Cervical Cancer

Definition

Cervical cancer is a disease in which cancer cells grow in the cervix. The cervix is the lower, narrow part of the uterus (womb) that connects the uterus with the vagina.

Cancer occurs when cells in the body (in this case, epithelial cervix cells) divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant tumors, which can invade nearby tissue and spread to other parts of the body. A benign tumor does not invade or spread.

Cervical Cancer

© 2008 Nucleus Medical Art, Inc.

Causes

Research suggests that some sexually transmitted viruses (eg, human papilloma virus) can cause the nuclei in cervical cells to begin the changes that can lead to cancer.

Risk Factors

Scientists believe several risk factors act together, they include:

  • Infection of the cervix with the human papillomavirus (HPV)—the primary risk factor for cervical cancer
  • History of cervical dysplasia (a precancerous condition)
  • Being a woman whose mother took the drug diethylstilbestrol (DES) during pregnancy
  • HIV/AIDS
  • Age: over 25 years old
  • Multiple sexual partners
  • Sexual activity prior to age 18
  • First pregnancy prior to age 20
  • History of not having Pap tests
  • Smoking

Symptoms

Symptoms usually do not appear until the abnormal cells become cancerous. They invade nearby tissue. When this happens, the most common symptom is abnormal bleeding, which may include:

  • Bleeding between regular menstrual periods
  • Bleeding after sexual intercourse, douching, or a pelvic exam (most common)
  • Menstrual bleeding that lasts longer and is heavier than usual
  • Vaginal bleeding after menopause
  • Increased vaginal discharge that is not blood

These symptoms may also be caused by other, less serious health conditions. If you experience these symptoms, see you doctor.

Diagnosis

Tests to diagnose cervical cancer include:

Pap Test

The Pap test detects cervical cancer. It will also detect cervical dysplasia. The doctor collects a sample of cells from the cervix to be tested. The annual Pap smear or test is the single greatest success story in the reduction of cancer in developing countries.

It is important that sexually active woman receives annual Pap test. She also needs to follow up with any abnormal results as described by her physician. New studies indicate that women over the age of 30 who have had three or more normal annual Pap tests can safely lengthen the Pap screening to once every three years.

HPV Test

The same material from the Pap test can be tested for the HPV virus itself.

Colposcopy

Colposcopy is the exam of the vagina and cervix. The procedure uses a lighted magnifying instrument. It is needed if the Pap test suggests cervical dysplasia (precancer) or cancer.

Biopsies

Biopsies are then performed on any suspicious areas. The removed tissue is tested for the presence of cancer cells.

Treatment

Once cervical cancer is found, staging tests are performed to find out if the cancer has spread and, if so, to what extent. Treatments for cervical cancer depend on the stage of the cancer.

Treatments include:

Surgery

The cancerous tumor, nearby tissue, and possibly nearby lymph nodes is removed. The doctor may remove only the tumor and surrounding normal tissue. In some cases, a hysterectomy (removal of the entire uterus) is necessary. Sometimes the ovaries and fallopian tubes also are removed.

Radiation Therapy (Radiotherapy)

Radiation therapy is the use of radiation to kill cancer cells and shrink tumors. Radiation may be given in two ways:

  • External radiation therapy—radiation directed at the tumor from a source outside the body
  • Internal radiation therapy—radioactive materials placed in or near the cancer cells.
    • It is very important that you receive your therapy from an experienced radiation oncologist
    • Ask whether you will receive high-dose or low-dose therapy

Chemotherapy

Chemotherapy is the use of toxic drugs to kill cancer cells. It may be given in many forms including: pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body. It kills mostly cancer cells, but also some healthy cells. Chemotherapy alone rarely cures cervical cancer. It may be used in addition to surgery and/or radiation.

This therapy may also be used to help control pain and bleeding when a cure is no longer possible.

Chemoradiotherapy or Combined Modality Therapy

For most cervical cancers, chemotherapy and radiation therapy combined have been shown to cure more women than radiation alone.

Prevention

Finding and treating precancerous tissue in the cervix is the most effective way to prevent cervical cancer. Talk to your doctor about an appropriate schedule of check-ups. You should continue to receive regular Pap smears. Another effective approach is to reduce your risk of exposure to the HPV virus. There are currently two methods to accomplish this:

  • Safe sexual practice—Limit the number of sexual partners and use condoms.
  • HPV vaccination—In preliminary research this vaccine was 100% effective in preventing the HPV infection. It remains to be seen whether vaccinated women will actually see a decrease in their risk of cervical cancer and precancer. If you are at risk for HPV, talk to your doctor about receiving this new vaccine.

RESOURCES:

American Cancer Society
http://www.cancer.org/

National Cervical Cancer Coalition
http://www.nccc-online.org/

CANADIAN RESOURCES:

Canadian Cancer Society
http://www.cancer.ca/

Women's Health Matters
http://www.womenshealthmatters.ca/

References:

Cervical cancer. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/cancer/cervical/. Accessed July 11, 2008.

Cervical cancer homepage. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/cervical. Accessed July 11, 2008.

What is cervical cancer. American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_cervical_cancer_8.asp. Accessed July 11, 2008.



Last reviewed April 2008 by Ganson Purcell Jr., MD, FACOG, FACPE

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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