i think pap smear should be encourage among sexually active women, because it's a very useful test to diagnose early abnormal changes.

according to clinical doctors, cervical cancer is very easy to treat if detected earlier. However, the problems of cervical cancecr is that the cancer only present signs and symptoms at a very late stage.

another word is that, when patients approach doctors about the problems they face: leuchorrhoea, dysparunia, vaginal bleeding, dysuria... it's already in late stage and the prognosis is not that good.

In US, cervical cancer was the leading cause of death 50 years ago, but with the screening with pap smear, cervical cancer has reduced this to the 8th cause of cancer mortality in women in US today.

the peak age of Invasive Carcinoma( agressive type)--> 5th decade
in situ carcinoma ( non agressive)----> 3rd decade

Pap smear indeed is a very sensitive and high specificity screening tool. it's cheap and easily done. it's important, especialy for those sexually active women.

yes, recommend for all sexually active ladies, but you dun need to do 3 times until you get normal result.
for age below 30, 3 yearly pap smear is recommended, in fact, it's carry out in government clinic for all sexually active women as primary screening tools if patients comes in with gynae problem.
if abnormal cells are found, it depends on staging...
early stage is very easy to treat...but if late stage might be a bit difficult.

vaccine for HPV is already in the market, if you're sexually active already...there's no point to take the vaccine ...
it's highly recommended for those sexually inactive girls...and u need to know HPV transmit by guys...
previously, there's recommendation of vaccinate guys as well , because they are the "vectors"..haha

frankly speaking, i'm not misguiding people...
if you read some medical journals, the recommendation are -
within 3 years after first sexual contact and 3 yearly ( means every 3 year, not once yearly for 3 years..then i'll just straight away say annually already...right? )

of course, pap smear sensitivity also depends on the experience and operator's technic. a good gynae doctor should be able to obtain a good smear.

why women still get cervical ca even though people doing pap smear increasing?
haha..this is a good question...i asked my brother before( he's a doctor).
this is because, previously, when pap smear was not popular, women only comes to doctor when they got serious problems like pervaginal bleeding, some lumps felt over the region, or other metastases symptoms etc. (but it's already in quite a late stage)
now a days, with pap smear, the detection is very sensitive, it can detect some very early changes even before it changed into neoplastic cell(cancer cell) it's call a metaplastic phase.
with more people doing pap smear, the pickup rate among general population increase...so as those who being detected to have cervical ca.(hope u understand )

about the point which i mentioned about the vaccination on sexually active women..

Ideally females should get the vaccine before they become sexually active, when they may be exposed to HPV. Females who are sexually active may also benefit from the vaccine, but they may get less benefit from it. This is because they may have already gotten an HPV type targeted by the vaccine. Few sexually active young women are infected with all HPV types covered by the vaccine so they would still get protection from those types they have not yet gotten.

i think you get the concept wrong already...
you have to understand the nature of HPV virus, these virus cannot be treated completely once you infected with it. the reason why most people doesn't have problems with HPV is because of our immune system which control the virus. Most of the time, it stays as "dormant" state in our body.

the HPV vaccine aims to give immunization to virgins to certain viral strain. strain 16,18 (high risk) while quadrivalent 6,11,16,18 (6,11 cause genital warts). the concept is same like hepatitis B, you dun give them after you infected with hepatitis B ( useless already...right?).
once you're sexually active, yes, within 3 months(maximum limit after exposure), you must get yourself vaccinated, else, after 3 month, virus started to establish in the body. there's nothing much you can do.

HPV itself is associated with neoplastic of cervical mucosa, because they noticed HPV virus within the neoplastic cells. however, how long it takes for it to become cancerous is still unknown...
Those who develop cervical cancer are those high risk group who have recurrent HPV infection...
however, cervical ca is very uncommon in sexually inactive group, that's why, pap smear is not indicated for those sexually inactive women.

the researchers evaluate the outcome between HPV vaccinated sexually active women and those who are not vaccinated with HPV vaccine(control group).
they noticed there's not much difference in the viral clearence between the group with vaccination and control group.
the theory behind this test is that human body does produce antibody against the HPV virus after exposure to clear the virus.
so, they give immunization to the subjects and see whether it helps to produce more antibody to fight against virus.
the result is not significant.

well, there's still some controversial whether this vaccine are indicated for those who are already exposed...
of course, as manufacturer, and pharmacy, they'll do everything to get into you wallet...
the best choice : go and get professional advice from a gynaecologist.

this is my modified statement
get the vaccine when you're still virgin!!!
if you're not virgin anymore, but with protected sex activity(100% protection=nvr missed a time putting up barrier protection), there's still some chance the vaccine works for you...(jus incase you havent expose to)..
if you're having unprotected sex activities, ... it's totally up to you, but the effect is not significant.

take a time shift to do it...it takes less than 15 mins for the whole process...
go to private clinic is faster...trust me.
let's say you clinic @ 9, by 10am u can go back to your work. simple.


This post has been edited by klifex: Nov 23 2008, 06:04 AM

3. If pap smear should given to girl who already have sex before, then how a virgin can test for uterus cancer ?

it's commonly seen in post menopausal women, also in peri menopausal women...predisposing factors as mentioned, nulliparous, polycystic ovarian syndrome, obesity, hypertension, diabetes.

to diagnose carcinoma of endometrium, need a good history..
usually they present with irregular per vaginal bleeding, spotting.
in pre-menopausal women, what is significant is that they have intermenstrual bleeding...
weight lost and lose of appetite is also one of the symptoms, but it can apply to most of the malignancies or chronic disease.


usually, vaginal examination finding is unremarkable...
in later stage, you might find a growth at the cervix, in the sense if the tunour spread to cervix.
bimanual examination will reveal a large uterus.
if disease spread to the ovaries and tubes, mass can be felt either one side or both.

to confirm the diagnosis, we need to take a proper biopsy by formal dilatation and curettage or a pippele sampling.
another method is to use hysteroscope to look into the endometrium.

then follow by a CT scan to see the extension of spread and staging.

single doesn't means virgin.
that's why the doctor always ask whether she's sexually active or not..

well, medical field is broad, a lot of things has to be taken into consideration before a decision is made.

website serve as a guidance only, human presentation can be very variable...that's why, in the end, we need doctor to get to the final diagnosis.

anyway, not all sources are correct. especially the wikipaedia one...haha ...
you should check on to medical journals, recognized health society, clinical practice guidelines which give the correct description.

about the hysterectomy, i couldn't really give you the answer, because there's no scenario given.

but if you refer to cancer of the uterus,
yes, no choice - you have to do totaly hysterectomy, in addition, both ovary also have to remove. even at stage 1a (the mildest stage).
age wont be a consideration in this case, because there's a high chance of spread(uterus got a lot of blood vessels)

inevitable...
if he's a real doctor/medical students...the medical terms just pop out from his head like that...
anyway, it's okie as long as you put a bracket there to define the medical terms you used...so that people like us can understand better.

plus, we learn new words everyday... good for us also. right?

diagnosis of testicular cancer is a combination of history, examination, and also laboratory tests and imaging.
biopsy is not done usualy...why?
because if you want to do a needle biopsy inserting a needle into the testis just to take out some cancer sample, u may cause seeding of cancer cell along the needle track.
the result is that, you may make the cancer worse, you just upgraded the stage of cancer.

then why needle biopsy is okie in breast cancer? because they will mark down the needle track together with the surgical excision. means the whole track will be remove along with the cancer part.

if there's enough evidence on physical examination shows high suspicious of testic cancer, they will proceed to cancer marker such as alpha fetoprotein and B-HCG, which will usually raised in testis cancer.

if both are raised, no doubt, the next thing to plan is a surgery and adjuvant therapy.

infection is usually detect by high vaginal swap and culture+sensitivity..

the main purpose of pap smear is look at the cell morphology... however, in some case, for research purpose, they do virology test from the cell sample for HPV infection.