WHAT IS HIV / AIDS

Posted By: Pankaj Patel

AIDS stands for acquired immune deficiency syndrome and is the final stage of the infection caused by the virus called HIV or Human Immunodeficiency Virus. The virus causes severe damage to the immune system.

WHAT IS HIV ?

H – Human – This particular virus can only infect human beings.
I – Immunodeficiency – HIV weakens your immune system by destroying important cells that fight disease and infection. A "deficient" immune system can't protect you.
V – Virus – A virus can only reproduce itself by taking over a cell in the body of its host.

Human Immunodeficiency Virus is a lot like other viruses, including those that cause the "flu" or the common cold. But there is an important difference – over time, your immune system can clear most viruses out of your body. That isn't the case with HIV – the human immune system can't seem to get rid of it. Scientists are still trying to figure out why.

We know that HIV can hide for long periods of time in the cells of your body and that it attacks a key part of your immune system – your T-cells or CD4 cells. Your body has to have these cells to fight infections and disease, but HIV invades them, uses them to make more copies of itself, and then destroys them. Over time, HIV can destroy so many of your CD4 cells that your body can't fight infections and diseases anymore. When that happens, HIV infection can lead to AIDS.

WHAT IS AIDS?

A – Acquired – AIDS is not something you inherit from your parents. You acquire AIDS after birth.
I – Immuno – Your body's immune system includes all the organs and cells that work to fight off infection or disease.
D – Deficiency – You get AIDS when your immune system is "deficient," or isn't working the way it should.
S – Syndrome – A syndrome is a collection of symptoms and signs of disease. AIDS is a syndrome, rather than a single disease, because it is a complex illness with a wide range of complications and symptoms.

Acquired Immunodeficiency Syndrome is the final stage of HIV infection. People at this stage of HIV disease have badly damaged immune systems, which put them at risk for opportunistic infections (OIs). You will be diagnosed with AIDS if you have one or more specific OIs, certain cancers, or a very low number of CD4 cells. If you have AIDS, you will need medical intervention and treatment to prevent death.

WHERE DID HIV COME FROM?

Scientists believe HIV came from a particular kind of chimpanzee in Western Africa. Humans probably came in contact with HIV when they hunted and ate infected animals. Recent studies indicate that HIV may have jumped from monkeys to humans as far back as the late 1800s.

CAUSES OF AIDS

AIDS is caused by HIV infection. The virus attacks the immune system leaving the individual susceptible to life-threatening infections and cancers. Common bacteria, yeast, parasites, and viruses that usually do not cause serious disease in people with healthy immune systems can turn deadly for AIDS patients.

HOW IS HIV TRANSMITTED?

HIV is found in all the body fluids including saliva, nervous system tissue and spinal fluid, blood, semen, pre-seminal fluid, which is the liquid that comes out before ejaculation, vaginal secretions, tears and breast milk. Only blood, semen, and breast milk have been shown to transmit infection to others.

The virus is transmitted by sexual contact including unprotected oral, vaginal, and anal sex and via transfusion of contaminated blood that contains HIV. Another mode of transmission is sharing needles or injections with HIV infected individuals. A pregnant woman can transmit the virus to her unborn baby through their shared blood circulation, or a nursing mother can transmit it to her baby in her breast milk. HIV infection does not spread by casual contact, mosquitoes, touching or hugging.

WHO IS AT RISK?

Those at highest risk include injection drug users who share needles, babies born to mothers with HIV (especially if the mother had not received anti- HIV therapy during pregnancy), those engaging in unprotected vaginal or anal sex with HIV positive individuals, and those who received blood transfusions or clotting products between 1977 and 1985 (before screening for HIV became standard practice).

SYMPTOMS OF HIV / AIDS

The symptoms of HIV and AIDS vary, depending on the phase of infection.

Primary infection
The majority of people infected by HIV develop a flu-like illness within a month or two after the virus enters the body. This illness, known as primary or acute HIV infection, may last for a few weeks. Possible symptoms include:

• Fever
• Muscle soreness
• Rash
• Headache
• Sore throat
• Mouth or genital ulcers
• Swollen lymph glands, mainly on the neck
• Joint pain
• Night sweats
• Diarrhea

Although the symptoms of primary HIV infection may be mild enough to go unnoticed, the amount of virus in the blood stream (viral load) is particularly high at this time. As a result, HIV infection spreads more efficiently during primary infection than during the next stage of infection.

Clinical latent infection
In some people, persistent swelling of lymph nodes occurs during clinical latent HIV. Otherwise, there are no specific signs and symptoms. HIV remains in the body, however, as free virus and in infected white blood cells. Clinical latent infection typically lasts eight to 10 years. A few people stay in this stage even longer, but others progress to more-severe disease much sooner.

Early symptomatic HIV infection
As the virus continues to multiply and destroy immune cells, you may develop mild infections or chronic symptoms such as:

• Fever
• Fatigue
• Swollen lymph nodes — often one of the first signs of HIV infection
• Diarrhea
• Weight loss
• Cough and shortness of breath
• Progression to AIDS

If you receive no treatment for your HIV infection, the disease typically progresses to AIDS in about 10 years. By the time AIDS develops, your immune system has been severely damaged, making you susceptible to opportunistic infections — diseases that wouldn't trouble a person with a healthy immune system. The signs and symptoms of some of these infections may include:

• Soaking night sweats
• Shaking chills or fever higher than 100 F (38 C) for several weeks
• Cough and shortness of breath
• Chronic diarrhea
• Persistent white spots or unusual lesions on your tongue or in your mouth
• Headaches
• Persistent, unexplained fatigue
• Blurred and distorted vision
• Weight loss
• Skin rashes or bumps

When to see a doctor
If you think you may have been infected with HIV or are at risk of contracting the virus, see a health care provider as soon as possible.

TREATMENT OF HIV / AIDS

There is no cure for AIDS once it develops. There are agents available that can help keep symptoms at bay and improve the quality and length of life for those who have already developed symptoms.

Drugs against HIV include antiretroviral therapy. These prevent the replication of the HIV virus in the body. A combination of several antiretroviral drugs, called highly active antiretroviral therapy (HAART), has been very effective in reducing the number of HIV particles in the bloodstream. Preventing the virus from replicating can improve T-cell counts or CD4 cell counts and help the immune system recover from the HIV infection. Medicines are also prescribed to prevent opportunistic infections if the CD4 counts are low.

PREVENTION OF HIV / AIDS

Safe sex measures with use of condoms, shunning use of illicit drugs or shared needles or syringes, avoidance of contact with blood and fluids by wearing protective clothing, masks, and goggles etc. helps prevent transmission. HIV-positive women who wish to become pregnant may need therapy while they are pregnant to prevent transmission to their babies. The Public Health Service recommends that HIV-infected women in the United States avoid breastfeeding to prevent transmitting HIV to their infants through breast milk.

Blood Cancer (Leukemia, Lymphoma, Myeloma)

Posted By: Pankaj Patel

Blood cancer is a form of cancer which attacks the blood, bone marrow, or lymphatic system. This group includes cancers of the bone marrow, blood, and lymphatic system, which includes lymph nodes, lymphatic vessels, tonsils, thymus, spleen, and digestive tract lymphoid tissue. Leukemia and myeloma, which start in the bone marrow, and lymphoma, which starts in the lymphatic system, are the most common types of blood cancer. What causes these cancers is not known.

There are three main groups of blood cancers:

1. Leukemia
2. Lymphoma
3. Multiple Myeloma

These malignancies have varying prognoses, depending on the patient and the specifics of the condition, but overall survival rates with blood cancer increased radically in the late 20th century with the development of advanced treatments. When caught early, blood cancer can be very manageable in some cases, which is one very good reason to make regular trips to the doctor a priority for people of all ages. In the case of leukemia, the cancer interferes with the body's ability to make blood. Leukemia attacks the bone marrow and the blood itself, causing fatigue, anemia, weakness, and bone pain. It is diagnosed with a blood test in which specific types of blood cells are counted. Treatment for leukemia usually includes chemotherapy and radiation to kill the cancer, and in some cases measures like bone marrow transplants may be required. There are several different types of leukemia, including chronic myelogenous leukemia, acute lymphoblastic leukemia, and hairy cell leukemia.

Leukemia:

Leukemia, a type of cancer found in your blood and bone marrow, is caused by the rapid production of abnormal white blood cells. The high number of abnormal white blood cells are not able to fight infection, and they impair the ability of the bone marrow to produce red blood cells and platelets.

There are four main types of leukemia (and several other less common types):

• Acute lymphocytic (or lymphblastic) leukemia ALL): The most common cancer in children, is highly curable with modern-day chemotherapy.
• Acute myelogenous leukemia (AML): Most commonly affects those over 60 years of age but can occur in younger people. Requires intensive chemotherapy and often an allogeneic stem-cell transplant (blood stem cells from another individual) to be cured. New strategies are desperately needed for older individuals who cannot tolerate the standard, intensive approach.
• CLL: Can be detected incidentally (example above) if not causing symptoms or when it presents aggressively with enlarged lymph nodes, a very high white blood cell count (the malignant lymphocytes), and profound fatigue. Those who have symptoms due to CLL require treatment, often a combination of chemotherapy and an immune therapy. Younger patients may require a stem-cell transplant for cure. Several newer therapies in the advanced stages of research (such as the drug PCI-32765) will likely revolutionize the treatment of this disease.
• Chronic Myelogenous Leukemia (CML): The treatment of this previously fatal form of leukemia was revolutionized by the development of the drug imatinib, followed by nilotinib and dasatinib. These pills, which are very well tolerated, drive the leukemia into remission in the vast majority of patients.

Lymphoma:

Lymphoma is a type of blood cancer that affects the lymphatic system, which removes excess fluids from your body and produces immune cells. Lymphocytes are a type of white blood cell that fight infection. Abnormal lymphocytes become lymphoma cells, which multiply and collect in your lymph nodes and other tissues. Over time, these cancerous cells impair your immune system.

There are two main types of lymphoma, Hodgkin’s and non-Hodgkin’s, which are distinguishable by their appearance under the microscope to a pathologist examining a lymph node biopsy (most commonly). Hodgkin’s and 85% of non-Hodgkin’s lymphoma (NHL) are caused by the abnormal proliferation of an immune cell called a B-lymphocyte; 15% of NHLs are of T-cell origin. There are only a few types of HL whereas there are over 30 types of NHL. A precise diagnosis may require a second opinion on the pathology specimen. Treatments may range from observation to well-tolerated immune therapies (such as rituximab, which has revolutionized the treatment of NHL) to intensive chemotherapy and even a stem-cell transplant (using the patient’s own stem cells, called an autologous transplant, or an allogeneic transplant, depending on the situation). The evaluation of a patient with lymphoma will also involve CAT scans and often a PET scan.

Multiple Myeloma:

Myeloma is a type of blood cancer that specifically targets your plasma cells. Plasma cells are white blood cells that produce disease- and infection-fighting antibodies in your body. Myeloma cells prevent the normal production of antibodies, leaving your body’s immune system weakened and susceptible to infection.

This very complicated blood cancer is caused by the overgrowth in the bone marrow of an immune cell called a plasma cell, which secretes a protein into the bloodstream, called an “M-protein,” that can be detected by a test called an immunoelectrophoresis. The malignant plasma cells can also burrow into the hard bones of the body to cause little holes called “lytic lesions” that can weaken the bones and cause them to fracture. A revolution in the treatment of this cancer has occurred in the last 10 years with the introduction of an autologous stem cell transplant and new drugs such as lenalidomide (Revlimid) and bortezomib (Velcade).

Symptoms of blood cancer

Blood cancer can produce a variety of symptoms, or none at all.

Common symptoms of blood cancer:

• Abdominal pain, especially in the upper abdomen
• Bone or joint pain
• Easy bleeding or bruising
• Enlarged liver and glands, such as the spleen and lymph nodes
• Fatigue
• Fever and chills
• Frequent infections
• Frequent urination
• Nausea, which may be described as feelings of wooziness, queasiness, retching, sea-sickness, car-sickness or upset stomach
• Night sweats
• Unexplained weight loss

Serious symptoms that might indicate a life-threatening condition

In some cases, blood cancer can be life threatening, especially if severe infections or uncontrollable bleeding occur. Seek immediate medical care if you, or someone you are with, have any of these life-threatening symptoms including:

• Bluish coloration of the lips or fingernails
• Change in level of consciousness or alertness, such as passing out or unresponsiveness
• Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions
• Chest pain, chest tightness, chest pressure, palpitations
• High fever (higher than 101 degrees Fahrenheit)
• Rapid heart rate (tachycardia)
• Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing
• Seizure
• Severe abdominal pain
• Uncontrolled or heavy bleeding

Causes of blood cancer

Although the specific cause of blood cancer is not known, a number of factors are associated with its development. Many blood cancers are more common among older adults. Some tend to run in families. Certain infections also appear to increase the risk of some blood cancers, as does a weakened immune system.

Risk factors for blood cancer

A number of factors increase the risk of developing blood cancer. Not all people with risk factors will get blood cancer. Risk factors for blood cancer include:

• Advanced age
• Certain types of infections
• Compromised immune system due to such conditions as HIV/AIDS, taking corticosteroids, or organ transplant
• Exposure to certain chemicals
• Exposure to radiation or certain types of chemotherapy
• Family history of blood cancer
• Personal history of certain blood disorders
• Personal history of certain genetic disorders
• Smoking

How to treat blood cancer?

The goal of blood cancer treatment is to permanently cure the cancer or to bring about a complete remission of the disease. Remission means that there is no longer any sign of the disease in the body, although it may recur or relapse later.

Some blood cancers grow slowly enough that delaying treatment may be an option. If the decision to delay treatment is made, close follow-up, called watchful waiting, is needed so that significant progression can be identified and treatments can be started when needed.

Common Treatments for blood cancer:

• Biological therapy to attack cancer cells
• Chemotherapy to attack cancer cells
• Participation in a clinical trial testing promising new treatments for blood cancers
• Radiation therapy to attack cancer cells
• Stem cell transplant to provide healthy stem cells that can make healthy blood cells
• Targeted therapy to attack cancer cells
• Watchful waiting to identify when to start treatment

Other treatments for blood cancer:

Other therapies may be added to help with your general state of health and any complications of the cancer or its treatment including:

• Anti-nausea medications if needed
• Antibiotics and other medications to reduce the likelihood of getting infections
• Blood transfusions to temporarily replace blood components (such as red blood cells or platelets)
• Dental care to manage oral symptoms of leukemia or chemotherapy
• Dietary counseling to help people with cancer maintain their strength and nutritional status
• Pain medications if needed to increase comfort
• Surgery to remove an enlarged spleen or to treat bone fractures
• Vaccinations to prevent diseases like the flu and pneumonia

Complementary treatments:

Some complementary treatments may help some people to better deal with blood cancer and its treatments. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for full medical care.

• Complementary treatments may include:
• Acupuncture
• Massage therapy
• Yoga

Hospice care:

In cases in which blood cancer has progressed to an advanced stage and has become unresponsive to treatment, the goal of treatment may shift away from curing the disease and focus on measures to keep a person comfortable and maximize the quality of life. Hospice care involves medically controlling pain and other symptoms while providing psychological and spiritual support as well as services to support the patient’s family.

Potential complications of blood cancer:

Complications of untreated or poorly controlled blood cancer can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of blood cancer include:

• Amyloidosis (rare immune-related disorder characterized by protein buildup in organs and tissues that can cause serious complications)
• Anemia (low red blood cell count)
• Broken bones
• Hypercalcemia (increased calcium in the blood)
• Hyperviscosity syndrome (thickened blood that is difficult for the heart to pump)
• Immune deficiency and frequent Infections
• Jaundice (yellowing of the skin and whites of the eyes)
• Kidney failure
• Peripheral neuropathy (disorder that causes dysfunction of nerves that lie outside your brain and spinal cord)
• Spread of cancer

Cervical Cancer Causes and Statistics

Posted By: Pankaj Patel 

Cervical Cancer

Cervical is a very slow growing type of cancer and therefore; it can sometimes take up to several years before any noticeable signs or cervical cancer symptoms usually start to show.  Normally, a pap smear should show any abnormal cells or dysplasia (abnormal changes in the cells); but finding abnormal cells doesn't actually mean you have cervical cancer. Sometimes a pap smear test does not pick abnormal cells or cancer, and they aren't always 100 percent accurate.  Try to understand your body; realize if something seems peculiar.

What is cervical cancer?

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

Causes of Cervical cancer:

Most cervical cancer is caused by a virus called human papillomavirus, or HPV. You can get HPV by having sexual contact with someone who has it. There are many types of the HPV virus. Not all types of HPV cause cervical cancer. Some of them cause genital warts, but other types may not cause any symptoms. You can have HPV for years and not know it. It stays in your body and can lead to cervical cancer years after you were infected. This is why it is important for you to have regular Pap tests. A Pap test can find changes in cervical cells before they turn into cancer. If you treat these cell changes, you may prevent cervical cancer.

There are several risk factors for the development of cervical cancer, both genetic and environmental. These include:

• Human Papillomavirus (HPV) Infection
• Family History of Cervical Cancer
• Age
• Sexual and Reproductive History
• Socioeconomic Status
• Smoking
• HIV Infection
• In Utero DES Exposure
• Long-term use of oral contraceptives

Human Papillomavirus (HPV) Infection:

Human papillomavirus (HPV) produces epithelial tumors of the skin and mucous membranes. More than 100 HPV types are known, and the genomes of more than 80 have been completely sequenced. People with multiple sexual partners and those who already have persistent HPV infection are at increased risk for acquiring additional HPV strains.[1, 2, 3, 4] The current classification system, which is based on similarities in genomic sequences, generally correlates with the 3 clinical categories applied to HPV:

• Anogenital or mucosal
• Nongenital cutaneous
• Epidermodysplasia verruciformis (EV)

The mucosal HPV infections are classified further as latent (asymptomatic), subclinical, or clinical. Clinical lesions are grossly apparent, whereas latent infections are detected only with tests for viral DNA. Subclinical lesions are identified by application of 3-5% acetic acid and inspection under magnification. Most HPV infections are latent; clinically apparent infections usually result in warts rather than malignancies.

Infections due to HPV are common and lead to a wide variety of clinical manifestations that involve the epidermal surfaces. Condylomata acuminata (genital warts) are generally recognized as benign proliferations of the anogenital skin and mucosa resulting from HPV infection. Genital warts are transmitted by sexual contact. Approximately two thirds of individuals who have sexual contact with an infected partner develop genital warts. The exact incubation time is unknown but estimated to be 3 weeks to 8 months.

There is no cure or treatment for HPV infection. Even without treatment, most infections are cleared by the immune system within two years. If the infection persists there is an increased chance of viral DNA integration and progression to cancer. Women can be tested to learn if they are infected with HPV. Even though there is currently no cure for HPV infection, the knowledge can help women make responsible choices regarding their sexual practices.

Family History of Cervical Cancer:

Women with a family history of cervical cancer, especially an affected mother or sister, have a two-fold risk of developing cervical cancer, suggesting an inherited susceptibility. However, there does not appear to be a correlation between a family history of other cancer types (i.e. colon cancer) and the risk of developing cervical cancer.

Age:

Very few women under the age of 20 are diagnosed with cervical cancer and more than half of those diagnosed are between the ages of 35 and 55. The risk decreases after age 55, but 20% of cases occur in women over 60 years old. The pattern seen is due to two conflicting factors, 

1) changes in sexual behaviors and 

2) the tendency of genetic mutations to accumulate over time.

Sexual and Reproductive History:

Epidemiological studies have shown an increased risk for invasive cervical cancer attributable to sexual and reproductive behavior. Increased numbers of sexual partners and lower age at first sexual act have both been associated with increased risk. Women who have had multiple pregnancies and are younger at the time of their first full-term pregnancy also demonstrate an increased risk. Long term use of oral contraceptives has been shown to increase risk in some studies, but this remains controversial. A 2007 study suggests that ongoing use of oral contraceptives raised the risk of cervical cancer but the risk diminishes when use of the contraceptives is stopped. Because HPV is a sexually transmitted disease, behaviors that increase sexual contacts are considered risk factors.

Socioeconomic Status:

Low socioeconomic status has proven to be a significant risk factor for invasive cervical cancer due to its large impact on education and medical resources. Results of the analysis of several epidemiological studies indicate that Hispanic and African-American women have a higher risk of invasive cervical cancer than Caucasian women.

Decreased risk is associated with increased education--women without a college degree have an increased risk, regardless of race. Therefore, it is possible that if access to screening and medical education were equalized, race would not prove to be a significant risk factor. The increased risk with low socioeconomic status is attributed to a lack of screening, failure to treat precancerous conditions, and lack of knowledge about prevention of HPV infection.

Smoking:

Current smoking is a risk factor for the development cervical cancer due to the ability of carcinogens in cigarette smoke to cause mutations in DNA. In the epidemiological studies that have been conducted, smoking was associated with an increased risk of squamous cell carcinoma of the cervix, but not adenocarcinoma.

Human Immunodeficiency Virus (HIV):

Women infected with HIV have been shown to have a five-fold risk of developing cervical cancer. HIV weakens the immune system, decreasing the ability to fight infection; therefore HPV infections are more likely to persist. This is thought to provide more time for the HPV to induce cancer. The high correlation between HIV infection and HPV infection is also partly due to the fact that both are sexually transmitted diseases and behaviors that put women at risk for one also put them at risk for the other. 

In Utero Diethylstilbestrol (DES) Exposure:

DES is a synthetic estrogen used from the 1930s to the 1970s to reduce complications during pregnancy. Use of this drug was discontinued after it was demonstrated that the drug could harm the developing baby. Elevated risk of cervical cancer is just one of the potential health effects for women who where exposed to DES while they were in their mothers womb; others include a variety of gynecological cancers, reproductive tract irregularities, infertility and complications during pregnancy.

Symproms:

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

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

Cervical cancer may spread to the bladder, intestines, lungs, and liver. Patients with cervical cancer do not usually have problems until the cancer is advanced and has spread. Symptoms of advanced cervical cancer may include:

• Back pain
• Bone pain or fractures
• Fatigue
• Leaking of urine or feces from the vagina
• Leg pain
• Loss of appetite
• Pelvic pain
• Single swollen leg
• Weight loss

Exams and Tests:

Precancerous changes of the cervix and cervical cancer cannot be seen with the naked eye. Special tests and tools are needed to spot such conditions. Pap smears screen for precancers and cancer, but do not make a final diagnosis.

If abnormal changes are found, the cervix is usually examined under magnification. This is called colposcopy. Pieces of tissue are surgically removed (biopsied) during this procedure and sent to a laboratory for examination. 

• Cone biopsy may also be done.
• If the woman is diagnosed with cervical cancer, the health care provider will order more tests to determine how far the cancer has spread. This is called staging. Tests may include:
• Chest x-ray
• CT scan of the pelvis
• Cystoscopy
• Intravenous pyelogram (IVP)
• MRI of the pelvis

Treatment:

Treatment of cervical cancer depends on:

• The stage of the cancer
• The size and shape of the tumor
• The woman's age and general health
• Her desire to have children in the future

Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. There are various surgical ways to do this without removing the uterus or damaging the cervix, so that a woman can still have children in the future.

Types of surgery for early cervical cancer include:

• Loop electrosurgical excision procedure (LEEP) -- uses electricity to remove abnormal tissue
• Cryotherapy -- freezes abnormal cells
• Laser therapy -- uses light to burn abnormal tissue

A hysterectomy (removal of the uterus but not the ovaries) is not often performed for cervical cancer that has not spread. It may be done in women who have repeated LEEP procedures.

Treatment for more advanced cervical cancer may include:

• Radical hysterectomy, which removes the uterus and much of the surrounding tissues, including lymph nodes and the upper part of the vagina.
• Pelvic exenteration, an extreme type of surgery in which all of the organs of the pelvis, including the bladder and rectum, are removed.

Radiation may be used to treat cancer that has spread beyond the pelvis, or cancer that has returned. Radiation therapy is either external or internal.

• Internal radiation therapy uses a device filled with radioactive material, which is placed inside the woman's vagina next to the cervical cancer. The device is removed when she goes home.
• External radiation therapy beams radiation from a large machine onto the body where the cancer is located. It is similar to an x-ray.

Chemotherapy uses drugs to kill cancer. Some of the drugs used for cervical cancer chemotherapy include 5-FU, cisplatin, carboplatin, ifosfamide, paclitaxel, and cyclophosphamide. Sometimes radiation and chemotherapy are used before or after surgery.