Healthy Skin Dos and Don'ts

Healthy Skin Dos and Don'ts

The key to healthy skin lies beyond which soap you use. It depends on what you eat, whether you exercise, how much stress you're under and even the kind of environment in which you live and work.
All of these things affect how fast your skin ages, and thus how it will look, by influencing certain processes that lead to oxidation and inflammation. Sounds complicated, but it really is not.
Basically, complex chemical processes in your body produce unstable molecules called free radicals. Think of them as Skin Enemy No. 1. Left to their own devices, they go on to damage otherwise healthy cells in a process called oxidation. This is the same process that turns an apple brown or changes a copper roof from reddish gold to blue-green, so you can just imagine the way it can affect your skin. Sun, smoking, air pollution and poor diet all speed production of these free radicals.
Luckily, your body also produces antioxidants, molecules whose job it is to sweep up those free radicals before they can do any serious harm. How you take care of yourself—including what you eat—can increase production of these valuable molecules, literally saving your skin.
Nutrition and your skin
Women have been using foods as facial treatments for centuries, making masks of egg whites and olive oil, putting cucumbers over their eyes to reduce swelling. But did you know that the food you put in your mouth can affect the health of your skin more than anything you could put on your face?
Although studies find certain individual foods can help you maintain healthy skin, your overall diet—as well as your weight—matters most. For instance, if you're overweight and/or you eat a diet high in processed foods, including white bread, cookies, ice cream and packaged dinners, and low in fiber and fresh fruits and vegetables, you have a higher risk of developing a condition called insulin resistance, which can lead to diabetes.
In this condition, insulin, a hormone that "unlocks" the cell so glucose, or fuel, can get in, doesn't work very well. Thus, all this glucose builds up in your bloodstream instead of disappearing into cells where it's supposed to go. This, in turn, damages skin. How? By reacting with the protein fiber network (i.e., collagen and other proteins) that make skin resilient. This reaction creates harmful waste products called advanced glycosylation endproducts, or AGEs, those free radicals mentioned earlier. Fibers stiffen, skin loses it elasticity and you become more vulnerable to wrinkling, sagging and damage from ultraviolet (UV) light.
But eat a varied and nutritious diet, and it's amazing what can happen to your skin. In one study, researchers from Monash University in Australia found people who ate the most fruits, vegetables and fish had the least amount of wrinkles. However, the researchers found, diets high in saturated fat, including meat, butter and full-fat dairy, as well as soft drinks, cakes, pastries and potatoes (called "high-glycemic" foods), increased the likelihood of skin wrinkling. Coincidentally, these high-glycemic foods are also implicated in insulin resistance.
So, if you want to follow a skin-healthy diet, make sure you pack your diet full of these nutrients

Vitamins E and C. Studies find these vitamins can help protect your skin from the harmful effects of the sun, particularly in supplement form. Meanwhile, vitamin C is a valuable nutrient in collagen synthesis, the protein that helps hold skin together and give it tone. If you do supplement, don't exceed 400 IU of vitamin E because it could increase the risk of bleeding. Best food sources: vegetable oils, margarine, eggs, fish, whole-grain cereals and dried beans for vitamin E; citrus fruits, berries, potatoes, tomatoes, sweet and hot peppers and leafy green vegetables for vitamin C.
Essential fatty acids. Several studies find that the amount of poly- and monounsaturated fats, particularly omega-3 fatty acids, in your diet can minimize sun and aging damage to your skin. Best food sources: cold-water fish, such as salmon, mackerel and tuna. For healthy mono fats, stick with olive oil and nuts.
Tea. Tea, particularly green tea, is an excellent source of antioxidants called polyphenols. That may be why one Arizona study found that the more hot tea people drank (particularly tea with lemon) the less likely they were to develop squamous cell skin cancer.
Vitamin A. Another powerful antioxidant, vitamin A forms the basis for a slew of pharmaceutical and over-the-counter skin products that contain retinoids. One study found a strong connection between vitamin A levels in the blood (an indicator of the amount in the diet) and skin dryness; the more vitamin A, the moister the skin. You shouldn't supplement with vitamin A, and it's hard to get enough via food, but it's easy to get vitamin A's precursor—beta-carotene—which is converted to vitamin A in your intestine. Best food sources: orange, red and yellow fruits; vegetables such as carrots, sweet potatoes, tomatoes and cantaloupe; and green leafy vegetables such as spinach and broccoli.
Exercise and your skin
You know the glow your skin takes on after a brisk walk outside or a tough aerobics class? Generally, that's related to perspiration, which is one way your body gets rid of toxins.
But exercise does much more than flush impurities out of your skin. It also promotes production of sebum, or oil, your skin's natural moisturizer, and enhances blood flow to the skin. That's important because blood carries oxygen and valuable nutrients that help maintain skin health.
Plus, regular physical activity helps you maintain a healthy weight and keep insulin resistance at bay. Exercise is also an important way to manage stress. If you're exercising outdoors, though, remember to protect your face and body from UVA and UVB rays by wearing a moisturizer with sunscreen protection. You don't want to "undo" all the good of that workout.
The environment and your skin
If you've ever had to slather on the moisturizer after a cross-country airplane flight or suffered a breakout while visiting a large urban city, then you know firsthand the way the environment can affect your skin.
It's never too late to quit smoking. Quit today, and your skin will show the health benefits tomorrow. Air pollution, the dry, recirculated air of an airplane, smoking and, of course, the sun are all enemies of skin health. They increase the production of free radicals, strip antioxidants from your skin and intensify the effects of aging. Smoking, for instance, constricts blood vessels, reducing blood flow to the skin. It also depletes levels of valuable antioxidant vitamins like vitamin A, increasing damage to the elastin, the elastic fibers in your skin that provide a healthy tone. Just the smoke curling up from the cigarette can damage skin as much as any other pollutant. In fact, studies find that people who smoke have significantly more wrinkles at an earlier age than those who don't. Of course, the greatest damage to your skin occurs from the ultraviolet rays of the sun. Over time, the sun, like smoking, damages elastin and collagen, leading to the formation of fine lines and wrinkles. Most of the damage occurs in your childhood years—it just doesn't show up until middle age.
And it's not just soaking up the rays on the beach that does the damage. Simply sitting near a window, driving your car and walking outside also expose you to the harmful rays of the sun, and these are all activities in which you're much less likely to wear sunscreen. No wonder, then, that skin cancer is the most common cancer in the United States, with more than one million skin cancers diagnosed each year. Overall, one in six Americans will develop skin cancer at some point in their lives. The reality is that there is no such thing as a healthy tan—unless it's one that comes out of a bottle.
Five suncreen facts
The higher the SPF (sun protection factor) the better. That's not only because of the increased protection higher SPF sunscreens provide, but because most people don't use nearly enough to begin with. However, the SPF only indicates protection provided against UVB rays—not the invisible, ultraviolet-A rays that can also affect skin health and hasten the aging process. That's why you need a broad-spectrum sunscreen.
The more the better. You need to apply at least a shot glass's worth of sunscreen every couple of hours you're in the sun. In fact, you should reapply your sunscreen every two to four hours. That means a six-ounce bottle of sunscreen should last just a couple of visits to the beach—not all summer.
UVB protection isn't enough. Early versions of sunscreen only protected against UVB rays, but both UVB and UVA rays contribute to skin cancer. To find a sunscreen that protects against both, look for Parsol 1789, also called avobenzone, zinc oxide or titanium dioxide on the ingredients list. Stay posted for what dermatologists are calling the superpower of sunscreen protection—a chemical called mexoryl, which has an SPF of 60 and provides much greater protection against UVA rays than anything else on the market. Available in Europe and Australia, it is under consideration for approval by the U.S. Food and Drug Administration (FDA).
SPF has nothing to do with how long you can stay in the sun. Studies find that people think the higher the SPF rating, the longer they can stay out in the sun. That's simply not true. While higher numbered products (SPF-40, for example) do provide more protection, using sunscreen doesn't prevent all the possible harmful effects of the sun. Plus, few people use sunscreen the right way—a full ounce every couple of hours; more if you've been swimming or sweating.
You need more than sunscreen to protect your skin from the sun. You also need a hat, protective clothing and a time limit for your stay in the sun.

Stress and your skin
Whether you're stressed about your job, a family member's health, a crumbling marriage or your first child going off to college, stress has a sneaky way of showing up on your face and skin. Think of it as your body's way of communicating what's going on inside to the outside world. There's even a name for it: psychodermatology.
The stress in your life turns up on your face. For instance, studies find that stress triggers 62 percent of psoriasis episodes (an inflammatory skin condition), with flares occurring within days of the emotional upset. Most hyperhidrosis episodes (in which you sweat excessively) are related to stress, and 94 percent of episodes in women with rosacea—a skin condition marked by excessive redness and bumps on the face—have an emotional trigger. Thus, you can see the very strong mind/body connection that exists between our emotions and our skin health. The connection is probably related to the immune system and the way it reacts to stress. Short bursts of stress—like those from a good workout—can improve your skin. But, when you're exposed to chronic stress—stress that just won't stop—or a lot of stress all at once, your immune system can get overloaded. The result? Negative effects on your skin. So it's important you learn to recognize the stressors in your life and modify your reactions to them. Relaxation techniques, biofeedback and breathing training can help you cope better with life stresses and reduce their effects on your skin.
A 2001 survey by the American Society for Dermatologic Surgery (ASDS) found that about 45 percent of dermatologic surgeons reported an increase in the number of patients they saw who needed corrective treatment for burns, splotching, irreversible pigmentation and scarring resulting from various medical procedures performed by aestheticians, cosmetic technicians and employees of physicians without appropriate physician supervision.
Make sure you're seeing the right skin-care professional for the right reason. And always look for physicians who are board-certified in their specialty. This means they've passed an intense examination and take continuing education courses to maintain their knowledge and skills.
Finding the right skin care professional

Healthy Skin Dos and Don'ts

Skin Care Professional	Reason to Visit	Special Training
Dermatologist	Prevention and treatment of hair, nail conditions.	After medical school and internship, completes three-year residency in dermatology.
Dermatologic surgeon	Surgical and non-surgical skin treatments.	Same as dermatologists; many also complete one- or two-year fellowships in dermatologic surgery. Many are members of the American Society for Dermatologic Surgery (ASDS).
Plastic surgeon	Cosmetic or reconstructive surgery.	After completion of medical school and internship, three-year residency in plastic surgery, often followed by fellowships in subspecialties.
Esthetician	Facial and non-invasive, non-medical skin treatments.	Cannot prescribe medication; should not use complex machines like lasers. Depends on state licensing laws. All states except Connecticut license estheticians, although requirements vary.

Natural Pain Relief Methods for Childbirth

Natural Pain Relief Methods for Childbirth

Many expecting women worry about the culmination of pregnancy—childbirth. What will it feel like? How bad will the pain be? Can I handle it? Being prepared with tools to cope can help instill confidence as your due date approaches and can create a more positive birth experience.

The pain that occurs during labor is caused by the contractions of the muscles in the uterus and the opening (dilation) of the cervix. It's often described as an intense cramping sensation in the belly, groin and lower back, sometimes radiating to the sides and thighs. It may start out feeling like menstrual cramps and then become much more intense, depending on the individual. Other sensations may include pressure on the bladder, the large intestines and the perineum as the baby's head descends.
 Many women opt for medical interventions, most commonly the epidural, which is a regional anesthesia injected into the back that blocks pain by numbing sensation in the lower half of the body. While many are pleased with the outcome of this intervention, others experience a stall in labor and difficulty pushing, as well as side effects of vomiting and shaking. There is also a risk of a drop in blood pressure and, rarely, severe headache if there is any spinal fluid leakage, as well as difficulty urinating, backache and some other very rare complications. The baby may experience breastfeeding or respiratory difficulties, though research in these areas remains uncertain.

Learn more about medical pain management options here.

So what other options are there? Opting for natural childbirth doesn't mean going in unprepared. The following techniques, when practiced prior to labor, have been extremely effective pain-management tools for women opting for a drug-free labor.

1. Lamaze
The Lamaze technique is one of the most commonly used methods in the United States for managing pain during childbirth. Often this method is what is taught in hospital childbirth education classes. Lamaze classes teach the philosophy that giving birth is normal, natural and healthy. A certified instructor coaches expecting parents through relaxation techniques, physical coping methods, breathing exercises and distraction techniques, which can ultimately help lower your perception of pain. The classes also educate attendees about childbirth so that they can make educated choices, including finding the right health care provider and birth environment. When it comes to medical interventions for pain management, the Lamaze technique does not take a specific stance, and it encourages women to make informed decisions as to whether physician-provided medication may be beneficial.
2. Bradley
The Bradley method, also referred to as the Husband-Coached Birth, aims to involve the partner as a birthing coach. It takes a holistic approach, by addressing overall prenatal health, including healthy eating and exercise. For childbirth, it promotes relaxation and deep-breathing techniques that work with the body's natural abilities to manage the pain, instead of receiving medication. It also encourages alternative pain management options, such as hypnosis, yoga, meditation, walking and massage. The standard length of classes is 12 weeks, and they include general childbirth education.

3. Hypnobirth
Hypnobirthing is a technique that aims to take the fear out of childbirth and create a more relaxing environment through self and partner-led hypnosis. It utilizes breathing techniques, guided imagery, visualization, counting and vocalization, all practiced through a series of classes, guided hypnosis CDs and a script that can be read by a birth partner or doula. It allows the mother to be in a meditative trance-like state, noticing and coping with contractions rather then resisting or fearing them, but still able to easily come out of the state if the need arises. A woman in labor who is practicing hypnobirthing often looks opposite to the childbirth images often portrayed in movies. Many practitioners describe them as quiet and internal. This technique is ideal for women who regularly meditate but can be used by anyone. Childbirth education classes may be needed in addition, depending on the specific class curriculum.
If you're unsure of which of these pain management options is right for you, talk with other moms about their birth experiences, and seek guidance from your health care provider or a specialist.

5 Ways to Prepare for Pregnancy

5 Ways to Prepare for Pregnancy

Technology can help in many ways, but don't overlook basic health practices when planning for pregnancy. For example, one of the most important things you can do for yourself and your baby is also one of the simplest: remember to take a daily vitamin before you try to get pregnant and throughout your pregnancy. Folic acid, found in prenatal vitamins, can slash the risk of major birth defects of the fetus' brain and spine between 50 and 70 percent. There's even some evidence it can reduce the risk of other birth defects, including cleft palate, stomach problems and defects in arms and hands.
That's why the U.S. Food and Drug Administration mandated fortifying all cereal products with folic acid in 1998. Since then, the incidence of neural tube defects dropped 26 percent.
All of which makes pre-pregnancy planning important, says Michelle Collins, CNM, a certified nurse midwife and clinical faculty member at Vanderbilt University in Nashville, TN. Pre-pregnancy or "preconception" planning involves a visit to your health care provider for a full medical evaluation, including a detailed medical history before you begin trying to get pregnant.

Consider the affect of preexisting conditions and current medications on pregnancyIt's a time to consider how you'll treat any preexisting condition that requires medication, such as depression, diabetes or epilepsy. A woman with diabetes, for instance, runs the risk of having a child with cardiovascular disease or other problems if her blood sugar levels aren't well-controlled before and during her pregnancy, says Ms. Reynolds. Plus, certain anti-seizure medications may cause defects in the infant by interfering with a woman's ability to use folic acid. And in late 2005, the FDA warned pregnant women not to use paroxetine (Paxil), a popular antidepressant, during pregnancy because of a potentially higher risk of birth defects.
That doesn't mean you have to stop taking all medications during pregnancy, says Ms. Reynolds. Usually, there are alternatives available that have been shown to be safer during pregnancy.

Understand how your weight can affect your chances of conceivingThe time before pregnancy is also the time to address any weight problems. Studies find that being overweight can increase your risk of gestational diabetes and may even make it harder to get pregnant. Conversely, being underweight can interfere with fertility.
Quit smoking before you get pregnant
And, of course, it's a time to quit smoking. Smoking not only increases the risk of having a low birth-weight baby, but also a baby with Down syndrome and a multitude of other birth defects.
Discuss preconception and genetic counseling with your health care provider and your options for pregnancy
In addition to preconception counseling, women might consider genetic counseling before they get pregnant, says Ms. Reynolds. During genetic counseling, a specially trained counselor takes a detailed medical history of you and your partner, as well as your families, to identify any potential or known genetic disorders. "Often, it is only when a woman becomes pregnant that genetic disorders come up, and for some, it's too late to make a difference in promoting a healthy outcome," she says. But even here, technology can step in.
A relatively new form of in vitro fertilization called preimplantation genetic diagnosis (PGD) can enable couples who carry genes for genetic disorders like Tay-Sachs or sickle cell anemia to have a healthy child. The procedure involves removing one cell from an eight-cell embryo and studying it for any genetic abnormalities. Only those embryos with no obvious problems are implanted into the woman's uterus.

The procedure isn't 100 percent effective, however. University of Florida researchers find that about 1.5 percent of embryos may be implanted with undetected genetic disorders because of a rare condition called chromosomal mosaicism.
But for women who know they have a genetic risk for one of these devastating diseases, PGD can be a tremendous advantage.
Another advantage is a test given to women in the first trimester of pregnancy who have a risk of having a child born with Down syndrome. The disorder is the most common chromosomal abnormality, affecting about one in 800 babies born each year.
Previously, the only way to know if a woman was having a baby with Down's was with second-trimester blood tests and/or invasive amniocentesis or chorionic villus sampling (CVS) tests, all of which carry a slight risk of miscarriage. If a woman then decided to terminate the pregnancy, she faced a more complex and emotionally wrenching second-trimester abortion.

But a major study published in the New England Journal of Medicine in November 2005 found that screening in the first trimester with an ultrasound and blood test can identify most fetuses with Down syndrome between the 11th and 13th weeks of pregnancy, allowing women to decide what they want to do earlier in their pregnancy.
The blood tests measure levels of certain proteins and hormones that could indicate Down's, while the ultrasound assesses the thickness of the fetus' neck, called the nuchal translucency. By learning of her risk in the first trimester, often before she even starts showing or telling people about her pregnancy, a woman has more privacy to make her decision and, if she decides to continue the pregnancy, more time to grow accustomed to the idea of having a child with Down syndrome, says Dr. Wu.

 

Psoriasis Pictures, Symptoms, Causes and Treatments

 

What Is Psoriasis?

Psoriasis is a genetically programmed inflammatory disease that affects primarily the skin in about 3% of individuals in the United States. Psoriasis begins as a small scaling papule. When multiple papules coalesce, they form scaling plaques. These plaques tend to occur in the scalp, elbows, and knees.
 

Symptoms of Psoriasis

Although psoriatic plaques can be limited to only a few small areas, the condition can involve widespread areas of skin anywhere on the body. These plaques can be itchy, and when the scale is peeled away, small bleeding points may appear. Psoriasis tends to occur in areas of trauma. This condition often waxes and wanes spontaneously.
 

Nail Psoriasis

Many patients with psoriasis have abnormal nails. Psoriatic nails often have a horizontal white or yellow margin at the tip of the nail called distal onycholysis because the nail is lifted away from the skin. There can often be small pits in the nail plate, and the nail is often yellow and crumbly.
 

Psoriatic Arthritis

Psoriasis can be associated with a destructive arthritis called psoriatic arthritis. Damage can be serious enough to permanently damage the affected joints. Prevention of joint damage in such cases is very important.
 

What Causes Psoriasis?

It is now clear that there is a genetic basis for psoriasis. This hereditary predisposition is necessary before the disease can be triggered by environmental factors. White blood cells called T-cells mediate the development of the psoriatic plaques that we seen in the skin.
 

Psoriasis Triggers

The environmental factors that seem to trigger psoriasis include:

• streptococcal sore throat,
• trauma to the skin,
• certain drugs,
• alcohol in excess.

 

The Stigma of Psoriasis

There is plenty of evidence that extensive psoriasis can have a very significant negative effect on a patient’s self-image and emotions. This is especially true in social situations, although all aspects of life can be disturbed. Inverse psoriasis, which affects the genital skin, and scalp psoriasis can be particularly troubling. Psoriasis affecting the hands may make it impossible to interact normally with others.
 

Diagnosing Psoriasis

Psoriasis is often diagnosed by a competent physician or at least suspected on the basis of its appearance and distribution. Occasionally it may be necessary to remove a small piece of skin (a biopsy) and have it examined by a pathologist to confirm this conviction. If there are joint symptoms, X-rays and other laboratory tests may be in order. Psoriasis cannot be cured, but like many other medical conditions, it is controllable with treatment.
 

Psoriasis Treatment: Topicals

Since psoriasis mainly affects the skin, topical treatments are very useful because they are relatively safe, quite effective, and can be applied directly to the disease. They take the form of lotions, foams, creams, ointments, gels, and shampoos. They include topical steroids, tar preparations, and calcium- modulating drugs. The precise drug used and the form in which it is delivered depends on the areas involved. In widespread disease in patients with more than 10% of the body surface involved, it may not be practical to use topical medication. treatments.
 

Psoriasis Treatment: Phototherapy

For more extensive disease, a useful option is ultraviolet light exposure. Ultraviolet light (UVL) exposure can treat large areas of skin with few side effects if performed in the physician’s office. It should be kept in mind that all UVL causes mutational events, which can lead to skin cancer. At this time, the most popular type of UVL for psoriasis is called narrow-band UVB. Only a small portion of the UVL spectrum is used, which seems to be particularly beneficial for psoriasis and may of less carcinogenic potential. This UVB is quite different from the UVA, the wavelength available in tanning salons.

 

Psoriasis Treatment: Laser Therapy

There are lasers that produce UVL in wavelengths similar to narrow-band UVB. These can be quite effective for small plaques of psoriasis, but because the areas of skin that can be treated at one time are small, they are not practical for extensive disease.
 

Psoriasis Treatment: Oral Medications

There are a variety of drugs administered systemically that are useful in controlling psoriasis. The choice of which drug to use depends upon many factors which make this a very individual choice. Since these drugs are administered either orally or through the skin, they are more risky for the patient than topical medications. As a generalization, most seem to act by targeting portions of the immune system. The only exception currently is a drug called acitretin (Soriatane), which is structurally similar to vitamin A. Since the immune system is necessary in order to survive, systemic treatments do have a downside. Drugs like methotrexate and cyclosporine are administered orally and can affect the liver, kidney, and bone marrow.

Psoriasis Treatment: Biologics

A new class of drugs has recently been developed called biologics; they're called biologics because living cells synthesize them. Since these drugs are proteins, they cannot be administered orally and must be given by injection through the skin or by an intravenous infusion. These drugs are very precise in their target and block a single step in the immune process. This seems to have increased their safety profile when compared to older drugs. On the other hand, they are quite expensive.
 

atural Remedies for Psoriasis

Since the natural solar spectrum contains ultraviolet light, there is no question that heliotherapy (medicinal sunbathing) can be effective in controlling psoriasis. There is mounting evidence that increased body mass is associated with psoriasis and that heavier individuals are more difficult to treat. So a normal body mass is desirable. There is some dispute as to the role of diet in psoriasis, but a diet low in saturated fats is desirable for many reasons including weight control. So-called "natural or botanical" treatments have very little evidence to support their use.
 

Climatotherapy

At the edge of Israel's Dead Sea, there are a group of resorts that cater to psoriasis patients by offering a combination of graded solar exposure and the application of crude coal tar along with a spa-like experience. For those with the time and the money, this is a reasonable alternative to standard medical treatment.
 

Stress Reduction

Although there is no doubt that psoriasis is a potent inducer of stress, the evidence that stress causes psoriasis is sparse. Dealing with stress with or without psoriasis is a challenge for most people living in the 21st century.
 

Social Support

The National Psoriasis Foundation is an excellent source of accurate information as well as emotional support for afflicted patients.

Cervical Cancer:(Cancer of the Cervix)

Cervical Cancer (Cancer of the Cervix)

 

1. Cervical Cancer Slideshow Pictures
2. Cancer Symptoms Women Ignore Slideshow
3. Ovarian Cancer Slideshow Pictures

• Cervical cancer facts*
• What is the cervix?
• What is cancer?
• What are the risk factors and causes of cervical cancer?
• What are the symptoms of cervical cancer?
• How is cervical cancer diagnosed?
• How is staging of cervical cancer determined?
• What is the treatment for cervical cancer?
• What are methods of treatment for cervical cancer?
• How do I go about getting a second opinion?
• What follow-up care is involved after cervical cancer treatment?
• What support, research, and clinical trials information is available for cervical cancer patients?
• Patient Comments: Cervical Cancer - Risk Factors
• Patient Comments: Cervical Cancer - Symptoms
• Patient Comments: Cervical Cancer - Treatments
• Patient Comments: Cervical Cancer - Share Your Experience
• Find a local Oncologist in your town

Cervical cancer facts*

*Cervical cancer facts medical author: Melissa Conrad Stöppler, MD

• Causes and risk factors for cervical cancer have been identified and include human papillomavirus (HPV) infection, having many sexual partners, smoking, taking birth control pills, and engaging in early sexual contact.
• HPV infection may cause cervical dysplasia, or abnormal growth of cervical cells.
• Regular pelvic exams and Pap testing can detect precancerous changes in the cervix.
• Precancerous changes in the cervix may be treated with cryosurgery, cauterization, or laser surgery.
• The most common symptoms and signs of cervical cancer are abnormal vaginal bleeding, increased vaginal discharge, bleeding after going through menopause, pain during sex, and pelvic pain.
• Cervical cancer can be diagnosed using a Pap smear or other procedures that sample the cervix tissue.
• Chest X-rays, CT scan, MRI, and a PET scan may be used to determine the stage of cervical cancer.
• Cancer of the cervix requires different treatment than cancer that begins in other parts of the uterus.
• Treatment options for cervical cancer include radiation therapy, surgery, and chemotherapy.
• Two vaccines, Gardasil and Cervarix, are available to prevent HPV infection.
• The prognosis of cervical cancer depends upon the stage and type of cervical cancer and the tumor size.

 

What is the cervix?

The cervix is part of a woman's reproductive system. It's in the pelvis. The cervix is the lower, narrow part of the uterus (womb).
The cervix is a passageway:

• The cervix connects the uterus to the vagina. During a menstrual period, blood flows from the uterus through the cervix into the vagina. The vagina leads to the outside of the body.
• The cervix makes mucus. During sex, mucus helps sperm move from the vagina through the cervix into the uterus.
• During pregnancy, the cervix is tightly closed to help keep the baby inside the uterus. During childbirth, the cervix opens to allow the baby to pass through the vagina.

What is cancer?

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the cervix and other organs of the body.
Normal cervical cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, and new cells take their place.
Sometimes, this process goes wrong. New cells form when the body does not need them, and old or damaged cells do not die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.
Growths on the cervix can be benign (not cancer) or malignant (cancer):

• Benign growths (polyps, cysts, or genital warts):
  • are rarely a threat to life
  • don't invade the tissues around them
• Malignant growths (cervical cancer):
  • may become a threat to life if not found soon enough
  • can invade nearby tissues and organs
  • can spread to other parts of the body

Cervical cancer begins in cells on the surface of the cervix. Over time, the cervical cancer can invade more deeply into the cervix and nearby tissues.
Cervical cancer cells can spread by breaking away from the cervical tumor. They can travel through lymph vessels to nearby lymph nodes. Also, cancer cells can spread through the blood vessels to the lungs, liver, or bones. The process of spreading of cancer cells from the tissue in which they arise to other tissues elsewhere is called metastasis.
After spreading, cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. See the Staging section for information about cervical cancer that has spread.

Risk factors

When you get a diagnosis of cervical cancer, it's natural to wonder what may have caused the disease. Doctors usually can't explain why one woman develops cervical cancer and another doesn't.
However, we do know that a woman with certain risk factors may be more likely than other women to develop cervical cancer. A risk factor is something that may increase the chance of developing a disease.
Studies have found that infection with the virus called HPV is the cause of almost all cervical cancers. More than half of women by the age of 50 have been exposed to HPV, but most HPV infections clear up on their own. An HPV infection with a high risk type of HPV that doesn't go away can cause cervical cancer in some women.
Other risk factors, such as smoking, can act to increase the risk of cervical cancer among women infected with HPV even more.
A woman's risk of cervical cancer can be reduced by getting regular cervical cancer screening tests. If abnormal cervical cell changes are found early, cancer can be prevented by removing or killing the changed cells before they become cancer cells.
Another way a woman can reduce her risk of cervical cancer is by getting an HPV vaccine before becoming sexually active (between the ages of 9 and 26). Even women who get an HPV vaccine need regular cervical cancer screening tests. Vaccines reduce a person's  risk of getting an infection, but do not prevent such infections in every vaccinated person.

Symptoms

Early cervical cancers usually don't cause symptoms. When the cancer grows larger, women may notice abnormal vaginal bleeding:

• Bleeding that occurs between regular menstrual periods
• Bleeding after sexual intercourse, douching, or a pelvic exam
• Menstrual periods that last longer and are heavier than before
• Bleeding after going through menopause

Women may also notice...

• Increased vaginal discharge
• Pelvic pain
• Pain during sex

Cervical cancer, infections, or other health problems may cause these symptoms. A woman with any of these symptoms should tell her doctor so that problems can be diagnosed and treated as early as possible.

 

Diagnosis

Reader Stories

• Share Your Story

If you have symptoms of cervical cancer, your doctor will try to find out what's causing the problems. You may have the following tests:

• Lab tests: The doctor or nurse scrapes a sample of cells from the cervix. For a Pap test, the lab checks the sample for cervical cancer cells or abnormal cells that could become cancer later if not treated. For an HPV test, the same or a similar sample is tested for HPV infection. HPV can cause cell changes and cervical cancer.
• Cervical exam: The doctor uses a colposcope to look at the cervix. The colposcope combines a bright light with a magnifying lens to make tissue easier to see. This exam is usually done in the doctor's office or clinic.
• Tissue sample: The removal of tissue to look for cancer cells is a biopsy. Most women have cervical tissue removed in the doctor's office, and usually only local anesthesia is needed.

The doctor will remove tissue in one of the following ways:

• Punch biopsy: The doctor uses a sharp tool to pinch off small samples of cervical tissue.
• LEEP: The doctor uses an electric wire loop to slice off a thin, round piece of cervical tissue.
• Endocervical curettage: The doctor uses a curette (a small, spoon-shaped instrument) to scrape a small sample of tissue from the cervical canal. Some doctors may use a thin, soft brush instead of a curette.
• Cone biopsy: The doctor removes a cone-shaped sample of tissue. A cone biopsy lets the pathologist look at the tissue beneath the surface of the cervix to learn whether it has abnormal cells. The doctor may do this test in the hospital under general anesthesia.

A pathologist checks the tissue under a microscope for cancer cells. In most cases, a biopsy is the only sure way to tell whether cancer is present.
Removing tissue from the cervix may cause some bleeding or other discharge. The area usually heals quickly. Some women also feel some pain similar to menstrual cramps. Your doctor can suggest medicine that will help relieve any pain.
 You may want to ask the doctor these questions before having a biopsy:

• Which biopsy method do you recommend?
• How will tissue be removed?
• Will I have to go to the hospital?
• How long will it take? Will I be awake? Will it hurt?
• Are there any risks? What are the chances of infection or bleeding after the test?
• For how many days afterward should I avoid using tampons, douching, or having sex?
• Can the test affect my ability to get pregnant and have children?
• How soon will I know the results? Who will explain them to me?
• If I do have cancer, who will talk to me about the next steps? When?

Staging

If the biopsy shows that you have cancer, your doctor will need to learn the extent (stage) of the disease to help you choose the best treatment. The stage is based on whether the cancer has invaded nearby tissues or spread to other parts of the body. Cervical cancer spreads most often to nearby tissues in the pelvis or to lymph nodes. It may also spread to the lungs, liver, or bones.
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of cancer cells and the same name as the original tumor. For example, if cervical cancer spreads to the lungs, the cancer cells in the lungs are actually cervical cancer cells. The disease is metastatic cervical cancer, not lung cancer. It's treated as cervical cancer, not as lung cancer. Doctors sometimes call the new tumor in the lung "distant" disease or a distant metastasis.
Your doctor will do a pelvic exam, will feel for swollen lymph nodes, and may remove additional tissue. To learn the extent of disease, your doctor may order one or more tests:

• Chest X-ray: An X-ray of the chest can often show whether cancer has spread to the lungs.
• CT scan (CAT scan): An X-ray machine linked to a computer takes a series of detailed pictures of your pelvis, abdomen, or chest. Before a CT scan, you may receive contrast material by injection in your arm or hand, by mouth, or by enema. The contrast material makes abnormal areas easier to see. A tumor in the liver, lungs, or elsewhere in the body can show up on the CT scan.
• MRI: A powerful magnet linked to a computer makes detailed pictures of your pelvis and abdomen. Before MRI, you may receive an injection of contrast material. MRI can show whether cancer has invaded tissues near the cervix or has spread from the cervix to tissues in the pelvis or abdomen.
• PET scan: Cancer cells often take up or concentrate sugar- or glucose- more than normal tissues. Radioactive glucose can be given as an injection into a vein. Pictures are then made using a machine which images the areas of radioactive glucose in the body. Combining those images with a CT scan can provide excellent information on the presence or absence of spread of the cancer.

The stage is based on where cancer is found. These are the stages of invasive cervical cancer:

• Stage I: Cancer cells are found only in the cervix.
• Stage II: The tumor has grown through the cervix and invaded the upper part of the vagina. It may have invaded other nearby tissues but not the pelvic wall (the lining of the part of the body between the hips) or the lower part of the vagina.
• Stage III: The tumor has invaded the pelvic wall or the lower part of the vagina. If the tumor is large enough to block one or both of the tubes through which urine passes from the kidneys, lab tests may show that the kidneys aren't working well.
• Stage IV: The tumor has invaded the bladder or rectum. Or, the cancer has spread to other parts of the body, such as the lungs.

Treatment

Reader Stories

• Read 2 Stories
• Share Your Story

Treatment options for women with cervical cancer are...

• Surgery
• Radiation therapy
• Chemotherapy
• A combination of these methods

The choice of treatment depends mainly on the size of the tumor and whether the cancer has spread. The treatment choice may also depend on whether you would like to become pregnant someday.
Your doctor may refer you to a specialist, or you may ask for a referral. You may want to see a gynecologic oncologist, a doctor who specializes in treating female cancers. Other specialists who treat cervical cancer include gynecologists, medical oncologists, and radiation oncologists.
Your health care team may also include an oncology nurse and a registered dietitian. Your health care team can describe your treatment choices, the expected results of each, and the possible side effects. Because cancer treatments often damage healthy cells and tissues, side effects are common. These side effects depend on many factors, including the type of treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. You and your health care team can work together to develop a treatment plan that meets your medical and personal needs.
At any stage of the disease, supportive care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns. You can get information about coping on NCI's website at http://www.cancer.gov/cancertopics/coping.
Also, you can get information about supportive care from NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237). Or, chat using LiveHelp, NCI's instant messaging service, at http://www.cancer.gov/livehelp.
You may want to talk with your doctor about taking part in a clinical trial. Clinical trials are research studies testing new treatments. They are an important option for women with all stages of cervical cancer. See the section on Taking Part in Cancer Research 4.
You may want to ask the doctor these questions before treatment begins:

• What is the stage of my disease? Has the cancer spread? If so, where?
• May I have a copy of the report from the pathologist?
• What are my treatment choices? Which do you recommend for me? Will I have more than one kind of treatment?
• What are the expected benefits of each kind of treatment?
• What are the risks and possible side effects of each treatment? What can we do to control the side effects?
• What can I do to prepare for treatment?
• Will I have to stay in the hospital? If so, for how long?
• What is the treatment likely to cost? Will my insurance cover the cost?
• How will treatment affect my normal activities?
• How may treatment affect my sex life?
• Will I be able to get pregnant and have children after treatment? Should I preserve eggs before treatment starts?
• What can I do to take care of myself during treatment?
• What is my chance of a full recovery?
• How often will I need checkups after treatment?
• Would a research study (clinical trial) be right for me?

Surgery

Reader Stories

• Share Your Story

Surgery is an option for women with Stage I or II cervical cancer. You and your surgeon can talk about the types of surgery and which may be right for you.
If you have a small tumor, the type of surgery may depend on whether you want to get pregnant and have children later on. Some women with very early cervical cancer may decide with their surgeon to have only the cervix, part of the vagina, and the lymph nodes in the pelvis removed (radical trachelectomy).
Other women may choose to have the cervix and uterus removed (complete hysterectomy). The surgeon may also remove some tissue around the cervix, part of the vagina, the fallopian tubes, or the ovaries. In addition, the surgeon may remove lymph nodes near the tumor.
It's common to feel tired or weak for a while after surgery for cervical cancer. The time it takes to heal is different for each woman. You'll probably be able to leave the hospital within a couple of days. Most women return to their normal activities within 4 to 8 weeks after surgery.
You may have pain or discomfort for the first few days after surgery. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your health care team. After surgery, they can adjust the plan if you need more pain control.
After a trachelectomy, some women need to have a tube put into the bladder to drain urine. It usually can be removed a few days after surgery.
After a hysterectomy, some women become constipated or have nausea and vomiting. In addition, some women lose control of their bladder or have trouble emptying their bladder. These effects are usually temporary. After a hysterectomy, you'll stop having menstrual periods, and you won't be able to become pregnant.
After the ovaries are removed, menopause occurs at once. You may have hot flashes, vaginal dryness, and night sweats. These symptoms are caused by the sudden loss of female hormones. Talk with your health care team about your symptoms so that you can develop a treatment plan together. There are drugs and lifestyle changes that can help, and most symptoms go away or lessen with time.
Surgery to remove lymph nodes may cause swelling (lymphedema) in one or both legs. Ask your health care team about how you may prevent or control the swelling. Information about lymphedema is available on NCI's website at http://www.cancer.gov/cancertopics/coping.
For some women, surgery to remove the cervix and nearby tissues can affect sexual intimacy. You may have feelings of loss that make intimacy difficult. Sharing these feelings with your partner may be helpful. Sometimes couples talk with a counselor to help them express their concerns.
You may want to ask the doctor these questions before having surgery:

• Do you recommend surgery for me? If so, which kind? Will my ovaries be removed? Do I need to have lymph nodes removed?
• What is the goal of surgery?
• What are the risks of surgery?
• How will I feel after surgery? If I have pain, how will it be controlled?
• How long will I have to be in the hospital?
• Will I have any lasting side effects?
• When will I be able to resume normal activities?

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. It's an option for women with any stage of cervical cancer. Women with early cervical cancer may choose radiation therapy instead of surgery. It also may be used after surgery to destroy any cancer cells that remain in the area. Women with cancer that extends beyond the cervix may have radiation therapy and chemotherapy.
Doctors use two types of radiation therapy to treat cervical cancer. Some women receive both types:

• External radiation therapy: A large machine directs radiation at your pelvis or other areas with cancer. The treatment usually is given in a hospital or clinic. You may receive external radiation therapy 5 days a week for several weeks. Each treatment takes only a few minutes.
• Internal radiation therapy (also called brachytherapy): A narrow cylinder is placed inside your vagina, and a radioactive substance is loaded into the cylinder. Usually, a session of internal radiation therapy lasts only a few minutes. The cylinder and substance are removed, and you can go home. The short session may be repeated two or more times over several weeks. When the radioactive substance is removed, no radioactivity is left in your body. With a less common method of internal radiation therapy, you may stay in the hospital for several days during treatment.

Although radiation therapy is painless, it may cause side effects. The side effects depend mainly on how much radiation is given and which part of your body is treated. Radiation to the abdomen and pelvis may cause nausea, vomiting, diarrhea, or urinary problems. You may lose hair in your genital area. Also, skin on the abdomen and pelvis may become red, dry, and tender.
You may have dryness, itching, or burning in your vagina. Your doctor may advise you to wait until a few weeks after radiation treatment ends to have sex.
You are likely to become tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.
Although the side effects of radiation therapy can be upsetting, they can usually be treated or controlled. Talk with your doctor or nurse about ways to relieve discomfort.
It may also help to know that most side effects go away when treatment ends. However, you may want to discuss with your doctor the possible long-term effects of radiation therapy. For example, radiation therapy may make the vagina narrower. A narrow vagina can make sex or follow-up exams difficult. There are ways to prevent this problem. If it does occur, however, your health care team can tell you about ways to expand the vagina.
Another possible long-term effect is damage to the ovaries. Menstrual periods usually stop, and women may have hot flashes and vaginal dryness. Menstrual periods may return for some women, especially younger women. Women who may want to get pregnant after radiation therapy should ask their health care team about ways to preserve their eggs before treatment starts.
You may want to ask the doctor these questions before having radiation therapy:

• What is the goal of this treatment?
• How will the radiation be given?
• Will I need to stay in the hospital? If so, for how long?
• When will the treatments begin?
• How often will I have them? When will they end?
• How will I feel during treatment? Are there side effects?
• How will we know if the radiation therapy is working?
• Will I be able to continue my normal activities during treatment?
• How will radiation therapy affect my sex life?
• Are there lasting side effects?

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. For the treatment of cervical cancer, chemotherapy is usually combined with radiation therapy. For cancer that has spread to distant organs, chemotherapy may be used alone.
Most drugs for cervical cancer are given directly into a vein (intravenously) through a thin needle. Some drugs can be taken by mouth. Most women receive chemotherapy in a clinic or at the doctor's office. Drugs that are swallowed may be taken at home instead. Some women need to stay in the hospital during treatment.
The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:

• Blood cells: When chemotherapy lowers the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If the levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of drug. They may also give you medicines that can help your body make new blood cells.
• Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back, but it may change in color and texture for a while. Ultimately it will return to being naturally as it was before.
• Cells that line the digestive tract: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems.

Other side effects include skin rash, tingling or numbness in your hands and feet, hearing problems, loss of balance, joint pain, or swollen legs and feet. Your health care team can suggest ways to control many of these problems. Most go away when treatment ends.
You may want to ask the doctor these questions before having chemotherapy:

• Why do I need this treatment?
• Which drug or drugs will I have?
• How do the drugs work?
• What are the expected benefits of the treatment?
• What are the risks and possible side effects of treatment? What can we do about them?
• When will treatment start? When will it end?
• How will treatment affect my normal activities? 

Second opinion

Before starting treatment, you might want a second opinion about your diagnosis, stage of cancer, and treatment plan. Some people worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it. Some companies require a second opinion.
If you get a second opinion, the second doctor may agree with your first doctor's diagnosis and treatment plan. Or, the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at all of your options.
It may take some time and effort to gather your medical records and see another doctor. In most cases, it's not a problem to take several weeks to get a second opinion. The delay in starting treatment usually will not make treatment less effective. To make sure, you should discuss this delay with your doctor.
There are many ways to find a doctor for a second opinion. You can ask your doctor, a local or state medical society, or a nearby hospital or medical school for names of specialists.

Nutrition

Eating well is important before, during, and after cancer treatment. You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.
Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods don't taste as good as they used to. In addition, poor appetite, nausea, vomiting, mouth blisters, and other side effects of treatment can make it hard for you to eat.
Your doctor, a registered dietitian, or another health care provider can suggest ways to help you meet your nutrition needs.

Follow-up care

You'll need regular checkups (such as every 3 to 6 months) after treatment for cervical cancer. Checkups help ensure that any changes in your health are noted and treated if needed. If you have any health problems between checkups, contact your doctor.
Cervical cancer may come back after treatment. Your doctor will check for the return of cancer. Checkups may include a physical exam, Pap test, and chest X-ray.
You may want to ask your doctor these questions after you have finished treatment:

• How often will I need checkups?
• How often will I need a Pap test?
• What other follow-up tests do you suggest for me?
• Between checkups, what health problems or symptoms should I tell you about?

Sources of support

Learning that you have cervical cancer can change your life and the lives of those close to you. These changes can be hard to handle. It's normal for you, your family, and your friends to need help coping with the feelings that a diagnosis of cancer can bring.
Concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, keeping your job, or continuing daily activities.
Here's where you can go for support:

• Doctors, nurses, and other members of your health care team can answer questions about treatment, working, or other activities.
• Social workers, counselors, or members of the clergy can be helpful if you want to talk about your feelings or concerns. Often, social workers can suggest resources for financial aid, transportation, home care, or emotional support.
• Support groups also can help. In these groups, patients or their family members meet with other patients or their families to share what they have learned about coping with cancer and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. You may want to talk with a member of your health care team about finding a support group.
• NCI's Cancer Information Service can help you locate programs, services, and NCI publications. Call 1-800-4-CANCER (1-800-422-6237). Or, chat using LiveHelp, NCI's instant messaging service, at http://www.cancer.gov/livehelp.
• Your doctor or a sex counselor may be helpful if you and your partner are concerned about the effects of cervical cancer on your sex life. Ask your doctor about possible treatment of side effects and whether these effects are likely to last. Whatever the outlook, you and your partner may find it helps to discuss your concerns.

Taking part in cancer research

Doctors all over the world are conducting many types of clinical trials (research studies in which people volunteer to take part). Research has already led to advances in the prevention, diagnosis, and treatment of cervical cancer.
Doctors continue to search for new and better ways to treat cervical cancer. They are testing new treatments, including new drugs, combinations, and schedules. Some studies are combining surgery, chemotherapy, and radiation therapy.
Clinical trials are designed to find out whether new treatments are safe and effective. Even if the women in a trial don't benefit directly, they may still make an important contribution by helping doctors learn more about cervical cancer and how to control it. Although clinical trials may pose some risks, researchers do all they can to protect their patients.
If you're interested in being part of a clinical trial, talk with your doctor.
NCI's website includes a section on clinical trials at http://www.cancer.gov/clinicaltrials. It has general information about clinical trials as well as detailed information about specific ongoing studies of cervical cancer.
NCI's Cancer Information Service can answer your questions and provide information about clinical trials. Contact CIS at 1-800-4-CANCER (1-800-422-6237) or at LiveHelp at http://www.cancer.gov/livehelp.