Cervical Cancer

 
Introduction

Cervical cancer occurs when the cells in the cervix grow abnormally or out of control.  The cervix is part of the female reproductive system.  The exact cause of cervical cancer is unknown.  Certain strains of the human papillomavirus (HPV), a sexually transmitted disease, cause the majority of cervical cancer. 

A new vaccine is available to prevent infection against the two types of HPV that are responsible for the majority of cervical cancer cases and the two types of HPV that are responsible for the majority of genital wart cases.  A pap smear test is a preventive measure that can detect precancerous or cancerous cells.  Precancerous cells are 100% curable.

Anatomy

The internal female reproductive system includes the ovaries, fallopian tubes, uterus, cervix, and vagina.  The ovaries are two small organs that produce eggs (ova) and hormones.  An ovary typically releases one mature egg each month.  Two fallopian tubes extend from near the ovaries to the uterus.  The fallopian tubes transport the mature eggs to the uterus (womb).

The uterus is a pear-shaped organ where a baby grows in during pregnancy.  The cervix is located at the bottom of the uterus.  The cervix joins the uterus to the vagina and opens during childbirth.  The vagina is a muscular passageway that extends from the cervix to the external female genitalia.

Causes

The exact cause of cervical cancer is unknown.  Cancer occurs when cells grow abnormally and out of control, instead of dividing in an orderly manner.  Cervical cancer starts as precancer in the cells on the cervix surface.  Precancerous changes are called dysplasia.  The development of cervical cancer is very slow.  Untreated cervical cancer can spread to the bladder, intestines, lymph nodes, bones, lungs, and liver.  Untreated cervical cancer can lead to death.

Certain strains of the human papillomavirus (HPV) cause most cases of cervical cancer.  HPV is a sexually transmitted disease.  There is a vaccine to prevent infection against the two types of HPV that are responsible for the majority of cervical cancer cases and the two types of HPV that are responsible for the majority of genital wart cases.

Precancerous cervical cells are generally completely treatable.  A pap smear test screens for precancer or cancerous cells.  Pap smear testing should begin after the age of 21.

Symptoms

Early cervical cancer may not have symptoms.  Early symptoms may include a continuous vaginal discharge, abnormal bleeding, and changes in your period patterns.  Vaginal discharge may be watery, pale, pink, brown, bloody, or smell bad.  You may experience abnormal vaginal bleeding between your periods, after intercourse, or after menopause.  Your periods may become heavier and last longer than they usually do.

Symptoms of advanced cervical cancer may include weight loss and a loss of appetite.  You may feel very tired and have pelvic, back, or leg pain.  One of your legs may become swollen.  You may experience heavy bleeding, urine leakage, or feces leakage from the vagina.  Your bones may hurt or fracture.

Diagnosis

You should report any unusual vaginal discharge, bleeding, or changes in your periods to your doctor.  Pap smear testing should begin after the age of 21.  If a pap smear identifies abnormal cellular changes, precancerous cells, or cancerous cells, your doctor will conduct additional tests.

A colposcopy is a procedure that uses a colposcope to view the cervix.  A colposcope is a magnifying device.  The colposcope can biopsy an area of concern.  A biopsy entails removing a tissue sample for examination for cellular changes.  A biopsy is necessary to correctly diagnose cervical cancer.

In addition to colposcopy, there are several different methods for obtaining a biopsy.  For example, a cone biopsy removes a plug of tissue for examination.  Endocervical curettage (ECC) examines cells at the opening of the cervix.

If you are diagnosed with cervical cancer, your doctor will order tests to learn more information about your cancer.  Your doctor will check for metastasized cancer.  Cancer that has spread from its site of origin is termed metastasized.  Imaging tests are used to identify if cervical cancer has spread to other organs.  An intravenous pyelogram (IVP), X-ray, cystoscopy, proctoscopy, computed tomography (CT) scan, and magnetic resonance imaging (MRI) scan may be used.

An IVP uses X-rays and contrast dye to check for cancer or blockages in the urinary tract.  A chest X-ray can reveal cancer that has spread to the lungs.  A cystoscopy uses a thin viewing instrument to examine the bladder for cancer.  A proctoscopy uses a lighted camera device to check for cancer in the rectum.  CT scans take pictures of the organs from different angles, and MRI scans take pictures with even more details.

If you have cervical cancer, your doctor will assign your cancer a classification stage based on the results of all of your tests.  Staging describes the cancer and how it has metastasized.  Staging is helpful for treatment planning and recovery prediction.  There is more than one type of staging system for cancer, and you should make sure that you and your doctor are referring to the same one.

Your doctor will classify your cervical cancer in a stage labeled from 0-4.  Lower numbers indicate a less serious cancer, and higher numbers indicate a more serious cancer.  The stages 1 to 4 may be subdivided into classifications that use letters and numbers.

Treatment

Your doctor may refer you to an oncologist for treatment. An oncologist is a doctor with special training in cancer and cancer treatments.  Treatment for cervical cancer depends on many factors, including the stage of the cancer, the cancer cell type, your general health, and desire to have children in the future.  You may opt to receive a second opinion about the best kind of cancer treatment for you.  Cancer treatments include surgery, radiation therapy, chemotherapy, or a combination of therapy types.  Most people with cervical cancer receive surgery and another type of treatment. 

There are several surgical options for treating very early cervical cancer.  Cryosurgery freezes abnormal cells.  Laser surgery uses a beam of light to burn cells or obtain a tissue sample.  The loop electrosurgical excision procedure (LEEP) uses electricity to remove abnormal tissues.

For more advanced stages of cervical cancer, the uterus may need to be removed with a simple hysterectomy.  A radical hysterectomy and pelvic lymph node dissection removes the uterus, nearby tissues, the upper part of the vagina, and nearby lymph nodes.  A pelvic exenteration removes the same structures as in a radical hysterectomy plus the bladder, vagina, rectum, and part of the colon.  In this case, reconstructive surgery will create alternative ways to collect and void urine and feces.  Following hysterectomy, a woman will not be able to become pregnant. 

Radiation therapy uses high-energy rays to kill cancer cells.  Radiation can be delivered from outside of the body or from radioactive materials that are temporarily placed inside of the body.  Chemotherapy uses cancer-fighting drugs to destroy cancer cells.  There are different types of radiation therapies and chemotherapies.

Cervical cancers that are found in pregnant women are addressed with special regard for the life of the mother and unborn baby.  In some cases of very early cervical cancer, the pregnancy may continue to term.  If the cancer is at a later stage, the decision to continue the pregnancy or not must be made.  If the pregnancy is continued, the baby is delivered by cesarean section as soon as it is able to survive outside of the womb.  For very advanced cervical cancer, immediate treatment may be the best option.

Even with treatment, some cases of treated cervical cancer may return. This is termed “recurrent cervical cancer.” The cancer may come back in your cervix or in other parts of the body. Your doctor can explain your risk for recurrent cervical cancer and possible treatments if it does recur.

The experience of cancer and cancer treatments can be an emotional process for people with cancer and their loved ones.  It is important that you receive support from a positive source.  Some people find comfort in their family, friends, counselors, co-workers, and faith.  Cancer support groups are another good option.  They can be a good source of information and support from people who understand what you are experiencing.  Ask your doctor for cancer support group locations in your area.

Prevention

Cervical cancer can be prevented by early detection of precancerous cells. Precancerous cells are 100% curable. For women under 21-29, a Pap smear should be conducted once every 3 years. For women 30-65, cervical cancer screening should include a Pap smear and HPV test once every 5 years. For older women, Pap and HPV testing should only be performed if there is a history two or three abnormal test results in the last 5 or 10 years.

A vaccine is available to prevent infection against the two types of HPV responsible for most cases of cervical cancer and the two types of HPV responsible for most cases of genital warts. HPV is a sexually transmitted disease. The vaccine is approved for females ages 9-26 years old. However, HPV testing is not required for girls younger than 30 because the virus typically goes away on its own. Ask your doctor about receiving the vaccine.

You can prevent cervical cancer by not engaging in sexual acts with people that have HPV or genital warts. Condoms do not protect against HPV, but should be used to prevent other types of sexually transmitted diseases.  To further reduce the risk of HPV and cervical cancer, it is wise to limit your number of sexual partners and avoid partners that participate in high risk sexual activities.

Quitting smoking may reduce your risk of developing cervical cancer.  If you are unable to quit smoking on your own, ask your doctor for resources to help you quit.  There are a variety of smoking cessation products and methods that your doctor will be delighted to refer you to.

Am I at Risk

Risk factors may increase your likelihood of developing cervical cancer, although some people that experience this cancer may not have any risk factors.  People with all of the risk factors may never develop cervical cancer; however, the likelihood increases with the more risk factors you have.  You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for cervical cancer:

_____ The most important risk factor for cervical cancer is infection with the HPV virus that causes cervical cancer.  HPV is a sexually transmitted disease.
_____ Females that are not vaccinated against HPV and are sexually active have a higher risk of contracting HPV that can lead to cervical cancer.
_____ Smokers have a higher risk of developing cervical cancer.
_____ The human immunodeficiency virus (HIV) can be a risk factor for cervical cancer. HIV, the virus that causes AIDS, weakens the immune system and makes it more difficult to fight early cancers and viruses.
_____ Some studies indicate that women with genital herpes or Chlamydia, sexually transmitted diseases, have an increased risk for developing cervical cancer.
_____ Long term use of birth control pills increases the risk of cervical cancer.
_____ Having many full term pregnancies is associated with an increased risk for cervical cancer.
_____ Daughters of women who took diethylstilbestrol (DES) between 1940 and 1971 to prevent miscarriage have a slightly higher risk of cervical and vaginal cancer.
_____ If your mother or sister experienced cervical cancer, you have an increased risk for developing it.
____ Having sex at an early age, multiple sex partners, or sex partners that have had multiple partners increases your risk for cervical cancer.

Complications

Cervical cancer can have several complications.  Hysterectomy treatment for surgical cancer ends the chance of pregnancy, which may be a concern for women desiring to give birth to their children.  Some cervical cancers may be resistant to treatments.  In some cases, cervical cancer may come back following treatment.  Further, some treatments can cause problems with sexual, bowel, and bladder function.

Advancements

In June 2006, the US Food and Drug Administration (FDA) approved Gardasil as a vaccine to prevent infection against the two types of HPV responsible for most cervical cancer cases and the two types of HPV responsible for causing the majority genital warts cases.  The vaccine is approved for females ages 9-26 years old.  It is received in a series of three injections over a six month period. 

Researchers found that Gardasil prevented cervical cancer, precancerous lesions, and genital warts due to HPV types 6, 11, 16, and 18.  Gardasil is not protective for females that are already exposed to HPV.  It also does not protect against the less common types of HPV that can cause cervical cancer or genital warts.