What is cervical cancer?

The cervix is the neck of the uterus that opens into the vagina. Cervical cancer, also called cervical carcinoma, develops from abnormal cells on the surface of the cervix. Cervical cancer is one of the most common cancers affecting women.

Cervical cancer is usually preceded by dysplasia, precancerous changes in the cells on the surface of the cervix. These abnormal cells can progress to invasive cancer. Once the cancer appears it can progress through four stages. The stages are defined by the extent of spread of the cancer. The more widely the cancer has spread, the more extensive the treatment is likely to be.

How does it occur?

The exact causes of cervical cancer remain unclear.

There are two main types of cervical cancer:

• Squamous Type (epidermoid cancer): This is the most common type, accounting for about 80% to 85% of cervical cancers. Researchers believe that this cancer may be caused by sexually transmitted diseases. One such sexual disease is the human papillomavirus, which causes venereal warts. The cancerous tumor grows on and into the cervix. This cancer generally starts on the surface of the cervix and may be diagnosed at an early stage by a Pap smear.

• Adenocarcinoma: This type of cervical cancer develops from the tissue in the cervical glands.

You are at greater risk for cervical cancer if:

• You have had an abnormal Pap smear.

• You or your sexual partner has or had a genital wart virus infection.

• You have had many sexual partners or began sexual activity before age 18.

• You do not use condoms with new partners.

• You had previous genital or vaginal cancer.

• Your sexual partner's previous partner had cervical cancer or abnormal cervical cells.

• Your sexual partner has or had cancer of the penis.

• You smoke cigarettes.

• Your immune defenses are low, such as in the case of people with transplants, people taking immunosuppressive drugs, or people with AIDS.

• Your mother took the hormone DES (diethylstilbestrol) when she was pregnant with you.

What are the symptoms?

Early cervical cancer causes no symptoms, though bleeding or spotting between periods or after intercourse can be a symptom of cervical cancer. Most women have no symptoms. The cancer is usually detected at the time of the annual Pap smear and pelvic exam. This is why women should start having Pap smears and pelvic exams as soon as they become sexually active. Healthy young women who have never been sexually active should have their first annual pelvic exam by age 21.

Eventually, a woman who has cervical cancer will notice abnormal vaginal bleeding or a bloodstained discharge at unexpected times, such as between menstrual periods, after intercourse, or after menopause. Abnormal vaginal discharge may be cloudy or bloody or may contain mucus. In advanced stages there may be pain.

How is it diagnosed?

The doctor will take a Pap smear. During this test, using a small spatula and brush, the doctor gently scrapes cells from the cervix. The cells are spread across a glass slide. The slide is sent to a lab where the cells are examined.

Your Pap smear may show cells that are:

• normal

• mildly abnormal

• precancerous

• cancerous.

If the doctor discovers only minor abnormalities, these will most likely return to normal with minimal or no treatment. However, you should have follow-up Pap smears every few months as recommended by your doctor to make sure the cells have returned to normal.

If the Pap smear reveals more significant abnormalities, the doctor will want to inspect the cervix with a colposcope. A colposcope is a special type of microscope that allows the doctor to examine the vagina and cervix. During the exam the doctor will probably take a sample of the abnormal tissue by cutting off a tiny piece of the cervix (a biopsy) and/or taking scrapings from the lining of the cervical canal (endocervical curettage). The samples are sent to the lab to test for cancer cells.

How is it treated?

The early precancerous changes can usually easily be treated with laser surgery, freezing treatments (cryosurgery), electrocautery, or other surgery to remove precancerous tissue. Discuss the advantages and disadvantages of these treatments with your doctor.

More advanced lesions may require cone biopsy or even hysterectomy (removal of the uterus).

The earlier the cervical cancer is diagnosed and treated, the greater the likelihood of preserving a woman's ability to have children.

Treatment of severe, invasive cervical cancer depends on the extent of the disease, the age and general health of the woman, and the risk that it will have spread to other parts of the body.

If the invasive cancer is small and involves only the cervix or uterus, the doctor may recommend removing the uterus and cervix, upper vagina, and some surrounding tissue. The ovaries may or may not be left in place to preserve normal hormone function, depending on the age of the woman. Radiation treatment may be recommended after surgery when the full extent and spread of the tumor is determined. For more advanced tumors radiation is sometimes given before surgery to shrink the tumor so it is easier for the doctor to remove.

If cervical cancer is more advanced, or if the woman's health makes surgery risky, radiation treatment alone or combined with chemotherapy may be recommended.

How well will the treatment work?

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. If cervical cancer recurs, it most often occurs within the pelvis.

How can I take care of myself after treatment?

• Consult your doctor for instruction regarding intercourse, douching, or using tampons.

• Frequent exams and Pap smears will be recommended to look for early signs of recurrence. Keep all follow-up appointments.

• If your ovaries have stopped functioning as a result of treatment, your doctor may recommend estrogen replacement therapy.

What can be done to help prevent cervical cancer?

Several measures can be taken to reduce a woman's risk of cervical cancer:

• Ideally, a woman should not start having sexual intercourse until she is at least 18 to 20 years of age.

• Minimize your number of sexual partners and be aware that to minimize your risk, your partner should have had as few partners as possible. Ideally each of you should have had only the other as a partner.

• Use rubber latex condoms with every intercourse, particularly if you or your partner has had previous partners.

• Stop smoking.

• Maintain good personal hygiene.

• Women who are or have ever been sexually active should have regular gynecological checkups, including a Pap smear. This test should be done soon after the first experience of sexual intercourse, and every 12 months thereafter.

• Generally you should have a Pap smear every year. Your doctor will recommend how often you should be tested based on your risk factors for cervical cancer. If you have one or more risk factors, you should have a Pap smear at least once a year.

• Gynecologic symptoms such as vaginal discharge, bleeding between periods, bleeding with intercourse, and painful intercourse should be investigated promptly and adequate treatment given.