Learn the Symptoms of Cervical Cancer

January is cervical cancer awareness month. This article is the third in a series that discusses cervical cancer, its prevention, symptoms and treatment.

In its early stages, cervical cancer usually has no symptoms. It develops slowly, beginning as a pre-cancerous condition called dysplasia. Symptoms of cervical cancer often do not begin until the cancer spreads into nearby tissue.

Cervical cancer starts in the lower part of the uterus that opens at the top of the vagina. If cervical cancer spreads into nearby tissue, symptoms may include:

• Increased vaginal discharge including discharge that is pale, watery, pink, brown, bloody or foul-smelling
• Abnormal vaginal bleeding between periods, after intercourse, or after menopause
• Periods become heavier and last longer than usual
• Any bleeding after menopause
• Pain during intercourse

These symptoms can also be caused by other conditions, so it is best to contact a physician for a diagnosis. If interested in making an appointment with a Penn Medicine physician, call 1-800-789-PENN (7366) or make an online appointment here.

Read More

Cervical Cancer Risk and Prevention

January is cervical cancer awareness month. This article is part two in a series that discusses cervical cancer, its prevention, symptoms and treatment.

Cervical Cancer Risk and Prevention

Most risk factors for cervical cancer, like age and family history, cannot be prevented. Patients who feel they are at higher risk for cervical cancer may benefit from consulting with a risk assessment specialist through one of Penn Medicine’s programs at the Abramson Cancer Center or the Joan Karnell Cancer Center at Pennsylvania Hospital.

Cervical Cancer Risk Factors

Risk factors affect the chance of developing cervical cancer. Having a risk factor, or even several, does not mean that someone will get cancer.
All women need to be aware of the risk factors for cervical cancer, and what they can do to prevent it.

Penn Medicine gynecologists work with patients to identify their risk of developing cervical cancer and the steps they can take to lower their risk.
The human papilloma virus, or HPV, causes the majority of cervical cancers. HPV is a group of more than 100 related viruses that can infect cells on the surface of the skin, genitals, anus, mouth and throat.

Genital HPV is the most common sexually transmitted virus in the United States. An estimated 75 to 80 percent of males and females will be infected with HPV during their lifetime. For most people, the virus clears on its own. When it doesn’t, HPV can cause genital warts, precancerous dysplasia and cervical, vulvar or vaginal

Other risk factors for cervical cancer include:

• Having sex early
• Multiple sexual partners, or having sex with someone who has had multiple partners
• Sexual partners who have multiple partners or who participate in high-risk sexual activities
• A weakened immune system
• Lack of regular pap tests
• Weakened immune system
• Smoking
• Long term birth control use
• Having more than 5 children
• DES exposure

• Poor economic status or inadequate health coverage
• HPV infection or genital warts

Cervical cancer is easily treated if it is caught early, so it is important for women to get regular screening exams including a Pap test and HPV test.

Cervical Cancer Prevention

Penn Medicine gynecologists recommend several methods to prevent cervical cancer. Regular screenings, vaccines for preventing the human papilloma virus (HPV) and lifestyle choices can prevent cervical cancer or help find cervical cancer at an early stage when it is most treatable.

Pelvic Exam, Pap Test and HPV Test

Pelvic exams, Pap test screening and HPV testing can detect cervical cancer in its early stages. Pap tests are one of the most effective screening tools used to determine if women have infections, abnormal (unhealthy) cervical cells, cervical cancer or other reproductive problems. A Pap test is the screening of cells scraped from the cervix during a pelvic exam that are examined under a microscope. Pap tests screen for pre-cancers and cancer, but do not provide a final diagnosis.

The American College of Obstetrics and Gynecologists (ACOG) recommends that cervical cancer screening begin at age 21. Most women under the age 30 should undergo cervical screening once every two years and women 30 and older with no other risk factors can be screened every three years. These are not the guidelines. See below.

• Under 21 and never sexually active: No pap
• Adolescent: Within 3 yrs of onset of sexual activity
• 21 to 29 years old: Annual pelvic exam with Pap Smear
• 30 to 64 years old: ACOG recommends annual Pap. After 3 consecutive normal paps, screening = every 2-3 years. (This is only if the patient has never had CIN 2 or 3, is not immune-compromised or HIV-positive, and has not been exposed to diethylstilbestrol (DES) in utero.
• 65 and older:  Pap Smears may be disontinued if the woman has had 3 or more consecutive negative paps; no abnormal tests in the previous 10 years; no history of cervical cancer; no DES-exposure; is HIV negative and has a normal immune system; and has no other risk factors for STDs. 

The above was taken from http://www.kltv.com/story/10543955/acog-changes-pap-smear-guidelines. i had trouble accessing the ACOG site.

Preventing HPV: The HPV vaccine

Vaccines are now available that protect against four major types of HPV, including the two types that cause about 70 percent of cervical cancer cases and two types that cause about 90 percent of genital warts.

The HPV vaccine is expected to be long-lasting, but because the vaccine does not protect against all HPV types that cause cervical cancer vaccinated women still need cervical cancer screening (Pap tests and HPV tests). The vaccine does prevent HPV, but does not protect against HPV exposure before vaccination. Also add that it is not a cure.

Condoms do not protect completely against HPV because they don't cover all of the potential HPV-infected areas of the body. However, condoms do provide some protection against HPV, and they protect against HIV and other sexually transmitted diseases.

Although penetrative intercourse is not necessary to get and spread HPV women can do the following to decrease their risk of cervical cancer:

• Stay up-to-date with recommended paps and exams.
• Avoid smoking
• Avoid early onset of sexual activity and sexual activity with people who have had several sexual partners.
• Use condoms
• Try to maintain a healthy immune system
• Limit the amount of sexual partners

Women may avoid HPV, and therefore reduce their risk of cervical cancer, by waiting to have sex until they are older and limiting the number of sexual partners. They should also avoid having sex with anyone who has had multiple sexual partners.

Learn more about cervical cancer treatment at the Abramson Cancer Center.

Learn more about the Jordan Center for Gynecologic Cancer.

Learn more about the MacDonald Women’s Cancer Risk Evaluation Center.

Read More

Include These Vegetables in Your Diet to Prevent Gynecologic Cancer

Nutrition plays a role in the prevention of various gynecological cancers.

The World Cancer Research Fund along with the American Institute for Cancer Research analyzed research on nutrition and its role in cancer and published the “Food, Nutrition and the Prevention of Cancer: A Global Perspective."



The recommendations for the general public are as follows:

• Be as lean as possible within the normal range of body weight.
• Be physically active as part of everyday life.
• Limit consumption of energy-dense foods.  Avoid sugary drinks.
• Eat mostly foods of plant origin.
• Limit intake of red meat and avoid processed meat.
• Limit alcoholic drinks.
• Limit consumption of salt.
• Aim to meet nutritional needs through diet alone.

This report analyzes the evidence by cancer type including three gynecological cancers.

Nutrition to prevent cervical cancer

Specific to cervical cancer, there is some evidence that an intake of carrots may protect again cervical cancer.  According to the American Institute for Cancer Research “The evidence, from case-control studies only, is sparse but consistent.  There is limited evidence suggesting that carrots protect against cervical cancer.”

Additional sources of produce high in carotenoids include:

• Sweet potatoes
• Spinach
• Kale and other greens
• Papaya
• Oranges
• Sweet peppers
• Tomatoes

Nutrition to prevent ovarian cancer

For ovarian cancer, evidence suggests that consuming these non-starchy vegetables may decrease the risk of ovarian cancer:

• Asparagus
• Carrots
• Tomatoes
• Cauliflower
• Broccoli

Nutrition to prevent endometrial (uterine) cancer

For endometrial cancer, a high percentage of body fat as well as weight gain in the adult years may increase the risk of endometrial cancer.

So clearly at the top on your priority is weight management and just as your mother said “eat your vegetables."

The two work hand in hand as well as vegetables are a very high fiber, low calorie food which can provide cancer fighting compounds and assist with the feeling of fullness.  Easy ways to incorporate vegetables in your diet are:

• Breakfast: Top your cereal off with berries or make a spinach omelet.
• Lunch: Layer sandwiches with greens, tomatoes and cucumber.  Have raw vegetables on the side instead of chips.
• Dinner: always include a colorful salad and aim to fill half your dinner plate with non-starchy vegetables like steamed asparagus, broccoli and carrots.
• Snacks: Try baby carrots, sugar snaps peas and sliced red peppers dipped into hummus.

Continue following this blog for more recipes with cancer fighting properties.

Debra DeMille, MS, RD, CSO is a nutritional counselor at the Joan Karnell Cancer Center.  Debra has worked at Pennsylvania Hospital since 1988 with the last 12 years specializing in oncology.  Debra guides individuals receiving chemotherapy and radiation as well as addressing survivorship issues including the use of Integrative therapies.  She conducts cooking programs and group counseling sessions for cancer survivors. 

Read More

What is Cervical Cancer?

January is cervical cancer awareness month. This article is part one in a series that discusses cervical cancer and its prevention symptoms and treatment.

According to National Cancer Institue, there were approximately 12,000 women diagnosed with cervical cancer last year. Cervical cancer develops in the cervix, the narrow outer end of the uterus that extends into the vagina. When diagnosed early, cervical cancer is generally curable and patients have an excellent chance of recovery. Penn Medicine physicians and scientists are working together to develop new ways to diagnose and treat cervical cancer.

There are two types of cervical cancer:

• Squamous cell carcinoma. The most common type of cervical cancer consisting of flat, thin cells called squamous cells that cover the surface of the cervix.
• Adenocarcinoma. Develops in the mucus-producing glands of the endocervix or opening to the uterus.

About half of the women diagnosed with cervical cancer are between the ages of 35 and 55 (check stats). The majority of cases are caused by exposure to the human papillomavirus (HPV), a common sexually transmitted disease. HPV affects up to 80 percent of females and males in their lifetime. Many cases of HPV clear on their own, but certain types of HPV can cause cervical, vulvar and vaginal cancer in females.

Cervical cancer treatment at Penn Medicine is provided by the Jordan Center for Gynecologic Cancers. As part of Penn’s Abramson Cancer Center, the Jordan Center takes a multidisciplinary approach to care, combining the expertise of Abramson Cancer physicians and scientists from the Penn’s division of gynecologic oncology, the Joan Karnell Cancer Center and the Penn Ovarian Cancer Research Center.

Read More

How to Build Strength After Cervical Cancer Treatment

A common, but manageable side effect of cervical cancer treatment is the loss of strength and flexibility of the pelvic floor.

The pelvic floor refers to the muscles and connective tissue that span the area under the pelvis. In women, the pelvic floor muscles support the bladder, intestines and uterus. Like other muscles in the body, these muscles need to be strong and flexible in order to work correctly.

Strong muscles and tissues in the pelvic floor are important to for sexual activity, maintaining urinary and anal continence and providing support for the abdomen and lower back.

Women who have undergone radiation therapy in the pelvic region may have difficulty with strength and flexibility of their pelvic floor muscles and surrounding tissues. Your vaginal wall, hips and upper thighs may lose normal motion due to radiation fibrosis. Gentle exercises including Kegel exercises and dilators can help them regain mobility and strength in these tissues. 

Kegel exercises build strength in the pelvic floor muscles. Strong pelvic floor muscles help maintain urinary continence. Some women describe this exercise as if they were stopping a stream of urine.

In order to perform a correct pelvic floor exercise, you should:

• Place one hand on top of your pubic bone.
• Tighten, and draw in the muscles around the anal and the vaginal openings so that you feel the muscles lift towards your pubic bone and squeeze the openings shut.
• Start lying down with your knees bent and supported with pillows.

There are two types of exercise contractions: 

1. Quick contractions that tighten, lift and release.
2. Endurance contractions that tighten, lift and hold the muscles for up to 10 seconds.

Kegel exercises can be performed sitting or standing.

Treatment for cervical cancer can also cause the vagina and vaginal opening to shrink. This can make it difficult for a doctor to perform internal exams, and can also make sexual intercourse difficult and uncomfortable.

A vaginal dilator stretches the scar tissue that has formed in the vagina. It can take up to eight to 12 weeks to feel an increase in the size of the vaginal opening and a softening of the tissues. 

Because the process takes several weeks, patience is important. For most women, there is a period of adjustment, and then using the dilator will become more routine.

Building strength of your pelvic floor will make you feel better all over.  Strength and flexibility of these muscles can help you feel more in control and more like yourself.

Some women find it difficult to do Kegel exercises or use their dilator, especially when they first start. If you are having difficulty a physical therapist who specializes in treating the pelvic region can help. Good Shepherd Penn Partners has pelvic floor specialists. If interested in making an appointment call 1-877-9-MY-REHAB.

Read More

The HPV Vaccine: Recommended for Both Boys and Girls

The Centers for Disease Control and Prevention (CDC) recently announced it is recommending boys also get the HPV vaccine. Previously, the CDC recommended only girls get the vaccine.

What is HPV?

Genital human papillomavirus (HPV) is the most common sexually transmitted virus in the United States. There are over 100 types of HPV, with more than 40 able to affect the genital area (CDC.gov). Nearly 20 million people in the United States are infected, and about 6.2 million more become infected each year with more than 50 percent of sexually active men and women infected with HPV at some time in their lives.

Most HPV infections do not cause any symptoms, and go away on their own. However, HPV can cause cervical cancer in women. The National Cancer Institute estimates that in 2011 alone, 12,710 new cases of cervical cancer will be diagnosed with 4,290 deaths from the disease.  It is the second leading cause of cancer deaths among women around the world.

HPV can cause genital warts and warts in the oral and upper respiratory tract in both men and women. HPV is also associated with several less common types of cancer in both men and women. There is no treatment for an HPV infection, but many of the conditions it causes can be treated.

Why get the HPV vaccine?

There are 2 FDA approved HPV vaccines on the market; Gardasil and Cervarix. The HPV vaccine Gardasil, protects against four major types of HPV; HPV 16 and 18, the two types that cause about 70 percent of cervical cancer and HPV 6 and 11 which cause 90 percent of genital warts. Cervarix is protective against HPV 16 and 18.

Protection from the HPV vaccine is expected to be long lasting, but vaccinated women still need cervical cancer screening (such as Pap tests and HPV tests) because the vaccine does not protect against all HPV types that can cause cervical cancer.

Who should get the HPV vaccine?

The HPV vaccine is approved for girls and boys ages 9-26.  Only Gardasil has been approved for use in males.

The CDC recommends that all girls aged 11 to 12 years old receive vaccination with either brand of HPV vaccine to protect against cervical cancer. (CDC) They also recommend that girls and young women ages 13 through 26 get the HPV vaccine if they have not received any or all doses when they were younger.

The CDC recommends Gardasil vaccine for all boys aged 11 or 12 years, and for males aged 13 through 21 years, who did not receive any or all of the recommended doses when they were younger. It is recommended that all men receive the vaccine through age 26. (CDC)

The vaccine is given in a three-dose series with the second dose given two months after the first dose and the third given six months after the first dose.

Why is the HPV vaccine given at this age?

It is important for girls and boys to receive the HPV vaccine before their first sexual contact — when they have not been exposed to HPV. For these girls and boys, the vaccine can prevent almost 100 percent of diseases caused by the four types of HPV targeted by the vaccine. However, if a girl or boy is already infected with a type of HPV, the vaccine does not prevent disease from that type of the virus and will not cure a current HPV infection.

Catch–up HPV vaccinations

The vaccine is also recommended for those between the ages of 13 and 26 who did not receive it when they were younger. No booster doses are recommended at this time. The HPV vaccine may be given at the same time as other vaccines.

Who should not get the HPV vaccine?

Anyone who has ever had a life-threatening allergic reaction to yeast, latex, to any other component of the HPV vaccine, or to a previous dose of the HPV vaccine should not get the vaccine. People with severe allergies should tell their doctor before receiving the vaccine.

Pregnant women should not get the vaccine. The vaccine appears to be safe for both the mother and the unborn baby, but it is still being studied. Receiving the HPV vaccine when pregnant is not a reason to consider terminating the pregnancy. Women who are breastfeeding may safely get the vaccine.

People who are mildly ill when the shot is scheduled can still get the HPV vaccine. People with moderate or severe illnesses should wait until they recover

What are the risks of the HPV vaccine?

The HPV vaccine does not appear to cause any serious side effects. However, vaccines, like any medication, may cause problems such as severe allergic reactions. The risk of any vaccine causing serious harm, or death, is extremely small. If side effects do occur, they happen within a few minutes to a few hours after the vaccination.

Mild problems that may occur with the HPV vaccine:

• Pain at the injection site (eight of 10 people)
• Redness or swelling at the injection site (one in four people)
• Mild fever (100 degrees F) (one person in 10)
• Itching at the injection site (one person in 30)
• Moderate fever (102 degrees F) (one person in 65)
• These symptoms do not last long and go away on their own.

These are just some of the side effects that may occur. It's best to speak with your physician about side effects from the HPV vaccine.

What to do for severe reaction to the HPV vaccine

Any unusual condition, such as a high fever or behavior changes could indicate a severe reaction. Signs of a serious allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heartbeat or dizziness.

If you believe you or your child is having a severe reaction to the HPV vaccine, call a doctor or get the person to a doctor right away. Tell your doctor what happened, the date and time it happened and when the vaccination was given.

Ask your doctor, nurse, or health department to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form or you can file this report through the VAERS website or by calling 1-800-822-7967.

Learn more about the HPV vaccine

Ask your doctor or nurse. They can show you the vaccine package insert or suggest other sources of information.

Call your local or state health department.

Contact the Centers for Disease Control and Prevention (CDC).

Call 800-232-4636 (1-800-CDC-INFO).

Visit the CDC’s website http://www.cdc.gov/std/hpv.

Learn more about cervical cancer and other gynecologic cancers at the Abramson Cancer Center’s Focus On Gynecologic Cancers Conference.

Learn more about cervical cancer treatment at the Abramson Cancer Center.

Read More