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Pap Smear

Pap Smear Introduction

Cancer of the cervix (cervical cancer) is the second most common cause of cancer-related disease and death among women worldwide. The best way to detect cervical cancer is by having regular Papanicolaou tests, or Pap smears. (Pap is a shortened version of the name of the doctor who developed the screening test.) A Pap smear is a microscopic examination of cells taken from the cervix.
A Pap smear can detect certain viral infections (such as human papillomavirus [HPV]) and other cancer-causing conditions. Early treatment of these conditions can stop cervical cancer before it fully develops. A woman may have cervical cancer and not know it because she may not have any symptoms.
The incidence of cancer and deaths from cervical cancer has significantly declined over the years because of prevention, screening, and early detection by the Pap smear. In the United States, about 2-3 million abnormal Pap smear results are found each year. Most of them indicate the early stages of disease and need reasonable observation by a doctor.

• Risks factors for cancer of the cervix include the following:

• Multiple sexual partners (or sexual partners who have had multiple partners)
• Starting sexual intercourse at an early age
• Viral infection, such as HPV, human immunodeficiency virus (HIV), or herpes simplex virus (HSV)
• Weakened immune system
• Previous cancer of the lower genital tract
• Smoking

Cervical cancer screening is recommended yearly starting when women are aged 18 years, or when they become sexually active if younger than 18 years. Physicians may screen a woman less frequently if she had negative Pap smear results 3 years in a row or is not sexually active.
No upper age limit for screening exists because the incidence of cancer of the cervix increases with age at a time when women may be less likely to get a Pap smear. Diagnosis of most of these cancers is in women older than 50 years. Even after menopause, a woman should continue to have regular Pap smears.

• The National Cancer Institute encourages women aged 65 years and older to get a Pap smear at least every 2 years (Medicare covers the cost), and every year if they are at higher risk and advised by their doctor. Many older women believe they no longer need Pap smears (and think they are not at risk for cervical cancer) because of their age, because they may not be sexually active, or because they have had a hysterectomy. That is not correct. These women need Pap smears because their risk is higher.

If a woman has had her uterus removed, she should still have yearly screening if there is a history of abnormal Pap smear results or other lower genital tract cance

fight cervical cancer: Cervical Cancer: Every sexually active woman is at risk

fight cervical cancer: Cervical Cancer: Every sexually active woman is at risk

Cervical Cancer: Every sexually active woman is at risk

In recent times, statistics available have shown that in Nigeria, cervical cancer accounts for 15 per cent of female cancers as compared to just about 3.6 percent in the developed countries. Shockingly, less than 0.1 per cent of Nigerian women have ever had cervical cancer screening in their lifetime and less than 1 per cent is aware of the existence of this silent killer. Consequently, cervical cancer kills a woman every hour in the country. Although 100 percent preventable, the cancer kills more women aged 24 to 35 years old women in developing countries than any other cancer in other parts of the world.
The World Health Organisation (WHO) projects a 25 per cent increase over the next decade in the absence of widespread interventions. This is a sharp contrast to what obtains in countries like Britain which have national screening programmes. There, deaths from cervical cancer have reduced by 75 per cent and reducing by further 7 percent annually.

Unfortunately, according to WHO estimates, Nigeria has a population of 40.43 million women aged 15 years and older who are at risk of developing cervical cancer. Current estimates indicate that every year 14,550 women are diagnosed with cervical cancer and 9659 die from the disease.
Worse still, Cervical cancer ranks as the 2nd most frequent cancer among women in Nigeria, and the 2nd most frequent cancer among women between 15 and 44 years of age. About 23.7 per cent of women in the general population are estimated to harbour cervical HPV infection at a given time and percentage of invasive cervical cancers are attributed to HPV s 16 or 18.
Cervical cancer is one of the most common cancers that affect a woman’s reproductive organs and various strains of the human papillomavirus (HPV), a sexually transmitted infection, playa role in causing most cases of cervical cancer.
When exposed to HPV, a woman’s immune system typically prevents the virus from doing harm. Thanks largely to Pap test screening, the death rate from cervical cancer has decreased greatly over the last 50 years. Today, most cases of cervical cancer can be prevented with a vaccine for young women
In a study, Senior Lecturer/ Consultant at the Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Dr. Marliyya Zayyan noted that all Nigerian sexually active women are at risk of cervical cancer but the risk of cancer of the cervix is reduced with male circumcision.
She says cancer of the cervix is the commonest malignancy among women in northern Nigeria. Three to four new cases are diagnosed every week in ABUTH, Zaria
“We had 203 cases of cervical cancer in 2007. This number represents 75 percent of the total cases of confirmed gynecologic cancers presenting to the unit. The age distribution was very wide and youngest age of presentation was 28 years and the oldest was a 90year old with very advanced disease.
The median age of presentation is 35 years. Maj ority of the women were married however 3 per cent were single women who have never married and 20 per cent were divorced or widowed. It affected family women with an average of 5 children.”
Stating in Nigeria cervical cancer patients present late, she said only four cases (1.9 per cent) out of 203 presented early enough for cure to be achieved. “For 98.5 per cent of cases the disease could best be palliated.
“The early symptom of bleeding after intercourse is often ignored by the patients. Two hundred cases were not possible to treat surgically. These cases were treated by heat treatment (radiotherapy).
A quarter of the patients presented with complications of very late disease like leaking urine or faeces, or blockage of their intestines or urinary flow”
Challenges of management, includes deaths from cervical cancer on poverty. “The cost per cycle of heat treatment is N25,000 and six to seven cycles are normally required. Special drugs required to melt out the cancer are very expensive and toxic. Could be unavailable. Follow up of discharged patients is difficult. Many specialists are required to effect treatment in the advanced stages patients present.”
On the way forward, “Cancer of the cervix is about the only human cancer that is almost entirely preventable. “It is also 100 per cent curable if picked at very early stage. Treatment is cheap and simple in early stages requiring minimal manpower to achieve the high cure rate. Cancer of the cervix has an established screening method that works. Today vaccines are available for primary prevention of cervical cancer. Theses vaccines are already in use in other places and technology for their production is known.
Control of Cervical cancer depends on increase in public awareness of the disease. Government should subsidise the treatment and incorporate screening programme into the primary health care as well as improve infrastructure and development of health facilities.
To reduce the burden, she posited that there should be constant training and re-training of personnel. She recommended that “We need a strategy to reduce the burden of disease in the community through education. We need to roll out a reliable screening plan to cover at least 80 per cent of our population.
The vaccine for cervical cancer should be part of our immunization plan. We should get rid of cervical cancer like other countries have done so we can direct attention on other cancers that have more complex biology.
Overview of Cervical Cancer
Cervical cancer is one of the most common cancers that affect a woman’s reproductive organs. Various strains of the human papillomavirus (HPV), a sexually transmitted infection, playa role in causing most cases of cervical cancer.
When exposed to HPV, a woman’s immune system typically prevents the virus from doing harm. In a small group of women, however, the virus survives for years before it eventually converts some cells on the surface of the cervix into cancer cells. Cervical cancer occurs most often in women over age 30. Thanks largely to Pap test screening, the death rate from cervical cancer has decreased greatly over the last 50 years. And today, most cases of cervical cancer can be prevented with a vaccine for young women.
At a glance
In Nigeria, cervical cancer is the second most common cancer in women after breast cancer
It accounts for 13 percent of all female cancers. Overall, the mortality: incidence ratio is 52 percent. There has been a steady rise in frequency of cancer over the years. Cancers of the cervix (30.1 percent) topped the list of the most frequent female cancers. Recent predictions of an increase in incidence of cervical cancer is manifesting. Findings at the Kano Cancer Registry, Ahmadu Bayero University, Kano, supports evidence for establishment of comprehensive cancer control programmes.
At a rough estimate, Nigeria records 10,000 cases of cervical cancer yearly,” notes Prof. Isaac Adewole, Consultant Obstetrician and gynaecologist at the College of Medicine, University of Ibadan. “The women with this ailment die in a painful, miserable and undignified manner.
At least 80 per cent of cases in Nigeria are at advanced stage where very little can be done. Measures including prevention, early detection and effective management of cervical are necessary to prevent an increase in incidence and deaths of women from the disease. He said there is need for stronger advocacy to ensure that cervical cancer vaccine becomes available in the public health sector. Adewole, also principal investigator Operation Stop Cervical Cancer Nigeria laments that cervical cancer fuels a cycle of poverty. Most of these women are low income earners and often located far from health institutions.
The disease which affects the poorest and most vulnerable women sends a ripple effect through families and communities that rely heavily on women’s role as both providers and care givers.”
Every 10 minutes, two women die from cervical cancer worldwide, affecting more of younger productive women between 20 years and mid 30s. Once a woman is affected, it can take between five and 30 years for the virus to develop into full cancer, but since it has no early symptoms, the woman feels very healthy while the virus continues to ravage her. By the time the symptoms begin to show, the situation becomes uncontrollable. Virtually nothing can be done to remedy the situation and the woman waits for death. Cervical cancer has been reduced drastically in the western world thanks to universal screening. “The rate of the cancer in Nigeria is 70 per cent and rising. If we can introduce universal screening, it would reduce drastically.”
Symptoms
Early cervical cancer generally produces no signs or symptoms. This is why regular screening is so important. As the cancer progresses, the following signs and symptoms of more advanced cervical cancer may appear:
* Vaginal bleeding after intercourse, between periods or after menopause
* Watery, bloody vaginal discharge that may be heavy and have a foul odor
* Pelvic pain or pain during intercourse
When to see a doctor: If you experience any unusual bleeding between periods or pain during intercourse, make an appointment with your doctor.
Risk factors
* The greater your number of sexual partners – and the greater your partner’s number of sexual partners – the greater your chance of acquiring HPV.
* Early sexual activity. Having sex before age 18 increases your risk of HPV.
* If you have other STDs – such as chlamydia, gonorrhea, syphilis or HIV / AIDS – the greater your chance is of also having HPV.
* A weak immune system. Most women who are infected with HPV never develop cervical cancer. However, if you have an HPV infection and your immune system is weakened by another health condition, you may be more likely to develop cervical cancer.
* Cigarette smoking. The exact mechanism that links cigarette smoking to cervical cancer isn’t known, but tobacco use increases the risk of precancerous changes as well as cancer of the cervix. Smoking and HPV infection may work together to cause cervical cancer.
Complications
Treatments for invasive cervical cancer often make it impossible to become pregnant in the future. For many women especially younger women and those who have yet to begin a family infertility is a distressing side effect of treatment. For a specific subgroup of women with early cervical cancer, fertility-sparing surgery may be a treatment option.
Causes
In general, cancer begins when healthy cells acquire a genetic mutation that turns normal cells into abnormal cells. There are two main types of cervical cancer:
* Squamous cell carcinomas begin in the thin, flat cells that line the bottom of the cervix (squamous cells).
Screening
Most guidelines suggest beginning screening at age 21, and some recommend starting within three years of becoming sexually active, or no later than age 21.
*Pap test. During a Pap test, your doctor brushes cells from your cervix – the narrow neck of the uterus – and sends the sample to a lab to be examined for abnormalities.
* HPV DNA test. Your doctor also may use a lab test called the HPV DNA test to determine whether you are infected with any of the 13 types of HPV that are most likely to lead to cervical cancer.
Diagnosis
Your doctor may examine your cervix:: During an exam called colposcopy, your doctor uses a special microscope (colposcope) to examine your cervix for abnormal cells.
Staging exams:
* Imaging tests. Tests such as X-rays, computerised tomography (CT) scans and magnetic resonance imaging (MRI) help your doctor determine whether your cancer has spread beyond your cervix.
* Visual examination of your bladder and rectum. Your doctor may use special scopes to see inside your bladder (cystoscopy) and rectum (proctoscopy). Your doctor then assigns your cancer a stage.
Treatments and drugs
Treatment of cervical cancer that’s confined to the outside layer of the cervix typically requires treatment to remove the abnormal area of cells. For most women in this situation, no additional treatments are needed.
For Invasive cancers
Cervical cancer that invades deeper than the outside layer of cells on the cervix is referred to as invasive cancer and requires more extensive treatment.
Treatment options may include: Surgery to remove the uterus (hysterectomy) is typically used to treat the early stages of cervical cancer. Hysterectomy can cure early-stage cervical cancers and prevent cancer from coming back, but removing the uterus makes it impossible to become pregnant.
* Radiation therapy uses high-powered energy to kill cancer cells.
* Chemotherapy uses strong anti-cancer medications to kill cancer cells. Chemotherapy drugs, which can be used alone or in combination with each other are usually injected into a vein and they travel throughout your body killing quickly growing cells, including cancer cells.
Prevention
You can reduce your risk of cervical cancer by taking measures to prevent HPV infection. HPV spreads through skin-to-skin contact with any infected part of the body – not just during intercourse. Use a condom every time you have sex in order to reduce your risk of contracting HPV.

5 THINGS YOU NEED TO KNOW ABOUT CERVICAL CANCER STAGES

1. Carcinoma in Situ

Stage zero is the least progressed stage of all cervical cancer stages. This stage, often referred to as carcinoma in situ, occurs when abnormal cells are present, or cancer cells present in the epithelium or lining of the cervix. At this point, the cancer hasn't moved from the location where it began. It hasn't yet permeated into the deeper tissues of the cervix. Frequently, doctors treat this stage of cancer the same as they treat abnormal cells found in the cervix. Treatment options at stage zero include the loop electrosurgical excision procedure (LEEP), laser surgery, conization, cryosurgery, hysterectomy or internal radiation.

2. Invasion of Deeper Cervical Tissues

Stage I cervical cancer occurs when the cancer spreads deeper into the cervical tissue. In this stage, the cancer hasn't yet spread past the cervix. Doctors divide this stage into two categories: IA and IB. A cancer in stage IA is very small and requires a microscope to see it. These early stage IA cancers are less than 1/4 inch wide and have grown only about an 1/8 inch into the cervix tissue. Cancer in stage IB is observable without the aide of a microscope. Early stage IB cervical cancer is no larger than 1.6 inches. Later stage IB cervical cancer is larger than 1.6 inches, but hasn't permeated tissues other than the cervix. Stage I treatment options include hysterectomy, conization, radical hysterectomy, chemotherapy and radiation therapy.

3. Beyond the Cervix

Stage II marks a turning point in the progression of cervical cancer as it moves beyond the cervix. By early stage II, the cancer has spread into the upper portion of the vagina. Later stage II cervical cancers move into the tissues adjacent to the cervix. Hysterectomy is still an option at stage II, in addition to chemotherapy and internal and external radiation.

4. Blocking the Flow of Urine

Once cervical cancer reaches stage III, it has moved into the lower part of the vagina. By the later part of stage III, it's permeating the pelvic wall. Sometimes, it even presses against the ureters, which are tubes that facilitate the flow of fluid from the kidney to the bladder. At this point, kidney functioning may be impaired. Treatment options at stage III include internal and external radiation as well as chemotherapy.

5. Metastasis Into Other Organs

When cervical cancer reaches stage IV, it's at its most advanced point. Early stage IV cervical cancer invades nearby organs, such as the bladder and rectum. At this point, cervical cancer may spread to the lymph nodes and pelvis. Once the cancer has reached the later part of stage IV, it has metastasized beyond the immediate area surrounding the cervix. At this point cancer spreads to other parts of the body, such as the intestines, liver or lungs. While radiation therapy and chemotherapy are recommended treatment strategies at stage IV, the use of palliative therapies minimizes the symptoms of the disease.

Cervical cancer: What every woman needs to know

Cervical Cancer Prevention Week

© Alexander Raths - Fotolia.com

When Big Brother star Jade Goody contracted cervical cancer in 2008, her battle against the illness sparked a sudden rise in the numbers of young women going to be screened.
But since her death at the tragically young age of 27, and despite the huge press attention her plight received, those numbers have plummeted again.
Last year, one in five women failed to attend an appointment for free cervical screening.
A recent survey for gynaecological cancer research charity The Eve Appeal also showed women’s awareness of cervical cancer remains “woefully low”.
Now, for Cervical Cancer Prevention Week (January 22-28), experts are desperately trying to raise awareness of the illness once more – and urge women to have a regular smear test.
Up to 1,000 women in Britain die from the illness every year, with 2,800 new cases diagnosed. More than half of those cases involve women below the age of 50 – in fact, it is the second most common cancer in women under 35.
Yet, as Richard Winder, deputy director of NHS Cancer Screening, said: "Unlike many cancers, cervical cancer is a largely preventable disease.
"A woman can control her risk of developing the disease by being screened regularly. Any abnormalities that might be found can then be treated in order that they do not go on to develop into cancer.
"Where a cervical cancer is found through screening, it is usually at a very early stage where treatment has a greater chance of success.
"It is essential that women are aware of this when deciding whether or not to be screened. Cervical screening is estimated to save 4,500 lives a year in England alone."
For under-18s the first step is to get vaccinated: since 2008 there has been a national programme to immunise girls against the human papilloma virus (HPV), two strains of which are responsible for about 70 per cent of cervical cancer cases.
The jab is given in three doses over a period of around six months, and a new version of the vaccine, Gardasil, to be given from September 2012, also protects against genital warts as well as cervical cancer.
Because the HPV vaccine does not guard against every form of cervical cancer, the next step is regular cervical screening, provided free by the NHS to all women aged between 25 and 65 – also known as a smear test, where a small sample of cells is taken from the cervix for examination.
Doctors recommend women between 25 and 49 should be screened every three years, and those between 50 and 65 every five. The last step is to arm yourself with the facts.
As Gemma Byrne of The Eve Appeal says: “The earlier cervical cancer is diagnosed, the better the outcome will be, so even if women have been vaccinated and had regular screening, none of these is 100 per cent effective so women owe it to themselves to be aware of the early warning signs”
While there are no symptoms in the early stages, unusual bleeding – which can occur after sex, in between periods or after the menopause – is often the first noticeable cause for concern.
Other signs may include pain in and around the vagina when having sex, an unpleasant smelling discharge, pain when passing urine or, in the more advanced stages, blood in the urine, loss of bladder control, bone pain, leg and kidney swelling and weight loss.
The important thing is to seek your GP’s advice if you notice any of these unusual signs.

 

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Stories of women with cervical cancer

Today, we would be looking at the several women who has had cervical cancer and who still has. I want you to read and leave your comments and also tell your experience or your advice...Thank you
 At this time they were interviewed.......

  HEATHER BONYGE

Age: 30
Hometown: Saskatoon
What was your diagnosis? Cervical Cancer
What are your career goals? I would eventually like to work in a cancer organization, possibly as a counselor or as a fundraiser organizer. I generally just want to help people.
What is your occupation?Optician

Your Cancer experience:

My beautiful daughter, Brynn, was born on July 29, 2008. My husband and I had been married for six years, and I had wanted a baby for a long time. It was the happiest moment of my life (clichéd, I know, but true!).
Six weeks after she was born, I went for my routine follow-up and pap test with my gynecologist and went about my life not thinking anything of it. One month later I got a phone call saying the tests had come back abnormal, and I needed to have another test done. An appointment was set up for the following month. Still, I thought nothing of it. I have a friend who had abnormal cells before, and just had to go have them removed; I figured mine would be similar.
On November 19 I went for my biopsy and colposcopy, and even the doctor thought it would turn out as nothing—at worst it would be the HPV virus which she said would be entirely manageable. On December 19, 2008, exactly one month later, I got my results. The phone rang—my daughter was four and a half months old and napping, my husband was at work, and I was alone. The doctor was incredibly sympathetic, but told me she didn’t want me to have to wait to come into the office to give me the news. She just told me over the phone, “You have cervical cancer.” I was 27-years-old.
I acted very in control of the situation on the phone with the doctor. I mean, what good was it going to do to cry to her? I held it together, but I started to cry as soon as I got off the phone. I have to be honest, even though people had said it was nothing, I think I always had a feeling deep down it was going to turn out to be something—I don’t know why.
I called my husband immediately, and through tears I told him I had cancer. He told me he was on his way, and just left work without even telling them why. He came home, and he held me and I cried.
I already had an action plan that no matter what happened we had to get rid of it, no matter what it entailed—a hysterectomy, whatever!  At that point we had no idea what stage it was at, or really any idea at all of what were the options for cervical cancer. The doctor was nice enough though to give us her direct number so we could talk to her anytime during the weekend (although later we found out we still had to go through a secretary who wasn’t as willing to be as accommodating).
I was diagnosed six days before Christmas and 12 days before our trip to South Africa where our daughter was going to meet her grandparents for the first time. We had no idea if we would still be able to go.
We told my family that night, and they had no idea any of this was going on and were completely caught by surprise. Of course they were supportive, and just as we did, they wanted answers. We made some phone calls to the doctor, tried to get a few answers, but still felt very in the dark even after getting off the phone. There wasn’t really anything we could do until we had the scans, saw the oncologist, and could determine what stage the cancer was at. In the meantime I could go to South Africa, enjoy my holiday as it would not delay my treatment since mostly everyone would be on holidays over Christmas. I was told cervical cancer generally moves very slowly, so it would not do any harm waiting a month or so. Of course, this is never what you want to hear, as all of us wanted this dealt with like yesterday.
We went to South Africa though, surprised my in-laws with a visit from their first grandchild and then surprised them a few days later with my diagnosis. They were also devastated, but very supportive. We didn’t tell anyone else until after I had more answers as to the stage of my cancer, as we wanted to be able to give people more information.
My first scan was on January 26, 2009. I finally saw the oncologist on January 29. I was fully prepared to have the hysterectomy, but he told us of a new procedure called a trachelectomy that removes the cervix and upper vaginal canal but leaves the uterus and ovaries in place to hopefully maintain fertility. This procedure was only done two places in Canada, so I would have to travel, but he really felt it was the best option. With the idea that my husband and I always wanted to have more than one child, we decided to go ahead with the procedure, and the doctor told us he would get us in within a couple of weeks.
After a week, I still had heard nothing of my impending surgery date, so I started making phone calls to Toronto (where I had been told I would be sent). The doctor in Toronto said he would get me in quickly, and not to worry because cervical cancer is generally a very slow moving cancer and I had nothing to worry about. His receptionist told me different stories each day, and said that my situation was very complicated and there would be no way she could get me in that quickly; I would just have to wait. Later when I got to Toronto I found out one of my files was still sitting on her desk and had never even been opened. I finally got my surgery date for March 12, 2009.
In order to travel to Toronto my family and friends threw a fundraiser in my honour which raised over $8000! I felt so lucky and truly blessed. Cancer may be terrible, but I definitely realized how many wonderful people I had in my life.
When I got to Toronto I had a few days of appointments with various parts of the Cancer Centre there to get all the information I needed for the surgery. One was another colposcopy that resulted in the doctor telling me my tumour had nearly grown to three centimetres, and may be at the point where he could not do the new procedure, but he wouldn’t know until he was in surgery. Luckily, he was able to perform the trachelectomy. I was only supposed to be booked as a day surgery, but ended up spending three nights in hospital because of complications with low blood pressure and intense bleeding.
Finally I got to go home and be with my family during my recovery. My husband had come with me to Toronto, but I had to leave my daughter for the first time and that was the hardest part of this entire journey. During my recovery I was not allowed to pick my daughter up for six weeks, so I had to depend on people to hand her to me. I would rock her to sleep every night so I still felt like I was being active in her life (it made for some very bad sleep habits later on though). My mom was fantastic and took sick leave from work from the time of my surgery until the time of my final treatments to help take care of me and my daughter.
A week or so after my surgery, I went in to see my oncologist in Saskatoon, and he told me that the cancer had spread to my lymph nodes, which would require radiation and chemotherapy, and also an ovary suspension to keep my ovaries out of the radiation beams and prevent early menopause.
I had my ovary suspension April 23, 2009, and had another six weeks of not being able to lift my daughter. My mom continued to help me, and my mother-in-law even flew from South Africa to help for two weeks. My radiation started in the middle of May: 25 rounds, and my chemo at the same time, five treatments of cisplatin. I was very lucky and didn’t have a large enough dose of chemo to lose my hair, although it did thin. Luckily I have very thick hair so no one could tell but me. I completed my treatments June 18, 2009.
Since finishing my treatments, I continue to see my oncologist now every four months. There have been a few scares a couple times with abnormalities arising, and new biopsies being done, but thankfully everything comes back negative. I have had quite a few trips to the emergency room as well, for complications arising from my surgery (a few bleeding episodes, ovarian cysts).
After all is said and done, I have never felt sorry for myself or been angry that I have cancer, but I do question the decisions that were made in my treatment. If I were to have to do it again, I don’t think I would have had the tracheotomy as there are so many complications and unknowns that have arisen from it, answers that people can’t give me, and because of the radiation and chemo I can no longer have any more children. I’m not saying I regret it because I believe we are always learning from our experiences, I just would’ve done it differently and want to share my experience with others so they know to educate themselves with their options instead of just taking the first thing they are told.
In which hospitals were you treated?
Sunnybrook Cancer Centre, Toronto - Allan Blair Cancer Centre, Saskatoon
At what level of education were you at diagnosis?  
Working full-time.
What were your first thoughts when diagnosed?
I am going to beat this; my daughter needs me. I don’t know if I’ve still ever dealt with the emotion of the diagnosis. I have always felt like I’m telling people about someone else who has cancer.
How did your family react?
Sad, scared, and supportive. My sister’s best friend died of breast cancer one month after my diagnosis; she was 31. I think dealing with that on top of my diagnosis really freaked my family out, although they never said that to me.
How did your friends react?
My friends were amazing and still are!
What is your current medical status?
Clear, but no one will use the words remission or cancer-free.
How is life different for you now post diagnosis?
I feel like I have a story to share, not just with my cancer experience, but with the events in my life that I now believe have lead to my diagnosis. I want to change the world, in a manner of speaking, and more so I want to change the face of cancer in Canada so it is more recognized that young adults are being diagnosed more and more every day. I don’t feel like the petty things in life are worth worrying about anymore, and I sometimes have trouble being around people who I feel are negative and have bad energy in a matter of speaking. I like to surround myself with positive people, with a great energy, as I feel now more than before that energy from other people affects me more than ever.
What is the toughest part of your challenge?
I find the waiting in between treatments, and appointments to be the hardest. I always felt very positive while going through everything, and like I said, as though someone else was going through it. The time in between though, I find questions arise about my health and treatment, that is sometimes hard to deal with; and whenever I have something wrong with me now there is always the thought that comes to my head—is the cancer back? I don’t know if that ever goes away.
What was the best lesson you took away from your challenge?
To cherish the time I have with my daughter and to enjoy life more and try not to stress so much. I don’t know if I’ve lived up to the latter part of that statement as much as I could, but I had always planned to go back to work full time after having children. Now I’ve decided to only work part time, and it was the best decision I ever made. I have more time with my daughter, more time to do the things I love, and be with the people I love.
What really motivated you to keep going while you were sick?
My daughter.
What are your thoughts and feelings about your illness now?  How have they changed since before your diagnosis?
I feel now, nearly three years after my diagnosis, I am just starting to deal with the emotions that surround it. I find I want to reach out more, and find people that have gone through similar experiences, and get answers from professionals about the treatment of cervical cancer—answers I maybe should have sought out at the time of my diagnosis.
What are some preventative measures people can take to lower their risk of having an experience like yours?
Educate yourself, and have an advocate for yourself (family, friend whoever) that can help you get the information you need to make the right decisions with your treatment, and make all the critical phone calls to health centres. You are dealing with enough when you are diagnosed, it helps to have someone there to deal with the stressful stuff so you can just relax and concentrate on yourself for a while.
Did you attend any support groups during your challenge?
I did not. I always felt very detached from my diagnosis, and it is only now that I am trying to connect with people in similar situations. I am looking to start a support group now in Saskatchewan for young adults with cancer, as I have since found there is not much in my city for that.

SAMANTHA PATRICIA MCDOWELL









Name: Samantha Patricia McDowell
Age: I am 24 years old (d.o.b. Aug 3, 1986)
What school did you attend? I graduated from high school (Sir Winston Churchill)
Where do you work? I work in the insurance industry
What is your career goal? My career goal would be to eventually go to school and get accepted into nursing

How did you find out you were sick?
I would consider myself in good health for my age and since I turned 18 I have always had my yearly checkups. I had started to notice random bleeding after intercourse but didn’t think anything of it. I booked a physical with my doctor for a pap. It came back irregular (cells) and my doctor recommended I get a colposcopy to look into it a bit further but she reassured me I should not be concerned about it. The results came back early. I will never forget this day and forever hope I’ll never experience this kind of pain ever again. The doctor that had taken my tissue sample called me at work and all he said was, “Are you alone? You have cancer.” I felt my entire world stop and the room started to spin. Is this the end? And I just broke down.

What year were you diagnosed? How old were you at the time?
I was diagnosed in 2010 and I was 23 years old.

What was your diagnosis? 
I was diagnosed with Cervical Cancer stage 1B

What were your thoughts when you were diagnosed?
I instantly thought “this is a bad dream and I will wake up anytime now.” I just could barely grasp the concept that I—at the age of 23—had cervical cancer. Seriously, how does one my age cope with this deadly disease—I am yet to experience life and what it has to offer. Was I being punished for things that happened in the past?  Or does God have another plan for me once my lifetime is over. All I could do was cry and cry until I cried myself to sleep night after night. Pure denial. Depression started to grow on me.

How did your family react?   
I had called my mother of who was living in Lethbridge at the time (two hours away from me). She did not believe me and demanded that she called the doctor to get the clear story; she just told me I was being dramatic and I didn’t listen to what the doctor said. Soon enough she faced the hard facts and put on a smile and told me we’d get through this together. She’s my hero. My father and siblings where my strongest support. My dad is as tough as nails and he didn’t even fret, or at least he didn’t in front of me. I’d talk to him everyday and he’d cheer me up by giving me positive feedback and just by giving me the boost I needed to hear. I developed a better relationship with my sister and at the time one of my brothers finally reached out and supported me.

How did your friends react?
Most of my friend where there for me and a lot of my co-workers helped out a lot with cards, emails, and calls. I found a few close friends grew rather distant and also my boyfriend had given up on me in the midst of healing. You definitely find out who you want in your life when you get diagnosed and deal with cancer—it’s unfortunate that people walk out of your life but I understand sometimes it’s a lot to handle especially when we are young.

What did your treatment consist of?
Finding out what treatment would work best for me was probably the hardest part because this is the biggest decision I’d ever make in my life. I couldn’t do this on my own so I had the support of my parents, my (ex) boyfriend’s mother, myself, and my doctor. We had eventually decided that chemotherapy for three months (once every three weeks) and the major surgery, radical tracheotomy. The chemo was to try to clear out my cells of the bad cancer and the surgery is not common but it would allow me to have children later in life.

How did you feel?
Chemo seriously knocks the s*** out of you. I had no energy, and I lost all my hair, so I felt I lost my identity. That, by far, was the hardest part. Chemo also takes away your strength. I know for a fact I got extremely bad anxiety and very depressed. It was exactly one week after my first dose of chemotherapy that my hair started to fall out; I couldn’t believe this was all happening. As for the surgery, I was not prepared for this kind of pain. It was the kind of pain that was unbearable and my poor father had to watch me in that amount of pain, and yet he was my personal nurse helping me and encouraging me to move.

What hospital were you treated at?
I was treated at the Tom Baker Hospital in Calgary, AB

What is your current health status?
I am currently six months cancer free!

How life is different?
After dealing with the fight of your life you change drastically. I am still the same person I was before, but I’m A LOT stronger. I try not to fret on the little things in life and embrace each day at a time. I feel like I want/need to give back to the community so I joined the Cancer Society as peer support. I now have a lot more patience and feel I treat others with more care and compassion.

What was the toughest part of your challenge?
The toughest part was loosing my identity. Cancer stripped me of who I was. I hated how not only did I have cancer, but my family also had to deal with it. I could always feel the worry in my mother’s voice and I remember her coming to my first dose of chemo. All we could do was cry, cry in fear of the unknown. I always told myself, “I have cancer, it will NEVER have me.”

What was the best part of your challenge?
The best part of being diagnosed with cancer was the new outlook I have in life. I have met so many beautiful survivors, nurses, and doctors. Most people were so humble and kind to me because they could see the pain and fear I was in. Cancer forever has changed my life, and I feel it’s for the best.

What motivated you to keep going?
I was motivated by my friends & family. My family was my #1 support system and was there for me when I was down and would always cheer me up. I had a blog that they all read every single day and commented on issues I was struggling with. I have the most amazing family and feel so blessed.

What are some preventative measures people can take to avoid an experience like yours?
I was one of the few women that had HPV and for whatever reason this formed into cancer. I truly wish they had more education about this virus.

Did you attend any support groups?
I attended a lot of support groups at the Wellness Center in Calgary. My favorite part was the beauty class where we all were taught how to apply makeup when we had no hair and eyelashes, etc. The smile on these women’s faces after the makeup was applied was priceless. I felt normal with all these women for the first time in months. 

HOLLY LE TUAL

Age: 28
Hometown: St. John's, Newfoundland
Do you work?
I am working as an IT Business Analyst for a Satellite Communications Company, here in St. John's.
How did you find out you were sick?
I simply went for my yearly checkup with my family doctor.  At the time, I had no idea anything was wrong, no symptoms of cancer and I felt I was in perfect health.
What year was it?What was your age at the time? 2008, I was 27
What was your diagnosis? Cervical Cancer
What were your first thoughts when diagnosed?
I think everyone is scared when they hear the "C" word.  My first thoughts were wondering how bad it was and if it had already spread to any of my organs.
How did your family react?
My family was worried, but very supportive!  They were with me every step of the way.  My parents helped with my children, and my boyfriend kept me smiling and laughing everyday.
How did your friends react?
I have a very large circle of friends.  My Friends at work and in my networks were amazing!  Everyone was very encouraging and very supportive.
What did your treatment consist of?
My treatment consisted of several biopsies, laser treatment and eventually a hysterectomy.
 
What is your current medical status? Cancer Free!
What was the toughest part of your challenge?
I'd say the toughest part was having people worry about me. It's hard to see your parents upset.
What was the best part about having your challenge? You learn to appreciate your health and to not take things for granted!
What really motivated you to keep going while you were/are sick?
While I was going to appointments and resting up after surgeries, my children kept me going. They're awesome. No matter how tired I was, or whatever else was going on, I was still their mom!  They read me stories while I was resting, and bought me snacks. They definitely kept me smiling and happy!
What lessons or messages have you taken away from your experience?  Live!  Just enjoy every day like it's your last!
What are some (if there are any you know of) preventative measures that people can take to lower their risk of having an experience like yours?
Never ever skip your yearly check up!  Women take that for granted and think there's nothing wrong if you're feeling ok.  I've been pushing all my friends to keep up with their checkups and to never assume anything because you really just don't know.

What is cervical cancer?

The cervix is the lower part of the uterus (womb). It is sometimes called the uterine cervix. The body of the uterus (the upper part) is where a baby grows. The cervix connects the body of the uterus to the vagina (birth canal). The part of the cervix closest to the body of the uterus is called the endocervix. The part next to the vagina is the exocervix (or ectocervix). The 2 main types of cells covering the cervix are squamous cells (on the exocervix) and glandular cells (on the endocervix). The place where these 2 cell types meet is called the transformation zone. Most cervical cancers start in the transformation zone


Most cervical cancers begin in the cells lining the cervix. These cells do not suddenly change into cancer. Instead, the normal cells of the cervix first gradually develop pre-cancerous changes that turn into cancer. Doctors use several terms to describe these pre-cancerous changes, including cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL), and dysplasia. These changes can be detected by the Pap test and treated to prevent the development of cancer (see "Can cervical cancer be prevented?").
Cervical cancers and cervical pre-cancers are classified by how they look under a microscope. There are 2 main types of cervical cancers: squamous cell carcinoma and adenocarcinoma. About 80% to 90% of cervical cancers are squamous cell carcinomas. These cancers are from the squamous cells that cover the surface of the exocervix. Under the microscope, this type of cancer is made up of cells that are like squamous cells. Squamous cell carcinomas most often begin where the exocervix joins the endocervix.
Most of the other cervical cancers are adenocarcinomas. Cervical adenocarcinomas seem to have becoming more common in the past 20 to 30 years. Cervical adenocarcinoma develops from the mucus-producing gland cells of the endocervix. Less commonly, cervical cancers have features of both squamous cell carcinomas and adenocarcinomas. These are called adenosquamous carcinomas or mixed carcinomas.
Although cervical cancers start from cells with pre-cancerous changes (pre-cancers), only some of the women with pre-cancers of the cervix will develop cancer. The change from cervical pre-cancer to cervical cancer usually takes several years, but it can happen in less than a year. For most women, pre-cancerous cells will go away without any treatment. Still, in some women pre-cancers turn into true (invasive) cancers. Treating all pre-cancers can prevent almost all true cancers. Pre-cancerous changes and specific types of treatment for pre-cancers are discussed in the sections, "How are cervical cancers and pre-cancers diagnosed?" and "Treating pre-cancers and other abnormal Pap test results."
Pre-cancerous changes are separated into different categories based on how the cells of the cervix look under a microscope. These categories are discussed in the section, "How are cervical cancers and pre-cancers diagnosed?"
Although almost all cervical cancers are either squamous cell carcinomas or adenocarcinomas, other types of cancer also can develop in the cervix. These other types, such as melanoma, sarcoma, and lymphoma, occur more commonly in other parts of the body.

How Common is Cervical Cancer?

While cervical cancer used to be a common cause of cancer death among women in the United States, it is now much less common. In 2007, it is estimated that over 11,000 women will be diagnosed with invasive cervical cancer in 2007 within the United States. Over 40,000 will be diagnosed with non-invasive cervical cancer. Unfortunately, 3,670 women will die of the disease in 2007.

In underdeveloped countries, cervical cancer is the second leading cause of cancer related death in women.

What are the Symptoms of Cervical Cancer?

In the early stages of cervical cancer, there usually are no symptoms. Cervical cancer symptoms begin to appear as the disease advances, invading deeper into the cervix and surrounding tissue. As the disease progresses, women may experience:

• abnormal vaginal bleeding, including post-coital bleeding
  
• pain during sexual intercourse, however this can be common and unrelated to cervical cancer
  
• pelvic pain
  
• heavy vaginal discharge

What are the Risk Factors for Cervical Cancer?

One of the main risks for developing cervical cancer being infected with the human papillomavirus (HPV). HPV is a common virus that is transmitted through sexual contact. Other cervical cancer risk factors include having sex at an early age, smoking cigarettes, having multiple sexual partners, and having a weakened immune system.

Keep in mind that risk factors only increase the likelihood of developing cervical cancer, they do not guarantee you will develop it.

• Cervical Cancer Risk Factors
• HPV and Cervical Cancer

How is Cervical Cancer Diagnosed?

The first step in diagnosing cervical cancer is through the Pap smear, a simple test that allows cervical cells to be examined under a microscope. If suspicious cells are found, then a colposcopy is performed. A colposcopy allows a doctor to view the cervix more closely. During the colpsocopy, a cervical biopsy may be done. If the biopsy finds cancerous cells, additional tests will be done to determine the stage of the disease.

• What to Expect During a Pap Smear
• How Often Should You Have a Pap Smear?
• The Best Time to Have a Pap Smear

How is Cervical Cancer Treated?

Cervical cancer is treated in several ways. The type of cervical cancer and the stage of the disease greatly affects what treatment methods are used.

Cervical cancer may be treated with surgery, such as a hysterectomy. Other forms forms of treatment include chemotherapy and radiation therapy. Treatment varies from patient to patient. One patient may only have surgery, while another may undergo several types of treatment. It all depends on the type and stage of cervical cancer.

• Cervical Cancer Treatment Overview
• Treating Cervical Cancer with Chemotherapy
• Radiation Therapy and Cervical Cancer