“Several risk factors can increase your chance of developing cervical cancer. People without any of these risk factors rarely develop cervical cancer. Although these risk factors can increase the odds of developing cervical cancer, many with these risks do not develop this disease.

When you think about risk factors, it helps to focus on those you can change or avoid (like smoking or human papillomavirus infection), rather than those you cannot (such as your age and family history). However, it is still important to know about risk factors that cannot be changed, because it’s even more important for those who have these factors to get regular screening tests to find cervical cancer early.”

American Cancer Society (https://www.cancer.org/cancer/types/cervical-cancer/causes-risks-prevention/risk-factors.html)

Cervical cancer risk factors

GENERAL

• Pregnancy: Women who have had three or more full-term pregnancies, or who had their first full-term pregnancy before age 17, are twice as likely to get cervical cancer.

GENETICS

• Family history: Women with a sister or mother who had cervical cancer are two to three times more likely to develop cervical cancer.

LIFESTYLE

• Sexual history: Certain types of sexual behavior are considered risk factors for cervical cancer and HPV infection. These include: sex before age 18, sex with multiple partners and sex with someone who has had multiple partners. Studies also show a link between chlamydia infection and cervical cancer.
• Smoking: A woman who smokes doubles her risk of cervical cancer.
• Oral contraceptive use: Women who take oral contraceptives for more than five years have an increased risk of cervical cancer, but this risk returns to normal within a few years after the pills are stopped.

OTHER CONDITIONS

• Weakened immune system: In most people with healthy immune systems, the HPV virus clears itself from the body within 12-18 months. However, people with HIV or other health conditions or who take medications that limit the body’s ability to fight off infection have a higher risk of developing cervical cancer.
• Diethylstilbestrol (DES): Women whose mothers took DES, a drug given to some women to prevent miscarriage between 1940 and 1971, have a higher risk of developing cervical cancer.
• HPV: Though HPV causes cancer, having HPV does not mean you will get cancer. The majority of women who contract HPV clear the virus or have treatment so the abnormal cells are removed. HPV is a skin infection, spread through skin-to-skin contact with a person who has the virus.

Additional facts about HPV:

• There are more than 100 types of HPV, 30-40 of which are sexually transmitted.
• Of these, at least 15 are high-risk HPV strains that can cause cervical cancer. The others cause no symptoms or genital warts.
• Up to 80 percent of women will contract HPV in their lifetime. Men get HPV, too, but there is no test for them.
• A healthy immune system will usually clear the HPV virus before there is a symptom, including the high-risk types of HPV.
• Only a small percentage of women with high-risk HPV develop cervical cancer.

Understanding risk factors:

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer. Not having risk factors doesn’t mean that you will not get cancer. If you think you may be at risk, you should discuss it with your doctor.

Regarding symptoms of cervical cancer:

In most cases, cervical cancer does not cause noticeable symptoms in the early stages of the disease. Routine Pap screening is important to check for abnormal cells in the cervix, so they can be monitored and treated as early as possible. Most women are advised to get a Pap test starting at age 21.

The Pap test is one of the most reliable and effective cancer screening methods available, and women should have yearly exams by an OB-GYN. However, the Pap test may not detect some cases of abnormal cells in the cervix. The HPV test screens women for the high-risk HPV strains that may lead to cervical cancer. It is approved for women over age 30.

Although screening methods are not 100 percent accurate, these tests are often an effective method for detecting cervical cancer in the early stages when it is still highly treatable. Talk with your doctor about which type of cervical cancer screening is right for you.

When present, common symptoms of cervical cancer may include:

• Vaginal bleeding: This includes bleeding between periods, after sexual intercourse or post-menopausal bleeding.
• Unusual vaginal discharge: A watery, pink or foul-smelling discharge is common.
• Pelvic pain: Pain during intercourse or at other times may be a sign of abnormal changes to the cervix, or less serious conditions.

All of these cervical cancer symptoms should be discussed with your doctor.

Signs of advanced stages of cervical cancer:

Cervical cancer may spread (metastasize) within the pelvis, to the lymph nodes or elsewhere in the body. Signs of advanced cervical cancer include:

• Weight loss
• Fatigue
• Back pain
• Leg pain or swelling
• Leakage of urine or feces from the vagina
• Bone fractures

“Cervical cancer begins when healthy cells in the cervix develop changes in their DNA. A cell’s DNA contains the instructions that tell a cell what to do. The changes tell the cells to multiply quickly. The cells continue living when healthy cells would die as part of their natural life cycle. This causes too many cells. The cells might form a mass called a tumor. The cells can invade and destroy healthy body tissue. In time, the cells can break away and spread to other parts of the body.

Most cervical cancers are caused by HPV. HPV is a common virus that’s passed through sexual contact. For most people, the virus never causes problems. It usually goes away on its own. For some, though, the virus can cause changes in the cells that may lead to cancer.”

MAYO CLINIC (https://www.mayoclinic.org/diseases-conditions/cervical-cancer/symptoms-causes/syc-20352501)

Cervical cancer screening used to all be so simple==PREVENTION.   Women were told just go for your annual Pap but now we have new tests to screen for cervical cancer, plus updated guidelines that—for most women—mean routine screening is done every few years rather than annually. Dr. Warner Huh of the University of Alabama, Birmingham sorts out the new landscape of Pap and HPV tests.

Human papillomavirus, or HPV, is a common sexually transmitted infection. So common that most (~80%) sexually active people will be infected with HPV at some point.

Cervical cancer begins in the cervix, the narrow organ at the bottom of the uterus that connects to the vagina. The cervix dilates during childbirth to allow for passage of a baby.

Picking up on risk factors and warning signs could save an individual from a lifetime of suffering. These include whether or not you’ve contracted HPV, if you eat a whole diet, have used birth control, have HIV, smoke cigarettes, or if it’s just in your genetics.

Here are some signs to watch out for:

Leg Pain – Some women exhibiting early stages of cervical cancer experience swelling and pain in the leg. When the cervix swells it can lead to an obstructed blood flow, which eventually causes the leg to swell and gives a sore, painful sensation. This may be a sign of early cervical cancer.

Vaginal discharge colored with blood – It’s normal for a woman to experience small amounts of clear discharge without color or odor. However, bloody, dark, or smelly discharge is usually a sign of infection. But sometimes, it’s a sign of cervical or endometrial cancer.

Abnormal vaginal bleeding – More than 90% of women diagnosed with endometrial cancer experience irregular bleeding. If you have already undergone menopause, any bleeding — spotting included — should be evaluated. Haven’t gone through menopause yet? See your doctor if you experience bleeding between periods, heavy bleeding or bleeding during sex.

Discomforting Urination – Keeping track of urination can help reveal the presence of cervical cancer in several ways. The most immediately obvious and prevalent symptom is discomfort while urinating.  You may experience burning, stinging, or a tight sensation. This is another symptom to see a doctor about either way.

Irregular Urination – The appearance of the urine and urinary habits can also be symptoms of cervical cancer. If you notice strange changes in the frequency of your urine, loss of bladder control (incontinence) or a discoloration – especially with blood – seek the input of a medical professional.

Irregular Menstrual Cycles – There should be some level of consistency when it comes to monthly periods. If time, frequency, or any other changes disrupt the regular routine, it can also be a sign that you’re at a much higher risk for cancer and will require regular screenings.

Uncomfortable Sex – Painful intercourse, otherwise known as dyspareunia, is another discomforting side effect of cervical cancer. There are several possible reasons for this symptom to develop, as is the case with many of the symptoms on this list. This symptom is most commonly linked to conditions that require medical attention, however, so it shouldn’t be ignored.

Pain in the pelvis or abdominal area – Abdominal pain or discomfort — including gas, indigestion, pressure, bloating, and cramps — can signal ovarian cancer. And, constant pelvic pain or pressure can be a sign of endometrial cancer.

Back Pain – Back pain is common, affecting around 80 percent of the population, and it can happen for a wide variety of reasons, but if accompanied with other symptoms from the list, go for a medical check-up.

“According to the National Cancer Institute, in 2023 more than 106,000 women in the United States are expected to be diagnosed with a gynecological cancer, and more than 32,000 will die from one. Each gynecological cancer has different signs and symptoms, as well as different risk factors. Risk increases with age. ”

American Cancer for Cancer Research (ACCR)

“Leukemia, lymphoma and multiple myeloma are cancers of the blood, bone marrow or lymph (clear fluid that circulates white blood cells throughout the body). Unlike most types of cancer which form solid masses of abnormal cells called tumors, blood cancers cause the uncontrolled growth of mutated disease-fighting cells, making it harder for the body to fend off infection.

• Leukemia begins in bone marrow, producing abnormal leukocytes (white blood cells).
• Lymphoma (Hodgkin and non-Hodgkin) produces abnormal lymphocytes, immune system cells in the bone marrow, thymus, spleen and other organs.
• Multiple myeloma develops in bone marrow, producing abnormal plasma cells.”

Temple Health (https://www.templehealth.org/services/conditions/leukemia-lymphoma-multiple-myeloma)

Blood cancer is a very broad term that describes multiple types of cancer. The common factor is that the cancer originates in blood cells and can spread throughout the body via the bloodstream or through the lymphatic system. White blood cells are the immune cells in our bodies that fight disease. Red blood cells carry oxygen throughout the body and remove carbon dioxide.  Platelets are for clotting.  Remember most importantly what was stated in Part I all cells are created by the bone marrow and then after created released out in the bloodstream (a free flowing unit system in the body that cells move along in going from tissues  in the toes to the brain).  When cancer cells created by marrow also go in the bloodstream allowing the cancer cells to free float through -out the bloodstream.

The different types of blood cancer are classified by the cell type that has become cancerous, where the cancer is located in the body, and how fast the cancer is progressing.

The three most common major types of blood cancer are myeloma, leukemia, lymphoma.

What is leukemia?

Leukemia usually involves the white blood cells. Your white blood cells are potent infection fighters — they normally grow and divide in an orderly way, as your body needs them. But in people with leukemia, the bone marrow produces abnormal white blood cells, which don’t function properly.  There are many types of leukemia, which are classified by the specific type of white blood cell involved. White blood cells include the neutrophils and monocytes, which ingest (eat) bacteria and other germs; eosinophils and basophils, which are involved in allergic reactions; and lymphocytes, which play a key role in our body’s immune system.

Leukemia begins within the bone marrow, which is the soft spongy tissue inside our bones. In adults, remember we said yesterday bone marrow is found mainly in the flat bones, like the pelvis, skull, breastbone, ribs, shoulders, and vertebrae.

The bone marrow is where blood cells are made in a complex biological process called “hematopoiesis.” When a blood cell in the bone marrow changes to become cancerous, it can crowd out other cells and spread to the rest of the body via its primary channel the bloodstream.

What are the major types of leukemia?

There are four major sub-types of leukemia. Your specific diagnosis depends on how quickly the cancer grows and in which blood cell type it originates.  Acute types of leukemia affect very young white blood cells and can progress rapidly. Chronic leukemias affect slightly more mature cells and progress more slowly. Lymphocytic leukemias affect white blood cells called lymphocytes, whereas myeloid leukemias affect cells that are destined to become any other type of blood cell.

• Acute lymphocytic leukemia (ALL)
• Chronic lymphocytic leukemia (CLL)
• Acute myeloid leukemia (AML)
• Chronic myeloid leukemia (CML)

What is lymphoma?

Lymphoma is a cancer that begins in the lymphatic system, which is part of the immune system. The lymphatic system is made up mainly of immune cells.  We said yesterday they are called lymphocytes. B-cells and T-cells are the main lymphocytes, and each has a specific function in protecting our bodies from disease.

Lymphoma originates in lymph tissues, which can be found in many parts of the body, including in the lymph nodes, thymus, tonsils, adenoids, spleen, lymphatic vessels, and parts of the digestive system.  If you have been diagnosed with lymphoma, your specific symptoms will depend on where your tumor began.

What are the major types of lymphoma?

There are two major sub-types of lymphoma. Your diagnosis depends on the type of cell where the cancer originated plus other characteristics of the tumor. Hodgkin lymphoma is characterized by the presence of Reed-Sternberg cells, which are named after the researchers who discovered them. Non-Hodgkin lymphoma does not have Reed-Sternberg cells.

• Hodgkin lymphoma
• Non-Hodgkin lymphoma

What is Multiple Myeloma?

Multiple myeloma is a cancer of plasma cells (B and T cells).  Multiple myeloma is a cancer of plasma cells. Normal plasma cells are found in the bone marrow and are an important part of the immune system.The immune system is made up of several types of cells that work together to fight infections and other diseases.

We stated yesterday myeloma is most often found in bone marrow. Remember normal plasma cells are found in the bone marrow & an important part of the immune system.

The immune system is made up of several types of cells that work together to fight infections and other diseases. Lymphocytes (lymph cells) are one of the main types of white blood cells in the immune system and include T cells and B cells. Lymphocytes are in many areas of the body, such as lymph nodes, the bone marrow, the intestines, and the bloodstream.

When B cells respond to an infection, they mature and change into plasma cells. Plasma cells make the antibodies (also called immunoglobulins) that help the body attack and kill germs.

When plasma cells become cancerous=cancer cells (intially made in the bone marrow than released in the blood), they multiply and begin to crowd out healthy cells and produce abnormal antibodies called M proteins.  This continues to to replicate till the body dies or some treatment takes over decreasing them by destroying them (Ex. Chemo) or possibly putting the patient in remission.

What are the major types of myeloma?

There are four major sub-types of myeloma. Diagnosis depends on how localized or spread out the cancer has become and where it originated. The most common form of myeloma is multiple myeloma. Over 90% of people with myeloma have multiple myeloma.

• Multiple myeloma -This is the one we will be discussing in this topic.
• Plasmacytoma
• Localized myeloma
• Extramedullary myelom

Multiple Myeloma Complications:

In multiple myeloma, the overgrowth of plasma cells in the bone marrow can crowd out normal blood-forming cells:

1-Leading to low cell counts=RBCs-low in iron/anemia, level of platelets in the become low (called thrombocytopenia)=increased bleeding and bruising & WBCs low called leukopenia=problems fighting infections.

2-Myeloma cells make a substance that tells the osteoclasts to speed up dissolving the bone. So old bone is broken down without new bone to replace it, making the bones painful, weak, thinning the bones and easy to break.

3-Abnormal plasma cells cannot protect the body from infections. As mentioned before, normal plasma cells produce antibodies that attack germs. In multiple myeloma, the myeloma cells crowd out the normal plasma cells, so that antibodies to fight the infection can’t be made. The antibody made by the myeloma cells does not help fight infections. That’s because the myeloma cells are just many copies of the same plasma cell – all making copies of the same exact (or monoclonal) antibody.

A monoclonal gammopathy is when plasma cells make too many copies of the same antibody. It is usually found on a routine blood test when looking for other conditions.In monoclonal gammopathy of undetermined significance (MGUS), abnormal plasma cells make many copies of the same antibody (called a monoclonal protein). However, these plasma cells do not form an actual tumor or mass and do not cause any of the problems seen in multiple myeloma. MGUS usually does not affect a person’s health. It doesn’t cause weak bones, high calcium levels, kidney problems, or low blood counts.

4-Myeloma cells make an antibody that can harm the kidneys, leading to kidney damage and even kidney failure.

Factors that may increase your risk of multiple myeloma include:

• Increasing age. Your risk of multiple myeloma increases as you age, with most people diagnosed in their mid-60s.
• Male sex. Men are more likely to develop the disease than are women.
• Black race. Black people are about twice as likely to develop multiple myeloma as are white people.
• Family history of multiple myeloma. If a brother, sister or parent has multiple myeloma, you have an increased risk of the disease.
• Personal history of a monoclonal gammopathy of undetermined significance (MGUS). Every year 1 percent of the people with MGUS in the United States develop multiple myeloma.

Diagnosing Multiple Myeloma:

• Blood tests. Laboratory analysis of your blood may reveal the M proteins produced by myeloma cells. Another abnormal protein produced by myeloma cells — called beta-2-microglobulin — may be detected in your blood and give your doctor clues about the aggressiveness of your myeloma.Additionally, blood tests to examine your kidney function, blood cell counts, calcium levels and uric acid levels can give your doctor clues about your diagnosis.
• Urine tests. Analysis of your urine may show M proteins, which are referred to as Bence Jones proteins when they’re detected in urine.
• Examination of your bone marrow. Your doctor may remove a sample of bone marrow for laboratory testing. The sample is collected with a long needle inserted into a bone (bone marrow aspiration and biopsy).In the lab, the sample is examined for myeloma cells. Specialized tests, such as fluorescence in situ hybridization (FISH) can analyze myeloma cells to understand their genetic abnormalities. Tests are also done to measure the rate at which the myeloma cells are dividing.
• Imaging tests. Imaging tests may be recommended to detect bone problems associated with multiple myeloma. Tests may include an X-ray, MRI, CT or positron emission tomography (PET).

After someone is diagnosed with cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging (I,II,III,IV). The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it.

Treatment:

1-Targeted therapy. Targeted drug treatment focuses on specific abnormalities within cancer cells that allow them to survive. Bortezomib (Velcade), carfilzomib (Kyprolis) and ixazomib (Ninlaro) are targeted drugs that block the action of a substance in myeloma cells that breaks down proteins. This action causes myeloma cells to die. Targeted-therapy drugs may be administered through a vein in your arm or in pill form.

Other targeted-therapy treatments include monoclonal antibody drugs that bind to the specific proteins present on myeloma cells, causing them to die.

2-Biological therapy. Biological therapy drugs use your body’s immune system to fight myeloma cells. The drugs thalidomide (Thalomid), lenalidomide (Revlimid) and pomalidomide (Pomalyst) enhance the immune system cells that identify and attack cancer cells. These medications are commonly taken in pill form.

3-Chemotherapy. Chemotherapy drugs kill fast-growing cells, including myeloma cells. Chemotherapy drugs can be given through a vein in your arm or taken in pill form. High doses of chemotherapy drugs are used before a bone marrow transplant.

4-Corticosteroids. Corticosteroids, such as prednisone and dexamethasone, regulate the immune system to control inflammation in the body. They are also active against myeloma cells. Corticosteroids can be taken in pill form or administered through a vein in your arm.

5-Bone marrow transplant. A bone marrow transplant, also known as a stem cell transplant, is a procedure to replace your diseased bone marrow with healthy bone marrow.

Before a bone marrow transplant, blood-forming stem cells are collected from your blood. You then receive high doses of chemotherapy to destroy your diseased bone marrow. Then your stem cells are infused into your body, where they travel to your bones and begin rebuilding your bone marrow.

6-Radiation therapy. This treatment uses beams of energy, such as X-rays and protons, to damage myeloma cells and stop their growth. Radiation therapy may be used to quickly shrink myeloma cells in a specific area — for instance, when a collection of abnormal plasma cells form a tumor (plasmacytoma) that’s causing pain or destroying a bone.

“”Every 3 minutes, someone in the U.S. is diagnosed with a blood cancer; more than 1.3 million Americans are living with or in remission from a blood cancer.  Although they are the 3rd leading cause of cancer deaths in the U.S., many people don’t know the impact of the blood cancers – leukemia, lymphoma and myeloma.  LLS has invested more than $1.2 billion in cancer research, with groundbreaking results. We are leaders in advancing breakthroughs in immunotherapy, genomics and personalized medicine. These revolutionary new treatments are powering our efforts to attack cancer from every angle.”

Leukemia and Lymphoma Society (https://www.lls.org/article/september-blood-cancer-awareness-month)

“Overdose is the leading cause of accidental death in the U.S. Using opioids, whether prescribed or illegally, comes with a significant risk of overdose. It’s important for Veterans and their family members and caregivers to know what to do in an emergency. Learn about the signs of overdose and about the medication naloxone.  Knowing how to use this medication could save a life.”

U.S. Department of Veterans Affairs

(https://www.mentalhealth.va.gov/substance-use/overdose.asp?utm_source=google&utm_medium=cpc&utm_campaign=search-va-naloxone&utm_term=broad-match&utm_content=opioid%20overdose&gclid=EAIaIQobChMItN3F4Mv_gAMVh9LjBx1jRwL7EAAYAiAAEgKN-_D_BwE)