Stage 3 Cancer: Definition, Diagnosis, Treatment, Prognosis
6 Signs Of Cervical Cancer That Can Be Too Easy To Miss
As Diana Pearre, MD, a gynecologic oncologist at the Providence Saint Joseph Medical Center in Burbank, California, tells SELF, it's really difficult to tell cervical-cancer-related bleeding and pain from sex apart from other things, like vaginal dryness or even uterine fibroids. But importantly, "bleeding after intercourse should not be happening all the time," she explains. "There are a lot of benign reasons it could be happening, but it's something to report to your doctor—especially if it's something you're experiencing all of a sudden."
2. A wonky menstrual cycleIf you get a period, it can look and feel different from month to month—sometimes it's short and light, or drawn-out and heavy. But as Dr. Avila notes, when your flow is off, your body might be prodding you to listen up. According to Dr. Pearre, it's typically one of the most tell-tale signs of the disease.
If you're bleeding after menopause, between periods, or a lot—soaking through your pad or tampon every one to two hours or your period is lasting longer than seven days—it can sometimes signal cervical cancer. Dr. Avila says it's important to look out for any strange bleeding patterns, particularly if you're skipping periods and then running through pads all of a sudden. She says people who had heavy bleeding and were eventually diagnosed with cervical cancer came to her office and just assumed a change in their diet or taking a new supplement was to blame. "I hear it all the time," she stresses. "If there's any abnormal bleeding, it's important to come in [for an exam]."
3. Unpleasant vaginal dischargeAs SELF has previously reported, your vagina cleans itself by releasing discharge—a.K.A. That mucus-y fluid that piles on your underwear throughout the day. Yours might have a slight odor that's more fragrant during certain parts of your menstrual cycle or even after a workout. But if the smell is particularly bothersome to you, cervical cancer could potentially be one reason to have on your radar—particularly if it's happening alongside a wonky period, per Dr. Avila.
According to Dr. Pearre, when a person with late-stage cervical cancer has discharge, you won't *not* be able to notice the odor. "It's very foul-smelling," she notes. Though Dr. Pearre says that some STIs, like trichomoniasis and gonorrhea, can present with similar smells, cervical cancer discharge odor is usually worse, Dr. Avila says. "That tumor is trying to get bigger and bigger and there's a lot of dead tissue that's there, and that's what we smell with those kinds of cancers," she notes. Though its smell is often the most defining characteristic, the discharge might be watery, pink, pale, yellowish, brown, or mixed with blood, per Dr. Pearre.
4. Bowel and bladder issuesSimilar to how having sex might affect the cervix (and cause pain and bleeding), cancerous cells or tumors can push up against other surrounding stuff too—and that includes your bladder and bowel. "I see a lot of patients [with cervical cancer] who either need to pee very frequently or have issues starting the stream," Dr. Avila says. Alternatively, she says people who ultimately get diagnosed with cervical cancer complain about constipation, or that they have to really strain to go. "I'll have patients say, 'Oh, I thought I was just constipated and straining too much, or I thought I had a meal that went bad.'" (There could also be blood in your poop or urine, per the National Cancer Institute.)
5. Pain and swelling in various parts of your bodyAs cervical cancer progresses, you might develop pain in your pelvis, back, belly, or legs. For McClellan, her lower back aches felt similar to period-related cramps.
Spinal Stenosis: Causes And Symptoms
Spinal stenosis is a condition in which open spaces within your spine get narrower. This puts pressure on your spinal cord and the nerves around it, which can cause pain and other problems.
Your spinal cord is a key part of your central nervous system that connects your brain to your body. It rests in the spinal canal, which is formed by the hollow spaces in the center of each vertebra, the interconnected bones that make up your spine. The narrowing can happen in the spinal canal, in the spaces between your vertebrae, or at points where nerves from your spine branch out to other parts of your body.
As these spaces get smaller, the tightness can pinch the spinal cord or the nerves around it, causing pain, tingling, or numbness in your legs, arms, or torso.
Injuries and conditions such as arthritis can lead to spinal stenosis. It's most common in people over 50. There's no cure, but there are a variety of nonsurgical treatments and exercises to keep the pain at bay.
There are two main types of spinal stenosis. The type you have depends on where on your spine the condition is:
Cervical spinal stenosis. Cervical stenosisis when the spinal canal in your neck area becomes narrowed.
Lumbar spinal stenosis. You have lumbar stenosis when there's narrowing in the spinal canal in your lower back. This is the most common type.
You can have one or both types of spinal stenosis. You can also have spinal stenosis in your middle back, but this is much less common.
Spinal stenosis and arthritis
For most people, stenosis results from wear and tear on the spine related to arthritis. With osteoarthritis, the cartilage between your joints breaks down. The vertebrae start to rub against each other, which triggers extra bone growth called bone spurs. This extra bone narrows the space within your spinal canal. Arthritis can also cause the ligaments (bands of tissue that hold bones together) in your spine to get thicker, which can make the canal narrower.
Not everyone has symptoms, but if you do, they tend to be the same: stiffness, numbness, and back pain.
More specific spinal stenosis symptoms include:
If you're having symptoms, tell your doctor. If you suddenly lose bowel or bladder control and have back pain, get medical help right away.
The leading reason for spinal stenosis is arthritis, which is caused by the breakdown of cartilage (the cushiony material between your bones) and the growth of bone tissue.
Other causes include:
Spinal stenosis risk factors
The main risk factor for spinal stenosis is being over 50. Women (and those assigned female at birth) as well as people who've had spinal surgery are at higher risk.
Spinal stenosis risk factors in younger adults
Some people are born with spinal stenosis or diseases that lead to it, such as scoliosis (curvature of the spine). For them, the condition usually starts to cause problems between the ages of 30 and 50. An injury to your spine can also put you at risk for stenosis at a younger age.
First steps in spinal stenosis diagnosis
The doctor will probably start by asking questions about your medical history and risk factors. They'll do a physical exam, and may press on areas of your spine to see where you have pain After that, they'll order X-rays or other imaging tests to give them further details about your condition. The tests may include:
Spinal stenosis MRI
An MRI uses radio waves to create a 3D image of your spine. It can show tumors, growths, and even damage to your disks and ligaments.
CT scan for spinal stenosis
A CT scan uses X-rays to create a 3-D image. With the help of a dye injected into your body, it can show damage to soft tissue as well as issues with your bones.
There's no cure for this condition. But treatment can help you manage your symptoms. What spinal stenosis treatment you need depends on which part of your spine is affected and how serious your symptoms are. For mild cases, you may not need any treatment. Instead, your doctor will keep an eye on your condition to see if anything changes.
What is the best painkiller for spinal stenosis?
Spinal stenosis medications include a variety of over-the-counter and prescription pain-relieving drugs. Your doctor will determine which is best for you, based on your symptoms and overall health. They'll also consider the possible side effects and complications of pain treatments.
Over-the-counter pain treatment. Common pain remedies such as aspirin, acetaminophen, ibuprofen, and naproxen can offer short-term relief. All are available in low doses without a prescription.
Antidepressants. Taking tricyclic antidepressants, such as amitriptyline, can help ease long-lasting pain.
Corticosteroid injections. Your doctor will inject a steroid such as prednisone into your back or neck. Steroids make the inflammation go down. But because of side effects, they are used sparingly.
Opioids. For short-term pain relief, your doctor might prescribe drugs with codeine, such as oxycodone (Oxycontin, Roxicodone) and hydrocodone (Norco, Vicodin). These drugs can be habit-forming and have serious side effects.
Nerve block. Done with precision, an injection of an anesthetic can stop pain for a certain time.
Muscle relaxants. These can help control muscle spasms.
Anti-seizure medication. You can take these to ease pain from damaged nerves.
Physical therapy. A physical therapist can come up with an exercise routine to build strength and flexibility in your back and core muscles. This can reduce pain and help you move better. They can also teach you less painful ways to do daily activities, such as walking.
Spinal stenosis surgery. If you have a serious case of spinal stenosis, you might struggle to walk or have issues with your bladder and bowels. Your doctor may recommend a type of surgery to create space between the bones so inflammation can go down. You might get:
Laminectomy. This procedure removes the back part of the affected vertebrae.
Laminoplasty. Your doctor puts metal hardware in your neck vertebrae to form a bridge within the open section of your spine.
Laminotomy. The doctor removes a part of your vertebrae to relieve pressure.
Minimally invasive surgery. This type of surgery helps avoid spinal fusion by removing bone tissue in a way that reduces damage to nearby healthy tissue.
Decompression procedure. The doctor uses needle-like instruments to remove part of the thickened ligaments in your spinal column. You get this procedure only if you have lumbar spinal stenosis caused by thickened ligaments.
Spinal fusion. A surgeon permanently fuses two of your vertebrae together. This operation is considered a last resort and used only if no other treatments have helped. While it can help ease pain, it limits your mobility.
All surgery options carry some risks. Talk to your doctor about how much it can help you, recovery time, and more.
What is the newest treatment for spinal stenosis?
One newer treatment option for spinal stenosis involves placing a spacing device called aninterspinous spacerbetween your vertebrae. The doctor makes a tiny cut in your back, inserts the device through a tube, then expands it once it's in place. You don't need to go to the hospital for this minimally invasive procedure.
Another is a joint replacement operation called the Total Posterior Arthroplasty System (TOPS). A doctor implants a device that stabilizes your spine but doesn't restrict your movement like spinal fusion.
Researchers are also looking at stem cell therapy to treat spinal stenosis. For this treatment, a doctor collects stem cells -- cells that can develop into any type of cell -- from your body. They inject the stem cells into the damaged area of your back, where they help generate healthy tissue.
Early results show promise, but we need more research into this treatment.
Some things that can help ease symptoms include:
Spinal stenosis exercise. Regular exercise helps you maintain mobility. Your physical therapist can give you stretching and strength exercises, tailored to your needs, to do at home. If your doctor says it's OK, add moderate cardio exercise such as walking, swimming, or riding a stationary bike.
Apply heat and cold. Heat boosts blood flow, loosens muscles, and soothes joints. Cold reduces inflammation. Try a hot or cold pack on your neck or lower back and see what works best for you. Hot showers are also good.
Posture. Stand up straight, sit on a supportive chair, and sleep on a firm mattress. And when you lift heavy objects, bend from your knees, not your back.
Weight loss. Because extra pounds put added pressure on your back, losing them may improve your symptoms.
Assistive devices. Braces, a corset, or a walker could help you get around, provide stability, and reduce pain.
Alternative medicine for spinal stenosis
Along with medical treatment, many people try nontraditional therapies such as chiropractic care, acupuncture, and massage therapy. Let your doctor know if you're trying an alternative approach.
If you don't treat spinal stenosis, it can get worse over time. Certain symptoms may even become permanent, including:
Spinal stenosis affects different people in different ways. Most people with the condition don't need surgery and are able to live active lives, though they may need to make some changes to the way they work or exercise.
To keep your back as pain-free as possible:
Things to avoid with cervical spinal stenosis
Stay away from or modify activities that could lead to pain or injuries. It's best to avoid:
With spinal stenosis, open spaces within your spine get narrower and pinch your spinal cord and the nerves around it. This can cause pain, numbness, and other issues. There's no cure, but treatment and lifestyle changes can help you manage the symptoms.
What are the stages of spinal stenosis?
Imaging tests can help your doctor see how serious your condition is. When they look at your MRI results, they can determine whether your spinal stenosis is:
What are the final stages of spinal stenosis like?
Symptoms of the later stages can include:
You may need surgery if your stenosis is in an advanced stage.
What does spinal stenosis leg pain feel like?
If you have spinal stenosis, you might have leg pain that feels like prickling or burning. It may start in your buttocks and spread down to your feet. You might also have cramps, numbness, or weakness in your legs. The symptoms often start or get worse when you stand, walk, or exercise. They may improve when you crouch down or lie in a fetal position.
How do you stop spinal stenosis from progressing?
You can't necessarily stop spinal stenosis from progressing. But you can slow it down with treatment and by taking steps such as exercising regularly, maintaining a healthy weight, and avoiding activities that could lead to further spine damage. Spinal stenosis tends to progress very gradually over many years.
What is the life expectancy of someone with spinal stenosis?
Spinal stenosis doesn't affect your life expectancy, though it can cause disability if you don't get treatment or take other steps to manage symptoms and maintain your mobility.
New Treatment Could Be Advance Against Cervical Precancers
Women who undergo regular Pap smears are no doubt familiar with the possibility of "precancerous" cells being detected.
These cells—called cervical intraepithelial neoplasias (CINs)—can progress to full-blown cervical cancers, but a new trial suggests that a vaginal suppository containing the drug imiquimod can halt that process.
The treatment might also help women diagnosed with advanced CIN avoid the most common therapeutic option, surgery.
"The imiquimod treatment was patient-friendly and easy to use, since it could be applied by the patient without requiring an office visit," added study lead author Dr. Sangini Sheth. She's associate professor of obstetrics at the Yale School of Medicine in New Haven, Conn.
Her team presented the findings this week at the annual meeting of the American Association for Cancer Research in San Diego. Their study was published simultaneously in the journal Clinical Cancer Research.
As Sheth's team explained, CIN can present in three grades—CIN1, CIN2 and CIN3—all involving the emergence of abnormal cells at the entrance to the cervix. As is the case with cervical cancers, CIN is very often caused by infection with the human papilloma virus (HPV).
Imiquimod is already approved as a topical skin cream to treat genital warts and works by stimulating an immune response. Sheth's team wanted to see if it might also help eliminate CIN when used as a vaginal suppository.
They focused on a group of 133 women who'd been diagnosed with CIN at grades 2 or 3. They did not include women with less severe CIN1, since these cases often regress on their own over time and do not require surgery.
"With CIN1, we don't do surgery, we advise the patients to come back and see us in 6 to 12 months, so we can repeat the pap smear," senior study author Dr. Alessandro Santin explained in a Yale news release.
"For CIN2, it is different," he said. Santin is professor of obstetrics, gynecology and reproductive sciences at Yale.
Patients in the study were divided into three groups: One received the imiquimod suppository alone; another got the suppository plus the HPV vaccine; and a third group was simply monitored by doctors without receiving either treatment.
The results were impressive: While 79% of women with CIN2 who received monitoring (no treatment) saw their condition regress to the safer CIN1 level, over 95% of those taking imiquimod were able to achieve that result, the researchers reported.
Interestingly, the number was somewhat lower (84%) among women who got both the suppository and the HPV vaccine. That suggests "that the medication and HPV vaccine may impact the success of each other," according to the researchers.
Use of the suppository "was also well-tolerated by the study participants, who experienced minimal side effects," Sheth noted.
The researchers are optimistic that this nonsurgical approach to CIN2 might someday replace surgery.
That could also be true for patients with CIN3, although more study is needed. Only about a quarter of the patients in the latest trial had CIN3, Santin noted, and he hopes that a future trial—one that includes more patients with CIN3—could settle that issue.
More information: Sangini S. Sheth et al, Randomized Phase II Trial of Imiquimod with or without 9-Valent HPV Vaccine versus Observation in Patients with High-grade Pre-neoplastic Cervical Lesions (NCT02864147), Clinical Cancer Research (2024). DOI: 10.1158/1078-0432.CCR-23-3639
Find out more about cervical intraepithelial neoplasia at the Cleveland Clinic.
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