Cystoscopy

Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.

Diagnostic cystoscopy is usually carried out with local anaesthesia. General anaesthesia is sometimes used for operative cystoscopic procedures.

A cystoscope

The urethra is the tube that carries urine from the bladder to the outside of the body. The cystoscope has lenses like a telescope or microscope. These lenses let the doctor focus on the inner surfaces of the urinary tract. Some cystoscopes use optical fibres (flexible glass fibres) that carry an image from the tip of the instrument to a viewing piece at the other end. Cystoscopes range from between the thickness of a pencil, up to approximately 9mm and have a light at the tip. Many cystoscopes have extra tubes to guide other instruments for surgical procedures to treat urinary problems.

Flexible Cystoscopy

There are two main types of cystoscopy - flexible and rigid - differing in the flexibility of the cystoscope. Flexible cystoscopy is carried out without the use of local anaesthesia on both sexes. Typically, xylocaine gel (such as the brand name Instillagel) is used as an anaesthetic, instilled in the urethra. Rigid cystoscopy can be performed under the same conditions, but is generally carried out under general anaesthesia, particularly in male subjects, due to the pain caused by the probe.

A doctor may recommend cystoscopy for any of the following conditions:

•   Frequent urinary tract infections
•   Blood in the urine (hematuria)
• Loss of bladder control (incontinence) or overactive bladder
• Unusual cells found in urine sample
• Need for a bladder catheter
• Painful urination, chronic pelvic pain, or interstitial cystitis
• Urinary blockage such as from prostate enlargement, stricture, or narrowing of the urinary tract
• Stone in the urinary tract
•  Unusual growth, polyp, tumor, or cancer

Source:
* wikipedia

Colposcopy

What is Colposcopy?

It is A follow-up to abnormal Pap test results

Colposcopy: A follow-up to abnormal Pap test results

Colposcopy is a procedure used to determine whether abnormal cervical cells are cancerous.
After your pelvic exam and Pap test, your doctor informs you of some troubling news: You have had abnormal cells identified on your Pap smear. The presence of abnormal cells could mean that you have a precancerous condition of the cervix or, possibly, cervical cancer.

What's next? Your doctor may recommend colposcopy — a procedure to closely examine your cervix — to identify the source of the abnormal cells. Alleviate some of your anxiety about this procedure by understanding what it involves, how you can prepare and what you can expect afterward.

Who is colposcopy for?

Colposcopy: A follow-up to abnormal Pap test results

Colposcopy is the direct examination of your genital area, including the cervix, vagina and vaginal opening (vulva), using a special lighted microscope called a colposcope. A trained specialist (colposcopist) performs this procedure. The colposcope magnifies the surface of your cervix and vagina by 10 to 40 times the normal size. This aids the colposcopist in identifying areas of abnormal cell growth that can't be seen by the naked eye.

If the colposcopist detects abnormal cells during the exam, he or she may collect a sampling of the tissue (biopsy) to send to a lab for analysis.

Your doctor might recommend a colposcopy to find out the cause of your abnormal Pap test results or to evaluate a visible abnormality. You might also have a colposcopy if your doctor wants to examine the outcome of previous treatment for an abnormal Pap test result.

Source:
* riverside.com

HPV (Human Papilloma Virus)

What is HPV?

HPV under microscope

HPV stands for Human Papilloma Virus, a virus that can infect many parts of the body.
There are more than 100 different sub-types of HPV, grouped into (i) high-risk types (may cause cancer) and (ii) low risk types (non-cancer causing). 

 About 30 - 40 HPV sub-types can infect the genital area; and these can cause genital warts in both men and women, cervical cancer in women and less commonly, anal or penile cancer in men.
Other HPV sub-types may infect the skin of the fingers, hands and face.

Who is at risk of HPV infection?

Risk factors for HPV infection include:

• Multiple sexual partners: The greater the number of sexual partners, the higher is your risk of HPV infection. Having sexual activity with a partner who has had multiple sex partners can also increase your risk. While using condoms can help reduce the risk of HPV infection, condoms however, do not cover all genital skin and does not guarantee 100% protection.

•  Weakened immune system: People with weakened immune systems (e.g. may be due to Human Immunodeficiency Virus (HIV) / Acquired Immune Deficiency Syndrome (AIDS) or on immune-system suppressing drugs) are at higher risk of HPV infection.

   How is HPV transmitted?

• HPV infection is very common in men and women.
• It can be transmitted through genital skin-to-skin contact during sexual activity, by sharing contaminated sex toys and very rarely, during delivery from the infected mother to the baby.
• HPV cannot be passed by sitting on toilet seats or touching the door knobs.

  What are the signs or symptoms of HPV infection?

 Most HPV infections occur without signs or symptoms. Sometimes, genital warts or warts in other parts of the body may appear and are a sign of HPV infection.

    Can HPV be treated?

• The virus itself cannot be treated. Most HPV infection (90% cases) goes away on its own without any treatment.
• Although HPV virus cannot be treated, regular Pap smear can help to detect changes in the cervical cells caused by HPV infection.
• With appropriate treatment, the abnormal or pre-cancerous cells can be prevented from developing into cervical cancer.

      How is HPV related to cervical cancer?

• Some types of HPV can infect the cervix (the lower part of the womb), causing the cells to change.
•  In about 90% of the infection cases, the virus clears by itself and the cells return to normal.
•  In some cases, the infection can persist and cause the cells to grow in an abnormal way.
•  When this goes undetected by a Pap smear at an early stage, some of these abnormal cells may develop into cervical cancer.
• Specifically, HPV sub-types 16 & 18 cause about 70% cervical cancer cases, while HPV sub- types 6 & 11 cause about 90% genital warts cases.

Source:
* health screening

Pap Smear

What is a Pap smear?

Pap smear to check abnormality in cervix

A Pap smear, also known as Pap test, is a test of a sample of cells taken from a woman's cervix. The test is used to look for changes in the cells of the cervix that show cervical cancer or conditions that may develop into cancer.
Detecting cervical cancer early with a Pap smear gives you a greater chance at a cure. A Pap smear can also detect changes in your cervical cells that suggest cancer may develop in the future. Detecting these cells early with a Pap smear is your first step in uncertain the possible development of cervical cancer.

Pap screen testing should begin at age 21. Routine screening is recommended every two years for women 21-29 years old. For certain women 30 years and older who have had three consecutive normal screening test results, testing can be done every three years.

How is Pap Smear done?

A woman should have a Pap smear when she is not menstruating. The best time for screening is between 10 and 20 days after the first day of her menstrual period. For about two days before testing, a woman should avoid douching or using spermicidal foams, creams, or jellies or vaginal medicines (except as directed by a physician). These agents may wash away or hide any abnormal cervical cells.

A Pap smear is performed in a doctor's office, hospital, or clinic by a
    * doctor
    * physician assistant
    * nurse midwife
    * nurse practitioner
or other specially trained healthcare provider. Each of these professionals is also qualified to perform a pelvic examination, which can help detect cancer in female reproductive organs other than the cervix.

do pap smear regularly to prevent cancer cervix

During a pelvic examination, the woman takes off her clothes, puts on a short paper or cotton gown that opens in the front, and lies on her back on an examining table. She positions herself for the Pap smear by bending her knees, aligning the tops of her thighs with the edge of the table, and placing her feet in stirrups or supports.

The healthcare provider performing the examination:

• looks for lumps, sores, inflammation, or other abnormalities of her external genitals
• inserts a metal or plastic instrument called a speculum into the vagina.
• uses a small disposable swab, wooden spatula, brush, or soft-bristled "broom" to remove cells from the entrance to the canal that connects the cervix with the uterus.
• may also remove cells from the back of the cervical canal.
•  places the cell sample on a glass slide, which is sent to a laboratory for examination under a microscope.

After removing the speculum, the healthcare provider gently inserts two gloved fingers into the woman's vagina and places his or her other hand on her abdomen. This enables the examiner to determine the size, shape, and consistency of the woman's uterus, ovaries, vagina, and fallopian tubes. After completing this part of the examination, the examiner inserts a gloved finger into the woman's rectum to detect abnormalities of the rectum and nearby structures.

A woman may feel some mild discomfort, cramping, or pressure during a Pap smear or pelvic exam. These procedures should not be painful.
Source:
* women webmd
* mayo clinic
* e health md
* medicine net

Cervical Cancer Treatment

Three treatments methods are commonly used to treat cervical cancer: surgery, chemotherapy, and radiation therapy. Sometimes they are used alone, and there are times when they are used in conjunction with one another.

The treatment method(s) chosen depend on several factors like type of cervical cancer, stage of the disease, general health of the patient, and if other treatments have been utilized.

Surgical Methods Used to Treat Cervical Cancer
Surgery is a common method used to treat cervical cancer. Many times, surgery is combined with other treatment methods, like chemotherapy or radiation therapy. The type of surgery chosen to treat cervical cancer depends on the stage and other factors.

Surgical treatments for cervical cancer include:

cervical cancer treatment: surgery

# Lymphadenectomy Surgical removal of the lymph nodes. It is common in treating women with cervical cancer.

# Radical Trachelectomy Removal of the cervix and its surrounding tissue while leaving the body of the uterus intact. A radical trachelectomy with lymphadenectomy is an option for young women with early stage disease who wish to maintain fertility.

# Radical Hysterectomy Surgical removal of the uterus, cervix, and part of the vagina. In some cases, the ovaries, fallopian tubes, and lymph nodes are removed. A radical hysterectomy may be combine with chemotherapy or radiation therapy.

# Bilateral Salpingo-Oophorectomy Surgical removal of both ovaries and the fallopian tubes. This type of surgery accompanies a hysterectomy is some cases.

cervical cancer treatment: chemotheraphy

Chemotherapy
Chemotherapy is prescribed to treat cervical cancer and also to help radiation therapy be more effective. Chemotherapy drugs work by killing cancer cells or preventing them from multiplying. Several chemotherapy drugs are available to treat cervical cancer and will be prescribed according to the stage of cancer, type of cervical cancer, and other health factors.

Radiation Therapy

cervical cancer treatment: radiation teraphy

Radiation therapy uses high energy beams to reduce the size of a tumor or to kill cancer cells. This type of treatment can be done internally with radioactive materials that are implanted in the uterus or externally with the use of a radiation therapy machines.

Often prescribed with chemotherapy, radiation therapy is an effective method of treating cervical cancer. It can however, be prescribed alone or before or after chemotherapy. Radiation treatment plans depend on stage of cervical cancer, other treatment methods used, and the general health of the patient.

Source:

* about.com

Prevent Cervical Cancer

The prevention of any disease can be primary or secondary. The earlier involves taking action on the determinant conclude of the ailment to prevent it from occurring. The latter involves the early detection of disease, followed by appropriate interventions to prevent its progression.

Cervical cancer is one of the most preventable types of cancer. Because of the Pap smear test, the number of cervical cancer cases has dropped over the past twenty years.
While some cases of cervical cancer cannot be prevented, there are many things a woman can do to reduce her risk of developing cervical cancer.

How to Reduce Your Risk of Cervical Cancer:

regular pap smear to prevent cancer cervix

 1. Get a regular Pap smear. The Pap smear can be the utmost defenses for cervical cancer. The Pap smear can discover cervical changes early before they turn into cancer. Check cervical cancer test guidelines to find out how often you should have a Pap smear, or check with your doctor.

 2. Limit the amount of sexual partners you have. Studies have shown women who have many sexual partners increase their risk for cervical cancer. They also are escalating their risk of developing HPV, a known cause for cervical cancer.

 3. Quit smoking or avoid secondhand smoke. Smoking cigarettes raises your risk of developing many cancers, including cervical cancer. Smoking combined with an HPV infection can actually accelerate cervical dysplasia. Your best bet is to stop the habit.

 4. If you are sexually active, use a condom. Having unprotected sex puts you at risk for HIV and other STD's which can increase your risk factor for developing cervical cancer.

 5. Follow up on abnormal Pap smears. If you have had an abnormal Pap smear, it is essential to follow up with regular Pap smears or colposcopies, whatsoever your doctor has decided for you. If you have been treated for cervical dysplasia, you still need to follow up with Pap smears or colposcopies. Dysplasia can return and when undetected, can turn into cervical cancer.

HPV Vaccine to prevent cervical cancer

 6. Get the HPV vaccine. If you are under 27, you may be eligible to receive the HPV vaccine, which prevents high risk strains of HPV in women. The HPV vaccine, Gardasil, was approved by the FDA to give to young girls as young as 9. The vaccine is most effective when given to young women before they become sexually active.



7. Improve your Nutrition intake:

• Fruits and vegetables

Higher levels of vegetable consumption were associated with a 54% decrease risk of HPV persistence.

•  Vitamin A

There is an evidence to suggest a significant deficiency of retinol can increase chances of cervical dysplasia, independently of HPV 

• Vitamin C

Risk of type-specific, persistent HPV infection was lower among women reporting intake values of vitamin C in the upper quartile compared with those reporting intake in the lowest quartile.

• Vitamin E

good nutrition to prevent cervical cancer

HPV clearance time was significantly shorter among women with the highest compared with the lowest serum levels of tocopherols. Results from this investigation support an association of micronutrients with the rapid clearance of incident oncogenic HPV infection of the uterine cervix.

•  Folic acid

Higher folate status was inversely associated with becoming HPV test-positive. Women with higher folate status were significantly less likely to be repeatedly HPV test-positive and more likely to become test-negative. Studies have shown that lower levels of antioxidants coexisting with low levels of folic acid increases the risk of CIN development. Improving folate status in subjects at risk of getting infected or already infected with high-risk HPV may have a beneficial impact in the prevention of cervical cancer.

• Carotenoids

There is a data suggests that vegetable consumption and circulating lycopene may be protective against HPV persistence

Stages of Cervical Cancer

Once cervical cancer has been diagnosed the stage needs to be determined. A stage reveals how much the cancer has progressed. 

stages of cervical cancer

The Stages of Cervical Cancer has five different categories. The system used is referred to as the "Figo" system (International Federation of Gynecology and Obstetrics. You will notice that within each stage is a "sub-stage" and represent levels within that specific stage of cancer.

The staging system begins at 0 and ends at IV. 0 meaning the very early stages of cervical cancer and IV being advanced. The stage at diagnosis is one factor that determines the treatment options available.

Stage 0

Also called carcinoma in situ, stage 0 means that cancerous cell that have not invaded deeper tissues. The cells are superficial and are only found on the surface.

Stage I

In stage I, cancerous cells have invaded the cervix, and cells are no longer just at the surface. Cancer is still confined to the cervix and has not spread.

# Stage IA: This is the earliest form of stage I cervical cancer. The cancer can only be identified under microscopic examination.

    * Stage IA1: The invasion area is less than 3mm (1/8 inch) deep and less than 7mm (1/4 inch) wide.

    * Stage IA2: The invasion area is between 3 mm and 5 mm (about 1/5 inch) deep and less than 7 mm (about 1/4 inch) wide.

# Stage IB: This stage indicated that cancer can be seen without a microscope. It also includes cancers that have invaded the connective tissue of the cervix, deeper than 5mm (1/5 inch).

    * Stage IB1: Cancer is no more than 4 centimeters large (1 3/4 inches).

    * Stage IB2: Cancer is larger than 4 centimeters (1 3/4 inches)

Stage II

In stage II, the cancer has spread to nearby tissues, but is still contained within the pelvic area.

# Stage IIA: Cancer has spread to the upper part of the vagina. The lower third of the vagina has not been affected.

# Stage IIB: In this stage, cancer has spread to tissue near the cervix. This tissue is called parametrial tissue.

Stage III

This stage indicates that cancer has spread to the lower portion of the vagina. It could have also spread to the pelvic wall in this stage.

# Stage IIIA: Cancer has spread to the lower part of the vagina and is contained in that area.

# Stage IIIB: Cancer has spread to the pelvic wall. This also includes cancer that blocks the flow of urine to the bladder.

Stage IV

In stage IV, the cancer has spread to other areas of the body. This is the most advanced stage of cervical cancer.

# Stage IVA: This stage includes cancer that has spread to areas close to the cervix, such as the bladder or rectum.

# Stage IVB: Stage IVB cervical cancer is not considered curable. In this stage, cancer has spread to distant areas of the body, like the lungs.

Source:

* about.com