Survival stage 4 cervical cancer,wilderness survival course wisconsin 2014,what is edp expenses xls,b ed entrance exam jammu university - Downloads 2016

In the UK, over 2,900 women will be diagnosed with cervical cancer and nearly 1,000 women will die from the disease.
The most effective method of preventing cervical cancer is through regular cervical screening which allows detection of any early changes of the cervix and for younger women the HPV vaccination can help prevent 70% of cervical cancers. There are usually no symptoms with abnormal cells (in their pre-cancerous state) and sometimes also no symptoms with early stage cervical cancer.
If you are experiencing any or all of these symptoms or are concerned about any new symptom you should make an appointment to see your GP as soon as possible. Not all women diagnosed with cervical cancer experience symptoms, this means attending regular cervical screening is even more important. The appointment only goes away if (a) you ignore it, cancel it, stay in denial telling yourself  ‘it won’t happen to me’ or (b) attend and face it head on knowing this appointment is to keep you healthy, be honest you know  (b)  really is the only sensible option. When you use the Vagi-Wave and follow the 21 night vaginal training programme you will be amazed as you notice a change in your attitude.
Now imagine a product that when used effortlessly over 21 nights  puts you in control so you can and do attend that appointment. Stage 4a: Cancer has spread to other parts of the body, such as the bladder or rectum (organs close to the cervix). Any abnormalities that might be found can then be treated in order that they do not go on to develop into cancer. The most common adverse prognostic factors for ovarian cancer are advanced-stage, high-grade, and suboptimally de-bulked disease [see Table 3].1,39-45 These prognostic factors are predictive of a poor response to chemotherapy and poor durability of complete remission. Borderline ovarian tumors, also known as tumors of low malignant potential, are epithelial tumors that show no histo-logic evidence of invasion and often appear at an early stage during patients’ fourth or fifth decade of life. Malignant ovarian germ cell tumors may be histologically classified as either dysgerminoma or nondysgerminoma.
Finally, women with ovarian stromal neoplasms such as granulosa cell tumors may present with signs and symptoms related to estradiol production.63,64 A young girl may develop precocious puberty, or a postmenopausal woman may develop breast tenderness or vaginal bleeding as a result of either en-dometrial proliferation or the presence of a separate uterine cancer caused by unopposed estrogen production by the gran-ulosa cell tumor.
Invasive cervical cancer is uncommon in developed countries, partly because of the effectiveness of Papanicolaou (Pap) smear screening.
Cervical cancer is typically a disease of women in their fifth and sixth decades, whereas premalignant cervical lesions (see below) are often discovered in women younger than 40 years.65 This rather large gap in the age distribution between precursor lesions and invasive cancer is indicative of a long latency period for malignant transformation. The Pap smear detects cytologic changes that indicate the possible presence of precursor lesions that could give rise to invasive disease if not removed. Cervical cancer is often asymptomatic and is commonly detected as a gross cervical lesion at the time of a routine pelvic examination.
Biopsy of a grossly visible lesion or discovery of invasive cancer as part of the evaluation of an abnormal Pap smear may reveal squamous cell carcinoma, the most common histologic variant of cervical cancer.
Accurate staging is necessary to help determine whether the disease is amenable to a surgical approach (appropriate for stages IA, IB, and IIA) or primary radiotherapy (appropriate for stages IIB, III, and IVA).
Patients with stage IA squamous cell carcinoma that has extended to a depth of greater than 3 mm (stage IA2) or who have involvement of the lymphovascular space or surgical margins, as revealed by cone biopsy, are appropriate candidates for a radical hysterectomy with pelvic lymph node dissection. Local disease that is technically resectable with tumor-free margins, such as stage IB or IIA disease [see Figure 2], is often treated with a radical hysterectomy and pelvic lymph node dissection. Once the tumor involves the parametrial tissues and beyond, a surgical approach is not technically feasible, because the chance of obtaining tumor-free resection margins is very low. Patients with disease at stages IA2, IB, or IIA are reasonable candidates for radical hysterectomy and pelvic lymph node dissection. Bulky stage IB tumors that are at least 4 cm or greater (stage IB2) have a high probability of local relapse if managed with radical hysterectomy.
Figure 2 International Federation of Gynecology and Obstetrics (FIGO) clinical staging of cervical cancer. After breast cancer, cervical cancer is the second most common cancer in women aged 35 and under. Remember, these symptoms can be associated with many other conditions that are not cancer related. You realise that you can effortlessly attend that appointment, because you will come to view such appointments as no different to going to the dentist for a check up.
No longer do you  have to imagine such a product because Vagi-Wave is here, all you have to do is order now and follow the programme. A very small amount of cancer that is only visible under a microscope is found deeper in the tissues of the cervix. Thus, approximately 30% of patients with advanced disease have residual, active tumor after treatment with paclitaxel and carboplatin. For patients with relapse detected only by the finding of an elevated CA125 level, there is no convincing evidence that second-line, cytotoxic chemotherapy improves survival rate; however, it can compromise quality of life at a time when patients are feeling well. These tumors are generally associated with excellent survival rates (about 90% at 10 years).51-55 Even advanced borderline tumors involving the upper abdomen may have a very indolent natural history, characterized by serial tumor recurrences that are managed by repeated surgical resection. Because of its highly vascular nature, a ruptured granulosa cell tumor may sometimes mimic an ectopic pregnancy, with hypotension and abdominal pain caused by intraperitoneal bleeding.

Nevertheless, it is estimated that in the United States in 2003, cervical cancer affected 12,200 women and caused approximately 4,100 deaths.2 Part of the success of Pap smear screening is due to the fact that this approach typically detects premalignant lesions, as opposed to invasive cancer.
Infection with human papil-lomavirus (HPV)—most commonly, subtypes 16, 18, 31, 33, and 35—is largely responsible for the development of precursor lesions and subsequent transformation to invasive dis-ease.65-67 Not surprisingly, factors that predispose to transmission of this virus are associated with an increased risk of the development of cervical cancer.
Thus, the main role of this screening test is to identify patients who require further evaluation by a gynecologist and possible cervical biopsy. The presence of a grossly visible cervical lesion warrants biopsy, even if the Pap smear is normal. Adenocarcinoma is the second most common histologic finding; it is clinically similar to squamous cell carcinoma, with the exception of its propensity to be located within the endocervical canal and to sometimes display an endophytic growth pattern, which results in a barrel-shaped cervix. Stage I disease is limited to the cervix and may be either microscopic (stage IA) or grossly visible (stage IB).
To determine whether disease involves the parametrial tissue, it is often necessary to perform a pelvic examination with the patient under anesthesia. Radical hysterectomy is a procedure in which the uterine corpus and cervix are removed en bloc along with parame-trial tissue, the ureterosacral ligaments, and a 2 to 3 cm cuff of vagina. For patients with comorbid disease that precludes surgical resection, primary radiotherapy is an option that produces equivalent survival rates for patients with stage IB or IIA disease, although possible toxicities are vaginal stenosis, bladder and bowel enteritis, and cessation of ovarian function.
In the past, patients with this extent of disease progression were treated with primary radiotherapy consisting of external-beam pelvic radiation (to encompass the pelvic lymph nodes) followed by intracavitary treatment, which provides high local doses of radiation to control areas of tumor bulk.
In this regard, three large randomized studies have recently been performed to investigate the value of concomitant platinum-based chemotherapy and radiation in patients with cervical cancer at stages IIB to IVA.70-72 The theoretical basis for this concept stems from in vitro observations that suggest that cisplatin can function as a radiosensitizer, presumably by virtue of inhibiting DNA repair.
However, the unanticipated discovery of disease in pelvic lymph nodes, parametria, or surgical resection margins places such patients at a higher risk of local relapse.
Patients with such tumors are reasonable candidates for primary radiotherapy and are treated similarly to those with more advanced local disease; the expected survival rate is about 70%.
Conversely, about 70% of newly diagnosed patients achieve a complete response to surgery followed by treatment with paclitaxel and carbo-platin, although most of these women eventually experience relapse. In contrast to more typical invasive epithelial ovarian cancer, borderline tumors are generally not sensitive to chemotherapy, and there is no well-defined role for the use of postoperative adjuvant therapy. After resection, dysger-minoma that is limited to the ovary (stage IA) is often managed by careful follow-up; assuming that adequate staging has been performed, postoperative adjuvant chemotherapy is not necessary. This unique feature makes it possible to eradicate precursor lesions before the development of frankly invasive cancers. These high-risk factors are sexual intercourse at an early age, multiple male sexual partners, and male sexual partners who themselves have multiple partners.65 A history of smoking also confers a higher risk. If a subsequent cervical biopsy reveals preinvasive disease, it may be appropriate to eradicate the lesion with conservative outpatient techniques, such as laser vaporization or the loop electric excision procedure (LEEP), or with more aggressive surgical techniques, such as cervical conization (also known as cone biopsy, in which a conical portion of cervix is removed along with a portion of the endocervical canal). Occasionally, microscopic invasive disease is found during the evaluation of an abnormal Pap smear.
In rare instances, small cell carcinoma of the cervix is discovered on biopsy, usually in a young woman; small cell carcinoma of the cervix may be associated with rapid metas-tases and the syndrome of ectopic adrenocorticotropic hormone secretion.
In stage II, the cancer has extended beyond the cervix, to involve either the upper two thirds of the vagina (stage IIA) or the parametrial tissue (stage IIB). In addition, radiographic visualization of the ureters is often required to exclude hydronephrosis and to define the ureteral anatomy if a surgical approach is deemed appropriate. This procedure is designed to remove lymphatic channels, which may harbor microscopic tumor cells. The overall survival rate of patients with cervical cancer of stage IB or IIA is in the range of 80% to 90%. However, recent data suggest that these patients are best served by treatment with concomitant chemotherapy and radiation (see below).
All three studies were performed in patients with disease at stages IIB to IVA without para-aortic lymph node involvement. In the past, these high-risk features indicated the need for postoperative external-beam radiotherapy to a pelvic field, which yields overall survival rates in the range of 40% to 60%. In an approach similar to that demonstrated in patients with disease at stages IIB to IVA, platinum-induced radiosensitization has recently been tested in a large randomized study involving 369 patients with stage IB2 dis-ease.74 Patients in this trial were randomized to receive pelvic radiation with or without weekly cisplatin. Staging may include information obtained from an examination under anesthesia, an intravenous pyelogram, cystoscopy, and proctoscopy. You do not want to be hearing words like ‘ if only you had come sooner’ from a  doctor or an oncologist. More advanced disease is usually treated with postoperative platinum-based chemotherapy containing bleomycin, etoposide, and cisplatin (BEP). Recurrence of ovarian stromal cell tumors may occur many years after the original diagnosis, and patients therefore require long-term follow-up.
In addition, the interval of time between the development of a precursor lesion and the occurrence of invasive disease may be several years, thus allowing many opportunities for the detection and eradication of premalignant disease. Immunosup-pression associated with either an underlying lymphoprolifer-ative disorder such as Hodgkin disease or immunosuppressive drugs used in the prevention of allograft rejection also confers a higher risk of cervical cancer.68 In women with HIV infection, the immunosuppressive state associated with the infection increases the risk of development of cervical precursor lesions, although it is not clear whether the development of such lesions results in a higher incidence of invasive cervical disease.

Pap smear screening should begin when a female becomes sexually active or reaches 18 years of age and should continue annually for at least 3 years. It should be remembered, however, that abnormal Pap smears do not usually signify the presence of invasive disease but rather indicate the possibility of precursor lesions that could give rise to invasive disease if not removed. Stage III disease is more locally extensive, involving the lower one third of the vagina (stage IIIA) or extending to the pelvic side wall or causing hy-dronephrosis (stage IIIB).
For more locally advanced lesions, consideration of cystoscopy and proctoscopy is reasonable to exclude stage IVA disease.
Pelvic lymph node dissection is typically performed as part of the radical hysterectomy procedure because the finding of metastatic disease within this nodal chain will alter postoperative treatment [see Special Management Considerations, below].
Intracavitary radiotherapy is typically provided by either cesium-137 or radium-226, which is temporarily inserted into the uterine cavity and vaginal fornices. The studies differed with respect to the type of chemotherapy used and inclusion of other high-risk patient subsets. However, a recent randomized intergroup study conducted by the Southwest Oncology Group (SWOG) demonstrated that treatment with concomitant platinum-based chemotherapy and radiation produced a significant survival advantage.
All patients in both treatment groups subsequently underwent adjuvant hysterectomy, although it has been recently recognized that performance of surgery after primary radiotherapy confers no added survival advantage in this patient group. The staging assignment for cervical cancer is determined on the basis of clinical assessment and does not change on the basis of information obtained at the time of surgery.
Now is the time to put yourself first in the interest of yourself and those you love such as family and friends. Although patients who undergo successful secondary cytoreduction tend to survive longer than those whose cancer cannot be resected, it is unclear whether the surgery itself confers the survival advantage or whether it is simply the fact that the patients who are selected to undergo cytoreduc-tion have more indolent, chemoresponsive disease. Immature teratoma is a form of malignant ovarian germ cell tumor that is occasionally treated with surgery alone if the tumor is confined to the ovary and characterized as grade I or, sometimes, grade II.57,58 Patients with stage I, grade III immature teratoma or with more advanced disease are often treated with BEP. Because these tumors often produce estradiol, inhibin, and mullerian inhibitory substance (MIS), these serum markers may prove to be valuable for postoperative surveillance.
In developing countries, however, cervical cancer is a major cause of death in patients with gynecologic cancer; Pap smear screening on a routine basis is difficult because of a lack of resources and poor patient compliance. Stage IV disease is the most advanced, representing either extensive infiltration of local pelvic structures (involvement of the bladder or rectal mucosa—stage IVA) or disease outside of the pelvis (stage IVB).
Finally, a chest x-ray is obtained to exclude hematogenous spread to the lungs, which is a common site of metastasis in this disease. The ovaries are typically not removed; they are seldom the site of cervical cancer spread, although they may be transposed to the outside of the pelvis in the event that postoperative radiotherapy is required (see below). A common reference point used in the assessment of total radiation dose is known as point A, which is located 2 cm lateral and 2 cm superior to the cervical os. Nevertheless, these studies convincingly demonstrated that platinum-based chemotherapy administered concomi-tantly with radiation can reduce the chance of relapse by 30% to 50% and can improve the survival rate of patients with locally advanced cervical cancer. Patients with more advanced disease may present with lower extremity edema, caused by involvement of pelvic lymph nodes; such edema can be painful and can cause ureteral obstruction. In contrast, a simple hysterectomy (removal of the uterus and cervix, leaving intact the other associated structures mentioned above) is a reasonable procedure for patients with stage IA cervical cancer with less than 3 mm of invasion and an absence of lymphatic channel or margin involvement on cone biopsy (stage IA1).
An optimal target dose to point A is approximately 85 Gy delivered over 8 weeks (total external beam plus intra-cavity dose).
In addition, the toxicity profile of platinum-based chemotherapy is acceptable, and treatment delays are infrequent.
On the basis of this study, it is reasonable to consider concurrent chemoradiation with a platinum-based regimen for the primary management of patients with bulky stage I disease.
Stage IA disease is a microscopic lesion not exceeding 5 mm in depth from the basement membrane and no wider than 7 mm in lateral extent.
Alternatively, selected patients with stage IA1 disease are sometimes treated with cervical conization only, especially if future childbearing is desired. Although the optimal chemotherapy regimen has not been completely defined, it is reasonable to conclude that radiosensitization with single-agent cisplatin is a new standard with which other chemotherapy regimens will be compared in the treatment of patients with cervical cancer at stages IIB to IVA. The Society of Gynecologic Oncologists (SGO) definition of microinvasion is a lesion with invasion < 3 mm beneath the basement membrane, without evidence of lymphovascular space involvement. Stage IB lesions are often grossly visible tumors limited to the cervix, although they may also include microscopic lesions that are more extensive than stage IA. Stage IIA tumors involve the upper two thirds of the vagina and are often amenable to surgical resection. Stage IVB disease involves distant sites and is primarily treated with systemic chemotherapy, although pelvic radiotherapy may also be needed for local control.

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