Cervical Cancer - (Cancer of the Cervix)

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

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

A risk factor is something that increases your chance of getting a disease or condition. Scientists believe that cervical cancer develops when several risk factors act together. Risk factors 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 of cervical cancer usually do not appear until the abnormal cells become cancerous and 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 as well as precancerous tissues in the cervix, called cervical dysplasia. The doctor collects a sample of cells from the cervix to be tested. The performance of an annual Pap smear or test is the single greatest success story in the reduction of cancer in developing countries. However, cervical cancer is still the second leading cause of cancer death in women worldwide.

It is important that a sexually active woman receives an annual Pap test, and that she follows up with any abnormal results by getting future tests 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

During an HPV test, the same material from the Pap test can be tested for the HPV virus itself.

Colposcopy

Colposcopy is the examination of the vagina and cervix using a lighted magnifying instrument called a colposcope. Colposcopy is needed if the Pap test suggests cervical dysplasia (precancer) or cancer.

Biopsies

Biopsies are then performed on any suspicious areas and 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 are surgically removed. If the cancer has reached deeper layers of the cervix but has not spread beyond the cervix, 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 administered 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 internal radiation therapy from an experienced radiation oncologist. You should inquire as to how many cases that doctor performs annually, and whether you will receive high-dose or low-dose therapy.

Chemotherapy

Chemotherapy is the use of toxic drugs to kill cancer cells. Chemotherapy may be given in many forms including: pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body killing 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.

Chemotherapy and radiation therapy together have been shown to be more effective than radiation therapy alone. Chemotherapy may also be used to help control symptoms (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 therapy 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, therefore, continue to receive regular Pap smears. In addition, since cervical dysplasia and cancer are so closely linked to HPV infection, another effective approach is to reduce your risk of exposure to this virus. There are currently two methods to accomplish this:

Safe sexual practice—Limit the number of sexual partners and always use condoms, unless you’re in a longstanding monogamous relationship
HPV vaccination —In preliminary research this vaccine was 100% effective in preventing the HPV infection, though 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
www.cancer.org

National Cervical Cancer Coalition
www.nccc-online.org

CANADIAN RESOURCES:

Canadian Cancer Society
www.cancer.ca

Women's Health Matters
www.womenshealthmatters.ca/index.cfm