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Cervical cancerDysplasia; Human papillomasvirus
An in-depth report on the causes, diagnosis, treatment, and prevention of cervical cancer.
Cervical Cancer Screening
Cervical cancer is curable in its early stages. Regular screening can help detect this cancer. Cervical cancer screening uses two kinds of tests:
- The Pap test, which checks for abnormal changes in cervical cells that may indicate cancer. The Pap test is the main test used for cervical cancer screening.
- The HPV test, which checks for high-risk strains of the human papillomavirus (HPV) that cause cervical cancer. The HPV test may be used along with a Pap test or after a woman has had an abnormal Pap test result.
Current cervical cancer screening guidelines from the United States Preventive Services Task Force (USPSTF), the American Cancer Society (ACS), and the American College of Obstetricians and Gynecologists (ACOG) recommend:
- Women ages 21 - 29 should be screened once every 3 years with a Pap test.
- Women ages 30- 65 should be screened with either a Pap test every 3 years OR a Pap test and HPV test every 5 years.
- Women age 65 and older no longer need Pap tests as long as they have had regular Pap tests with normal results. Women who have been diagnosed with pre-cancer should continue to receive regular screenings.
HPV Vaccination
Human papillomavirus (HPV) is the most common sexually transmitted disease. High-risk strains of HPV cause cervical cancer, as well as other types of cancer. Low-risk strains of HPV cause genital warts. Nearly all cases of cervical cancer are caused by HPV.
Two vaccines, Gardasil and Cervarix, are available to prevent (not treat) cervical cancer in girls and young women. Gardasil is also approved for boys. Both vaccines protect against HPV-16 and HPV-18, the two HPV strains that cause most cases of cervical cancer. Gardasil, but not Cervarix, also protects against HPV-6 and HPV-11, the two viruses that cause most cases of genital warts.
Current immunization guidelines recommend the HPV vaccine for all girls and boys ages 11- 12. The vaccine is given as a 3-dose series.
The cervix is the lower third portion of the uterus (womb). It serves as a neck to connect the uterus to the vagina. The opening of the cervix, called the os, remains small and narrow, except during childbirth when it widens to allow a baby to pass from the uterus into the vagina.
Cervical cancer develops in the thin layer of cells called the epithelium, which cover the cervix. Cells found in this tissue have different shapes:
- Squamous cells (flat and scaly). Most cervical cancer arises from changes in the squamous cells of the epithelium (squamous cell carcinoma).
- Columnar cells (column-like). These cells line the cervical glands. Cancers found here are known as adenocarcinomas.
- Mixed carcinomas are cells that combine features of squamous cells and adenocarcinomas.
Cervical cancer usually begins slowly with precancerous abnormalities, and even if cancer develops it generally progresses very gradually. Cervical cancer usually takes about 10- 20 years to develop.
Cervical cancer is the most preventable type of cancer and is very treatable in its early stages. Regular Pap tests and human papillomavirus (HPV) screening can help detect this disease early.
Pre-Cancerous Changes in the Cervix
Dysplasia is a term that refers to a pre-cancerous condition. In the case of cervical cancer, dysplasia indicates that some cells on the outside of the cervix (squamous epithelial cells) are abnormal in size and shape and are beginning to grow. However, the abnormal cells are still confined to the surface (epithelial layer). These abnormal cells may eventually become cancerous, but this does not always happen.
Pap test screening can help identify abnormal cells that may be pre-cancerous, but a biopsy is necessary for confirmation. In a biopsy test result, pre-cancerous cells are classified as cervical intraepithelialneoplasia (CIN), which is another term for dysplasia. The severity of CIN is graded on a scale of 1 to 3:
- CIN I is mild dysplasia
- CIN II is moderate dysplasia
- CIN III is severe dysplasia. CIN III is considered the same as carcinoma in situ (CIS) or Stage 0 cervical cancer. The cancer has not yet invaded deeper tissues. However, if not surgically removed, there is a high chance it can progress to invasive cancer.
(For more information on pre-cancer, see the Diagnosis and Screening section of this report.)
Invasive Cervical Cancer
The cells of the epithelium rest on a very thin layer called the basement membrane. Invasive cervical cancer occurs when cancer cells in the epithelium cross this membrane and invade the stroma, the underlying supportive tissue of the cervix.
In later stages, the original cancer may spread to areas surrounding the uterus and cervix or near organs such as the bladder or rectum. It may also spread to distant sites in the body through the bloodstream or the lymph nodes.
Human Papillomavirus
The human papillomavirus (HPV) is the main cause and risk factor of cervical cancer. Nearly all cases of cervical cancer are caused by HPV. In general, doctors assume that a woman with cervical cancer has been infected with HPV.
HPV is a very common sexually transmitted virus. There are many different types of HPV:
- Low-risk HPV types, such as HPV 6 and 11, cause genital warts but are rarely associated with cancer
- High-risk HPV types cause cervical cancer, as well as cancers of the vagina, vulva, anus, penis, oropharyngeal (throat, tongue, soft palate) and possibly lung.
- HPV 16 and HPV 18 are the causes of most cases of cervical cancer
At least half of sexually active women and men are infected with HPV at some point in their lives. HPV usually goes away on its own. Only 10% of women remain infected for more than 5 years. But sometimes HPV does not go away. A chronic, long-term infection with a high-risk type of HPV can cause changes in cervical cells that eventually lead to cancer.
HPV infection is spread primarily by having sex with a partner infected with HPV. It is transmitted through skin-to-skin contact with infected areas of the genitals, anus, or mouth. Using condoms and limiting the number of sexual partners can help reduce the risk of contracting HPV.
Risk Factors
About 12,000 new cases of invasive cervical cancer are diagnosed each year in the U.S. However, the number of new cervical cancer cases has been declining steadily over the past decades.
Although it is the most preventable type of cancer, each year cervical cancer kills about 4,000 women in the U.S. and about 300,000 women worldwide. In the United States, cervical cancer mortality rates plunged by 74% from 1955 - 1992 thanks to increased screening and early detection with the Pap test.
Cervical cancer is extremely rare in women younger than age 20. The median age of diagnosis is 48 years. Half of all cervical cancer diagnoses occur in women ages 35- 54 years. About 20% of cervical cancer diagnoses occur in women over 65 years of age, mostly in women who did not receive regular cancer screening during their younger years. .
Race and Poverty
In the United States, Hispanic women are most likely to develop cervical cancer, followed by African-American women. African-American women have the highest death rate from cervical cancer. Asians, Caucasians, and Native American women have the lowest risks for being diagnosed with and dying from cervical cancer.
These differences are probably related to socioeconomic factors. Numerous studies report that high poverty levels are linked with low screening rates. In addition, lack of health insurance, limited transportation, and language difficulties often hinder a poor woman's access to screening services.
Sexual History
Human papillomavirus (HPV) is the main risk factor for cervical cancer. The most important risk factor for HPV is sexual activity with an infected person. Women most at risk for cervical cancer are those with a history of multiple sexual partners, sexual intercourse at age 17 years or younger, or both. A woman who has never been sexually active has a very low risk for developing cervical cancer.
Sexual activity with multiple partners increases the likelihood of many other sexually transmitted infections (chlamydia, gonorrhea, syphilis). Studies have found an association between chlamydia and cervical cancer risk, including the possibility that chlamydia may prolong HPV infection.
Family History
Women have a higher risk of cervical cancer if they have a first-degree relative (mother, sister) who has had cervical cancer.
Use of Oral Contraceptives
Long-term use of oral contraceptives (OCs, birth control pills) may increase the risk for cervical cancer. Women who take birth control pills for more than 5 - 10 years appear to have a much higher risk HPV infection (up to four times higher) than those who do not use OCs. (Women taking OCs for fewer than 5 years do not have a significantly higher risk.)
The reasons for this risk from OC use are not entirely clear. Some research suggests that the hormones in OCs might help the virus enter the genetic material of cervical cells. Another possible reason is that women who use OCs may be less likely to use condoms. Latex condoms can help reduce the risk of HPV transmission and other STDs.
Having Many Children
Having given birth to three or more children may increase the risk for cervical cancer.
Smoking is associated with a higher risk for pre-cancerous changes (dysplasia) in the cervix and for progression to invasive cervical cancer.
Women with weak immune systems, such as those with HIV/AIDS, are more susceptible to acquiring HPV. Immunocompromised patients are also at higher risk for having cervical pre-cancer develop rapidly into invasive cancer.
Diethylstilbestrol (DES)
From 1938 - 1971, diethylstilbestrol (DES), an estrogen-related drug, was widely prescribed to pregnant women to help prevent miscarriages. The daughters of these women face a higher risk for cervical cancer as well as other gynecological problems. DES is no longer prescribed.
The best ways to prevent cervical cancer are:
- Avoid getting infected with human papillomavirus (HPV). Because HPV is sexually transmitted, practicing safe sex and limiting the number of sexual partners can help reduce risk.
- Get vaccinated before becoming sexually active. A vaccine can protect against the major cancer-causing HPV strains in girls and young women who have not yet been exposed to the virus.
- Have regular Pap test screenings. Pap tests remain the most effective way of catching cervical cancer while it is in its earliest pre-cancerous stages and preventing the development of invasive cervical cancer.
HPV Vaccine
Two vaccines are approved by the Food and Drug Administration (FDA) to prevent either HPV or cervical cancer: Gardasil and Cervarix.
Gardasil is approved for:
- Girls and women ages 9 - 26, for protection against HPV-16 and HPV-19, the HPV strains that cause most cases of cervical cancer. It also protects against HPV-6 and HPV-11, which cause genital warts.
- Boys and young men ages 9 - 26 years to prevent genital warts.
- Gardasil is also approved to prevent anal cancer in people ages 9 - 26 years.
- Because it protects against four strains of HPV, Gardasil is called a quadrivalent or HPV4 vaccine.
Cervarix is approved for:
- Girls and women ages 10 - 26 for protection against HPV-16 and HPV-19, the HPV strains that cause most cases of cervical cancer.
- Cervarix does not protect against genital warts.
- Cervarix has not been approved for use in boys or men.
- Because it protects against two strains of HPV, Cervarix is called a bivalent or HPV2 vaccine.
Current immunization guidelines recommend:
- Routine vaccination for girls ages 11 - 12 years. The vaccine should be administered in 3 doses, with the second and third doses administered 2 and 6 months after the first dose. The HPV vaccine can be given at the same time as other vaccines. Either Gardasil or Cervarix may be used, and one vaccine can be substituted for another in the 3-dose series.
- Girls as young as age 9 can receive the vaccine at their doctors' discretion.
- Girls and women ages 13 - 26 who have not been previously immunized or who have not completed the full vaccine series should get vaccinated to catch up on missed doses. [The U.S. Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP) recommend catch-up doses for ages 13 - 26. The American Cancer Society (ACS) recommends catch-up for ages 13 - 18. The ACS suggests that women ages 19 - 26 discuss with their doctors the relative risks and benefits of vaccination.]
- Women should not get the vaccine during pregnancy.
- A routine 3-dose vaccination with Gardasil is recommended for all 11 - 12 year-old boys. The vaccine is recommended all men through age 26 but is most effective when given at a younger age.
The HPV vaccine can only prevent -- not treat -- HPV infection, genital warts, and cervical cancer. Because the vaccine cannot protect females who are already infected with HPV, doctors recommend that girls and boys get vaccinated before they become sexually active. Studies indicate that the vaccine is nearly 100% effective in preventing cervical cancer and genital warts (caused by the HPV types covered in the vaccine) when given prior to HPV exposure. However, young women who are sexually active may still derive some benefit from the vaccine, at least for protection against any of the four HPV strains that they have not yet acquired.
The most common side effects of the vaccine include discomfort or pain at the injection site, headache, and mild fever.
These vaccines do not protect against all types of cancer-causing HPV. Women should receive regular screening to detect any early signs of cervical cancer. For girls and women who have been sexually active before they receive the vaccine, screening still provides the best protection against cervical cancer.
Condoms provide some protection against HPV as well as other sexually transmitted diseases.
Male circumcision may possibly reduce the risk of HPV, but it does not completely prevent it. Men who are circumcised should still use condoms.
Intrauterine Devices (IUDs)
Some recent evidence suggests that the intrauterine device (IUD) may help protect against cervical cancer. The IUD is a type of birth control that is inserted into the uterus by a health professional. It is a small plastic T-shaped device that contains either the hormone progesterone or copper. Researchers are not certain exactly how the IUD reduces cervical cancer risk, but think that the process of inserting or removing the device may destroy pre-cancerous lesions. Still, there may also be some risks associated with IUDs. Discuss the risks and benefits with your doctor.
Pap Tests
Regular Pap tests are the most effective way to diagnose cervical cancer when it is still in its earliest, most curable stages. In some cases, a HPV test may also be used. [For more information, see Diagnosis and Screening section of this report.]
A patient's prognosis for cervical cancer depends on the stage of the cancer, the type of cervical cancer, and the size of the tumor.
General Survival Rates in Women with Cervical Cancer
Over the past 30 years, the death rate from cervical cancer has declined significantly. African-American women tend to have poorer 5-year survival rates than Caucasian women, although survival rates have significantly improved in African-American women in recent years.
The earlier that cervical cancer is detected, the better the odds for survival.
Survival Rates and Cervical Cancer Stage
About half of cervical cancer cases are diagnosed in the early stageswhen the cancer is confined to the cervix (localized; Stage I). About 35% of cases are diagnosed after the cancer has spread to adjacent areas or lymph nodes (regional; Stage II/III), and about 10% of cases are diagnosed when the cancer has already spread to distant regions (metastasized; Stage IV).
Depending on the stage and spread of cancer, 5-year survival rates are:
- 91% for localized cervical cancer
- 58% for regional cancer
- 16% for metastasized cancer
Most women with dysplasia or pre-invasive cancer have no symptoms. Screening tests, therefore, are very important.
Symptoms of invasive cancer include:
- Unusual vaginal bleeding. Bleeding may stop and start again between regular periods, or there may be bleeding after menopause. Unexpected bleeding can also occur after intercourse or a pelvic exam. Menstrual periods sometimes last longer or are heavier than usual.
- Increased vaginal discharge, which may contain blood. The discharge may occur between periods or after menopause.
- Pelvic pain or pain during sexual intercourse.
These symptoms are not exclusive to cervical cancer. Sexually transmitted diseases, for instance, can cause similar symptoms.
Diagnosis and Screening
The changes that lead to cervical cancer develop slowly. Screening tests performed during regular gynecologic examinations can detect early changes. The two tests used for cervical cancer screening are:
- The Pap test, which can detect pre-cancerous cell changes and cervical cancer. This test is used for all women ages 21- 65.
- The HPV (human papillomavirus) test, which may be used along with a Pap test or after a woman has had an abnormal Pap test result. The HPV test can identify the high-risk types of HPV that are known to cause cervical cancer. This test is not used for women younger than age 30 because HPV is very common in this age group. In younger women, the virus usually goes away on its own within 2 years.
Pap Test
The Papanicolaou test, better known as the Pap test or Pap smear, can help detect cervical cancer when it is in its earliest stages. It can also detect pre-cancerous changes in cells. Use of the Pap test has significantly reduced the death rate from cervical cancer. Most cases of cervical cancer occur in women who have not had regular Pap tests.
Preparing for a Pap Test. To help get the most accurate results, doctors recommend scheduling a Pap test for the 10 - 20 days after menstruation begins. Those are the best days for obtaining the most accurate results. The Pap test should not be performed during menstruation.
In the 24- 48 hours before the test:
- Do not have sexual intercourse
- Do not use vaginal spermicides, lubricants, or tampons
- Do not douche (in general, douching is not recommended at all)
The Procedure. A Pap test is usually painless, although some women may have some discomfort.
- The test is done in a doctor's office. The woman removes her clothes from the waist down and puts on a medical gown. She lies on her back on the examination table, bends her knees, and puts her feet in supports (called stirrups) at the end of the table.
- The doctor inserts a plastic or metal device (called a speculum) into her vagina to widen it.
- Using a spatula, brush, or both, the doctor gently scrapes the surface of the cervix, and sometimes the upper vagina, to gather living cells. The doctor will also obtain cells from inside the cervical canal. The scraping is completely painless.
- The cells are preserved, stained for microscopic viewing, and then analyzed under a microscope by a specialist known as a cytopathologist.
Reliability and Accuracy. The Pap test is not a perfectly reliable measure of a woman's risk for cervical cancer. In general, about 10% of Pap tests have abnormal results, but only about 0.1% of the women who have these results actually have cancer. In most cases, abnormal cells are low grade and not likely to progress to cancer or are due to benign conditions, including natural cell changes after menopause.
No test is 100% accurate, and it is possible for the Pap test to miss the presence of cancer. However, if abnormal cells are missed on one test, they are likely to be spotted during the next one. It is also possible for a test to indicate abnormal cells when the cells are really normal. If a test indicates possible abnormal cells, your doctor will order another Pap test or additional other tests to confirm the results.
HPV DNA Test
For a HPV test, the doctor collects a sample of the cervical cells the same way (and usually at the same time) as the Pap test. This test looks for the types of human papillomavirus that cause cervical cancer by analyzing the DNA of the cervical cells. The HPV test can be used along with the Pap test to screen for cervical cancer in women ages 30 years and older. It may also be used to provide more information after an abnormal Pap test in women ages 21 years and older.
Current Cervical Cancer Screening Recommendations
General guidelines for cervical cancer screening recommend:
- Initial Screening. Women should begin to have Pap tests at age 21 regardless of whether or not they have been sexually active. Women under age 21 should not be screened.
- Women Ages 21 - 29. Women ages 21 - 29 who are at average risk for cervical cancer should be screened once every 3 years with a Pap test. They do not need a HPV test unless they have had an abnormal Pap test result.
- Women Ages 30 - 65. Women in this age bracket can have either a Pap test every 3 years OR a Pap test and HPV test every 5 years.
- Women Ages 65 and Older. Women age 65 and older no longer need Pap tests as long as they have had regular Pap tests with normal results. Women who have been diagnosed with pre-cancer should continue to receive regular screenings.
- After a Hysterectomy. Women who have had a hysterectomy that preserves the cervix (called a supracervical hysterectomy) should continue to have Pap screening according to the guidelines listed above. Women who have had their cervix removed at the time of hysterectomy no longer need Pap tests.
How Pap Test Results Are Reported
The cells viewed in a cervical smear sample are classified on a scale representing the spectrum of cell changes from normal to cancerous. The Pap test is first characterized as either normal or abnormal.
Once abnormal epithelial cells are identified, the doctor must decide whether the patient needs a repeat Pap test, an HPV test, or more invasive testing with colposcopy and biopsy. (Colposcopy is a procedure used to magnify the cervix and to help find lesions for biopsy). To help the doctor make the decision, the abnormal cells are divided into categories, depending on the degree of abnormality, and whether they are squamous or glandular (adenocarcinoma).
Squamous cell carcinoma represents the large majority of all cervical cancers. The remaining cases are either a combination of squamous and glandular, or rarer types.
The Bethesda System (TBS) is used to report Pap test results. It classifies abnormal results as atypical squamous cells (ASC with subtypes of ASC-US and ASC-H), squamous intraepithelial lesions (SILs) or atypical glandular cells.
Atypical Squamous Cells. Atypical squamous cells (ASC) are mildly abnormal cells on the surface of the cervix. It is difficult to know if they are pre-cancerous. They may be normal cells with changes simply be caused by inflammation. Atypical squamous cells are further categorized as ASC-US or ASC-H:
- ASC-US. Atypical squamous cells of undetermined significance (ASC-US) are the lowest risk abnormal cells and are very often not pre-cancerous. Women with ASC-US need to have a repeat Pap test in 6- 12 months and the doctor may also recommend a HPV test and possibly colposcopy.
- ASC-H. This category refers to atypical squamous cells that may indicate high-grade squamous intraepithelial lesions (HGSIL). Such women have a higher risk of having CIN II and III (moderate or severe dysplasia). All are referred for colposcopy.
Squamous Intraepithelial Lesions (SILs). Squamous intraepithelial lesions (SILs) are classified as either low-grade (LGSIL) or high-grade (HGSIL). High-grade SILs are more serious than low-grade SILs, and need to be treated because they can develop into invasive cancer. Pap tests can identify the presence of SILs but not their grade. All patients with SILs should undergo colposcopy. A colposcopy can determine whether SILs are high-grade or low-grade and whether treatment is required.
Atypical Glandular Cells and Adenocarcinoma. Atypical glandular cells pose a higher risk for cancerous changes than atypical squamous cells or low-grade squamous intraepithelial lesions. Patients with atypical glandular cells need colposcopy and endocervical testing. Adenocarcinoma refers to glandular cells that are cancerous.
Colposcopy and Biopsy
The Pap test shows only the presence of abnormal cells. It is useful simply as a screening test that identifies women who may have pre-invasive or early cancerous changes. For a definitive diagnosis, the next step is usually colposcopy, during which the cervix is visualized under low power magnification. The surgeon takes samples of suspicious cells for biopsies. A biopsy will determine the stage of the pre-cancerous growth or whether invasive cancer is present.
The Procedure. Colposcopy can be performed in a doctor's office without anesthesia in 10 - 15 minutes. It causes about as much discomfort as mild menstrual cramps:
- First, using a speculum to keep the vagina open, the doctor aims a light at the cervix.
- The doctor then looks through the eyepiece of a special microscope, known as a colposcope, to view the cervix.
- A biopsy (a sampling of the tissue) is taken of suspicious areas, of the endocervical canal (the inner part of the cervix and uterus), and any abnormal-looking areas. This may cause cramping or pinching.
After the colposcopy, the woman may have a brownish discharge from an iron solution called Monsel's solution, which the doctor applies to prevent bleeding. Doctors usually advise sexual abstinence for 1 - 2 weeks.
Biopsy Results
The pre-cancerous changes from biopsy results of colposcopy are called cervical intraepithelial neoplasia. They aregraded according to severity: CIN I, CIN II, and CIN III.
- CIN I is classified as mild dysplasia. It is equivalent to a low-grade squamous intraepithelial lesion (LGSIL) identified by a Pap test. CIN I may progress if untreated but often goes away without treatment.
- CIN II is classified as moderate dysplasia. It is equivalent to a high-grade squamous intraepithelial lesion (HGSIL) found in a Pap test.
- CIN III is classified as severe dysplasia. It is the most aggressive form of dysplasia. It is also equivalent to a high-grade squamous intraepithelial lesion.
CIN III is considered the same as carcinoma in situ (CIS) or Stage 0 cervical cancer. In both CIN III and CIS the pre-cancerous cells still rest on the surface of the cervix and have not yet invaded deeper tissues. However, if not surgically removed, there is a high chance that CIN III or CIS can progress to invasive cancer.
Follow-Up Procedures. Women with evidence of cervical intraepithelial neoplasia (CIN) or cervical cancer need treatment. Women with biopsies that show low-grade abnormal cells, but whose cervix is otherwise normal, are generally given follow-up colposcopies.
If a biopsy detects invasive cancer, the patient will need additional tests to find out how far the cancer has spread. Tests to stage cancer may include a computed tomography (CT) scan (to check for the spread of the disease to lymph nodes and areas around the pelvic region), chest x-ray, ultrasound, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, and other imaging tests.
Treatment of Pre-Invasive Cancer
Treatment of cervical intraepithelial neoplasia (CIN), including pre-invasive cancer, depends on the type and extent of abnormal changes. Some of the treatments for CIN are also used for early-stage cancer.
- CIN I often goes away on its own. Careful follow up is required to make certain that the Pap smear and colposcopic exam return to normal.
- CIN II or CIN III may turn into invasive cancer if the suspicious area is not removed. This is often done using an outpatient technique called loop electrosurgical excision procedure (LEEP). [See Surgery section.]
- If doctors cannot see extensive areas of CIN II or III with colposcopy or if these areas have spread into the mucous membrane in the cervical canal, a more aggressive procedure called conization (cone biopsy) may be required. [See Surgery section.] Since CIN III is considered equivalent to Stage 0 cervical cancer, other procedures may be used if LEEP or conization are inadequate.
Treatment of Invasive Cervical Cancer
In contrast to cervical intraepithelial neoplasia, cervical cancer represents true invasion of cells beyond the epithelium into surrounding tissue. Cervical cancer may be detected in a biopsy performed during colposcopy for an abnormal Pap smear, or it may be visible to the naked eye when the doctor performs a speculum exam.
After making a diagnosis, the doctor will classify the stage of the cancer according to how far the disease has spread into the lining of the cervix, throughout the cervix, or beyond. Doctors use these classifications to determine treatment and prognosis.
Stages of Cervical Cancer
Stage 0. Stage 0 cancer is also called carcinoma in situ. It is equivalent to CIN III pre-invasive cancer. In stage 0, the cancer cells are confined to the first layer of cervical tissue (the epithelium) lining the cervix and have not yet spread further in the cervix.
Stage I. Stage I is invasive cancer, but the tumor is confined to the cervix. This stage is further categorized as IA and IB, which each have further subcategorizations based on the size of the tumor:
- In stage IA, the cancer cells can be seen only under a microscope. In stage IA1, there is minimal invasion (less than 3 mm and less than 7 mm wide) In stage IA2, there is deeper invasion of 3 - 5 mm) but the microscopic tumor is still less than 7 mm wide.
- In stage IB, the cancer is either visible without a microscope, or it is still microscopic but is more than 5 mm deep or 7 mm wide. Cancer that can be seen without a microscope is divided into Stage IB1 and Stage IB2. In stage IB1, the cancer is smaller than 4 cm. In stage IB2, the cancer is larger than 4 cm.
Stage II. Stage II invasive cancer has spread beyond the cervix, but it has not spread to the pelvic side wall. This stage is further categorized as IIA and IIB.
- In stage IIA, the cancer has spread to the upper two-thirds of the vagina but not to the uterus.
- In stage IIB, the cancer has spread beyond the vagina into the tissues of the uterus.
Stage III. In stage III, the cancer has spread to the lower third of the vagina.
- In stage IIIA, the cancer has not spread to the pelvic wall.
- In stage IIIB, the cancer has spread to the pelvic wall. The tumor may have become large enough to block the ureters of the kidney, which can cause the kidney to stop functioning.
Stage IV. Stage IV is advanced (metastasized) cancer. The cancer has spread to other organs or parts of the body.
- In stage IVA, the cancer has spread to organs located near the cervix, such as the bladder or rectum.
- In stage IVB, the cancer has spread beyond the pelvic area to other parts of the body, such as the liver, intestinal tract, or lungs.
Treatment Options by Stage
Treatments for cervical cancer depend on the stage of the cancer. Clinical trials investigating new treatment approaches are available for all stages of cervical cancer.
Stage 0. Stage 0 cancer is carcinoma in situ (CIN III) and is considered a pre-invasive cancer. Treatment options include:
- Loop electrosurgical excision procedure (LEEP)
- Laser surgery
- Conization
- Cryosurgery
- Total (simple) hysterectomy (removal of uterus and cervix), for women who no longer want children
- Internal radiation therapy, for women who cannot have surgery
Stage IA1. Treatment options for stage IA1 may include:
- Conization
- Total hysterectomy
- Radical hysterectomy (removal of uterus, cervix, part of vagina, and pelvic lymph nodes)
- Internal radiation therapy
Stage IA2. Treatment options for stage IA2 may include:
- Radical hysterectomy
- External beam radiation therapy plus brachytherapy (implantation of radioactive pellets)
- Radical trachelectomy (removal of the cervix but not the uterus) may be an option for some women who want to preserve fertility
Stage IB1. Treatment options for stage IB1 may include:
- Radical hysterectomy
- High-dose internal and external radiation therapy
- Radical trachelectomy
Stage IB2. Treatment options for stage IB2 may include:
- Combination of chemotherapy and radiation therapy
- Radical hysterectomy, followed by radiation therapy (and possibly chemotherapy) if cancer cells are found.
Stage IIA. Treatment options for stage IIA may include:
- Internal and external radiation therapy
- Radiation therapy plus chemotherapy
- Radical hysterectomy followed by radiation therapy and chemotherapy
Stage IIB. Treatment options for stage IIB may include:
- Combined internal and external radiation therapy along with chemotherapy with cisplatin
- Other drugs may be given along with cisplatin
Stage III. Treatment options for stage IIIA and stage IIIB may include combined internal and external radiation therapy plus chemotherapy Stage IVA.
Treatment options for stage IVA may include combined internal and external radiation therapy plus chemotherapy.
Stage IVB. Stage IVB cancer is generally not considered curable. Treatment options may include:
- Radiation therapy to relieve symptoms and improve quality of life
- Chemotherapy with cisplatin or carboplatin in combination with another drug (paclitaxel, gemcitabine, topotecan, or vinorelbine)
Recurrent Cancer. Cervical cancer may recur locally in the lymph nodes near the cervix, it may spread to distant sites, such as the lung or bones, or it may appear both locally and in distant locations. Treatment options depend on where the cancer has recurred. They include:
- Pelvic exenteration if cancer has spread to only local areas. This involves surgical removal of the cervix, uterus, vagina, and perhaps the bladder, lower colon, or rectum.
- Chemotherapy or radiation if cancer has spread to distant area.
Treatment of Pregnant Women with Cervical Cancer
Cervical cancer is one of the most common cancers diagnosed during pregnancy. To diagnose the condition, a cervical biopsy, in which a small amount of tissue is removed for diagnosis, can be performed anytime during the pregnancy. However, a cone biopsy (conization), which removes larger amounts of tissue, is typically delayed until after the first trimester to reduce the risk of causing a miscarriage. Conization does increase the risk for preterm delivery and may increase this risk for future pregnancies. The loop electrosurgical excision procedure (LEEP/LLETZ) may be performed in centers equipped to handle it, but should be reserved only for patients in whom invasive disease is strongly suspected.
Treatment of cervical cancer depends in part on whether a patient wishes to continue the pregnancy, and her desire for future fertility. For pregnant women who want to continue the pregnancy, and preserve fertility when possible, treatment options may include:
- If the abnormality is diagnosed as dysplasia or pre-invasive cancer, treatment is usually delayed until after the mother gives birth. The baby is delivered vaginally. It is rare for cervical cancer to progress from pre-invasive to invasive within the space of 1 - 2 trimesters.
- For stage IA1, a cesarean section is performed at term, or earlier if the fetus is viable. After delivery, LEEP/LLETZ or conization is performed.
- For stages IA2 and IB1, a cesarean section and radical hysterectomy is performed when the fetus is viable. After delivery, radiation and chemotherapy is given.
- For stages IB2 - IVA, a cesarean section is performed as soon as possible. Treatment should not be delayed beyond weeks 32 - 34. For patients who have a delayed cesarean, chemotherapy may be given. After delivery, the patient is treated with radiation and chemotherapy.
- For stage IVB, a pregnancy of less than 20 weeks is terminated, and the patient is treated with chemotherapy. For pregnancies more than 20 weeks, a cesarean may be delayed while the woman receives chemotherapy.
Fertility Preservation
Women of child-bearing age should discuss with their doctors any concerns and questions they may have about how various cancer treatments could affect their fertility. They may also wish to have a consultation with a fertility specialist. Some women with cervical cancer may be candidates for surgical procedures that preserve fertility. Other women may want to consider assisted reproductive technology such as embryo or oocyte (egg) cryopreservation ("freezing"). It is very important that you have these discussions with your health care team before you begin cancer treatment.
In the early stages of cervical cancer, surgery is usually the preferred primary treatment approach. Not all women are candidates for all surgical procedures.
Surgery procedures by stage are:
- Loop Electrosurgical Excision Procedure (LEEP) and Laser Surgery. Used for pre-invasive cancer including cervical intrapethelial neoplasia (CIN) and stage 0.
- Conization. Used for treating pre-invasive cancer (CIN and stage 0) and invasive cancer stage IA1.
- Cryosurgery. Used for stage 0.
- Total (Simple) Hysterectomy. Used for stage 0, stage IA1.
- Radical Hysterectomy. Used for stage IA2, stage IB1 and IB2, stage IIA.
- Radical Trachelectomy. Used for select women with stage IA2, stage IB1.
Loop Electrosurgical Excision Procedure
Loop electrosurgical excision procedure (LEEP), also called large loop excision of the transformation zone (LLETZ), uses a high frequency electrical current to cut away diseased tissue.
- A local anesthetic is applied to the cervix, and a wire loop is inserted into the vagina.
- A button-sized slice of tissue is removed from the cervix for examination.
- A deeper slice is used to evaluate the endocervical canal.
The procedure is done in one office visit. Extensive and deep sections of damaged tissue can be effectively removed in this visit. Disease can be cured in one treatment. When used for dysplasia, it appears to be as effective as more invasive procedures.
Laser Surgery
Laser surgery for cervical cancer uses a laser beam, in place of a knife, to burn off abnormal cells or to remove pieces tissue for biopsy. The laser beam is directed through the vagina.
Conization is a surgical procedure that removes a cone-shaped piece of tissue from the cervix. Conization uses either a heated wire, like LEEP, or it may involve a scalpel or laser (in which case the procedure is sometimes called "cone knife cone biopsy"). The surgery is performed under general anesthesia in an operating room. With conization, the ability to become pregnant can be preserved in most cases.
A hysterectomy attempts to eliminate the cancerous tissue by removing the uterus and cervix. Hysterectomy causes infertility. After a hysterectomy, a woman no longer has menstrual periods and she can no longer become pregnant.
Depending on the stage of the cervical cancer and how far it has spread, the patient will usually have either a total (simple) hysterectomy or a radical hysterectomy.
Total Hysterectomy. A total (also called simple) hysterectomy involves the removal of the uterus and the cervix, but leaves the parametrium (tissue surrounding the uterus) and vagina intact. Lymph nodes in the pelvis are not usually removed. The uterus may be removed through an open abdominal incision or vaginally. There are various ways to perform vaginal hysterectomy, including laparoscopically. A simple hysterectomy is usually performed to treat early-stage cancer that is still confined to the cervix, such as stage IA1 cervical cancer.
Radical Hysterectomy. A radical hysterectomy removes not only the uterus and the cervix but also the parametrium, the supporting ligaments, the upper vagina, and some or all of the pelvic lymph nodes (a procedure called lymphadenectomy). The fallopian tubes and ovaries are not usually removed, (a procedure called bilateral-salpingo-oopherectomy) unless there are other medical reasons for doing so. The procedure may be performed through open abdominal surgery or through a laparoscopic vaginal hysterectomy. Radical hysterectomy is generally used to treat cervical cancers that have spread beyond the cervix such as those in stages IA2, IB1, and IB2.
Recovery. Hospital stays for simple hysterectomy range from 1 - 2 days for vaginal hysterectomy to 3 - 5 days for abdominal hysterectomy. Total recovery time is generally 2 - 3 weeks for vaginal hysterectomy and 4 - 6 weeks for abdominal hysterectomy. Radical hysterectomy generally requires a 5 - 7 hospital stay and about a 6-week recovery period.
Side Effects. Side effects after hysterectomy can include painful lower abdomen if an abdominal incision was used. About half of women develop minor and treatable urinary tract infections. There is usually mild pain and light vaginal bleeding post operation. More serious complications are uncommon but can include infection and blood clots. Normal activity, including sexual intercourse, can be resumed in about 4 - 8 weeks.
The effects of hysterectomy on sexuality vary among women. Women retain their clitoris and can still experience sexual arousal and climax. Some women note a change in their orgasmic response because they no longer experience uterine contractions. However, many women with cervical cancer have improved sexuality after hysterectomy as they no longer have symptoms such as pain or bleeding during intercourse.
Once the uterus is removed, menstruation will cease. If the ovaries are removed, the symptoms of menopause will begin. These symptoms are likely to be more severe in surgical menopause than in natural menopause. The patient should discuss the benefits and risks of hormone replacement therapy with her doctor.
Women who have had a hysterectomy with removal of the cervix no longer need to have Pap tests.
Radical Trachelectomy
For some women with stage IA2 and stage IB1 cancer, radical trachelectomy may be a fertility-sparing alternative to hysterectomy. Radical trachelectomy involves removing the cervix, surrounding lymph nodes, and upper part of the vagina. The uterus is then reattached to the remaining vagina. Patients must meet strict criteria in terms of lesion size and lymph node involvement.
Radical trachelectomy poses a high risk for miscarriage during future pregnancy, but about half of women who have had this procedure have been able to carry a baby to term. The baby is delivered by cesarean section.
Pelvic Exenteration
If the cancerous tumor recurs within the pelvis after primary treatment, the patient may need a more extreme procedure called a pelvic exenteration, which combines radical hysterectomy with removal of the bladder and rectum. The surgeon will perform a colostomy to create a new passage for the stool to leave the body and will similarly construct a new urinary drainage system. If the vagina is removed, a plastic surgeon may be able to reconstruct a new one. Full recovery for pelvic exenteration can take up to 6 months.
Radiation therapy is a treatment option for early stage cervical cancer (stages IA2 - IB1). Radiation given along with cisplatin-based chemotherapy is commonly used for stages IB2 - IVA cervical cancer.
There are two types of radiation therapy:
- External beam radiation uses high-energy x-rays aimed at the pelvic area from an outside machine. It usually involves a short period of direct-radiation 5 days a week for about 6 weeks in an outpatient setting.
- Internal radiation (also called brachytherapy or intracavitary radiation) is designed to deliver high doses of radiation to the local tumor area. Radioactive material encased in capsules is inserted into the uterus and placed against the cervix as close to the cancerous cells as possible. Radiation implants may also be inserted directly into the tumor using a needle. Low-dose brachytherapy usually requires a hospital stay for a few days, as the patient must remain immobilized. High-dose brachytherapy is given on an outpatient basis during several short treatments.
Both types of radiation therapy may be used together.
In order to be effective, radiation therapy must be powerful enough to destroy the cancer cells' capacity to grow and divide. This means that normal cells are also affected, which may cause significant side effects. Fortunately, healthy cells usually recover quickly from the damage, whereas abnormal cells do not.
Side Effects. Side effects of radiation therapy include fatigue, redness or dryness in the treated area, diarrhea, frequent or uncomfortable urination, and vaginal dryness, itching, or burning. After treatment, side effects usually disappear.
Long-Term Complications. Complications include proctitis (inflammation of the rectum) and cystitis (inflammation of the bladder). Radiation therapy may also cause vaginal scarring, sexual difficulties, and premature menopause in younger women.
Radiation itself may increase the risk for later development of cancer in the area surrounding the treated tissue. Although newer more precise radiotherapy approaches should reduce this risk, the development of secondary cancers may be of particular concern for younger patients.
Chemotherapy uses cell-killing drugs called cytotoxic drugs to destroy widespread cancer cells that have spread from the primary tumor and can no longer be treated with surgery or radiation alone. Chemotherapy is usually used along with radiation (a combination called "chemoradiation") for treatment of stages IB1 - IVB cervical cancer. Chemotherapy can help increase the effectiveness of radiation therapy. In the most advanced cancer stage, IVB, chemotherapy is used palliatively to help relieve symptoms.
Platinum-Based Drugs. Platinum-based drugs are the main chemotherapy treatment for cervical cancer. Cisplatin is the primary drug used. Carboplatin is an alternative platinum drug that is used for treating more advanced cervical cancer.
Other drugs. Other drugs may be given alone or in combination with a platinum-based drug. They include paclitaxel, topotecan, gemcitabine, 5-FU, vinorelbine, and others.
Administration. Chemotherapy is given intravenously at a medical center or doctor's office. The drugs are given in cycles with a period of rest following a period of treatment, to allow recovery from the side effects.
Side Effects. Chemotherapy affects all fast-growing cells, including healthy ones. So, side effects are inevitable. Side effects occur with all chemotherapeutic drugs. They are more severe with higher doses and increase over the course of treatment. Side effects also tend to be more severe when chemotherapy is given along with radiation.
Common side effects may include:
- Nausea and vomiting (drugs can help relieve these side effects)
- Diarrhea
- Temporary hair loss
- Loss of appetite and weight
- Fatigue
Complications. Serious short- and long-term complications can also occur and may vary, depending on the specific drugs used. They include:
- Severe drop in white blood cell count (neutropenia). The reduction in white blood cells suppresses the immune system and makes patients more susceptible to infections.
- Reduction of blood platelets (thrombocytopenia), which can lead to bruising
- Anemia, reduction in red blood cells, is a common side effect of chemotherapy. Chemotherapy-induced anemia is usually treated with erythropoiesis-stimulating drugs, which include epoietin alfa (Epogen, Procrit) and darberpetin alfa (Aranesp). These drugs may contribute to rapid tumor growth in patients with cervical cancer. Doctors need to follow strict dosing guidelines when administering these drugs. Patients should discuss the risks and benefits of erythropoiesis-stimulating drugs with their oncologists.
- Premature menopause
- Liver and kidney damage
- Problems with concentration, motor function, and memory
- www.cancer.gov -- National Cancer Institute
- www.cancer.org -- American Cancer Society
- www.acog.org -- American College of Obstetricians and Gynecologists
- www.ashastd.org -- American Social Health Association
- www.nccc-online.org -- National Cervical Cancer Coalition
- www.foundationforwomenscancer.org -- Foundation for Women's Cancer
- www.cancer.net -- Cancer.Net
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American College of Obstetricians and Gynecologists. Screening for cervical cancer. Obstet Gynecol. 2012 Nov;120(5):1222-38.
Castellsagué X, Díaz M, Vaccarella S, de Sanjosé S, Muñoz N, Herrero R, et al. Intrauterine device use, cervical infection with human papillomavirus, and risk of cervical cancer: a pooled analysis of 26 epidemiological studies. Lancet Oncol. 2011 Oct;12(11):1023-31. Epub 2011 Sep 12.
Centers for Disease Control and Prevention (CDC). FDA licensure of bivalent human papillomavirus vaccine (HPV2, Cervarix) for use in females and updated HPV vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2010 May 28;59(20):626-9.
Committee on Infectious Diseases; American Academy of Pediatrics. Recommended childhood and adolescent immunization schedules--United States, 2012. Pediatrics. 2012 Feb;129(2):385-6.
Hunter MI, Monk BJ and Tewari KS. Cervical neoplasia in pregnancy. Part 1: screening and management of preinvasive disease. Am J Obstet Gynecol. 2008;199(1):3-9.
Hunter MI, Tewari K and Monk BJ. Cervical neoplasia in pregnancy. Part 2: current treatment of invasive disease. Am J Obstet Gynecol. 2008;199(1):10-8.
Jhingran A, Russell AH, Seiden MV et al. Cancers of the cervix, vulva, and vagina. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, eds. Abeloff's Clinical Oncology. 5thed. Philadelphia, PA: Elsevier Churchill-Livingstone; 2013:chap 87.
Kahn JA. HPV vaccination for the prevention of cervical intraepithelial neoplasia. N Engl J Med. 2009 Jul 16;361(3):271-8.
Loren AW, Mangu PB, Beck LN, Brennan L, Magdalinski AJ, Partridge AH, et al. Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013 Jul 1;31(19):2500-10. Epub 2013 May 28.
Lowy DR, Solomon D, Hildesheim A, Schiller JT, Schiffman M. Human papillomavirus infection and the primary and secondary prevention of cervical cancer. Cancer. 2008 Oct 1;113(7 Suppl):1980-93.
Massad LS, Einstein MH, Huh WK, Katki HA, Kinney WK, Schiffman M, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol. 2013 Apr;121(4):829-46
Mayrand MH, Duarte-Franco E, Rodrigues I, Walter SD, Hanley J, Ferenczy A, et al. Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med. 2007;357(16): 1579-88.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Cervical Cancer. Version 3.2013.
Noller KL. Intraepithelial neoplasia of the lower genital tract (cervix, vulva): Etiology, screening, diagnostic techniques, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds.Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 28.
Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. 2012 May-Jun;62(3):147-72. Epub 2012 Mar 14.
Smith RA, Brooks D, Cokkinides V, Saslow D, Brawley OW. Cancer screening in the United States, 2013: a review of current American Cancer Society guidelines, current issues in cancer screening, and new guidance on cervical cancer screening and lung cancer screening. CA Cancer J Clin. 2013 Mar-Apr;63(2):88-105. Epub 2013 Feb 1.
U.S. Preventive Services Task Force. Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012 Jun 19;156(12):880-91, W312.
Vesco KK, Whitlock EP, Eder M, Burda BU, Senger CA, Lutz K. Risk factors and other epidemiologic considerations for cervical cancer screening: a narrative review for the U.S. Preventive Services Task Force. Ann Intern Med. 2011 Oct 17. [Epub ahead of print].
Advanced Studyec
Review Date: 12/17/2013�
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.


text:
Welcome to the April 2013 Baby Shower! Brought to you by Evenflo and BabyCenter! Today we'll have six discussion topics/games and each topic will have a prize to win!
This hour's topic is the virtual diaper bag! Just comment with something you'll pack in your hospital bag and we'll fill up our virtual diaper bag!
Just comment on this thread to enter for a chance to win! One lucky winner will receive the Evenflo Bebek Feeding Multi-Pack pictured below!
Every comment = a chance to win, so feel free to comment multiple times. We'll announce the winner at 5:00 pm ET!

subset: commoncrawl


text:
Paul Mero, president of Utah's conservative Sutherland Institute, said Wednesday he believes gay Boy Scout leaders could have grounds for a lawsuit, based on the organization's proposal to allow gay youth to join but continue to ban gay adults.
"If I was a member of the gay community, I would probably call the ACLU (American Civil Liberties Union) and I'd file another lawsuit, just to highlight the inequity of the whole idea," Mero said during Wednesday's live online forum Trib Talk, offered by The Salt Lake Tribune.
The online chat centered around a possible new admissions policy for the Boy Scouts of America, which will go to a vote by selected leaders on May 24, and the LDS Church's statement that it was "satisfied" with the proposal.
Joining in the discussion was Kendall Wilcox, an openly gay member of The Church of Jesus Christ of Latter-day Saints and an Eagle Scout.
Wilcox said the Boy Scouts and the LDS Church have been affiliated for the past 100 years.
"Scouting is enmeshed in the young men's program in the church," Wilcox said. "I'd be a different person had I not been allowed to participate in Boy Scouts. I'm in favor and happy the church has chosen to express its support of this proposal."
Mero said he objected to the issue being "politicized."
"The BSA is a private organization and the Supreme Court has said as recently as 2000 that they have a right to set their own policies," Mero said. "For me, whatever they decide to do is their business."
In the end, the discussion moved to whether people choose to be gay or are born gay.
Trib Talk host Jennifer Napier-Pearce, a Tribune reporter, asked Mero about his recent blog essay "Scouts, Saints and 'sexual orientation.'" Both the BSA and the LDS Church draw distinctions between sexual orientation and sexual behavior.
"I can see why the Boy Scouts have settled on the compromise they have settled on," Mero said. "And I can also see why the gay community could be upset with that compromise."


text:
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text:
St. Julian Samba Showdown 27 by J Thyme (2011) 320 kbps - 198 mb (reup)
This is my hello to Spring post. Spring has come a few days earlier here, so I'm sharing my latest installment of the Samba Showdown series. I hope you fans of MPB enjoy this. If I can find another 24 tracks that sound good, then I'll be back. Until then, enjoy this tour through 70's Brasil. Happy Spring!
My favorite track here, in terms of fidelity, is the Elton Medeiros track "Vazio". I marvel at the amazing tape saturation, compression and warmth of the composition & the expert handling of material. When this sits next to another track, the jump in fidelity is quite noticeable!
St. Julian Samba Showdown 27 by J Thyme (2011)
01. Até Parece - Dóris Monteiro (1973)
02. Desfigurado - Cartola (1977)
03. O Patrão Mandou - Paulinho Soares (1978)
04. Toda Tarde - Trio Mocotó (1975)
05. Menina Da Ladeira - João Só (1971)
06. Perspectiva - Antônio Carlos & Jocafi (1975)
07. Tatuagem - Nelson Cavaquinho (1972)
08. Terecô - Nonato E Seu Conjunto (1978)
09. Tá Chegando Fevereiro - Os Originais Do Samba (1970)
10. Pimenta No Vatapá - João Nogueira (1977)
11. Nao é Hora de Tristeza - Elza Soares (1974)
12. Ironia - Batatinha (1976)
13. O Mundo Encantado de Monteiro Lobato - Jair Rodrigues & Escola De Samba Acadêmicos Do Salgueiro (1971)
14. Não Suje O Meu Caixão - Alcione (1979)
15. Num Arredo O Pe - Djalma Dias (1974)
16. Tocar Na Banda - Adoniran Barbosa (1975)
17. Caramba - Ed Lincoln (1966)
18. Dia 4 Dezembro - Aquarius Y Luiz Antonio (1973)
19. Maria Portugal - Paulo Diniz (1973)
20. Miudinho - Paulinho Da Viola (1978)
21. Requenguela - Brasilian Singers (1974)
22. Vazio - Elton Medeiros (1973)
23. Pros Filhos Do Ze - Ely Arcoverde (1972)
24. Tem Mais Samba - Chico Buarque de Hollanda (1966)
25. Que Samba é Esse - Jorginho Pessanha (1971)
P.S. This very special post goes out to my friend Paul Kennedy. This one's for you Paul. Happy belated Birthday and congratulations on your new home & new family member.
Also, I could compare this series to "raiding the candystore". All 27 volumes of this series equals 651 tracks and that's a lot of gathered candy.
22 comments:
thank you Justin and for the special shout! will report back with new faves from this showdown - I own around 8 of these on LP so far - your showdowns are always good business for the Brazilian vinyl dealers!ReplyDelete
soberba! obrigado x1000!ReplyDelete
Santos, Meu Prazer.ReplyDelete
all killer no filler...me = candied out! thanksReplyDelete
- AnonymousMarch 28, 2011 at 6:15 PM
These are so excellent! Thanks so much for sharing! Much appreciated :-)ReplyDelete
Thanks Justin for this compilation, what a bunch of good songs. Take care.ReplyDelete
Thank you Matt & thank you Carlos.ReplyDelete
dearest justin, do you know who the woman is who sings manhã de carnaval on the orfeu negro ost? if memory serves, she was a little older, maybe her name begins with an 's'... i recall some solo lp's on loronix but my memory fails me. any help would be appreciated. thx :)ReplyDelete
I'll take a guess since you gave me a clue of the letter "S". Sylvia Telles, since she was very active at the time of that recording of 1958/1959.ReplyDelete
I hope that helps. Let me know if I got it right.
close but no spliff, but muchas gracias fer the reply. turns out twas Elizete Cardoso. i love her voice on that track so i spent the last half hour tracking down a few albums from around the net, especially older ones. unfortunately none of the arrangements [or songs] i heard are nearly as good [or moving] as that one track on orfeu negro! the hunt continues :)ReplyDelete
It's all a matter of taste with the singers. Most people claim that Elis Regina is the greatest singer ever from Brasil, but I prefer Dóris Monteiro.ReplyDelete
hi Justin, here's my song notes/reactions:ReplyDelete
01. Até Parece - Dóris Monteiro (1973)
love the way this song arrangement slowly builds, anchored by the swinging bass. Doris has such a lightness of touch and sweet tone (delicate, sparkling) - if ever a voice could caress this is it.
02. Desfigurado - Cartola (1977)
beautiful samba, with a lyrical trumpet (with personality). Cartola's verses are gentle and sincere/romantic. love the melodic syncopations in the chorus.
03. O Patrão Mandou - Paulinho Soares (1978)
funky clavinet and siren sounds. Paulinho's voice/delivery reminds me a little of Gilberto Gil (also Djavan). I like the way the english chorus contrasts within the song and the showdown as a whole. the soloing reed instrument (clarinet?) adds interest to the mix (and is also doing the siren notes?). the song improves with listens!
04. Toda Tarde - Trio Mocotó (1975)
this LP has a totally recognizable sound - the echo on the backing/chorus vocals, the sweet/mellow arrangements: shaker/percussion to the fore, very light pretty piano parts, wah wah guitar, etc. this band cooks! although Muita Zorra! was the album that sucked me in, I've warmed to this LP to the point where I would just listen to it for the sound, yet the songs are all so appealing too! strangely I didn't find the 1973 (middle) album interesting, perhaps need a re-listen.
05. Menina Da Ladeira - João Só (1971)
this is the song that's going to push the Joao So LP over into a must-have for me. it's the combination of the pretty guitar part with the soulful/saudade/melancholy vocals and the confident, almost stern horns. there's a feeling similar to "Everybody's Talkin' " here.
06. Perspectiva - Antônio Carlos & Jocafi (1975)
pretty ear-tickling tune with classic samba church-chords vocal chorus. traditional sounding - quite a change by now from the psych-rock of their debut album! even without understanding Portuguese, you can tell from song titles that Brasilian lyricists aim for (achieve?) poetry.
07. Tatuagem - Nelson Cavaquinho (1972)
it's irresistible hearing the older sambistas with their lifetime of world(weary)ly experience - tempted to call the vocal sound Marmite soul! this is a superb song with the sad/pretty young female chorus and guitar/horns interplay. courtyard melodrama.
08. Terecô - Nonato E Seu Conjunto (1978)
quick someone call Ultimate Breaks & Beats! (opening drums sound a bit like "Little Miss Lover") very recognizable song from this classic LP - one of those strangely pulsating Brazilian arrangements that seems almost like sonic op-art at times. loving the fact that on this run of Showdown cuts the male vocal songs include female chorus as a nice contrast!
09. Tá Chegando Fevereiro - Os Originais Do Samba (1970)
feeling the horn arrangements on this Showdown. always love this ensemble's spirit - they bring YOU to the party in Brazil!
10. Pimenta No Vatapá - João Nogueira (1977)
makes me realize I need to learn the meaning of these Portuguese lyrics - Nogueira always sounds like he's relating a humorous story/allegory. master of the laughing delivery. love the hyper acoustic guitar runs and flutes - colorful arrangement!
11. Nao é Hora de Tristeza - Elza Soares (1974)ReplyDelete
what a joyful, confident singer Elza Soares is - I bet she's great live. this song features mixed gender vocal chorus (can't remember who devised the science of the optimum gender ratio).
12. Ironia - Batatinha (1976)
Batatinha 1976 joins Geraldo Filme 1980 and Elton Medeiros 1973 as your most featured single album. such a sweet and perfect sound on this record - has the feeling of a great work of art, fine wine. love the way this track is minor based but resolves into major sevenths: bittersweet.
13. O Mundo Encantado de Monteiro Lobato - Jair Rodrigues & Escola De Samba Acadêmicos Do Salgueiro (1971)
Jair Rodrigues is one of the main(few?) points of agreement between you and your friend Joe Sixpack! classic old-world samba with the strong church harmonies.
14. Não Suje O Meu Caixão - Alcione (1979)
sounds like a hit single, quintessential Brazilian pop samba. one of the most confident singers, exacting arrangement and there's the mixed gender chorus vocals again.
15. Num Arredo O Pe - Djalma Dias (1974)
I just got this album - ordered all the way from from Brazil, then discovered a copy was available locally in Academy or Big City Records anyway...
is it mandolin that I hear in many Brazilian recordings, or another specific miniature guitar-type? so by now I'm getting my samba fix - feel like I've been to a spa - lifted spirits!
16. Tocar Na Banda - Adoniran Barbosa (1975)
has the use of samba in therapy been considered? love the arrangement, almost comic horns, memorable short syncopated chorus melody, feel good music.
17. Caramba - Ed Lincoln (1966)
icing on the cake - happy music - I defy anyone to repress a smile when they hear this.
18. Dia 4 Dezembro - Aquarius Y Luiz Antonio (1973)
wow - banger! a must-have for me as a (sometime, ok rarely these days) DJ. musically I'm drawn to the guitar harmonies and the bass melody towards the end - would sit down to work out what they're doing to get those sounds. is this a big Greg Caz track?
19. Maria Portugal - Paulo Diniz (1973)
great bass! I first became aware of Paulo Diniz via Allen Thayer's great Wax Poetics Joao Donato article - one of his LPs was pictured as a Donato production/involvement.
20. Miudinho - Paulinho Da Viola (1978)
never saw this LP cover before - as an acoustic guitar player I love it! a performer whose career has legs - not sure how many of his albums are essential but suspect at least 5 to 10 minimum. Bebadosamba is one of the most recent Brazilian albums I own. this song is spare, insistent, cyclical, hypnotic, distinctive! is this structured like a children's play chant?
21. Requenguela - Brasilian Singers (1974)ReplyDelete
nice use of echo/space/reverb here. you completely sold me on the Brazilian/Brasilian Singers LPs. I remember listening to them over and over because as I searched for the best songs the sound as a whole became addictive. by the way I think it's cicadas not bees on the one with the roosters also - I secretly know where a copy of that record is waiting for me to buy someday!
22. Vazio - Elton Medeiros (1973)
possibly my all-time fave Brazilian LP. seems to contain worlds of experience - I think of the songs as a collection of short stories / vignettes. the arrangements/sounds seem to hit every spot. this is a Babette's Feast of Brazilian albums.
23. Pros Filhos Do Ze - Ely Arcoverde (1972)
Regresso is my current most-wanted. shhh don't tell the bidding competition! highly subtle yet expansive (Marcos Valle-esque) arrangement, though I had to smile at the straight snares on the fours at the beginning. another sonic bouquet.
24. Tem Mais Samba - Chico Buarque de Hollanda (1966)
is this Chico's debut album? I have a few of the later ones. this has that mysterious spare 60's sound that evokes black & white and the echo of stone/bare-walls (like the Os Afro-Sambas LP). hypnotic delivery - and the chorus vocalists only emerge at the end.
25. Que Samba é Esse - Jorginho Pessanha (1971)
cuica! another great samba with a 60's beat -sounding blues-riff thrown in. good choice for an end song, since that riff's cadence acts as a summation/resolution.
thank you!
- Paul
Hi Paul, I'm glad you did this in 3 parts. It gives me chance to respond to your insights.ReplyDelete
In reference to Trio Mocotó, yeah, I never clicked with that middle LP at all. My favorite part of that Menina Da Ladeira by João Só is that scat of the horn hook. Listen for that. I like your Op-Art reference to Terecô by Nonato E Seu Conjunto. It's a pulsing thing. Have you given a good listen to that Os Originais Do Samba from 1970? Boy, they really hit their stride on this disc. The João Nogueira is a sick triple-time race. Tap your toe to find the tempo and your foot will be moving quite fast, once it finds that bass tempo. Ha, ha.
The clarity on that Batatinha is outstanding. Listen to the variety of percussion on this track. Love the wood stick accents.ReplyDelete
The Jair Rodrigues & Escola De Samba Acadêmicos Do Salgueiro is another sick triple-time tickler, with that bass just making laugh with joy. This song just puts a smile on my face. You can feel that they really give their all.
The Alcione is all about that "in your face" cuica and if that's not enough, just wait until the chorus gets dropped. Short & sweet!
That Djalma Dias is a bit of a sleeper, but then I woke up to it's sweetness.
The Adoniran Barbosa is such a circus act. An over the top triple-time march with Tuba thrown in for good effect.
Caramba is the first song I've dropped from the Ed Lincoln (1966). It was just screaming "Pick me".
The Dia 4 Dezembro - Aquarius Y Luiz Antonio is not from Brasil. It's from Spain, but who cares? It's super fun and lovely!
The Paulo Diniz has just creeped up on me in a very nice way. I like the record as a whole & there are some really outstanding numbers on it. Go Odeon!!!
There's only one word for that Paulinho Da Viola...Sublime!
I want all of those Brasilian Singers LP's. If you find another, please share it with me.ReplyDelete
The fidelity on the Elton Medeiros is mind-blowing. Such wonderful tape saturation & compression. Flawless. Oozing with fidelity!
The Pros Filhos Do Ze by Ely Arcoverde is so Marcos Valled out with a yummy organ surprise.
The Chico Buarque de Hollanda is his debut and a masterpiece, if don't know it. Only 1 minute & 46 seconds long and listen to that juicy sign off.
The Jorginho Pessanha is so rare that I don't even have an album cover to even look at. Rare, rare, rare and hot, hot, hot.
Thanks for your comments.
Great great post! Thank you so much!ReplyDelete
- AnonymousMay 2, 2011 at 6:29 PM
thanks for this i lost a lot of these tunes in computer related tragedy! but this compilation has restored my faith in humanity! and i want to know how you get so motivated to post these superb insights in to this musical carnival of sounds. if i ever make a lot of money i am gonna thank you big time...ReplyDelete
Thanks again.......ReplyDelete
- AnonymousJune 30, 2014 at 12:49 PM
Por favor, pode repostar esse link?ReplyDelete


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Seattle Spotlight: Vegan Foodz
Have you been to Seattle? Have you tried all the yummy foodz?
We haven't tried them all—YET—but we've tried a fair amount.
There are tacos:
…and bagels:
…and coffee galore:
…and fried pickles:
….and deep fried goodness at a sadly now-closed location:
….and don't forget the cocktails!:
Places seen in this post:
2 thoughts on "Seattle Spotlight: Vegan Foodz"
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This program is designed for students interested in teaching high school biology. In only five years, very good students will be able to complete all required courses for a Bachelor of Arts in Biology, a Master of Science in Education, and New York State certification in Adolescence Education.
The five-year Biology BA/MS Ed program at Mount Saint Mary College seeks to prepare teachers to present modern scientific concepts in an exciting and dynamic way. Successful graduates will gain a broad and balanced background that addresses the standards of the National Science Teachers Association (NSTA). All students, after successfully completing this program, will have been exposed to topics that constitute the core, advanced, and supporting competencies recommended for teachers by the NSTA.
There are many advantages to studying Biology at the Mount:
Opportunities outside of the classroom. You could be a student rep at a division meeting, an officer in the Biology and Chemistry honor societies, or part of the American Chemical Society student chapter on campus. Students organize speakers, museum tours, hiking trips, campus activities like faculty vs. student quiz bowl, and science night for elementary school students.
A strong peer group. Biology majors quickly become a part of the science community at the Mount. Students who have majors within the Division of Natural Science take their math and science classes together and quickly form study groups and friendships.
Peer tutoring. Science majors work together toward a successful college career as upper-classmen serve as peer tutors, and all students have the opportunity to get help to support their learning efforts.
Research. All full-time faculty members have PhD degrees in a variety of different fields and can offer you the opportunity to develop a research project that will help you to apply your coursework to real problems. A research project will enhance your knowledge and ability to integrate your learning and will impress graduate schools and future employers.
Learning science as a process. Many of our laboratory courses use inquiry-based collaborative learning to introduce you to the process of science and scientific research.
Mentoring. All science students are assigned a full-time faculty advisor to help you explore career options, plan your course schedule and follow your academic progress. New freshmen are assigned a "science sibling" before coming to campus, so that they have the opportunity to ask questions of an upperclassman, student to student.
Requirements for entrance and continuing enrollment in the five-year master's program in Biology and Adolescence Education at the Mount::
According to the National Education Association (NEA), teacher shortages are expected in science and math in New York State in the near future.
The Division of Education at Mount Saint Mary College is accredited by the National Council for Accreditation of Teacher Education (NCATE), www.ncate.org. This accreditation covers initial teacher preparation programs and/or advanced educator preparation programs at the College in Newburgh, New York. However, the accreditation does not include individual education courses that the institution offers to P-12 educators for professional development, relicensure, or other purposes.
As part of the maintenance of NCATE accreditation, the college is required to display data revealing the success of our programs. The following link displays a connection to the most recent results of Mount Saint Mary College teacher candidate "completers" (graduates of our programs recommended for certification) on New York State Teacher Certification Exams.
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Thanks and gratitude for making a difference.
please help this go viral so shame MD, my attacker, NYPD and IAB thank you.
The NYPD an internal affairs fix crime in my opinion based on my own experience.
Time for a Permanent Commission in to NYPD, IAB, and DA Corruption: Title 18.subsection 242.conspiring of rights.which is a felony that can land that detective behind bars for ten years. I was sent this -- is this applicable to Det John Vergona and his partner, Det Andy Dwyer his partner, supervisor Lt Angelos Burgos, supervisor Sgt Chen and all involved including in Internal Affairs? NYPD Internal Affairs DA want to do the crime do the time. Turn Broken Windows back on them!
http://nypdnewcommission.blogspot.com/2017/04/ray-kelly-charles-campisi-bratton.html They love using Ron Kuby's letter to pretend I was not coerced and the NYPD did not commit a pile up of crimes.
The Detectives in my case Det Vergona and Det Andy Dwyer, their partners, and supervisors and facebook friends NYPD PO Eugene Schatz aka Gene Schatz and Det Tommy Moran were party to the fact Verogna was lying in his DD5s and was going to verbally violently threaten me over the phone because the cowardly criminal detectives and supervisors did not have it in them to commit the crimes they committed and face me but they did use Ron Kuby's letter to pretend they dd not commit crimes and Internal Affairs has protected them along w/ top brass all party to retaliation.


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Anyone know the details of the sand being pumped onto the beach at Rockaway and how it will affect the sand bars?
This flat spell has rough so today I headed to 90th street just to get wet and drop in on some shin high bombs. One of the lifeguards said they were "fixing the sand" and that the beach was closed and that only 67th street was accessible. The concept of God's ocean being "closed" really bothers me but whatever. Anytime the Army Corps of Engineers is involved, you gotta worry about a good wave being turned into a closeout lapping on the beach. Just curious if anyone knows the plan.
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Aug 19, 2013, 10:19 PM #1
Rockaway Beach sand replenishment


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Lunching With Claire Danes, and Her Eyelashes
The actress is the newest face of Latisse.
-Sarah Polonsky
Thursday's luncheon at the London Hotel in NYC had me very skeptical. I was there to meet the beautiful Claire Danes to discuss the first ever FDA-approved eyelash-lengthening product, Latisse.
Rumors of iris-discoloration and sudden darkness under the eyes had me wondering why Claire would agree to the possibility of a frightening outcome just to attain some lengthier lashes.
Then she entered the room, batting those big eyes and I started to cave into the idea a bit. Actually her lashes arrived five minutes before she did.
Read Love It or Hate It: The Makeup Edition
Said Claire of her new stint as Latisse spokes model: "I'd become aware of the product and was curious so I met my doctor. And it has been amazing! It happens in stages so I had to be patient. Then they started to become fuller and darker. I was amazed."
Claire's lashes, before and after Latisse.
Claire said she did experience some redness around her eyes at first but it quickly faded and now she couldn't be happier. "It looks like I'm wearing make-up first thing in the morning," she said.
Even her husband, Hugh Dancy, who she claims prefers her look most when she's dressed down, sans make-up enjoys her new mile-long eyelashes. "He likes them a lot," she added. "Butterfly kisses are better."
Claire makes a convincing case. Will eyelash lengthening be the newest fad in beauty? Only time will tell.
Tell us: Would you use Latisse to have your lashes lengthened?
Sarah Polonsky is a senior editor at BettyConfidential.


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'Rochester will continue to be the top developmental team for the Buffalo Sabres. The affiliation agreement calls for the Buffalo Sabres to provide the Amerks organization with a minimum of 10 prospects and the entire coaching staff. The remainder of the roster will be filled by Rochester.'
Sabres, Amerks sign affiliation agreement
June 8, 2007 Submitted by
Via: Sabres.com


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Six society finches looking for home together!!! 2 parents 4 babies about 5 months old comes with cage and stand$70
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3 males and 1 female @ $75.00 each. Cages are an additional $30.00 - $150.00 depending on size. Photos will be provided upon request.$75


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BMW Top Consumer Reports 2010 Best Cars for Teens List
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BMW Top Consumer Reports 2010 Best Cars for Teens List
Bimmerfest.com Founder
Join Date: Dec 2001
Location: SF
Posts: 15,589
posted by
This is actually the second report on the topic from Consumer Reports. In the
first report
all the choices were $10,000 plus with many cars hovering around 15 grand. That seems like a lot of money in a car that going to suffer at the hands of a noobie teen driver. Consumer Reports went back to the drawing board to come up with a set of more affordable teen cars for 2010 and BMWs are topping the charts with the 2000-2003 323i/325i and the 2000-2003 528i/525i!
2010 Best cars for teen drivers: More affordable alternatives
Response to our
recent post
suggesting best cars for teens has been tremendous, and not all responses have been positive.
Trying to pick the best car for our kids while balancing the budget may be one of the toughest decisions parents ever have to make. For starters, we'd insist that the car have electronic stability control--even though this important safety feature hasn't been around that long, limiting its availability on older vehicles. Studies by the National Highway Traffic Safety Administration (NHTSA) and the Insurance Institute for Highway Safety (IIHS) show that ESC could well be the most important safety feature since the safety belt, and it could save as many as 10,000 lives per year if all vehicles were so equipped. NHTSA says ESC could also prevent more than 230,000 injuries annually.
Of course, not every family can afford to put a new driver behind the wheel of a car with the latest safety features. That said, it's important to come as close as you can. Car crashes remain the number one killer of young people, and the younger the driver, the worse the fatality rate.
So our advice remains: Buy your teen driver the safest, most reliable, and newest vehicle you can.
Unfortunately, some of the best vehicle choices will be out of reach for many of us. But it doesn't change the facts. As one commenter to our last blog pointed out, the $10,000 or so necessary to get a good used vehicle with ESC, curtain air bags, and other safety gear that might save your kid's life isn't cheap. But it's cheaper than even one day in a hospital.
After considering myriad factors, our engineers have identified more candidates for your teen's first ride. Some are luxury models, because those are usually the first to get the latest safety equipment. The downside to buying an older luxury model is that repairs, when they're needed, are apt to be costly.
The cars listed below take some more careful shopping, as ESC was optional. In the case of the Camry and Optima, it often required a higher trim level. Curtain air bags were also optional in the Camry in some years.
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Bimmerfest 2017 California June 3rd-4th
Bimmerfest East July 29th-30th
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Dalhousie Park, it may be gratefully admitted, has been much improved, mainly by the devoted attention of the late Mr. John Short.
A flag will be shown at Fore Mast-head of "Dalhousie" at that time.
Jaspar did not reply, and it was plain Dalhousie's remarks had had their effect.
Old Colonel Dalhousie did not deal in moral subtleties, that was clear.
When the Girl got home she was told that the Dalhousie team had won the game, eight to four.
They turned me out twelve hundred feet above the city on the military road to Dalhousie, as it will be when India has a surplus.
Dalhousie felt the full weight of Mr. Faxon's rebuke, and acknowledged the justice of the punishment he had received.
Twenty-two miles out of Dalhousie it began to rain—not a mere hill-shower, but a good, tepid monsoonish downpour.
It was attended by the Earl of Dalhousie, who occupied the chair, and a number of officials.
Once the seat of the Lindsays the estate now belongs to the earl of Dalhousie.


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AbilityFirst's Long Beach Center recently held a well-attended open house for the Long Beach Area Chamber of Commerce and the Signal Hill Chamber of Commerce.
The networking reception included impressive refreshments provided by The Peppercorner and Rossmoor Bakery.
Tours of the center were ongoing throughout the evening. Guests were able to see firsthand several of AbilityFirst's programs in progress and learn about the various programs that the center provides.
Guests participated in helping to decorate the center's Christmas tree, culminating in Long Beach Mayor Bob Foster performing the official tree lighting.
Seen at the scene: Long Beach Center Guild members Liz Minor, Annemarie Forster and Mary Alice Braly, Long Beach Chamber member Joel Perler, Signal Hill Chamber President Terry Rodgers, Signal Hill Chamber member Denise Damrow, Long Beach Rotary President-Elect Kay Cofield, Port of Long Beach Commissioner Doug Drummond, Signal Hill Councilman Ed Wilson, Japanese Chamber of Commerce member Charlene Ogami, Long Beach Community Foundation board member Eleanor Aquilar, Long Beach Councilwoman Gerry Schipske's assistant Misha Houser, Union Bank Vice President Andrew Westling, "Run With It" project manager Tina Thompson, Northwestern Mutual's Steven Osborn and Chris Wilson, field representative for Assemblywoman Bonnie Lowenthal.
Andy Street fundraiser
The Andy Street Community Association in Long Beach gathered about 90 supporters a few months ago to celebrate another year of continued success in building a community and changing lives. Ian Gee, president of the association, remarked that this is a community that came together to revitalize a crime-ridden neighborhood and improve the quality of the lives of its residents.
It's a remarkable story of a neighborhood that was so crime-ridden and violence-prone that the post office refused to deliver mail for the carrier's safety. The determination, hard work and perseverance of property owners, residents and youths turned the situation around to one of success, with their youth gaining academic achievement to become scholarship recipients.
More than 75 youth on Andy Street have benefited from the following programs: Cooking with "Let's Move" Chef Michael Poompan, Environmental Art, Youth Ambassadors and Youth Entrepreneurship.
Guests enjoyed a delicious dinner buffet by Chef Richard of the Sheraton Los Angeles Downtown Hotel and wines provided by Friends of Andy Street.
The event raised more than $18,000 for the scholarships.
Seen at the scene: Henry Taboada, former U.S. Rep. Laura Richardson, Assistant City Manager Reggie Harrison, Minnie Douglas, Councilman Al Austin and his wife, Daysha, Kezia and Don Daniels, Gene and Leanne Johnson, Damon Dunn, Ivy and Ken Goolsby, Roberta Jenkins, host Anthony Gagliardi, Councilman Steve Neal, Val Lerch and Mark Platt.
Day of Southern Elegance
More than $65,000 was raised at the National Charity League, South Coast Chapter's 39th annual Tournament Day, recently held at the Long Beach Hilton.
Erin Kahlert, this year's event chair, chose the beautiful theme "Graceful Living, Gracious Giving - A Day of Southern Elegance" in honor of the more than 400 attendees.
NCL President Joy Harn thanked guests for attending and spoke proudly of the group's commitment to strengthen mother-daughter relationships through philanthropic work, leadership development and cultural awareness. She added that members have generously given more then 20,000 hours to our local philanthropies. She also welcomed special guests, numerous past presidents and representatives from the NCL National Office.
The Tournament Day chair spoke about the chapter's mission to make a positive difference in the community and how the money raised supports philanthropic organizations and scholarships for college-bound young women.
Special thanks went out to NCL support groups, Las Mariposas, Las Amigas, Las Campanas and NCL Juniors.
Following a delicious lunch, the audience enjoyed a fashion show featuring stunning clothes from The Sue Wong Collection as well as hats from Lyn Frances. The fashion show was directed by Lucida Miedema.
A dynamic auctioneer presented many exciting auction packages, including trips to Hawaii and a week's stay at beautiful Les Moulieres located in the South of France. There were also sensational items like a VIP viewing of the pregame show Fox NFL Sunday, an exhilarating ride on the Good Year blimp, a champagne lunch cruise to Catalina for six, tickets to the Toyota Grand Prix of Long Beach with a pace car ride, and adorable Chihuahua and cockapoo puppies.
Guests purchasing a beautiful bracelet had an opportunity to win a gorgeous diamond necklace or a brilliant diamond ring beautifully designed by Warren Marriott and graciously donated by Marsha Moeller.
National Charity League is a charitable, nonprofit, national organization of mothers and daughters who join together in community service, leadership development and cultural experiences. NCL South Coast Chapter, with members from the Long Beach and West Orange County areas, donate more than $75,000 to local philanthropies and scholarships annually.
Seen at the scene: Special contributors to the event were silent auction Co-chairwomen Michele Crowder and Kristi Kahl, NCL fashion show Chairwoman Sue Iritani, decorations Chairwoman Pam Kellogg, The Game Chairwoman Karyn Edmondson and opportunity Chairwomen Cortny Kutzke and Sandra Schroeder.
News of social events with charitable purposes may be sent to Shirley Wild at email@example.com or by fax to 562-594-9668. Please include a contact phone number. Send high-resolution jpeg photos, by attachment, to email@example.com and include group name and identification of individuals from left. Call Shirley at 562-594-9468 for more information. Please check the website for coverage of additional events: wwwpresstelegram.com/social.


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Did Ben the Muppet win that last fight? ...because you were injured? Why did you feel you lost that last fight? Maybe watch this first before thinking about your next reply.
Last edited by Luke; 26-08-2010 at 10:06 PM.
haha i love the way Luke strikes up apparently earnest conversation with trolls. top stuff!


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http://www.eliterestaurantequipment.com/thunder-group-6-0-external-tankless-water-heater-rc80in.html http://www.eliterestaurantequipment.com/media/catalog/product/cache/1/image/265x/9df78eab33525d08d6e5fb8d27136e95/t/h/thundergroup_rc80in.jpg RC80IN Thunder Group
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Product Description
|Thunder Group
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|6 gal.
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To perform a search, enter a keyword, phrase or item number in the search field and click "search."
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The most famous of the California wine regions is Napa Valley, and these wines are certainly outstanding – but it's not as broad and diverse as its larger neighbor, Sonoma County. Down south, Santa Barbara's Santa Maria Valley is well-known for its Rhône blends, as well as cool-climate varieties like Pinot and Chardonnay. The Central Coast, the largest California AVA, has many different microclimates that lead to a wide range of wines with many sub-AVAs.


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Ascended Masters
Perhaps the most intriguing legend associated with our mountain concerns Guy Ballard's claim to have met the Ascended Master Saint Germain in 1930 while hiking on the mountain. Ballard's encounter, as well as subsequent interactions with Ascended Masters, were published under the pseudonym of Godfre Ray King in a series of books that now serve (along with The Bible) as the texts for the "I AM" religious activity.
According to Gordon Melton's Encyclopedic Handbook of Cults in America, "I AM" is the name God uses for Himself in Exodus (3:14). The "I AM" followers believe that God's energy, as well as the energy from Ascended Masters, can be tapped by each person's "higher self." Before becoming an Ascended Master, Saint Germain used this connection to divine energy to purify himself and then "ascend" to God. "I AM" members also consider themselves Christian in that they believe Jesus (also an Ascended Master) is responsible for the "Christ Light," the Divine Light of Love available to those wishing to ascend from darkness to light. The "I AM" student studies how to tap into the "Christ Light" (or Mighty I AM Presence) to eliminate evil, purify themselves, and eventually (with the help of the Ascended Masters) perhaps ascend to become an Ascended Master as well.
In 1957, A.F. Eichorn put together a brief but interesting historical overview of the local "I AM" activity, and the full-text article is worth reading for its extensive quotes from King's Unveiled Mysteries and Eichorn's comments about the early persecution of the "I AM" membership. Still, anyone wanting a more thorough understanding of the "Ascended Masters" should refer to Legends: Ascended Masters in Mr. Miesse's Mount Shasta: An Annotated Bibliography.
Geology ~ Environment ~ Native Americans ~ Folklore ~ History ~ Art ~ Literature
Recreation ~ Maps ~ Mount Shasta Collection ~ Bibliography ~ Lesson Plans ~ About Project


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Fila Scotland 2003 Official away white shirt.features embroidered team crest and logo.Fila tec fabric that allows moisture to pass from skin to surface of the garment to stay dry and comfortable.Mesh throughout for breathability.V-neck design with navy blue on each side and gold tubing.100% polyester.
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text: Over his rematch with Big Al? All I keep reading is him spitting his dummy out about having to fight him, where the fight is taking place and keeping on bigging up Cormier. Is he right, should he be able to pick and choose? Choose location being the champ. Does this take place of local shows in this country?


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Bruce Springsteen's 'Born To Run' handwritten lyrics going to auction
Listen to Bruce Springsteen on iHeartRadio
Some handwritten lyrics on a sheet of ruled paper by rock icon Bruce Springsteen will be going on the auction block.
Those lyrics are to the song "Born To Run." On December 5th, nearly 40 years later, the handwritten genesis of one of the Boss' biggest hits will by auction off by Sotheby's of New York.
The auction house expects bids to reach between $70,000 to $100,000.
Photo Credit Getty Images


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Reinforcing its commitment to help people gain basic literacy skills, the Dollar General Literacy Foundation announced that it has awarded Central Florida Community College with a $20,000 grant. Central Florida Community College will use the funds to further its literacy and basic education outreach efforts.
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Yes, I recommend this product.
By minji ko| June 26th, 2017
I love it
Yes, I recommend this product.
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By AuLait Untitled| July 14th, 2015
This little wooden scoop is actually a necessity. I've been using the Vanilla Coconut Body Scrub since 2011 and even though the scoop is only $1.00 I always passed on it because "I could use my fingers".
I finally got annoyed with having to clean the salt from under my finger nails and the shower water getting into the jar and diluting the oil.
I purchased the scoop December 2015 and absolutely love it. Leaving it inside the jar doesn't seem like a good idea to me because it is wood and I don't want lose oil from it adsorbing into the 'scooper'.
It is definitely easier to mix the salt and oil using the scoop. Water doesn't get into the jar anymore.
I would recommend this product because it is convenient and it only costs A DOLLAR :-D
By Amy| November 25th, 2012
I use this scrub, with its longer handle to get mineral powder for baths. But it's too long to fit inside a body scrub jar. I was lucky enough to pick up the original shorter scoops which fit inside the body scrub jar. But even if it doesn't fit inside the jar, I'd still recommend using the scoop over your fingers for the body scrub - there's less contamination this way and the idea of some of the scrub lodging itself under my nails is a little uncomfortable. Overall, I'd recommend.
By David| April 28th, 2012
This scoop is so necessary for my scrubs! How else will I mix and measure out my glorious scrub?! A must for every scrub you own!
By lisa| March 31st, 2012
i forgot to mention that because it is made of wood, it is porous & if left in jar, it absorbs the fragrance. I have one for each flavor I use, as it is necessary to use a scoop so not to get H2o into the jar, which happens when using just your fingers over & over. It loses the purity.
By lisa| March 31st, 2012
a must have for the scrubs in tub jars & perfect measurement for each application.
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