Cervical Cancer

 

What is cancer of the cervix?
If abnormal cells on the surface of the cervix spread deeper into the cervix, or to other tissues or organs, the disease is then called cervical cancer, or invasive cervical cancer. Cervical cancer occurs most often in women younger than the age of 50. It 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. According to the American Cancer Society about 12,340 cases of invasive cervical cancer will be diagnosed in the U.S. during 2013. Some researchers estimate that noninvasive cervical cancer (also referred to as carcinoma in situ) is nearly 4 times more common than invasive cervical cancer.
 

What are risk factors for cervical cancer?
The following have been suggested as risk factors for cervical cancer:

  • Infection with the human papillomavirus (HPV). HPV is the cause of nearly all cervical cancers. Infection with HPV is most often the result of unprotected sex.
  • Not getting regular Pap tests. Cervical cancer is more common in women who don't have regular Pap tests. Pap tests help doctors find abnormal cells. These cells can then be removed, which usually prevents cervical cancer.
  • Infection with HIV or other conditions that weaken the immune system. HIV is the precursor to AIDS and can increase your risk of cervical cancer. Taking certain medications that suppress the immune system also increases the risk of cervical cancer.
  • Smoking. Women who smoke are nearly twice as likely as nonsmokers to have cervical cancer.
  • Diet. Women with diets low in fruits and vegetables and those who are overweight are at increased risk for cervical cancer.
  • Chlamydia infection. Some studies have seen a higher risk of cervical cancer in women whose blood test results show evidence of past or current chlamydia infection when compared with women who have normal test results. Chlamydia is spread by sexual contact.
  • Using birth control pills for a long time. 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. So they are not screened or treated for cervical precancers.
  • Family history of cervical cancer. This cancer may run in some families. A woman's chance of developing it are 2 to 3 times higher if her mother or sister had cervical cancer than if no one in her family had it.
  • Diethylstilbestrol (DES). DES is a drug that was used to prevent miscarriage between 1940 and 1971. Women whose mothers took DES while pregnant with them develop this cancer more than would normally be expected. The risk seems to be highest in women whose mothers took the drug during their first 16 weeks of pregnancy. (The FDA stopped the use of DES during pregnancy in 1971.)
     

What are the symptoms of cervical cancer?
Symptoms of cervical cancer usually do not appear until abnormal cervical cells become cancerous and invade nearby tissue:

  • 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.
  • Other symptoms may include:
    • Heavier menstrual bleeding, which may last longer than usual
    • Bleeding after menopause
    • Increased vaginal discharge
    • Pain during intercourse

The symptoms of cervical cancer may resemble other conditions or medical problems. Consult a doctor for diagnosis.
 

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.
There are several types of cervical biopsies that may be used to diagnose cervical cancer, and some of these procedures that can completely remove areas of abnormal tissue may also be used for treatment of precancerous lesions. Some biopsy procedures only require local anesthesia, while others require a general anesthesia. Several types of cervical biopsies include:

  • Loop electrosurgical excision procedure (LEEP). A procedure that uses an electric wire loop to obtain a piece of tissue so it can be examined under a microscope.
  • Colposcopy. A procedure that uses an instrument with magnifying lenses called a colposcope, to examine the cervix for abnormalities. If abnormal tissue is found, a biopsy is usually performed (colposcopic biopsy).
  • Endocervical curettage (ECC). A procedure that uses a narrow instrument called a curette to scrape the lining of the endocervical canal. This type of biopsy is usually completed along with the colposcopic biopsy.
  • Cone biopsy (also called conization). A biopsy in which a larger cone-shaped piece of tissue is removed from the cervix by using the loop electrosurgical excision procedure or the cold knife cone biopsy procedure. The cone biopsy procedure may be used as a treatment for precancerous lesions and early cancers.
  • HPV DNA test. A test that detects the presence of cervical HPV infection. The cells are collected as they are for a regular Pap test, but it is not a replacement for a Pap test. The HPV DNA test may be used as a screening test for women over 30 or for women with slightly abnormal Pap test results to determine if further testing or treatment is required.
  • Cold knife cone biopsy. A procedure in which a laser or a surgical scalpel is used to remove a piece of cervical tissue for further examination. This procedure requires the use of general anesthesia.
     

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:
    • Cryosurgery. Use of liquid nitrogen, or a probe that is very cold, to freeze and kill cancer cells.
    • Laser surgery. Use of a powerful beam of light, which can be directed to specific parts of the body without making a large incision, to destroy abnormal cells.
    • Hysterectomy. Surgery to remove the uterus, including the cervix. In some cases, a hysterectomy may be required, particularly if abnormal cells are found inside the opening of the cervix.
  • Radiation therapy
  • Chemotherapy
  • LEEP or conization may also be used to remove abnormal tissue.