stilbestrol

Cervical cancer is cancer that starts in the cells of the cervix. The cervix is part of the female reproductive system. It is the lower, narrow end of the uterus (womb), which opens into the vagina (birth canal).

Cervical cancer usually develops slowly. Before cervical cells become cancer, they start to look abnormal. These cells are called "precancers." If they aren't destroyed or removed, they may become cancer cells that grow out of control and spread to other parts of your body.

Screening tests for cervical cancer can help find abnormal cells so you can get treatment to prevent cervical cancer. These tests can also find cervical cancer early when it's usually easier to treat.

Almost all cervical cancers are caused by a long-lasting infection with a virus called human papillomavirus (HPV). There are many types of HPV. The types that cause cancer are called "high-risk HPV." High-risk HPV is very common. It can be passed from one person to another through close skin-to-skin touching, usually during vaginal, anal, or oral sex. Most people who are infected have no symptoms and don't know they have it.

If you're infected with high-risk HPV, usually your immune system will get rid of it within a year or two. But if your immune system can't control the infection, it may last for many years. Over time, HPV can turn normal cervical cells into abnormal cells. Without treatment, these cells may keep changing until they become cervical cancer.

Cervical cancer is most common in people over age 30. If you have a high-risk HPV infection in your cervix, you're more likely to develop cervical cancer if you:

• Have a weakened immune system because you:
  • Have a disease that harms your immune system, such as HIV.
  • Take medicine to control your immune system, such as certain medicines to treat cancer or autoimmune diseases
• Smoke tobacco or breathe secondhand smoke.
• Use birth control pills or have given birth to many children.
• Have obesity.
• Were exposed to a medicine called DES (diethylstilbestrol) before you were born. Between 1940-1971, DES was sometimes prescribed during pregnancy to prevent miscarriages. DES was later linked to health problems, including cervical cancer.

Cervical cancer usually doesn't cause symptoms when it first starts to grow. But when it does cause symptoms, they may include:

• Vaginal bleeding that's not normal for you, such as bleeding after sex or between menstrual periods
• Vaginal discharge (fluid) that's watery and has a strong odor or contains blood
• Pelvic pain or pain during sex

If cervical cancer spreads to other parts of your body, symptoms may include:

• Unusual vaginal bleeding or discharge
• Pelvic pain or pain during sex
• Difficult or painful bowel movements (poops) or bleeding from the rectum when having a bowel movement
• Difficult or painful urination (peeing) or blood in your urine (pee)
• Dull backache
• Swollen legs
• Abdominal (belly) pain
• Fatigue

If you have symptoms or had an abnormal result on a screening test for cervical cancer, your health care provider will do more tests to find out if you have cervical cancer. They will:

• Ask about your medical history and your family health history
• Do a pelvic exam
• Suggest tests to diagnose or rule out cervical cancer, including:
  • Colposcopy, a procedure using a device called a colposcope, which helps your provider examine your cervix for abnormal areas
  • Cervical biopsy, a procedure to remove a tissue sample from your cervix so that it can be examined under a microscope to look for signs of cancer. Most biopsies can be done in your provider's office

Different treatments are available for cervical cancer. The best treatment for you depends on your health, how much cancer you have, whether it has spread, and which treatment you prefer. You may have more than one treatment, including:

• Surgery to remove the cancer.
• Radiation therapy, which uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. The therapy may use radiation from a machine, or a radioactive substance may be placed in your body near the cancer.
• Chemotherapy (chemo), which uses special medicines to shrink or kill the cancer. The medicine may be pills, or it may be given through a vein (by IV). Sometimes, both types of chemo are used.
• Targeted therapy, which uses special medicines to block the growth and spread of cancer cells.
• Immunotherapy, which helps your immune system fight cancer cells.

Almost all cervical cancer can be prevented by:

• HPV vaccination. HPV vaccines provide the most protection if you get them before you're exposed to HPV. So, it's best to get vaccinated before you become sexually active. Medical experts recommend vaccinating children between ages 9 and 12.
• Routine cervical cancer screening. Two types of screening tests may be part of your routine health checkup. Both tests use a sample of cervical cells that your provider collects with a swab:
  • A Pap smear checks for abnormal cells so they can be treated before they become cancer
  • An HPV test checks for high-risk HPV infections that can cause cancer.
• Getting the right follow-up treatment if a screening test finds abnormal cells and/or high-risk HPV.

You can lower your risk for cervical cancer by not smoking. Using condoms correctly during sex lowers your risk of getting an HPV infection, but doesn't prevent it completely. Condom use has been linked to fewer cases of cervical cancer. If you or your partner is allergic to latex, you can use polyurethane condoms.

NIH: National Cancer Institute

Vaginal cancer is a rare type of cancer that starts in the vagina. The vagina is the canal leading from your cervix (the opening of your uterus) to the outside of your body.

You are more likely to develop vaginal cancer if:

• You're age 60 or older.
• You've had certain types of human papillomavirus (HPV) infections.
• You were exposed to a medicine called DES (diethylstilbestrol) before you were born. Between 1940-1971, DES was sometimes prescribed to prevent miscarriages. DES was later linked to different health problems, including vaginal cancer.
• You have had abnormal cells in your vagina, cervix, or uterus.

Vaginal cancer often doesn't have early symptoms. However, see your health care provider if you notice:

• Vaginal bleeding that is not your period
• A vaginal lump
• Pelvic pain
• Pain during sex
• Pain while urinating (peeing)
• Constipation or blood in your stool (poop) or urine (pee)

To find out if you have vaginal cancer, your provider will use tests that examine the vagina and other organs in your pelvis. These tests may include:

• A pelvic exam. Your provider may also do a Pap test and/or an HPV test during your pelvic exam.
• Colposcopy, a procedure to examine your cervix, vagina, and vulva.
• Biopsy, a procedure to remove some cells so they can be checked for cancer.

Vaginal cancer can often be cured if it is found early. Treatments for vaginal cancer may include surgery, radiation therapy, and/or chemotherapy.

Vaccines that protect against HPV infection may reduce your risk of vaginal cancer. The vaccines provide the most protection if you get them before you are exposed to HPV. So it's best to get vaccinated before you become sexually active.

NIH: National Cancer Institute

Breast cancer is a cancer that starts in breast tissue. It happens when cells in the breast change and grow out of control. New cells grow even when you don't need them, and old cells don't die when they should. These extra cells can form a mass called a tumor.

Sometimes the cancer does not spread any further. This is called "in situ." If the cancer spreads outside the breast, the cancer is called "invasive." It may just spread to nearby tissues and lymph nodes. Or the cancer may metastasize (spread to other parts of the body) through the lymph system or the blood.

Breast cancer is the second most common type of cancer in women in the United States. Rarely, it can also affect men.

There are different types of breast cancer. The types are based on which breast cells turn into cancer. The types include:

• Ductal carcinoma, which begins in the cells of the ducts. This is the most common type.
• Lobular carcinoma, which begins in the lobules. It is more often found in both breasts than other types of breast cancer.
• Inflammatory breast cancer, in which cancer cells block lymph vessels in the skin of the breast. The breast becomes warm, red, and swollen. This is a rare type.
• Paget's disease of the breast, which is a cancer involving the skin of the nipple. It usually also affects the darker skin around the nipple. It is also rare.

Breast cancer happens when there are changes in the genetic material (DNA). Often, the exact cause of these genetic changes is unknown.

But sometimes these genetic changes are inherited, meaning that you are born with them. Breast cancer that is caused by inherited genetic changes is called hereditary breast cancer.

There are also certain genetic changes that can raise your risk of breast cancer, including changes in the BRCA1 and BRCA2 genes. These two changes also raise your risk of ovarian and other cancers.

Besides genetics, your lifestyle and the environment can affect your risk of breast cancer.

The factors that raise your risk of breast cancer include:

• Older age
• History of breast cancer or benign (noncancer) breast disease
• Inherited risk of breast cancer, including having BRCA1 and BRCA2 gene changes
• Dense breast tissue
• A reproductive history that leads to more exposure to the estrogen hormone, including:
  • Menstruating at an early age
  • Being at an older age when you first gave birth or never having given birth
  • Starting menopause at a later age
• Taking hormone therapy for symptoms of menopause
• Radiation therapy to the breast or chest
• Obesity
• Drinking alcohol

The signs and symptoms of breast cancer include

• A new lump or thickening in or near the breast or in the armpit.
• A change in the size or shape of the breast.
• A dimple or puckering in the skin of the breast. It may look like the skin of an orange.
• A nipple turned inward into the breast.
• Nipple discharge other than breast milk. The discharge might happen suddenly, be bloody, or happen in only one breast.
• Scaly, red, or swollen skin in the nipple area or the breast.
• Pain in any area of the breast.

Your health care provider may use many tools to diagnose breast cancer and figure out which type you have:

• A physical exam, including a clinical breast exam (CBE). This involves checking for any lumps or anything else that seems unusual with the breasts and armpits.
• A medical history.
• Imaging tests, such as a mammogram, an ultrasound, or an MRI.
• Breast biopsy.
• Blood chemistry tests, which measure different substances in the blood, including electrolytes, fats, proteins, glucose (sugar), and enzymes. Some of the specific blood chemistry tests include a basic metabolic panel (BMP), a comprehensive metabolic panel (CMP), and an electrolyte panel.

If these tests show that you have breast cancer, you will have tests that study the cancer cells. These tests help your provider decide which treatment would be best for you. The tests may include:

• Genetic tests for genetic changes such in the BRCA and TP53 genes.
• HER2 test. HER2 is a protein involved with cell growth. It is on the outside of all breast cells. If your breast cancer cells have more HER2 than normal, they can grow more quickly and spread to other parts of the body.
• An estrogen and progesterone receptor test. This test measures the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If there are more receptors than normal, the cancer is called estrogen and/or progesterone receptor positive. This type of breast cancer may grow more quickly.

Another step is staging the cancer. Staging involves doing tests to find out whether the cancer has spread within the breast or to other parts of the body. The tests may include other diagnostic imaging tests and a sentinel lymph node biopsy. This biopsy is done to see whether the cancer has spread to the lymph nodes.

Treatments for breast cancer include:

• Surgery such as
  • A mastectomy, which removes the whole breast
  • A lumpectomy to remove the cancer and some normal tissue around it, but not the breast itself
• Radiation therapy
• Chemotherapy
• Hormone therapy, which blocks cancer cells from getting the hormones they need to grow
• Targeted therapy, which uses drugs or other substances that attack specific cancer cells with less harm to normal cells
• Immunotherapy

You may be able to help prevent breast cancer by making healthy lifestyle changes such as:

• Staying at a healthy weight
• Limiting alcohol use
• Getting enough exercise
• Limiting your exposure to estrogen by
  • Breastfeeding your babies if you can
  • Limiting hormone therapy

If you are at high risk, your provider may suggest that you take certain medicines to lower the risk. Some women at very high risk may decide to get a mastectomy (of their healthy breasts) to prevent breast cancer.

It's also important to get regular mammograms. They may be able to identify breast cancer in the early stages, when it is easier to treat.

NIH: National Cancer Institute

Cervical cancer is cancer that starts in the cells of the cervix. The cervix is part of the female reproductive system. It is the lower, narrow end of the uterus (womb), which opens into the vagina (birth canal). Cervical cancer screening is an important part of routine health care for people who have a cervix.

Cervical cancer screening tests look for cancer before you have any symptoms. Cervical cancer usually develops slowly. Before cervical cells become cancer, they start to look abnormal. These cells are called "precancers". If they aren't destroyed or removed, they may become cancer cells that grow out of control and spread to other parts of your body.

Screening can help find abnormal cells so you can get treatment to prevent cervical cancer. These tests can also help to find cervical cancer early when it's usually easier to treat.

Cervical cancer screening is usually part of a woman's health checkup during a pelvic exam. These tests use a sample of cervical cells that your health care provider collects with a swab:

• A Pap test (also called a Pap smear or cervical cytology) checks for abnormal cells so they can be treated before they become cancer.
• An HPV (human papillomavirus) test checks for certain HPV infections that can cause cancer. HPV is a group of viruses that spread through sexual contact. The types that cause cancer are called "high-risk HPV."
• The HPV/Pap cotest uses an HPV and Pap test together to check for both high-risk HPV and cervical cell changes.

If your screening tests are abnormal, your provider may do more tests, such as a biopsy. How often you should be screened for cervical cancer and which tests you should get will depend on your age and health history.

Cervical cancer screening saves lives. Screening can detect cervical changes early, lowering your chance of dying from cervical cancer. But, cervical cancer screening has potential harms.

The possible harms of cervical cancer screening include:

The results can sometimes be wrong.

• Getting a false-positive result means that your test results appear abnormal, but there are no precancerous or cancerous cells. A false-positive may lead to:
  • Worry while you have more tests to look for signs of cancer.
  • Follow-up tests or treatment that you may not have needed.
• Getting a false-negative result means that your test results appear normal, but there are precancer or cancerous cells. A false-negative may lead to:
  • You may delay seeking treatment even if you have symptoms.

Talk with your provider about how often you should be screened for cervical cancer and which tests you should get. This will depend on your age and health history. If you have a cervix, it's recommended that you have your first Pap smear at age 21 and begin screening with an HPV test at age 25. You may need screening more often if you:

• Had an abnormal HPV test, Pap smear, or cervical biopsy in the recent past.
• Have had a diagnosis of cervical cancer.
• Have a weakened immune system.
• Were exposed to a drug called DES (Diethylstilbestrol) before you were born. Between the years 1940-1971, DES was sometimes prescribed to prevent miscarriages.

If you are over age 65 and have had regular Pap smear screenings with normal results, your provider may tell you that you no longer need them. If you have HIV, you may need to continue screenings after age 65.

You don't need cervical cancer screening if you had a total hysterectomy (surgery to remove your uterus and cervix) because of a condition that was not cancer. But if your hysterectomy was related to cervical cancer or precancer, ask your provider whether you need screening.

NIH: National Cancer Institute

The uterus, or womb, is the place where a fetus grows during pregnancy. In an ectopic pregnancy, the fertilized egg grows in the wrong place outside the uterus. It usually occurs in the fallopian tubes. These tubes carry eggs from the ovaries to the uterus. Sometimes, an ectopic pregnancy can occur in the ovaries, abdominal cavity, or the lower part of the uterus (cervix).

Ectopic pregnancies can't end in a healthy pregnancy because the egg cannot grow. If the pregnancy continues, the fallopian tube can burst. This can cause internal bleeding, which can be a life-threatening emergency that needs immediate surgery.

An ectopic pregnancy often happens because there is a problem with your fallopian tubes. But sometimes it's not clear why an ectopic pregnancy happens.

Factors that may increase your risk for an ectopic pregnancy can include:

• Previous ectopic pregnancy
• Prior pelvic, abdominal, or fallopian tube surgery
• Certain sexually transmitted infections (STIs)
• Pelvic inflammatory disease
• Endometriosis
• Becoming pregnant while using an intrauterine device (IUD) for birth control
• Becoming pregnant after a tubal ligation

Other factors that may increase your risk can include:

• Smoking
• Being older than age 35
• Infertility treatments

You may not notice any symptoms at first. Or you may have some of the usual signs of pregnancy such as a missed period, breast tenderness, or nausea.

Early signs of an ectopic pregnancy may be light vaginal bleeding and pelvic pain. Ectopic pregnancy can be a medical emergency. Get medical care right away if you have these signs:

• Abdominal (belly) pain
• Shoulder pain
• Vaginal bleeding
• Feeling dizzy or faint

An ectopic pregnancy can't be diagnosed without blood tests and an ultrasound. Your health care provider will do a pregnancy test to confirm that you're pregnant. They may do a pelvic exam to check for areas of pain, tenderness, or a mass.

An ectopic pregnancy needs treatment to stop any damage to your organs. Your provider will use medicine or surgery to take out the ectopic tissue.

Losing a pregnancy can be devastating. An ectopic pregnancy is like a miscarriage, but it must be treated to prevent problems. People cope with grief in different ways. It may be helpful to discuss your feelings with your provider or a counselor. Many women who have had ectopic pregnancies go on to have healthy pregnancies later.

Dept. of Health and Human Services Office on Women's Health

Infertility means not being able to get pregnant after at least one year of trying (or 6 months if the woman is over age 35). If a woman keeps having miscarriages, it is also called infertility. Female infertility can result from age, physical problems, hormone problems, and lifestyle or environmental factors.

Most cases of infertility in women result from problems with producing eggs. In primary ovarian insufficiency, the ovaries stop functioning before natural menopause. In polycystic ovary syndrome (PCOS), the ovaries may not release an egg regularly or they may not release a healthy egg.

About a third of the time, infertility is because of a problem with the woman. One third of the time, it is a problem with the man. Sometimes no cause can be found.

If you think you might be infertile, see your doctor. There are tests that may tell if you have fertility problems. When it is possible to find the cause, treatments may include medicines, surgery, or assisted reproductive technologies. Happily, many couples treated for infertility are able to have babies.

Dept. of Health and Human Services Office on Women's Health

Infertility means not being able to become pregnant after a year of trying. If a woman can get pregnant but keeps having miscarriages or stillbirths, that's also called infertility.

Infertility is fairly common. After one year of having unprotected sex, about 15% of couples are unable to get pregnant. About a third of the time, infertility can be traced to the woman. In another third of cases, it is because of the man. The rest of the time, it is because of both partners or no cause can be found.

There are treatments that are specifically for men or for women. Some involve both partners. Drugs, assisted reproductive technology, and surgery are common treatments. Happily, many couples treated for infertility go on to have babies.

NIH: National Institute of Child Health and Human Development

A miscarriage is an unexpected loss of pregnancy before the 20th week. Most miscarriages happen very early in the pregnancy, often before a woman even knows she is pregnant.

A miscarriage can happen in any pregnancy. Most miscarriages occur because the fetus doesn't develop properly. This is often linked to a genetic problem with the fetus, such as an extra or missing chromosome.

In many cases, the cause of a miscarriage is unknown. Some possible factors that may increase the chance of a miscarriage can include:

• Problems with the uterus or cervix
• Chronic diseases, including polycystic ovary syndrome
• Genetic problems with the fetus
• Pregnancy after 35 years of age
• Smoking, drug or alcohol use
• Certain chronic (long-term) health conditions, such as uncontrolled diabetes
• Severe malnutrition

The signs of a miscarriage may be different for everyone and can vary based on how far along you are in your pregnancy.

Signs of a miscarriage can include:

• Vaginal spotting or bleeding with or without pain. Some women may have some spotting in early pregnancy and don't miscarry. To be sure, contact your provider right away if you have any bleeding.
• Dark-colored vaginal discharge.
• A gush of fluid or tissue from your vagina.
• Cramping or pain in your abdomen (belly) or lower back.

Sometimes, it's hard to know what's normal during pregnancy. If something seems unusual or is worrying you, talk to your provider.

To check if you have had a miscarriage, your provider may do the following:

• A pelvic exam to check your cervix.
• Blood tests to check things such as the amount of blood loss and confirm pregnancy.
• An ultrasound to check the fetus.

Treatment after a miscarriage often depends on when it occurs during the pregnancy. If you miscarry early in your pregnancy, you may not need any treatment. If you are 12 or more weeks pregnant, you may need a shot to prevent problems with the Rh factor in future pregnancies.

In some cases, tissue is left in the uterus. If you don't have any signs of infection, your provider may recommend waiting for the tissue to pass naturally. If you need treatment to remove the tissue, it can include:

• Medicines
• A procedure called dilatation and curettage (D&C) or vacuum aspiration

No matter when it occurs, losing a pregnancy can be difficult. Counseling may help you cope with your grief. Later, if you decide to try to get pregnant again, talk with your provider to understand any risks. Many women who have a miscarriage go on to have healthy pregnancies later.

Miscarriage can affect anyone and often can't be prevented. Focus on taking good care of yourself and start prenatal care visits early in your pregnancy.

NIH: National Institute of Child Health and Human Development

Some medicines are safe to take during pregnancy, but many are not. If you're pregnant, check with your health care provider before taking any medicine. Some medicines can harm your developing fetus. This includes:

• Prescription drugs
• Over-the-counter medicines
• Herbs and supplements

Always talk to your provider before you stop or start any medicine. You may take medicine to treat a health problem you had before pregnancy. Not using the medicine that you need may be more harmful to you and your fetus than using the medicine. For example, many pregnant women take prescription medicines for health problems like diabetes, asthma, seizures, and heartburn. The decision about whether to take a certain medicine should depend on the risks and benefits that go with it. You and your provider should make this choice together.

If you're pregnant, you shouldn't take regular vitamins. They may have too much or too little of the vitamins you need. For example, everyone needs folic acid, a type of B vitamin. But if you're trying to get pregnant, it's really important. Getting enough folic acid before and during pregnancy can prevent birth defects of the brain or spine. During your prenatal care visits, your provider will talk about prenatal vitamins. These are a special kind of vitamin to take during pregnancy.

Food and Drug Administration

Tumors during pregnancy are rare, but they can happen. Tumors can be either benign (not cancer) or malignant (cancer). The most common cancers in pregnancy include breast cancer, thyroid cancer, cervical cancer, lymphoma, and melanoma. Cancer itself rarely harms the fetus, and some cancer treatments are safe during pregnancy. You and your health care provider will work together to find the best treatment. Your choices will depend on how far along the pregnancy is, as well as the type, size, and stage of your cancer.

Another type of tumor that women can get is called a gestational trophoblastic disease (GTD). It happens when a fertilized egg doesn't become a fetus. GTD is not always easy to find. It is usually benign, but some types can be malignant. The most common type of GTD is a molar pregnancy. In its early stages, it may look like a normal pregnancy. You should see your provider if you have vaginal bleeding (not menstrual bleeding).

Treatment depends on the type of tumor, whether it has spread to other places, and your overall health.