 4).

HPV vaccine injection performed three times at weeks 0, 2 and 6. The workings of this vaccine to stimulate antibody immune response against HPV in the which the antibody was arrested for the murder of the HPV virus HPV That cans not enter into the neck of the womb (cervix).

Cervical cancer tends to Arise in women aged 35-55 years (at the time of productive age). But it May Also Appear in younger women. The cause of this cancer is the Human Papilloma Virus is a virus attacks That Humans and Potentially lead to complications and infertility.

The journey was very long illness with symptoms Such as bleeding after intercourse, abnormal bleeding (excluding the time of menstruation), bleeding after menopause and disorders of the vagina (kekuniangan discharge, smelly). and other symptoms, the which Often occurs is pain in the hips and legs.

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52 million Indonesian Women at Risk of Cervical Cancer

Cervix or cervical cancer is the leading cause of cancer death among women in Indonesia. This is due to the majority of patients come for treatment when his health condition was critical, or when the disease has advanced stage. For that, a medical examination with pap smear tests should be done routinely as early detection of cancer.

By raising awareness of women to protect themselves from cervical cancer, Head of Education and Counseling Indonesia Sumarjati Arjoso Cancer Foundation, on Friday (22 / 8), in Jakarta, said, socialization to the community about the ins and outs of cervical cancer, including symptoms, prevention and early detection should continue to be done.

Cancer Foundation The success of Indonesia in implementing prevention education programs and prevention of cervical cancer for decades and future programs will be presented in the forum of the World Cancer Congress in 2008, in Geneva, the end of August.

Indonesia Cancer Foundation explained, the highest mortality rates of cervical cancer among other cancer types among women. An estimated 52 million Indonesian women at risk for cervical cancer, while 36 percent of women of all cancer patients is the cervical cancer patients. There are 15,000 new cases per year with the death of 8,000 people per year.

Life expectancy of five years if this r kanke detected and treated at stage 1 is 70-75 percent, in stage 2 is 60 percent, in stage 3 live 25 percent, and in stage four patients hardly be expected to survive. "If the disease is found while still pre-cancerous lesions, patients treated b isa perfect," he said.

P enyakit can be prevented by vaccination. The problem, vaccine to protect ourselves from HPV virus causes cervical cancer is expensive, so it does not reach all levels of society, said Sumarjati explained. Therefore, early detection with Pap smear testing routinely necessary.

However, b Udaya and indigenous in eastern Indonesia have shaped attitudes and perceptions that become a barrier for women to open themselves to medical professionals and empowered themselves to protect their reproductive health. As a result, more than 70 percent of cervical cancer patients come for treatment when his health condition was critical, and the disease was found in an advanced stage to be difficult to treat.

For that, YKI initiate a public awareness educational campaign Help Prevent Cervical Cancer Now in 2007 with the aim of spreading knowledge and references about the ins and outs of cervical cancer, including causes, risk factors, symptoms, prevention, early detection and treatment. In addition, the campaign aims memba ngkitkan awareness to protect themselves and the evocative power of women themselves to be able to determine the attitude to personal health, especially reproductive organs.

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Cervical Cancer Awareness Women will Inaugurated

Cervical cancer is the number one cancer that often occurs in women in Indonesia. However, information on this issue has not been known and there is a general assumption is wrong: many women feel at risk because they lead a healthy life  and not multiple partners.

However, the facts show, each woman without memadang ages and backgrounds at risk for cervical cancer is caused by infection or re-infection by HPV (Human Papilloma Virus) causes of cancer (oncogenic).

Therefore, Indonesia Cancer Foundation establish cervical cancer as a first priority in its program. One of the programs is to establish PPKS (Women's Cervical Cancer Awareness), which is the first in Indonesia advocacy committee that focuses on cervical cancer.

PPKS Inauguration will be done by the Minister of State for Women's Empowerment Meutia Farida Hatta Swasono on December 18, 2008.

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Cervical Cancer Cause of Death Number One in Indonesia

Cervical cancer or cervical cancer is the number one cause of death that often occurs in women in Indonesia. But the information on this issue has not been known because cervical cancer often causes no symptoms or complaints so that women come to the doctor in a state that it was too late.

"About 80 percent of cervical cancer cases occur in women who live in developing countries. In Indonesia, there are 90-100 cases of cervical cancer per 100,000 population," said State Minister for Women Empowerment Meutia Farida Hatta Swasono in Jakarta, Thursday (18/12 .)

According to the specialist obstetrics, cancer experts and content from the Faculty of Medicine, University of Indonesia Dr. Laila Nuranna, SpOG (K), 99.7 percent of cervical cancers caused by oncogenic HPV. H PV 16 and 18 is the main cause in 70 percent of cervical cancer cases in the world.

Every woman regardless of age and background risk of cervical cancer. The high case in developing countries is partly caused by the limited access to screening and treatment, so the majority of patients who came for a treatment already in critical condition and the disease is in an advanced stage.

Though known that cervical cancer is preventable through screening and vaccination. Vaccination for women who have never had sexual intercourse, while screening or pap smear should be women who already had experienced sexual intercourse.

According to Meutia Hatta, the above conditions showed the fact that there are many women in developing countries, including Indonesia lack access to information and services to this disease. Women who develop cervical cancer quality of life will decline. Though most likely they still have the economic and social responsibility towards the family and society.

Meanwhile, the current quality of life of women in Indonesia is still far behind compared to men. The low quality of life of women is partly due to the lack of public and government attention on the health aspects. Cervical cancer will increase the length of a row of the problems encountered in efforts to improve the quality of life of women in Indonesia.

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Prevent Cervical Cancer with Vaccines

Cervical cancer is the most common cancer in women in the country. Every woman regardless of  age and background risk of cervical cancer is  caused by  infection  or reinfection  virus  Human  Papilloma  Virus  (HPV) types 16 and 18 which together represent 71 percent of the primary  causes of  cancer. In fact, this type of cancer  could  be prevented.

"We are concerned with high rates of cervical cancer incidence in Indonesia, particularly since this disease is a health burden, economic, and social development for women everywhere," said Chairman of the Division of Social Services Cancer Foundation Dr. Melissa S Luwia Indonesia in Jakarta.

Head of Extension and Education Cancer Foundation Indonesia dr Sumarjati Arjoso added, counseling about the dangers of cervical cancer and its prevention should be encouraged so that more women in Indonesia have the opportunity to receive information about early detection and prevention of cervical cancer. "The role of cervical cancer survivors to provide support and information will help lighten the load of cervical cancer patients," he said.

Professor of Faculty of Medicine, University of Indonesia and Chairman of the Indonesian Association of Gynecological Oncology (Hogi) Prof. Farid Aziz explained that cervical cancer is one cancer that can be prevented. However, more than 70 percent of patients come see her in an advanced stage so many causes of death because of late found and treated.

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Encourage Early Detection of Cervical Cancer

Efforts for early detection of cervical cancer (cervix) needs to be encouraged to prevent evil consequences. During this time, many patients who come to the hospital when the cancer was in critical condition.

Hospital obstetrician Dr Hasan Sadikin Yudi Mulyana Hidayat SpOG (K) said that, until now there is no national data on the number of patients with cervical cancer. "However, in the world, cervical cancer is the number two killer after breast cancer so that cancer is called the silent killer ladies. In RSHS course, every month there are 150-200 new patients with cervical cancer. Most of them come in the condition is severe," said Yudi, Tuesday (3 / 2).

In fact, said Yudi, when disease is severe surgery is difficult. "Delays in treatment can be fatal form of death," he said. Yudi said the delay is generally caused by the examination of culture and financial problems.

Early detection of cervical cancer can be done by using Pap smears and colposcopy. Cervical cancer usually affect women who already had sexual intercourse. Yudi said the disease is caused by Human Papilloma Virus (HPV) which is transmitted through a man's penis.

"In the past, cervical cancer usually affects women aged 35 years and over. However, today I've found cases of cervical cancer in women aged 21 years," ujara Yudi. Early detection of cervical cancer will become one of the material in the Symposium and Workshop titled "Gynecology and Pelvic Surgery in Practice" which will be held at the Hotel Aston Villa Bandung, 11 to 14 February next.

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