• ColoRectal Cancer – Cancer

• Anatomy – abnormalities
 The Body’s Digestive System • How can one prepare for this test?
– Esophagus, Stomach, Small Intestine & • Colon must be completely empty
– Large Intestine – Prescribed laxatives or enema (pre-exam)
 1st 6 feet = large bowel or colon • Special Diet to follow (2 days prior)
 Last 6 inches = rectum & anal canal – Clear liquids
 The anal canal ends at the anus – Tea or coffee without milk or cream
Signs & Symptoms – Any juice without pulp (NO OJ or Tomato)
• Change in bowel habits – Broth
• Blood in Stool – Carbonated beverages
– Bright red Types of Barium Enemas
– Very dark red • Single Column
– Black/Tarry Stool – Lie on side on Xray table
• Diarrhea – Enema tube inserted into rectum
• Constipation – Barium bag is delivered into colon
• Does your bowel feel like it emptied completely? – May feel urge to have a bowel movement….DON’T
• General abdominal discomfort – Though, a small balloon will keep it inside you
– Gas pains – Take long deep breaths through mouth…helps relax
– Bloating – May be asked to turn & rotate to evenly coat all
– Fullness colon
– Cramps – Then the radiologist will take a number of X-ray
• Weight loss w/ no explained reason images from various angles
• Constant tiredness • Air Contrast (Double contrast)
• Vomiting (coffee grounds) • Similar to single-column
• Tests that examine… • Big difference…Air is inflated with air in addition to the barium
• Rectum, Rectal Tissue, & Blood to expand and improve the quality of the images
• Aids in diagnosing & preventing colon cancer • Polyps can be seen easier, among other abnormalities
• Physical Exam • Post Barium Enema instructions
• General Medical History • You will be able to go to the restroom immediately following
– Includes self health habits the procedure to expell the remaining barium
– Past self illnesses • Over next few days your stool will be white, gray, or pink
– Various treatments used for previous issues • Might be given a cleansing enema, laxatives, and told to drink
– Family health history a lot of liquids
• If patient reports problems with respect to signs and • The remaining barium can cause constipation.
symptoms related to common bowel change habits… • Refer back to MD if you don’t return to normal in 3-4 days
• Are symptoms affecting your everyday life? Results
• Fecal occult blood test • Negative = no abnormalities are found
• Check stool for evidence of blood • Positive = abnormalities found, such as polyps.
• Method • If positive you may be scheduled for further testing.
– Small samples of stool are placed on special cards • Pros of Barium Enema
and returned to the Dr. or Lab for testing under a • Pros
microscope – No sedation, complications are slight (perforation of
• Potential harms colorectal wall)
– False-positive & false negative results (uncommon… – If 50+ Medicare covers this every four years for
serious colorectal cancer screening as an alternative to
Digital Rectal Exam colonoscopy
• The doctor or nurse inserts a lubricated, GLOVED finger into – If you are high risk, covered every two years, though
the rectum to feel for lumps or abnormal areas. colonoscopy is preferred
• Barium Enema Cons of Barium Enema
• Barium is a liquid, that contains a silver-white compound, • miss small polyps or sometimes even small cancers
inserted into the rectum • Biopsy and polyp removal cannot be done during testing
• The barium coats the lower GI tract and a series of x-rays are • you may need to follow up with a colonoscopy
taken of the lower GI tract • Preparing for the procedure (emptying the colon) and the
• AKA = a lower GI series procedure itself can be unpleasant
• What does a Barium Enema do? Sigmoidoscopy
• Detects • Views the rectum and sigmoid colon areas for polyps,
– Ulcers abnormalities, or cancer
– Narrowed areas (strictures) • A sigmoidoscope is a thin lighted tube is inserted into rectum
– Growth of the lining (polyps) & up through the sigmoid colon
– Small pouches in the wall of the intestine • May remove polyps or tissue samples for biopsy
• Diverticula • Procedure Detection

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• The cause of diarrhea, abdominal pain, or constipation
• Detect early signs of cancer in descending (sigmoid) colon and
rectum can see bleeding, inflammation, abnormal growths,
and ulcers not sufficient to detect polyps or cancer in the
ascending or transverse colon (two-thirds of the colon).
Preparation
• Liquid diet
• Most likely given an enema pre-procedure
• Air is pumped into colon to help expand and see more surface
area
• Duration is 10-20 minutes
Complications
• Though very uncommon. It is likely that bleeding or a
puncture of the colon could result during procedure
• Polyp………...Removal
Colonoscopy
• Procedure to look into entire length of large intestine (colon)
to detect abnormalities
• Preparation, procedure, & results same as sigmoidoscopy
• New virtual colonoscopy as alternative procedure
• Virtual or (CT) Colonography
• a series of x-rays called computed tomography to make a
series of pictures of the colon
• Computer then puts these pictures together to create a
detailed image that shows polyps, etc.
Prognosis (chances of recovery)
• Depends on
– Stage : in the inner lining of colon only, whole colon?
Spread to other places in body
– Has it blocked or created a hole in the colon?
– Blood levels of carcinoembryonic antigen (CEA); a
substance in the blood that may be increased when
cancer is present, before treatment begins.
– Has cancer recurred?
– Patient’s general health?
Treatment Options
• Surgery (main treatment)
• Radiation Therapy
• Chemotherapy
• Newer targeted therapies
– Monoclonal antibodies
• Depending on stage of cancer, it is likely that 2-3 types of
treatment may be utilized at the same time or one after the
other
Surgery
• Removal of cancer and normal area of colon on either side, as
well as nearby lymph nodes
• Then sewn back together
• Colostomy (bag to catch the waste kept outside the body)
• If cancer is found early, a colonscope can be used without
cutting the abdomen
Surgery for Rectal Cancer
• Surgery is main treatment, along with a combination of
radiation therapy
• Polypectomy, local excision, and local transanal resection) can
be done with instruments placed into the anus,
• Stage I, II, & III rectal cancers, other types of surgery may be
done
• A low anterior resection is used for cancers near the upper
part of the rectum, close to where it connects with the colon.
• Abdominoperineal resection is done for cancers located close
near the lower rectum-anal conjunction. After this surgery, a
colostomy is needed
• Pelvic Exenteration:
– the surgeon removes the rectum as well as nearby
organs such as the bladder, prostate, or uterus if the
cancer has spread to these organs. A colostomy is
needed after this operation. If the bladder is
removed, a urostomy (opening to collect urine) is
needed
• Radiation Therapy high-energy rays (such as x-rays) to kill or
shrink cancer cells external radiation
• internal or implant radiation; placed directly into tumor
• Radiation can also be used to ease symptoms of advanced
cancer such as intestinal blockage, bleeding, or pain
• Main uses is for those where cancer had attached to an
internal organ or the lining of the abdomen
• can be aimed through the anus and reaches the rectum
without passing through the skin of the abdomen
• Chemotherapy
• use of anticancer drugs injected into a vein or given by mouth
• treatment useful for cancers that have spread to distant
organs
• increase the survival rate for patients with some stages of
colorectal cancer (will kill normal cells also)
• Side effects depend on amount, length, & type of drugs given
(i.e. diarrhea, nausea, vomiting, loss of appetite & hair, mouth
sores, increased chance of infections, bruising & bleeding after
minor cuts or injuries & overall increased fatigue
Risk Factors
• Age 50 or older
• Obesity (fat in waist area increases)
• 30%-40% of smokers diagnosed with cancer will die
• A family history of cancer of the colon or rectum.
• A personal history of cancer of the colon, rectum, ovary,
endometrium, or breast.
• A history of polyps or ulcerative colitis (ulcers in the lining of
the large intestine) or Crohn’s disease.
• Certain hereditary conditions, such as familial adenomatous
polyposis and hereditary nonpolyposis colon cancer (HNPCC;
Lynch Syndrome)
• Heavy use of Alcohol has been linked to this cancer
Dietary Risk Factors
• eat plenty of fruits, vegetables, and whole grain foods
• to limit high-fat foods (especially from animal sources) and
limit excessive alcohol consumption
• studies suggest that taking a daily multivitamin containing folic
acid or folate can lower risk
• Other studies suggest that getting more calcium with
supplements or low-fat dairy products can help
• Getting enough exercise is important as well 30 min of
physical activity on 5+ days per week.
• Survival Rates
• 9 of 10 people whose cancer is found & treated at early stage
(before spreading) will live at least 5 years
• Spread to nearby organs/lymph nodes= 5years – 66% survival
rate
• Spread to lungs/liver= 5 year – 9%
• (5 yr is based on percentage of patients that were alive 5 yrs
after diagnosis. Leaving out those who died of other causes)
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What is Ovarian Cancer?
• Ninth most common type of cancer and fifth most frequent
cause of cancer-related death in women
• An estimated 21,880 new cases in the United States in 2010
• A disease in which ovarian cells grow uncontrollably and form
a tumor
• 85% to 90% of cases begin in cells on the outer surface of the
ovary, called epithelial carcinoma
• What is the Function of the Ovaries?
• Every woman has two ovaries
• Almond-shaped glands that contain the germ cells or eggs
• During monthly ovulation, an egg is released from an ovary
and travels to the uterus through the fallopian tube
• Primary source of estrogen and progesterone, the hormones
that influence breast growth, body shape, and body hair, and
regulate the menstrual cycle and pregnancy
• What are the Risk Factors for Ovarian Cancer?
• Age
• Family history
• Genetics
• Ethnicity
• Reproductive history
• Hormones
• Obesity
• Behavioral and social factors
• Hereditary Ovarian Cancer: HBOC
• Hereditary breast and ovarian cancer (HBOC) is caused by a
mutation in BRCA1 and BRCA2 genes
• Women with HBOC have a 15% to 40% lifetime risk of ovarian
cancer
• Women with HBOC should have increased screening for
ovarian cancer
• Screening options include pelvic examinations, ultrasound,
and a CA-125 blood test
• Genetic testing is available
• Hereditary Ovarian Cancer: HNPCC
• Hereditary non-polyposis colorectal cancer syndrome (HNPCC)
is most often caused by a mutation in the MLH1, MSH2,
MSH6, or PMS2 genes, though other genes have been linked
to HNPCC
• Women with HNPCC have a 9% to 12% risk of developing
ovarian cancer
• HNPCC is most commonly associated with an increased risk of
colorectal cancer
• Genetic testing is available
• Hereditary Ovarian Cancer: Peutz-Jeghers Syndrome
• Peutz-Jeghers syndrome (PJS) caused by a mutation in the
STK11 gene (also called the LKB1 gene)
• Women with PJS have about a 20% risk of developing ovarian
cancer
• The most common sign of PJS is multiple hamartomatous
polyps in the digestive system
• Women with PJS have increased pigmentation (dark spots on
the skin) on the face and hands that appears in childhood but
fades over time
• Genetic testing is available
• Hereditary Ovarian Cancer: NBCCS
• Nevoid basal cell carcinoma syndrome (NBCCS) is caused by a
mutation in the PTCH gene
• Women with NBCCS have a increased risk of developing
fibromas (benign fibrous tumors) of the ovaries
• There is a small risk that these fibromas could develop into a
type of ovarian cancer called a fibrosarcoma
• Signs of NBCCS are macrocephaly (larger than average head
size), unique facial features, and skeletal changes in the ribs
and backbone
• Genetic testing is available
• Other Hereditary Ovarian Cancer Syndromes
• Several other genes and genetic conditions can increase a
woman’s risk of ovarian cancer
• Talk with your doctor about finding a genetic counselor if you
have a history of ovarian cancer in your family
• Ovarian Cancer and Early Detection
• Certain factors may reduce a woman's risk of developing
ovarian cancer
• Taking birth control pills for more than 5 years
• Breastfeeding
• Pregnancy
• A hysterectomy or a tubal ligation
• Women with strong family histories of ovarian cancer may
consider a risk-reducing salpingo-oophorectomy (removal of
both ovaries and fallopian tubes)
• What are the Symptoms of Ovarian Cancer?
• More common symptoms
• Bloating
• Pelvic or abdominal pain
• Difficulty eating or feeling full quickly
• Urinary symptoms (urgency or frequency)
• Other symptoms
• Fatigue
• Indigestion
• Back pain
• Pain with intercourse
• Constipation
• Menstrual irregularities
• How is Ovarian Cancer Diagnosed?
• A biopsy is rarely done as a separate procedure
• Diagnosis is confirmed with an analysis of tumor tissue
• Pelvic examination
• Transvaginal ultrasound
• CA-125 blood test
• Lower gastrointestinal (GI) series
• Computed tomography (CT or CAT) scan
• Positron emission tomography (PET) scan
• X-ray
• Ovarian Cancer Staging
• Staging is a way of describing a cancer, such as the size of a
tumor and if or where it has spread
• Staging is the most important tool doctors have to determine
a patient’s prognosis
• Staging is described by the TNM system: the size and location
of the Tumor, whether cancer has spread to nearby lymph
Nodes, and whether the cancer has Metastasized (spread to
other areas of the body)
• Some stages are divided into smaller groups that help describe
the tumor in even more detail
• Treatment depends on the stage of the cancer
• Recurrent cancer is cancer that comes back after treatment
• Stage IA Ovarian Cancer
• Tumor is encapsulated and limited to one ovary
• No spread to lymph nodes or other parts of the body
• Stage IB Ovarian Cancer
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• Cancer is encapsulated and located in both ovaries
• No spread to lymph nodes or the rest of the body
• Stage IC Ovarian Cancer
• Cancer is in both ovaries with a ruptured capsule
• There is spread to ovarian surface or malignant cells in the
abdominal fluid
• Stage IIA Ovarian Cancer
• Cancer is in one or both ovaries and has spread to the pelvis
• Cancer has spread to the uterus or fallopian tubes
• No spread to lymph nodes or other parts of the body
• Stage IIB Ovarian Cancer
• Cancer is in one or both ovaries and has spread to the pelvis
• Cancer has spread to other pelvic tissue
• No spread to lymph nodes or other parts of the body
• Stage IIC Ovarian Cancer
• Cancer is in one or both ovaries and has spread to the pelvis
• Cancer has spread to pelvic area
• Cancer is shedding cancer cells into the abdominal fluid
• Stage IIIA Ovarian Cancer
• Cancer is in one or both ovaries, the pelvis, and has spread to
the peritoneum
• Cancer has spread microscopically throughout the pelvis
• Stage IIIB Ovarian Cancer
• Cancer is in one or both ovaries and has spread to the pelvis
• Cancer has spread to other pelvic tissue
• No spread to lymph nodes or other parts of the body
• Stage IIIC Ovarian Cancer
• Cancer is in one or both ovaries and has spread to the pelvis
• Cancer has spread to pelvic area
• Cancer is shedding cancer cells into the abdominal fluid
• Stage IV Ovarian Cancer
• Cancer has spread to distant organs
• Treatment includes surgery and chemotherapy
• How is Ovarian Cancer Treated?
• Treatment depends on stage of cancer
• More than one treatment may be used
• Surgery
• Chemotherapy
• Radiation therapy
• Cancer Treatment: Surgery
• Primary treatment
• Removal of ovaries, fallopian tubes, the uterus, and/or the
omentum, the thin tissue covering the stomach and large
intestine
• Lymph nodes, tissue samples, and fluid from the abdomen
may be removed to determine if the cancer has spread
• It may be possible to remove only one ovary and fallopian
tube
• Surgery may cause short-term pain and tenderness or
difficulty emptying the bladder
• Women may have menopausal symptoms, including hot
flashes and vaginal dryness if both ovaries are removed
• Cancer Treatment: Chemotherapy
• Use of drugs to kill cancer cells
• Given to destroy cancer remaining after surgery, slow tumor
growth, or reduce side effects
• A combination of drugs is often used
• Types of Chemotherapy
• Most drugs used to treat ovarian cancer are given
intravenously (IV) or intraperitoneally (IP)
• Either injected into a vein or through a catheter
• Women with advanced ovarian cancer may have a
combination of IV and IP chemotherapy
• Side effects may include fatigue, risk of infection, nausea and
vomiting, loss of appetite, and diarrhea
• Cancer Treatment: Radiation Therapy
• The use of high-energy x-rays to destroy cancer cells
• Different methods of delivery
• Radiation treatment is not usually used to treat ovarian
cancer, but may be used to relieve side effects of progressive
cancer, such as tumor growth in the pelvic area
• Side effects may include fatigue, mild skin reactions, upset
stomach, and loose bowel movements
• Doctors may advise their patients not to have sexual
intercourse during radiation therapy
• Current Research
• Risk reduction: vitamins and drugs that may reduce the risk of
ovarian cancer
• Targeted therapy: treatment targeting faulty genes or proteins
that contribute to cancer growth
• Gene therapy: correcting or replacing damaged genes that
increase cancer risk
• Cancer vaccines: trigger the body’s immune system to kill
cancer cells
• The Role of Clinical Trials for the Treatment of Ovarian Cancer
• Clinical trials are research studies involving people
• They test new treatment and prevention methods to
determine whether they are safe, effective, and better than
the standard treatment
• The purpose of a clinical trial is to answer a specific medical
question in a highly structured, controlled process
• Clinical trials can evaluate methods of cancer prevention,
screening, diagnosis, treatment, and/or quality of life
• Clinical Trials: Patient Safety
• Informed consent: participants should understand why they
are being offered entry into a clinical trial and the potential
benefits and risks; informed consent is an ongoing process
• Participation is always voluntary, and patients can leave the
trial at any time
What is Bladder Cancer?
• Fourth most common cancer among men and ninth most
common cause of cancer death in men
• A malignant (cancerous) tumor that begins in the bladder
• Described as noninvasive (superficial) or invasive
• Three main types of bladder cancer: urothelial carcinoma
(90% of cases), squamous cell carcinoma (4%), and
adenocarcinoma (2%)
• What is the Function of the Bladder?
• The bladder is an expandable, hollow organ in the pelvis that
stores urine before it leaves the body during urination
• The bladder is part of the urinary tract, which is also made up
of the kidneys, ureters, and urethra
• What are the Risk Factors for Bladder Cancer?
• Smoking (smokers are four to seven times more likely to
develop bladder cancer than nonsmokers)
• Age, gender, race
• Exposure to chemicals
• Chronic bladder problems
• Cyclophosphamide (Cytoxan, Clafen, Neosar) use
• Personal history
• Low fluid intake
• Schistosomiasis (a parasitic disease)
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• Bladder Cancer and Early Detection
• No tests are recommended for screening the general
population
• Most bladder cancer is diagnosed in people who have
symptoms
• The most common symptom is blood in the urine, which can
signal bladder cancer or another noncancerous condition
• What are the Symptoms of Bladder Cancer?
• Blood in the urine
• Pain during urination
• Frequent urination
• Feeling the need to urinate throughout the night and/or not
being able to pass urine
• Lower back pain on one side of the body
• Symptoms of advanced bladder cancer may include pain,
change in bowel habits, unexplained loss of appetite, and
weight loss
• How is Bladder Cancer Diagnosed?
• Physical examination
• Cystoscopy (examination of the bladder with a small tube)
• Diagnosis is confirmed with a transurethral bladder tumor
resection (TURBT )
• Urine tests (cytology)
• Intravenous pyelogram (IVP)
• Computed tomography (CT or CAT) scan
• Magnetic resonance imaging (MRI)
• Bladder Cancer Staging
• Staging is a way of describing a cancer, such as the size of a
tumor and if or where it has spread
• Staging is the most important tool doctors have to determine
a patient’s prognosis
• Staging is described by the TNM system: the size and location
of the Tumor, whether cancer has spread to nearby lymph
Nodes, and whether the cancer has Metastasized (spread to
other areas of the body)
• Some stages are divided into smaller groups that help describe
the tumor in even more detail
• Treatment depends on the stage of the cancer
• Recurrent cancer is cancer that comes back after treatment
• Stage 0 Bladder Cancer
• Stage 0a: The cancer is only found on the surface of the inside
lining of the bladder, also called noninvasive papillary
urothelial carcinoma
• Stage 0is: The cancer is found only on the inner lining of the
bladder, also called flat or carcinoma in situ
• Stage I Bladder Cancer
• The cancer has grown through the inner lining of the bladder
to the connective tissue layer but has not spread to the thick
muscle wall of the bladder
• Stage II Bladder Cancer
• The cancer has spread into the thick muscle wall of the
bladder (called invasive or muscle-invasive cancer) but not to
the fatty tissue surrounding the bladder
• Stage III Bladder Cancer
• The cancer has spread to the fatty layer of tissue surrounding
the bladder and may have spread to the prostate (men) or the
uterus and vagina (women)
• Stage IV Bladder Cancer
• The cancer has spread to the pelvic or abdominal wall but not
to lymph nodes or other parts of the body, or
• The cancer has spread to one or more regional lymph nodes
but not to other parts of the body, or
• The cancer has spread to other parts of the body
• How is Bladder Cancer Treated?
• More than one treatment may be used
• Treatment depends on the stage of the cancer
• Surgery
• Radiation therapy
• Immunotherapy
• Chemotherapy (options include a combinations of drugs)
• Cancer Treatment: Surgery
• In early-stage cancer, the tumor is removed with a laser or
high-energy electricity
• Advanced cancer may require complete or partial removal of
the bladder (cystectomy) and nearby lymph nodes, tissues,
and organs
• If the bladder is removed, a new way for the body to divert
urine outside the body is made
• Cystectomy can cause impotence in men and loss of sexual
feeling and orgasm for men and women; these side effects are
often treatable
• Bladder Preservation and Substitution
• For some patients, chemotherapy and radiation therapy may
be an alternative to removing bladder surgically
• If the bladder is removed, the doctor will create a urinary
diversion (a new way for the body to eliminate urine)
• A urinary diversion can be a bag attached to an opening
outside of the body or can be a storage pouch that sits inside
the body (urinary reservoir)
• Cancer Treatment: Radiation Therapy
• The use of high-energy x-rays to destroy cancer cells
• External beam: outside the body
• Usually used in combination with chemotherapy
• May be used to treat bladder cancer before or after surgery
• Side effects may include fatigue, mild skin reactions, upset
stomach, loose bowel movements, bladder irritation, and
bleeding from the bladder
• Cancer Treatment: Immunotherapy
• Uses materials made by the body or in a laboratory to boost
patients’ natural defenses against cancer
• BCG (bacillus Calmette-Guerin) is the most common
immunotherapy drug for bladder cancer; it is given using
intravesical (local) therapy
• BCG irritates the inside of the bladder, attracting the patient’s
immune cells to the bladder to fight the tumor
• Cancer Treatment: Chemotherapy
• Use of drugs to kill cancer cells
• Earlier stage cancers are more likely to be treated with
intravesical chemotherapy
 Cervical Cancer
 Begins in the lining of the cervix
 Cells change from normal to pre-cancer (dysplasia) and then
to cancer
 Three Types
 Squamous cell Carcinomas
– Cancer of flat epithelial cell
– 80% to 90%
 Adenocarcinomas
– Cancer arising from glandular epithelium
– 10% - 20%
 Mixed carcinoma
– Features both types
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Site – Stage 4 Cancer has spread to nearby organs;
 Signs and Symptoms metastasis.
 Vaginal bleeding  Treatment
 Menstrual bleeding is longer and heavier than usual  Surgery
 Bleeding after menopause or increased vaginal discharge – Preinvasive cervical cancer
 Bleeding following intercourse or pelvic exam  Cryosurgery
 Pain during intercourse  Laser surgery
Risk Factors  Conization
 Human papillomavirus infection (HPV) – Primary factor – Invasive cervical cancer
– HPV 16, HPV 18, HPV 31, HPV 33, HPV 45  Simple hysterectomy
– 50% are caused by HPV 16 AND 18 – Removal of the body of the
 Sexual behavior uterus and cervix.
 Smoking  Radical hysterectomy and pelvic lymph
 HIV infection node dissection
 Chlamydia infection – Removal of entire uterus,
 Diet surrounding tissue, upper part of
 Oral contraceptives the vagina, and lymph nodes
 Multiple pregnancies from the cervix.
 Low socioeconomic status  Radiation
 Diethylstilbestrol (DES)  Chemotherapy
 Family history cervical cancer research and treatment?
Prevention  HPV test
 Avoiding the risk factors  HPV vaccine
– Especially HPV  Radical trachelectomy procedure
– Help for low-income women (NBCCEDP)  Other clinical trials
 Having the Pap Test
– 3 years after first vaginal intercourse or by age 21.
– Have test annually
 Diagnosis  Brain Cancer
 Cervical Cytology (Pap Test)  The brain is the center of thoughts, emotions, memory and
 Cells are removed from the cervix and examined speech.
under the microscope.  Brain also control muscle movements and interpretation of
 Can detect epithelial cell abnormalities sensory information (sight, sound, touch, taste, pain etc)
 Atypical squamous cells  Significance
 Squamous intraepithelial lesions  Tumors can effect any part of the brain and depending on
 Squamous cell carcinoma (likely to be what part(s) of the brain it affects can have a number of
invasive) symptoms.
 Diagnosis  Seizures
 Additional testing  Difficulty with language
– Colposcopy  Mood changes
 Cervix is viewed through a colposcope and  Change of personality
the surface of the cervix can be seen close  Changes in vision, hearing, and sensation.
and clear.  Difficulty with muscle movement
– Cervical Biopsies  Difficulty with coordination control
 Colposcopic biopsy – removal of small Gliomas: A general category of cancer that includes astrocytomas,
section of the abnormal area of the oligodendrogliomas, and ependymomas
surface.  Astrocytoma
 Endocervical curettage – removing some  Astrocytes brain cells abnormally dividing causing tumors
tissue lining from the endocervical canal. called astrocytomas.
 Cone biopsy – cone-shaped piece of tissue  Astrocytes are glial cells that help nourish neurons– they help
is removed from the cervix repair damage
 Staging  How the astroytomas are classified
 FIGO System (International Federation Of Gynecology and  How close the cells are together within the tumor
Obstetrics)  How abnormal the cells are
 Has five stages – 0 to 4  How many of the cells are proliferating
– Stage 0 Carcinoma in situ  Whether or not there are blood vessels growing
– Stage 1 Invaded cervix, but has not spread. near the tumor
– Stage 2 Has spread to nearby areas, not leaving  Whether or not some of the cancer cells have
pelvic area. degenerated or not
– Stage 3 Cancer has spread to the lower part of the  Astrocytomas--Treatments
vagina.  If tumors have not infiltrated normal brain tissue then surgery
can be a cure

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 Low-grade Astrocytomas are not curable by surgery. However
through surgery as much of the tumor as possible is removed
and then the patient usually goes through radiation
treatment.
 Astrocytomas--Treatment
 High-grade Astrocytomas are not curable by surgery. After
surgery has removed as much of the tumor as possible the
patient can go through radiation treatment and
chemotherapy.
 Most common drug given to these patients after
chemotherapy is BCNU
 Oligodendrogliomas
 These tumors start in mutated oligodendrocyte brain cells
 Oligodendrocytes make myelin which help neurons transmit
signals through the axons
 These tumors may spread through cerebrospinal fluid
pathways but typically do not usually spread to locations
outside of the brain or spinal cord.
 Oligodendrogliomas--Treatments
 Because these tumors infiltrate normal brain tissue these
tumors are not cured through surgery. However removal of
part of the tumors can relieve some symptoms and prolong
life.
 If the tumor is causing disabilities to the patient after surgery
the patient may go through chemotherapy, perhaps followed
by radiation treatments.
 Ependymomas
 Mutated ependymal cells
 Ependymal cells line the ventricles in the central area of the
brain and they line part of the pathway through which the
cerebrospinal fluid travels
 Theses mutated cells may block the cerebrospinal fluid from
exiting the ventricles causing the ventricles to enlarge
(hydrocephalus)
 Ependymomas--Treatments
 These tumors do not usually infiltrate normal brain tissue and
are therefore curable through surgery.
 If surgery is unable to completely remove the tumors the
patient may try radiation therapy.
 Diagnosis
 These tumors can be detected through a MRI, CT scan or a PET
scan.
 Once detected, depending on where the tumor is located, a
biopsy officially is used to diagnosis cancer.
 Risk Factors
 Most brain cancers happen for reasons unknown, however
some small risk factors are
 Radiation exposure
 Exposure to vinyl chloride
 Immune system disorders

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