Cervical Cancer

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This topic talks about the testing, diagnosis, and treatment of cervical cancer. For general information about abnormal Pap test results, see the topic Abnormal Pap Test.

What is cervical cancer?

Cervical cancer occurs when abnormal cells on the cervix grow out of control. The cervix is the lower part of the uterus that opens into the vagina. Cervical cancer can often be cured when it’s found early. It is usually found at a very early stage through a Pap test.

What causes cervical cancer?

Most cervical cancer is caused by a virus called human papillomavirus, or HPV. You get HPV by having sex with someone who has it. There are many types of the HPV virus. Not all types of HPV cause cervical cancer. Some of them cause genital warts, but other types may not cause any symptoms.

You can have HPV for years and not know it. It stays in your body and can lead to cervical cancer years after you were infected. This is why it is important for you to have regular Pap tests. A Pap test can find changes in cervical cells before they turn into cancer. If you treat these cell changes, you may prevent cervical cancer.

What are the symptoms?

Abnormal cervical cell changes rarely cause symptoms. But you may have symptoms if those cell changes grow into cervical cancer. Symptoms of cervical cancer may include:

• Bleeding from the vagina that is not normal, or a change in your menstrual cycle that you can’t explain.
• Bleeding when something comes in contact with your cervix, such as during sex or when you put in a diaphragm.
• Pain during sex.
• Vaginal discharge that is tinged with blood.

How is cervical cancer diagnosed?

As part of your regular pelvic exam, you should have a Pap test. During a Pap test the doctor scrapes a small sample of cells from the surface of the cervix to look for cell changes. If a Pap test shows abnormal cell changes, your doctor may do other tests to look for precancerous or cancer cells on your cervix.

Your doctor may also do a Pap test and take a sample of tissue (biopsy) if you have symptoms of cervical cancer, such as bleeding after sex.

How is it treated?

Cervical cancer that is caught early can usually be cured. If the cancer is caught very early, you still may be able to have children after treatment.

The treatment for most stages of cervical cancer removes the cancer and makes you unable to have children. These treatments include:

• A hysterectomy and removal of pelvic lymph nodes with or without removal of both ovaries and fallopian tubes.
• Radiation therapy.
• Chemotherapy.

Depending on how much the cancer has grown, you may have one or more treatments. And you may have a combination of treatments.

It’s common to feel scared, sad, or angry after finding out that you have cervical cancer. Talking to others who have had the disease may help you feel better. Ask your doctor about support groups in your area. You can also find people online who will share their experiences with you.

Can cervical cancer be prevented?

The Pap test is the best way to find cervical cell changes that can lead to cervical cancer. Regular Pap tests almost always show these cell changes before they turn into cancer. It is important to follow up with your doctor after any abnormal Pap test result to treat abnormal cell changes. This may help prevent cervical cancer.

A new vaccine called Gardasil protects against four types of HPV, which together cause most cases of cervical cancer and genital warts. You get three shots over 6 months. The vaccine is recommended for girls 11 to 12 years old. It is also recommended for females 13 to 26 years old who did not get the vaccine when they were younger.

The virus that causes cervical cancer is spread through sexual contact. The best way to avoid getting a sexually transmitted disease is to not have sex. If you do have sex, practice safer sex, such as using condoms and limiting the number of sex partners you have.

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Breast Cancer:Your Body Image

3 Ways Breast Cancer Can Screw Up Your Sex Life

Sex may not be quite the same for a while, depending on your treatments and the way you feel about your body.

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You might be one of the lucky few whose sex life cruises through breast cancer diagnosis and treatment without so much as a bounce. More likely, there are bumps in the road or you may have stalled out altogether. According to the National Cancer Institute, one in two women treated for breast or gynecologic cancer experiences some combination of low desire and pain with intercourse. Below, a list of the most common problems and some expert suggestions on what to do about it.

1. Fatigue
Breast cancer typically brings on the biggest libido-killer of them all: fatigue. Recovering from a mastectomy—and perhaps reconstruction—can sap your energy, as can chemotherapy and radiation. “Fatigue is a bigger problem because it can be pervasive and it can last a lot longer” than other physical changes such as hair loss or dry skin, says Helen L. Coons, PhD, president and clinical director of Women’s Mental Health Associates in Philadelphia.

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2. Vaginal dryness
If you’re on hormone treatment, you may be plunged into early menopause, and for some people that includes low desire and vaginal dryness, which can make sex painful. (Younger women and women who’ve had chemotherapy are more likely to report problems with sex.) Leslie R. Schover, PhD, professor of behavioral science at the University of Texas M. D. Anderson Cancer Center in Houston, suggests a vaginal lubricant and/or a vaginal dilator to make sex less painful. “Being on an antidepressant or anti-anxiety medication can also blunt sexual desire,” she says.

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3. Breast changes
Accepting how your body may have changed is obviously crucial to feeling sexual again. Scars, a new breast shape, or a missing breast or reconstructed one may take some time to get used to. As difficult as it can be to talk about these things with your partner and your doctor, if you’re not bouncing back to your usual sexual self over time, it is something to bring up.

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Bipolar Disorder

Managing Bipolar Disorder’s Highs and Lows

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Mania, the up side of bipolar disorder, is as destructive as the ensuing depression.

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Bipolar disorder, sometimes called manic depression, affects nearly six million American adults, or about 2.5% of the adult population, according to the National Institute of Mental Health. Some patients who eventually get diagnosed spend years, even decades, cycling through institutions and switching therapists before they get the correct treatment.

Mary, a mental health advocate who lives in western Massachusetts, is one of these people. She had episodes of mild depression starting when she was in her late teens.

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Have you ever experienced mania?

When these came on, a quick call to her primary care physician got her a prescription for Prozac. Each time she took antidepressants, the medications kicked her into a slightly manic state during which she was often pretty effective in her many roles at work, home, and community. “I survived that way for 20 years,” she says.

Then in 2002, her world crumbled when her son, who had been diagnosed with bipolar disease at age 7, spent more than four months in a hospital while awaiting transfer to a residential mental health facility. Mary became suicidally depressed. This time her doctors reached the conclusion that she, too, had bipolar disorder.

The term bipolar means “two poles,” like the Arctic and Antarctica, and that image describes this disease pretty well. People with bipolar experience periods of depression interspersed with periods of mania, when their thoughts race and they behave impulsively and often irrationally.

“Bipolar disorder gets you to commit acts of excess that nobody outside of Congress can get away with,” says Steven D. Hollon, PhD, professor of psychology at Vanderbilt University in Nashville.

Mania can feel like creativity
Kathleen Brannon, 49, of Herndon, Va., had spent time in a state mental hospital for depression but was reluctant to agree that she was bipolar. “I’d have some periods of intense creativity where I would write for 20 hours,” she says. “I hadn’t thought of it as mania, I just thought I was driven to write.”

Antidepressants can be ineffective or even damaging in people with bipolar disorder. In particular, antidepressants given to a person with bipolar disorder can trigger a manic episode unless the person is also taking a mood-stabilizing drug.

“When antidepressants don’t work, ask your doctor if you have bipolar disorder,” says Michael E. Thase, MD, professor of psychiatry at the University of Pennsylvania, in Philadelphia.

Dr. Thase adds that unusual reactions to antidepressants may also signal bipolar disorder. “If you start taking an antidepressant and have racing thoughts, a much stronger sex drive, or insomnia that has developed or worsened during antidepressant therapy, get help from your doctor. These are not symptoms of depression,” he says. Instead of signaling recovery from depression, such symptoms may signal a manic episode that was triggered by an antidepressant.

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Low Back Pain

Getting to the Bottom of Your Chronic Back Pain

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Finding the source of chronic back pain requires patience and perseverance.

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For a condition as common as back pain (one survey found that almost twenty percent of Americans suffer a month-long bout of back pain each year) it’s remarkably hard to find the actual cause in individual patients. According to the American Pain Society and the American College of Physicians, it’s impossible to say precisely why a person’s back hurts in more than 85 percent of cases. Cure, not surprisingly, can also be elusive.

“Unless you have leg pain, which usually means there’s a pinched nerve, it’s very hard for physicians to figure out where it comes from,” says Richard Guyer, MD, a past president of the North American Spine Society. “We have many structures: we have muscles, we have ligaments, we have the joints, we have the disk and we have the nerve,” says Guyer. “All of those can give you problems.”

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Most often, the cause is overuse or muscle injury. That kind of pain will often go away, untreated, over a few weeks. But in a structure as complex as the back, disks between your vertebrae can also bulge, rupture, or wear out. Vertebrae can slip out of place. The spinal canal can narrow, putting pressure on nerves (a condition known as stenosis, a problem related to aging). The facet joints that hold the spine in alignment can become inflamed due to arthritis or injury. And that doesn’t include poor posture, stress, tumors, osteoporosis, spinal deformities…and the list goes on.

You’ll need to be patient
This all means that back-pain sufferers need to muster some patience and look for doctors who will approach their pain with a comprehensive examination, a full history, and then proceed to X-rays or MRIs only if they suspect a specific cause. The strategy for chronic back pain involves a careful elimination process that—barring early discovery of an urgent problem such as tumor or nerve damage—moves very slowly to the most aggressive treatment: surgery.

Patience may be difficult when you’re in severe pain. But in the past things were worse. “Thirty years ago it was common practice to operate first, and look during the operation to see what was wrong,” says Richard Derby, MD, an anesthesiologist based in Daly City, Calif. That led to low cure rates and painful recovery times. Now that surgery is seen as a last resort, patients have the opportunity to first look for relief with fewer risks.

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