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Cervical cancer is a disease in which cancer cells grow in the cervix. The cervix is the lower, narrow part of the uterus that connects the uterus with the vagina. It is the outlet of the uterus through which menses flow and babies are delivered. Normally, the cells of the cervix divide in a regulated manner. If cells keep dividing in an unregulated manner, a mass of tissue forms. This mass is called a tumor. A tumor can be benign or malignant. In the cervix, cancer can arise either from the squamous cells (squamous cell carcinoma) that line the outer surface of the cervix or the glandular cells that are found in the channel that connects to the rest of the womb (adenocarcinoma).
The Cervix |
A benign tumor is not cancer. It will not spread to other parts of the body. A malignant tumor is cancer. Cancer cells divide and damage tissue around them. They can enter the bloodstream and spread to other parts of the body. This can be life-threatening.
Pap smears are largely responsible for the significant decline in deaths from cervical cancer over the past 30-40 years. Despite this success, 11,270 women in the US still learn they have cervical cancer each year.
Cervical cancer comes in two major forms:
- Squamous cell cancer—arises form the cells on the outermost portion of the cervix that connects with the vagina
- Adenocarcinoma—arises from the gland cells that are found on the inner lining of the cervical canal
Squamous cancer is more common than adenocarinoma. Many cases of squamous cancer are associated with infection with a virus ( human papillomavirus or HPV), which, in addition to increasing the risk for cervical cancer, causes tell-tale changes in the cells of the cervix. These changes can be detected by Pap smear and indicate an increased risk for developing cervical cancer.
A vaccine has recently been developed to protect against infection by some (but not all) of the HPV strains associated with cervical cancer. Additionally, the administration of this vaccine has come under some scrutiny, especially when given to young girls whose bodies are still developing.
[What are the treatments for cervical cancer?
[What are the risk factors for cervical cancer?
What are the symptoms of cervical cancer?
[How is cervical cancer diagnosed?
[Are there screening tests for cervical cancer?
How can I reduce my risk of cervical cancer?
[What questions should I ask my doctor?
Cervical Cancer |
There are no obvious signs or symptoms of cervical cancer in its beginning stages. The precancerous changes happening in the cervix usually do not cause pain or other symptoms. Most cervical cancers are detected through a routine pelvic exam and Pap test. Because of this, it is important to have regular Pap tests .
When the abnormal cells become cancerous, accumulate to a sufficient size, and begin to invade nearby tissues, signs and symptoms may appear. They include:
- Abnormal bleeding—This is the most common symptom. It may include:
- Bleeding between your regular menstrual periods
- Menstrual bleeding that is heavier or lasts longer than usual
- Bleeding after sexual intercourse
- Bleeding after douching
- Bleeding after a pelvic exam
- Bleeding after menopause
- Increased vaginal discharge
- Pain during sexual intercourse or in the lower pelvic region
These symptoms can be caused by other, less serious conditions. Experiencing these symptoms does not necessarily mean that you have cervical cancer. It is important, however, to see your doctor if you are having any of these symptoms. Remember that cervical cancer does not produce symptoms in its earliest and most curable stages. Regular examination by a doctor and regular Pap tests remain the best way to diagnose this disease in its earliest stages.
The diagnosis of cervical cancer usually begins in your doctor’s office during a routine pelvic exam and Pap test. (To learn about the pelvic exam and Pap test, see cervical cancer screening .) If your Pap test shows abnormal changes or unhealthy cell growth in the cervix, your doctor will need to perform further testing to determine if you have cancer, an infection, or some other condition.
Squamous Cell Carcinoma of the Cervix |
First, the doctor will take your complete personal and family medical history, including information about possible risk factors related to cervical cancer. You will also have a physical exam.
Testing
The initial diagnosis of cervical cancer can be made from the screening Pap test done in the physician’s office. However, additional diagnostic tests are necessary to determine the precise type, location and extent of tumor to plan effective treatment.
Diagnostic tests will determine the nature of the abnormal cell growth of the cervix. Diagnostic tests include:
Colposcopy—In this procedure, the doctor uses a colposcope, an instrument that shines a light on the cervix and magnifies the view, to examine your genitals, vagina, and cervix closely.
The doctor places the speculum into your vagina and opens it slightly to see the cervix. A vinegar solution is swabbed onto the cervix and vagina. This solution makes abnormal tissue turn white so the doctor can identify the areas that need to be evaluated. If abnormal cells are found during a colposcopy, the doctor may do a biopsy.
Biopsy—During a biopsy, the doctor removes a small amount of cervical tissue for examination. There are several procedures used to obtain biopsies, including:
Cone biopsy (also known as cold cone biopsy or cold knife cone biopsy)—a procedure that uses a laser or a surgical scalpel to remove tissue
Loop electrosurgical excision procedure (LEEP)—a procedure that uses an electric wire loop to slice off a thin, round piece of tissue
Endocervical curettage—a procedure that uses a small, spoon-shaped instrument called a curette to scrape tissue from inside the cervical opening
If the area of abnormal cell growth is small, these biopsy procedures may be able to remove all of the affected area. The tissue removed during biopsy is sent to a laboratory to be analyzed.
Staging
If cancer is found, your prognosis and treatment depend on the location, size, and stage of the cancer and your general health.
Staging is a careful attempt to determine whether the cancer has spread and, if it has, what body parts are affected. Additional tests to determine staging may include:
- Urine and blood tests
- Additional physical exam, including another pelvic exam in the operating room under anesthesia
- X-rays of various parts of the body, including lungs, bladder, kidney, lymph nodes
- Barium enema —to check intestines and rectum, helps to show the lower gastrointestinal tract on an x-ray
- CT or CAT scan—a series of x-rays put together by a computer to make detailed pictures of areas inside the body
- Ultrasonography—a procedure in which sound waves are bounced off tissues and the echoes produce a picture
- MRI —a procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body
The following staging system is used to classify cancer of the cervix:
- Stage 0—The abnormal cells are found only in the first layer of cells lining the uterus.
- Stage I—Cancer involves the cervix but is still confined to the uterus. This stage has six levels depending upon the size of the cancer: IA, IA1, IA2, IB, IB1, and IB2.
- Stage II—Cancer has spread to nearby areas but is still inside the pelvic area. This stage has two levels depending upon whether the cancer has spread to the upper two-thirds of the vagina (IIA) or into the pelvis (IIB).
- Stage III—Cancer has spread throughout the pelvic area. This stage has two levels depending on whether there is the cancer has spread to the lower-third of the vagina (IIIA) or more broadly into the oelvis (IIIB).
- Stage IV—Cancer has spread to other parts of the body. This stage has two levels depending on which organs the cancer has spread to: bladder, rectum or both (IVA); or, more distant organs (IVB).
The treatment and management of cervical cancer most often involves surgery and radiation therapy. Sometimes chemotherapy or biological therapy is used. The type of treatment depends on the location and size of the tumor, the stage of the cancer, your age and general health, and other factors.
Staging is a careful attempt to determine whether the cancer has spread and, if it has, what body parts are affected. The higher the stage, the more advanced the cancer and the greater the need for more aggressive therapy. Cure rates decline as the stage of the tumor increases.
The following stages are used to classify cancer of the cervix:
- Stage 0—The abnormal cells are found only in the first (outer) layer of cells lining the uterus.
- Stage I—Cancer involves the cervix, but is still confined to the uterus. This stage has six levels, depending upon the size of the cancer: IA, IA1, IA2, IB, IB1, and IB2.
- Stage II—Cancer has spread to nearby areas, but is still inside the pelvic area. This stage has two levels, depending upon whether the cancer has spread to the vagina: (IIA) or further into the pelvis (IIB).
- Stage III—Cancer has spread throughout the pelvic area. This stage has two levels, depending upon whether the cancer has spread to the Lower one-third of the (IIIA) vagina , or more broadly out to the pelvic sidewall (IIIB).
- Stage IV—Cancer has spread to other parts of the body. The stage has two levels, depending upon which organs the cancer has spread to: IVA and IVB.
Treatment involves the following:
Medications
References:
American Cancer Society website. Available at: http://www.cancer.org/docroot/home/index.asp .
Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ .
Grady D. Guidelines push back age for cervical cancer tests. The New York Times website. Available at: http://www.nytimes.com/2009/11/20/health/20pap.html?_r=1 . Published November 20, 2009. Accessed November 23, 2009.
National Cancer Institute website. Available at: http://www.cancer.gov/ .
Cervical cancer is a disease in which cancer cells grow in the cervix. The cervix is the lower, narrow part of the uterus that connects the uterus with the vagina. It is the outlet of the uterus through which menses flow and babies are delivered. Normally, the cells of the cervix divide in a regulated manner. If cells keep dividing in an unregulated manner, a mass of tissue forms. This mass is called a tumor. A tumor can be benign or malignant. In the cervix, cancer can arise either from the squamous cells (squamous cell carcinoma) that line the outer surface of the cervix or the glandular cells that are found in the channel that connects to the rest of the womb (adenocarcinoma).
The Cervix |
A benign tumor is not cancer. It will not spread to other parts of the body. A malignant tumor is cancer. Cancer cells divide and damage tissue around them. They can enter the bloodstream and spread to other parts of the body. This can be life-threatening.
Pap smears are largely responsible for the significant decline in deaths from cervical cancer over the past 30-40 years. Despite this success, 11,270 women in the US still learn they have cervical cancer each year.
Cervical cancer comes in two major forms:
- Squamous cell cancer—arises form the cells on the outermost portion of the cervix that connects with the vagina
- Adenocarcinoma—arises from the gland cells that are found on the inner lining of the cervical canal
Squamous cancer is more common than adenocarinoma. Many cases of squamous cancer are associated with infection with a virus ( human papillomavirus or HPV), which, in addition to increasing the risk for cervical cancer, causes tell-tale changes in the cells of the cervix. These changes can be detected by Pap smear and indicate an increased risk for developing cervical cancer.
A vaccine has recently been developed to protect against infection by some (but not all) of the HPV strains associated with cervical cancer. Additionally, the administration of this vaccine has come under some scrutiny, especially when given to young girls whose bodies are still developing.
What are the treatments for cervical cancer?
What are the risk factors for cervical cancer?
What are the symptoms of cervical cancer?
How is cervical cancer diagnosed?
Are there screening tests for cervical cancer?
How can I reduce my risk of cervical cancer?
What questions should I ask my doctor?
References:
American Cancer Society website. Available at: http://www.cancer.org/docroot/home/index.asp .
The Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ .
National Cancer Institute website. Available at: http://www.cancer.gov/ .
A risk factor is something that increases your chances of developing a disease or condition.
It is possible to develop cervical cancer with or without the risk factors listed below. However, the more risk factors you have, the greater your likelihood of developing cervical cancer. If you have a number of risk factors, ask your doctor what you can do to reduce your risk.
Risk factors include:
Human Papillomavirus (HPV) Infection
Infection of the cervix with human papillomavirus (HPV), a sexually transmitted disease, is the primary risk factor for cervical cancer. There are more than 70 types of viruses called papillomaviruses. Certain HPV types can cause warts on the female and male genital organs and anus. HPV is passed from one person to another during sexual contact. Large studies have found a particular type of HPV—called HPV C, with types HPV 16, 18, 31, and 45C— in more than 93% of cervical cancer cases.
A vaccine has recently been developed to protect against infection by the most common types of HPV associated with cervical cancer, but it must be given before infection to be effective.
Age
After the age of 25, the risk of developing cervical cancer begins to increase. But, this cancer, or its precancerous changes, can be diagnosed in young women in their early 20s and even in their teens. After age 40, the risk of developing cervical cancer stays about stable. The risk of dying from cervical cancer increases as women get older.
Sexual History
Women who had sexual intercourse at an early age or women who have had many sexual partners are at an increased risk of cervical cancer. If a woman is with a partner who has had many sexual partners, this also increases her risk.
History of Not Having Pap Tests
Women who have never had a Pap test or who have not had one for several years have a higher-than-average risk of developing cervical cancer. This screening tool is quite effective for catching abnormal cell growth early, before it progresses to cancer.
Smoking
By smoking, you are exposing your body to many cancer-causing chemicals. Tobacco by-products have been found in the cervical mucus in women who smoke. The risk appears to increase with the number of cigarettes smoked per day and the number of years a woman has smoked. Smokers are about twice as likely as nonsmokers to get cervical cancer.
Diethylstilbestrol (DES)
Between 1940 and 1971, doctors prescribed DES, a hormone, to pregnant women who were thought to be at an increased risk for miscarriage. About 1 out of every 1,000 women whose mother took DES when pregnant with them will develop cancer of the cervix or vagina. Almost all of these women who go on to develop cervical cancer as a result of DES have an early cellular pattern change in the cervix that can be detected. Women born between 1940 and 1972 who have been exposed to DES, or who are uncertain about their exposure history, should discuss with their doctor how to determine their risk and best screening measures.
Weakened Immune System
Several reports have shown that women with weakened immune systems—as with human immunodeficiency virus (HIV) or from immune-suppressing drugs taken after a transplant—are more likely to develop cervical cancer. (HIV damages the body’s immune system; this makes a woman more susceptible to HPV infection, which may increase the risk of cervical cancer.) In someone with a weakened immune system a cervical precancer may develop into an invasive cancer faster than it normally would in a woman without a weakened immune system.
Poor Nutrition
Diets low in fruits and vegetables are associated with an increased risk of cervical cancer.
Race and Ethnicity
In the United States, several racial and ethnic groups have higher cervical cancer death rates. Among African Americans, the death rate from cervical cancer is more than twice the national average. Hispanics and American Indians also have death rates above the average.
Low Socioeconomic Status
Experts believe that women with low socioeconomic status are at an increased risk due to a lack of ready access to adequate healthcare services. This may keep women from getting the necessary screening needed to diagnose and treat cervical cancer in its early stages.
References:
Hodgkin disease. American Cancer Society website. Available at: http://www.cancer.org/docroot/home/index.asp . Accessed April 24, 2009.
Hodgkin lymphoma. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/hodgkin . Accessed April 24, 2009.
Very few cancers can be identified so far ahead of the danger point as cancer of the cervix. A decade or more before invasive cancer develops, the cells lining the surface of the cervix begin to show changes visible under a microscope—in plenty of time for definitive treatment. For this reason, a regular, properly performed and interpreted Pap smear is one of medicine's most effective preventive methods.
The stages of progression from a healthy cervix to cancer begin with what is called mild dysplasia: precancerous alterations in structure and activity. Prolonged infection with human papilloma virus (HPV) is thought to be the primary cause of these changes. Subsequently, altered cells spread from the surface of the cervix down toward the underlying tissue. In the early stages, cancerous changes may disappear on their own, but once these cells fully penetrate the lining, progression to true cancer usually occurs within 5 to 10 years.
Luckily some herbal treatments and nutritional treatments are really helpful, especially during these early stages of dysplasia.
Medical treatment consists of watchful waiting for spontaneous regression during the early stages of dysplasia and, if no regression occurs, more aggressive removal of the cervical lining by laser, freezing, or other techniques. These options are usually successful; however, they are invasive and frequently uncomfortable. Take a look at some of the less invasive Treatments for Cervical Cancer.
The vaccine for preventing HPV infection is speculated to markedly reduce cervical cancer risk, although some doctors are wary of other side effects of this vaccine, especially when give to young developing women.
Chemotherapy uses drugs to kill cancer cells. The drugs enter the bloodstream and travel through the body in order to kill cancer cells. The side effects from the chemotherapy come from the fact that it destroys normal cells as well. Chemotherapy may be given either alone or along with radiation therapy . When given alone, it is given in a higher dose designed to kill off cancer cells. When given along with radiation therapy, it is delivered at a lower dose and is designed to make the cancer more sensitive to the radiation.
The amount and type of chemotherapy you receive will be determined by the stage and type of Hodgkin’s disease, as well as factors such as your age and health.
- Main drug regimen: ABVD ( doxorubicin [adriamycin], bleomycin [Blenoxane], vinblastine , and dacarbazine [DTIC])
- Other drug regimens: MOPP ( methotrexate [Rheumatrex], vincristine [Vincasar PFS], prednisone , procarbazine [Matulane]) alone oralternating with ABVD orABV, COPP, and ChlVPP ( chlorambucil [Leukeran], vincristine, prednisone, and procabizine)
Other regimens are in development, and you may be eligible for a treatment trial depending on your stage and health. In addition, chemotherapy may be used to prepare a patient for bone marrow transplantation , which may also be used in advanced cases of Hodgkin’s disease or in cases of relapse.
The side effects and amount of time required in the doctor’s office depend on the type of chemotherapy you receive, as well as how many cycles you receive and how often.
Possible side effects of chemotherapy include:
- Bone marrow suppression resulting in infection
- Low white blood cell counts
- Low red blood cell counts
- Low platelet counts
- Hair loss
- Appetite loss
- Taste changes
- Nausea and vomiting
- Inflammation and sores in the mouth, throat, and esophagus
- Constipation
- Diarrhea
- Fatigue
- Reproductive and sexuality problems and hormonal changes, such as hypogonadism
In addition, certain chemotherapy drugs can cause:
- Heart damage
- Nervous system changes
- Lung damage
- Liver damage
- Kidney and urinary system damage
The likelihood and extent of these side effects will vary according to each patient. Ask your doctor what you are likely to experience. If you develop any new symptoms, be certain to report them to your doctor right away. These complications of treatment are always more easily managed when discovered early.
When chemotherapy is given at a lower dose, as when it is given along with radiation, these side effects are less common. However, most people still feel very fatigued.
Some of the medications associated with these procedures may cause infertility. If your fertility is a concern, discuss the possibility of storing sperm or eggs before starting treatment.
References:
American College of Obstetricians and Gynecologists. First cervical cancer screening delayed until age 21 less frequent Pap tests recommended. American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/fromhome/publications/pressreleases/nr11-20-09.cfm . Published November 20, 2009. Accessed November 23, 2009.
American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html .
American Cancer Society website. Available at: http://www.cancer.org/docroot/home/index.asp .
American Medical Association website. Available at: http://www.ama-assn.org/ .
Grady D. Guidelines push back age for cervical cancer tests. The New York Times website. Available at: http://www.nytimes.com/2009/11/20/health/20pap.html?_r=1 . Published November 20, 2009. Accessed November 23, 2009.
National Cancer Institute website. Available at: http://www.cancer.gov/ .
The purpose of screening is early diagnosis and treatment. Screening tests are usually administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.
The number of new cases and deaths due to cervical cancer is decreasing each year. Experts agree that this is due to early detection and treatment. Early detection and treatment are possible due to the widespread availability and use of cervical cancer screening methods—the pelvic exam and Pap test.
Screening Tests
Pelvic Exam
This test is performed in a doctor’s office. You will change into a dressing gown and lie back on the examination table. There will be stirrups at the end of the table where you can rest your feet. The doctor may complete other aspects of a physical exam first, including examining your thyroid gland, heart, lungs, breasts, and abdomen. As part of the pelvic exam, your external genitalia will be examined for signs of infection or redness. Next, the doctor will slide a speculum into your vagina. The speculum allows the vagina to be opened slightly. This should not hurt or pinch, but may be uncomfortable. You also may feel a bit nervous or anxious. Try to take slow, deep breaths to help yourself relax.
At this point, the doctor will perform a Pap test (see below for a description of this procedure). The doctor may also perform additional tests at this time to check for sexually transmitted diseases, such as chlamydia or gonorrhea. After the doctor is done, the speculum will be removed. The doctor will then place two gloved fingers into your vagina while pressing on your lower abdomen. This identifies the size, shape, and position of your uterus, fallopian tubes, and ovaries. The doctor may then place one finger in your vagina and one finger in your rectum to examine the tissues separating those organs.
You should not feel pain during the exam, but you may experience a pressure discomfort. If you are experiencing pain, tell your doctor. You may have a trace of vaginal bleeding afterwards from irritation of your cervix.
Pap Test
The Pap test is performed during the pelvic exam. Once the doctor has inserted the speculum into your vagina, your cervix will be visible. The doctor will use a flat stick or a soft brush to collect a sample of cells from the outer cervix and its canal. These cells are placed on a slide or suspended in an aqueous solution and sent to a laboratory for evaluation. Your doctor should have the results of your Pap test in 1-3 weeks. If any abnormalities are found, your doctor will call you and discuss follow-up care.
Prior to your scheduled pelvic exam and Pap test, it is important to keep in mind the following things:
- Do not schedule the Pap test during your menstrual period. If possible, schedule it two weeks after the first day of your period.
- Do not use vaginal creams, medications, or douches for 72 hours before the test.
- Do not use contraceptives, such as spermicidal foams, creams, or jellies, for 72 hours before the test.
- Do not have intercourse for 24 hours before the test.
The American College of Obstetricians and Gynecologists recommends the following guidelines for cervical cancer screening:
- If you are aged 21-29 years—It is recommended that you have the Pap test every two years.
- If you are aged 30 or older—It is recommended that you have the Pap test every three years.
- If you are aged 65 or older—You may be able to stop having Pap tests if you have had three normal results in a row and no abnormal results in the past 10 years.
- Note:You will need to have Pap tests done more often if you have abnormal results or certain conditions, such as:
- HIV
- Suppressed immune system (eg, kidney transplant )
- Exposure to diethylstilbestrol (DES) in utero(in the womb)—an estrogen-like substance given to prevent miscarriages in high-risk pregnancies
- History of cervical dysplasia or cervical cancer
Talk to your doctor about the right screening schedule for you.
References:
American Cancer Society website. Available at: http://www.cancer.org/docroot/home/index.asp .
National Cancer Institute website. Available at: http://www.cancer.gov/ .
National Women’s Health Information Center website. Available at: http://www.4woman.gov/ .
