Cervical Cancer

What is cervical cancer?

Cervical cancer is the growth of abnormal cells in the cervix. The cervix is the lower part of the uterus that opens into the vagina. Cervical cancer is one of the most common cancers affecting women.

Dysplasia usually occurs before the cells become cancerous. Dysplasia is the term for precancerous changes in cells on the surface of the cervix. Early detection and treatment of precancerous cells can prevent them from becoming cancerous. Otherwise, the abnormal cells can become cancer and spread to other parts of the body.

How does it occur?

The exact causes of cervical cancer are unclear. There are 2 main types of cervical cancer:

• Squamous type (epidermoid cancer): This is the most common type, accounting for about 80% to 85% of cervical cancers. This cancer may be caused by sexually transmitted diseases (STDs), such as some types of the human papillomavirus (HPV) that can infect the cervix. The squamous type of cancer generally starts on the surface of the cervix.
• Adenocarcinoma: This type of cervical cancer develops from the tissue in glands in the cervical canal.

You are at greater risk for cervical cancer if:

• You have had an abnormal Pap test.
• You or your sexual partner has or had an HPV infection.
• You have had a herpes infection of the cervix.
• You have had a sexually transmitted disease (STD).
• You have had many sexual partners or began sexual activity before age 18.
• You do not use condoms.
• You have had genital or vaginal cancer.
• Your sexual partner's previous partner had cervical cancer or abnormal cervical cells.
• Your partner has had cancer of the penis.
• You smoke.
• Your immune system is weakened; for example, because you are taking immunosuppressive drugs, or you have AIDS.
• Your mother took the hormone DES (diethylstilbestrol) when she was pregnant with you.

What are the symptoms?

Early cervical cancer usually causes no symptoms. The cancer is usually detected by a Pap test and pelvic exam. This is why a Pap test is suggested for all women who are sexually active or 18 or older.

Later stages of cervical cancer cause abnormal vaginal bleeding or a blood-stained discharge at unexpected times. For example, you may have bleeding between menstrual periods, after intercourse, or after menopause. Abnormal vaginal discharge may be cloudy or bloody or may contain mucus with a bad odor. Advanced stages of the cancer may cause pain.

How is it diagnosed?

Pelvic exams and Pap tests are used to check for cervical precancer or cancer. For a Pap test, your health care provider uses a small spatula and brush to gently scrape cells from the cervix. The cells are sent to a lab for tests.

Your Pap test may show cells that are:

• normal
• mildly abnormal
• precancerous
• cancerous.

If your Pap test is not normal, your provider may look at the cervix with a colposcope. A colposcope is a special type of microscope for examining the vagina and cervix. The test is called a colposcopy. During the test, your provider may take a sample of tissue. This may be done by cutting off a tiny piece of the cervix (a biopsy) or by taking scrapings from the lining of the cervical canal (endocervical curettage). The samples are tested in the lab.

Sometimes there may be abnormal cells that are not picked up by the Pap test. If you have a normal Pap test but an area of the cervix does not look normal in a pelvic exam, your provider may recommend a biopsy of the area.

How is it treated?

Mild abnormalities detected by the Pap test will most likely return to normal with very little or no treatment. However, you should have follow-up Pap tests every few months as recommended by your health care provider to make sure the cells have returned to normal.

Early precancerous changes can usually be treated easily with:

• laser surgery
• cryosurgery (freezing treatments)
• electrocautery (burning with an electric current)
• loop electrosurgical excision procedure (LEEP), which is removal of abnormal tissue with a wire loop
• surgery with a knife to remove precancerous tissue.

Discuss the risks and benefits of these treatments with your provider.

Cancerous cells on the surface of the cervix are called cancer in situ of the cervix. Possible treatments for this type of cervical cancer are:

• cone biopsy of the cervix, which is removal of a cone-shaped piece of the cervix with a surgical knife, laser, or wire loop
• hysterectomy, which is removal of the uterus.

Treatment of invasive cervical cancer depends on how much the cancer has spread and your age and general health. If the invasive cancer is small and involves only the cervix or uterus, your provider may recommend removing the uterus and cervix, upper vagina, and some surrounding tissue in the pelvis. The ovaries are usually removed also, but sometimes they are not removed so you can keep your normal hormone functions. For more advanced cervical cancer, you may have radiation treatment and chemotherapy.

The earlier cervical cancer is diagnosed and treated, the greater the chances are that you will keep your ability to have children.

How long will the effects last?

If abnormal cells are found, diagnosed, and treated early, there is an excellent chance of complete cure. If left untreated, the cancer may spread to surrounding structures such as lymph nodes and nearby pelvic tissues. As the tumor enlarges or spreads beyond the cervix, the likelihood of cure decreases. However, studies have shown that combined treatment with radiation and chemotherapy can add years to the lives of women with invasive cervical cancer.

How can I take care of myself after treatment?

• Ask your health care provider for instructions regarding intercourse, douching, or using tampons.
• Frequent exams and Pap tests will be recommended to check for a return of cancer. You may also need other tests or scans, such as CT scans or MRI, after your treatment. Keep all follow-up appointments.

How can I help prevent cervical cancer?

To help reduce your risk of cervical cancer:

• Do not start having sexual intercourse until you are at least 18 years of age.
• Do not have a lot of sexual partners. It will also help if your partner has had very few other partners. Ask your partners if they have had any sexually transmitted diseases.
• Use latex or polyurethane condoms every time you have sexual intercourse.
• Do not smoke.
• Maintain good personal hygiene.
• If you are or have ever been sexually active, you should have regular pelvic exams, including a Pap test. Ask your provider how often you should have these tests.