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.

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The Future of Breast Cancer Treatment

Kevin Fox MD, is the Mariann T. and Robert J. MacDonald Professor of Medicine and medical director of the Rena Rowan Breast Center at Penn’s Abramson Cancer Center. He treats all aspects of early stage and advanced stage breast cancer researches adjuvant therapy of breast cancer.

The future of breast cancer treatment

The next 20 years will bring more targeted therapy for the treatment of advanced breast cancer, and will most likely see a decline in the use of chemotherapy.

Special drugs will continue to be developed that attack special “targets” that exist only in breast cancer cells. These drugs, we hope, will spare the patient’s normal cells, thus avoiding many of the side effects we have come to expect from chemotherapy.

Drugs with names like PARP inhibitors and MTOR inhibitors will become part of our everyday language, and more drugs that target HER-2 like trastuzumab will be released in the very near future.

Twenty years from now, many things about breast cancer treatment will have changed again. Tomograms may replace mammograms as the standard method of breast cancer detection,surgeons may not need to remove lymph nodes at all, and radiation therapy may become shorter in duration. Perhaps chemotherapy will have become a thing of the past.

Whatever the case, treatments will be better, more patients will be cured, and in every respect, there will be less suffering for patients at every stage of treatment.

Learn more about breast cancer treatment at the Abramson Cancer Center in Philadelphia.

Watch conference presentations from the 2011 Life After Breast Cancer conference.

Penn's Abramson Cancer Center is a national cancer center in Philadelphia providing comprehensive cancer treatment, clinical trials for cancer and is a cancer research center. The National Cancer Institute has designated the Abramson Cancer Center a Comprehensive Cancer Center, one of only 40 such cancer centers in the United States.

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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.

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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. 

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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.

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The BRCA Gene Mutation: Should You Tell Your Children?

Parents of who children learn they have the BRCA gene mutation have a difficult question to answer: Should they tell their children?

Jill Stopfer,MS, genetic counselor at Penn Medicine's Abramson Cancer Center, was recently interviewed by the Huffington Post about this topic.

"One of the questions we all have and we all worry about in this area is 'how much information is too much?'" said Stopfer. "Are we hopefully helping our children and not hurting them?"

Read the full article about telling children about a BRCA gene mutation here.  

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

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More Advances in Breast Cancer Treatment

Kevin Fox MD, is the Mariann T. and Robert J. MacDonald Professor of Medicine and medical director of the Rena Rowan Breast Center at Penn’s Abramson Cancer Center. He treats all aspects of early stage and advanced stage breast cancer researches adjuvant therapy of breast cancer.

Advances in surgery for breast cancer

Surgeons began using a technique in the mid-1990s called the sentinel node procedure to evaluate whether a breast cancer has spread to the lymph nodes under the arm.

For almost a century, the standard of care included removing a large number of lymph nodes from the underarm of most breast cancer patients in an operation called an axillary dissection. This procedure left many patients in pain, disabled, or with a swollen arm.

The sentinel node procedure allows the surgeon to detect the first lymph node in the underarm. If that lymph node contains no cancer, then the surgeon doesn’t need to perform the axillary dissection: if the first lymph node is cancer-free, the other lymph nodes will almost always be free of cancer as well.

Using this technique, hundreds of thousands of patients have avoided unnecessary axillary dissections.

Advances in radiation therapy for breast cancer

Radiation treatments for breast cancer, particularly in those women who do not choose a mastectomy, have also advanced during the last 20 years.

Partial breast radiation describes several techniques in which the radiation is applied only to the portion of the breast where the cancer was found, rather than the whole breast. Until recently, whole-breast radiation had been the standard of care. Partial breast techniques are not appropriate for all women, but are being offered to patients with increasing frequency.

At the present time, radiation oncologists are exploring more targeted, shorter treatment periods in the hope that many patients can finish treatment in as little as three or four weeks, rather than the current six or seven.

Adjuvant therapy for breast cancer

Most women who have early stage breast cancer have adjuvant therapy after surgery.

Adjuvant therapy describes drug treatments that are given for a period of time after surgery in order to reduce the risk of recurrence or spread of the breast cancer.

Patients may receive several months or years of adjuvant therapy in the form of chemotherapy, hormonal therapy or both.

The most significant advance in the adjuvant therapy of early stage breast cancer came in 2005 in the form of a substance called trastuzumab, or Herceptin®. Trastuzumab is an antibody that attacks HER-2, a protein that is present in large amounts on certain breast cancer cells.

Only 20 percent of breast cancer patients are HER-2 positive (have too much of the protein), but these cancers can be very aggressive and spread quickly and often. Patients treated with this antibody for a year, along with several months of chemotherapy, reduce the risk of their cancer spreading by 50 percent.

Nearly every patient with HER-2 positive invasive breast cancer now receives trastuzumab in addition to chemotherapy..

In 2006, we began using a special test called the Oncotype DX® assay in patients who had cancers that were considered hormone-sensitive, particularly women whose hormone-sensitive cancers has not spread to the lymph nodes.

Oncotype is a diagnostic test that can provide information about the biological activity of the specific tumor. Along with other information, the test results can help in making decisions about whether or not to include chemotherapy in the treatment plan and indicate how likely it is that a woman’s cancer may return in the future.

For many years, patients with hormone-sensitive cancers that have not affected the lymph nodes received both chemotherapy and hormonal therapy. The Oncotype assay enables us to determine which of these women really need the chemotherapy and determine those who can do just as well without it.

Up to 50 percent of women with this type of breast cancer don’t need chemotherapy at all.

Hormone therapy for breast cancer

Even the way in which we use hormonal therapy for early stage breast cancer has changed.

Hormone therapy works by blocking the actions of certain hormones that may trigger cancer growth, preventing the body from producing hormones that may trigger cancer growth, or eliminate hormone receptor in the body.

For many years, the drug tamoxifen was prescribed for most women who had hormone-sensitive breast cancers and it was very effective in reducing the risk of recurrence or spread of the cancer.

In late 2001, we began to prescribe a new type of pill called an aromatase inhibitor. Aromatase inhibitors work better in women who have entered menopause at the time they are first diagnosed with breast cancer.

Tamoxifen remains the best choice for premenopausal women with early stage breast cancer.

Chemotherapy for breast cancer

Over the years, the use of chemotherapy for treating patients with early stage breast cancer has changed considerably.

In general, courses of chemotherapy are now shorter, lasting from 12 to 18 weeks instead of 24 weeks or even longer. Different drugs, particularly paclitaxel and docetaxel, are used in almost every patient who receives chemotherapy. Many of the most dreaded side effects of chemotherapy, particularly nausea and the risk of infection, have decreased considerably as a result of the changes we have made in the last 20 years.

Advances in treating advanced breast cancer

The treatment of advanced (metastatic or stage IV) breast cancer has seen drastic changes in the last 20 years.

Six new chemotherapy drugs have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of advanced breast cancer since 1992, and several other chemotherapy drugs used for other types of cancer are given routinely to breast cancer patients as well, with some success.

For patients with hormone-sensitive breast cancer, the aromatase inhibitors mentioned above have proven very useful, as has the drug fulvestrant.

Special compounds such as pamidronate, zoledronate, and denosumab are used routinely in women whose breast cancer has spread to the bones. These compounds are not cancer treatments, but protect the bones against the injuries that the cancer can cause.


Learn more about breast cancer treatment at the Abramson Cancer Center in Philadelphia.


Watch conference presentations from the 2011 Life After Breast Cancer conference.


Penn's Abramson Cancer Center is a national cancer center in Philadelphia providing comprehensive cancer treatment, clinical trials for cancer and is a cancer research center. The National Cancer Institute has designated the Abramson Cancer Center a Comprehensive Cancer Center, one of only 40 such cancer centers in the United States.

Read More