Cervical Cancer

Early detection of cervical problems is the best way to prevent cervical cancer. A Pap test is one of the best ways to detect cervical problems early.

Precancerous Conditions of the Cervix

Precancerous conditions of the cervix are identified as cells that look abnormal, but are not cancerous at the present time. However, the appearance of these abnormal cells may be the first evidence of cancer that develops years later.

Precancerous changes of the cervix usually do not cause pain and, in general, do not cause any symptoms. They are detected with a pelvic exam or a Pap test.

Squamous intraepithelial lesions (SIL) is a term that refers to abnormal changes in the cells on the surface of the cervix:

• Squamous: These cells are the flat cells found on the surface of the cervix.
• Intraepithelial: This means that the abnormal cells are present only in the surface layer of the cell.
• Lesion: This refers to an area of abnormal tissue.

Changes in these cells can be divided into two categories:

• Low-grade SIL. This refers to early changes in the size, shape, and number of cells that form the surface of the cervix. Some may go away on their own, or, with time, may grow larger or become more abnormal, forming a high-grade lesion. These changes may also be called mild dysplasia or cervical intraepithelial neoplasia 1 (CIN 1).
• High-grade SIL. This means there are a large number of precancerous cells, and, like low-grade SIL, these changes involve only cells on the surface of the cervix. The cells often do not become cancerous for many months or years. Without treatment, they will become cancer. High-grade lesions may also be called moderate or severe dysplasia, CIN 2 or 3, or carcinoma in situ.

Cancer of the Cervix

Cervical cancer is a disease in which malignant (cancer) cells form in the tissues of the cervix. Cervical cancer occurs most often in women younger than the age of 50 and is different from cancer that begins in other parts of the uterus and requires different treatment. Most cervical cancers are squamous cell carcinomas and adenocarcinomas. The mortality rates for cervical cancer have declined sharply as Pap screenings have become more prevalent.

Symptoms

Symptoms of cervical cancer usually do not appear until abnormal cervical cells become cancerous and invade nearby tissue. The symptoms of cervical cancer may resemble other conditions or medical problems. Consult a doctor for a proper diagnosis.

The most common symptom is abnormal bleeding, which may:

• Start and stop between regular menstrual periods.
• Occur after sexual intercourse, douching, or a pelvic exam.
• Heavier menstrual bleeding, which may last longer than usual
• Bleeding after menopause
• Increased vaginal discharge
• Pain during intercourse

Can Cervical Cancer be Prevented?

Early detection of cervical problems is the best way to prevent cervical cancer. Routine, annual pelvic exams and Pap tests can detect precancerous conditions that often can be treated before cancer develops. Invasive cancer that does occur would likely be found at an earlier stage. Women who are age 21 or older should have regular checkups, including a pelvic exam and a Pap test. In addition to a pelvic exam and a Pap test, women who are 30 or older should have an HPV DNA test.

Women who have had a hysterectomy (surgery to remove the uterus, including the cervix) should ask their doctor for advice about having pelvic exams and Pap tests.

Because certain strains of HPV have been found to cause most cases of cervical cancer, research efforts have focused on developing a vaccine against HPV. Two HPV vaccines have been approved:

Gardasil protects against 4 types of the HPV virus — the 2 types of viruses that cause most cervical cancers, and the 2 that cause 90% of genital warts. It protects against other cancers caused by HPV, too, such as cancers and precancers of the vagina, vulva, and anus.

Cervarix protects against the 2 types of the HPV virus that cause most cervical cancers. It protects against anal cancers, too. These vaccines can only be used to prevent certain types of HPV infection before a person is infected. They cannot be used to treat an existing HPV infection.

Both vaccines are administered as a series of three injections over a 6-month period. To be most effective, one of the vaccines should be given before a person becomes sexually active.

Risk Factors for Cervical Cancer

• Infection with the human papillomavirus (HPV)
• Not getting regular Pap tests
• Infection with HIV or other conditions that weaken the immune system
• Smoking
• Diet – Women with diets low in fruits and vegetables and those who are overweight are at increased risk for cervical cancer.
• Chlamydia infection
• Birth control pills -Using birth control pills for 5 or more years may slightly increase the risk of cervical cancer, but the risk decreases when women stop using birth control pills.
• Having many children – Studies suggest that giving birth to 3 or more children may slightly increase the risk of cervical cancer in women with HPV infections.
• Having sexual intercourse before the age of 18
• Having many sexual partners, and having partners who have had many partners themselves
• First full-term pregnancy at a young age – Women who were younger than 17 years when they had their first full-term pregnancy are almost 2 times more likely to get cervical cancer later in life than women who waited until they were 25 years or older to get pregnant.
• Poverty – Many low-income women do not have access to adequate health care services, including Pap tests.
• Family history of cervical cancer – A woman’s chance of developing it is 2 to 3 times higher if her mother or sister had cervical cancer.
• Diethylstilbestrol (DES)

How is Cervical Cancer Diagnosed?

When cervical problems are found during a pelvic examination or abnormal cells are found through a Pap test, a cervical biopsy may be performed. Listed below are several types of cervical biopsies that may be used to diagnose cervical cancer:

• Loop electrosurgical excision procedure (LEEP)
• Colposcopy
• Endocervical curettage (ECC)
• Cone biopsy (also called conization)
• HPV DNA test
• Cold knife cone biopsy

Treatment for Cervical Cancer

Specific treatment for cervical cancer will be determined by your doctor based on:

• Your overall health and medical history
• Extent of the disease
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference

Treatment may include:

• Surgery (including: laser surgery, hysterectomy)
• Radiation therapy
• Chemotherapy
• Loop electrosurgical excision procedure (LEEP)