The cause of SLE remains unknown, but the existence of a seemingly limitless number of antibodies in these patients against self-constituents indicates that the fundamental defect in SLE is a failure of the mechanism that maintain self-tolerance.

Many different autoantibodies are found in patients with SLE. The most frequent are antinuclear, particularly anti DNA antibodies, others include antibodies against ribonucleoprotein, histone and nucleolar antigens. Immune complexes formed from these autoantibodies and their specific antigens are responsible for glomerulonephritis, arthritis, and vasculitis. Hemolytic anemia and thrombocytopenia are due to autoantibodies against erythrocytes and platelets, respectively.

SLE is a complex genetic trait with contribution from MHC and multiple non-MHC genes. Family members of patients have an increased risk of developing SLE. There is a higher rate of concordance (>20%) in monozygotic twins when compared with dizygotic twins (1%-3%).

There are many indications that, in addition to genetic factors, several environmental or non genetic factors must be involved in the pathogenesis of SLE. Drugs such as hydralazine, procainamide, and D-penicilamine can induce an SLE-like response in human. Exposure to ultraviolet light may cause exacerbation of the disease in many individuals. Sex hormones seem to exert an important influence on the occurrence and manifestation of SLE. During the reproductive years, the frequency of SLE is 10 times greater in women than in men, and exacerbation has been noted during normal menses and pregnancy.

Unusual heavy discharge. It is important to report any unusual vaginal discharge to your doctor. An increased vaginal discharge is also a symptom of cervical cancer. It may be foul smelling, watery, thick, or contain mucus.

Pelvic pain that is not related to the normal menstrual cycle can be a cervical cancer symptom. Many women describe them ranging from a dull ache to sharp pains that can last hours. It can be mild or severe.

Pain during urination. Bladder pain or pain during urination can be a symptom of advanced cervical cancer. This cervical cancer symptom usually occurs when cancer has spread to the bladder.

Bleeding after sexual intercourse, douching, or pelvic exam can be cervical cancer symptoms. This is due to the irritation of the cervix during these activities. While a healthy cervix may have a very small amount of bleeding, many conditions may cause bleeding after activities like sex.

Please remember once again, that these cervical cancer symptoms are also symptoms of many other illnesses. If you are experiencing these symptoms, please come to your doctor to get a complete examination. The earlier you are diagnosed, the better you will be.

Symptoms
Early cervical cancer may not cause noticeable signs or symptoms. In the late stage, symptoms may include pelvic pain, bleeding, unusual vaginal discharge and pain during intercourse Women should have yearly check-ups, including a Pap smear to check for abnormal cells in the cervix. The chance of recovery is better when cervical cancer is found early.

Risk Factors
Risk factor include giving birth to many children, having many sexual partners, having first sexual intercourse at a young age, smoking cigarettes, and oral contraceptive use. The main risk factor based on evidence based medicine is Human Papiloma Virus (HPV) infection.

Treatment
Depending on the stage, treatment for cervical cancer can include surgery, chemotherapy and radiation. The type of treatment used varies, depending on stage and type of cervical cancer.

Prevention
Prevention begins with avoiding the above risk factors. Women should also have regular Pap smears to check for any abnormal cervical changes that may lead to cervical cancer. The HPV vaccine, Gardasil, is a highly effective means of cervical cancer prevention. It works by preventing two types of HPV that are known to cause at least 70% of cervical cancer cases.

There is always the potential that pre-cancerous changes might go on to become actual cancer of the cervix. It is not certain how long it takes for the abnormal cells to develop into cancer. Early detection and treatment can prevent 75 per cent of cancers developing. If preventive measures are not taken, cancer does develop in up to 50 per cent of cases, although this might take several years to happen.

The Pap smear is performed as part of a gynecological exam. You will lie on a table and place your feet in stirrups to position your pelvis for examination. A speculum (an instrument used to open the walls of the vaginal canal to see the interior) will be inserted into your vagina and opened slightly. A sample of surface cells is taken from the cervix with a small flat wooden spatula or a small brush. The specimen is placed on a small glass slide, fixed, stained and sent away to a laboratory to be examined under a microscope. The pathologist or cytologist will then classify the smear test into either normal, inflammation, mild, moderate or severely dysplasia, or neoplasia (cancer).

A cervical biopsy (colposcopy) is usually performed when a pap smear indicates significant abnormalities, or when an abnormal area is seen on the cervix during a routine pelvic examination. When a positive pap smear shows minor cell changes or abnormalities, a biopsy probably will not be done immediately, unless there is a reason to believe you may be in a high-risk category. For minor cell changes, it is usually recommended that a repeat pap smear be done in 6 months.

Women should not wait until they notice gynaecological symptoms before having an examination. All women between the ages of 25 and 64 should do cervical screening test every three to five years. We can use the interval of screening done by NHS Cervical Screening Programme below as a guidance.

The intervals are:
First invitation at 25 years age group ; once in three years at 25-49 years age group ; once in five years at 50-64 years age group ; and for > 65 years age group, only screen those who have not been screened since age 50 or have had recent abnormal tests.

Epidemiology

NPC shows a distinct racial, geographical distribution and multifactorial etiology. Globally, there were approximately 65,000 incidence and 38,000 deaths in the year 2000. There are certain populations for which the incidence is considerably higher, notably native and foreign-born Chinese, Southeast Asian, North Africans and the Arctic region (Canada and Alaska). In high risk groups, NPC incidence rises after the age of 30 years and peaks at 40-60 years, with rates in men are commonly 2-3 fold those observed in women.

Etiology

Genetic susceptibility, infection of Epstein Barr Virus (EBV), and environmental factors (dieatary and non dietary) may play a role in pathogenesis of NPC.  The evidence of NPC and EBV association includes : raised level of IgA against EBV in most NPC patients, presence of EBV DNA or RNA in all tumour cells, presence of EBV in a clonal episomal form and presence of EBV in the precursor lesion of NPC, but not in the normal nasopharyngeal epithelium.

Diet of food contain high levels of volatile nitrosamines have been implicated as the carcinogen for NPC development. Other preserved or fermented foods, consume during weaning and early childhood, also have been incriminated as risk factors. Consumption of salted fish become a relative risk factor from case control studies in Hongkong and China.  Others environmental risk factors include cigarette smoking, occupational exposure to smoke, chemical fumes and dusts, formaldehyde and radiation exposure.

Clinical Features

About half of the patients have multiple symptoms, but 10% are asymptomatic. Painless enlargement of upper cervical lymph nodes, blood stained post nasal drip, and symptoms related to Eustchian tube obstruction such as serous otitis media are commonly presenting feature.

Treatment

Nasopharyngeal carcinoma is particularly sensitive to radiation therapy, making it the first line of treatment. Surgery and chemotherapy are used in certain cases.

Radiation therapy destroys quickly growing cells, including cancer cells, in the area where the beams are focused. You typically receive radiation treatment five days a week for six or seven weeks. Internal radiation therapy (brachytherapy) is sometimes used in recurrent nasopharyngeal carcinoma.

Chemotherapy may be used to treat nasopharyngeal carcinoma in three ways : Chemotherapy at the same time as radiation therapy (concomitant therapy), Chemotherapy before radiation therapy (neoadjuvant therapy), and Chemotherapy after radiation therapy (adjuvant therapy).

Surgery is usually reserved for recurrent nasopharyngeal carcinoma. Surgery to remove cancerous lymph nodes in the neck is the most common surgery for nasopharyngeal carcinoma. Surgery to remove a tumor from the nasopharynx requires surgeons to make an incision in the roof of your mouth in order to access the area.