Cervical cancer is a disease in which cancer cells grow in the cervix. Normally, the cells of the cervix grow, divide, and die in a regulated manner. If cells keep dividing in an unregulated manner, a mass of tissue forms. This mass is called a tumor. A tumor can be benign or malignant. A benign tumor is not cancer. It will not spread to other parts of the body.
A malignant tumor is cancer. Cancer cells grow, divide, and damage tissue around them. They can enter the bloodstream and spread to other parts of the body. As these cells accumulate, they compress, invade, and destroy normal healthy tissue. The spread of a tumor to a new site is called metastasis. This can be life threatening.
Anatomy and Physiology
The cervix is part of the uterus (womb). The uterus is located in the pelvis and is divided into two parts. The upper part, or the body of the uterus, is where a fetus grows during pregnancy. The lower, narrow part is the cervix. The cervix connects the uterus with the vagina. The part of the cervix that is closest to the uterus is the endocervix; the part of the cervix next to the vagina is the ectocervix.
The cavity of the cervix is called the cervical canal. The cervical canal has a mucosal lining with cervical glands that secrete mucus. This lining is called the epithelium. The mucus fills the cervical canal and blocks the external mouth of the cervix. Cervical cancer begins in the lining of the cervix.
During labor and childbirth, contractions force an infant's head against the cervix causing the cervix to soften, become thinner, and dilate. This allows for childbirth.
Development of Cervical Cancer
Cervical cancer does not "appear" suddenly. It develops slowly; there is a gradual change from a normal cervix to precancer to cancer. This usually takes several years, but it can happen in less than a year. Due to the effectiveness of cervical cancer screening, precancerous cells as well as cancer cells can be identified and treated.
Cervical intraepithelial neoplasias are potentially precancerous changes in the lining of the cervix, which is called the epithelium. The degree of CIN (1, 2, or 3) is based on the extent of cell growth and division (called mitotic activity), immature cell growth, and nuclear abnormalities:
CIN1 - lesions are present only in the lower third of the epithelium
CIN2 - lesions involve the middle third of the epithelium
CIN3 - lesions involve the upper third of the epithelium
is diagnosed when cancer cells replace normal endocervical gland cells. Cancer cells are tall, irregular columnar cells with abnormal nuclei and increased mitotic activity. Between 20% and 50% of women with cervical AIS also have squamous CIN, which is CIN in the skin-like layer of cervical tissue.
Invasive Squamous Cell Carcinoma
Between 85% and 90% of cervical cancers arise from squamous cells. This type of cancer begins in the ectocervix, often at the border between the ectocervix and the endocervix, called the transition zone. Based on histologic descriptors, squamous cell carcinomas are divided into keratinizing and nonkeratinizing types. Much less commonly seen are small cell carcinomas of the cervix.
10% to 15% of cervical cancers are adenocarcinoma. They develop from the mucus-producing gland cells of the endocervix. A wide variety of cell types, growth patterns, and degrees of cell differentiation have been seen with adenocarcinomas.
Adenosquamous carcinomas or mixed carcinomas
These cancers have features of both squamous cell carcinomas and adenocarcinomas and are less common. However, adenocarcinomas and adenosquamous carcinomas account for an increasingly greater percentage of cervical cancers, which is significant because there is a poorer prognosis associated with these types of cervical cancer.
Who Is Affected?
According to the American Cancer Society, an estimated 13,000 cases of invasive cervical cancer were diagnosed in 2002. However, incidence rates have decreased steadily over the last few decades. Between 1994 and 1998, the incidence rate was 11.3 per 100,000 in black women and 7.0 per 100,000 in white women. An alarming note: several studies have shown the incidence of cervical cancer among women in their 20s and 30s to be rising.
Death from cervical cancer is nearly 100% preventable. That said, the American Cancer Society estimated that 4,100 women died from cervical cancer in 2002. For cervical cancer to be effectively treated, it must be detected early. Because of the availability of advanced screening methods, the occurrence of death from cervical cancer has declined significantly over the last 20 to 30 years. In fact, since 1982 cervical cancer mortality rates in the US have declined on average by about 1.6% per year.
Currently, about 80% of cervical cancers occur in developing countries. Worldwide, cervical cancer is the second most common cancer among women (breast cancer is number one). In addition, cervical cancer remains the most common cause of cancer mortality in women worldwide.
Causes and Complications
There is a strong correlation between human papillomavirus (HPV) infection and the development of cervical cancer. In fact, infection with certain types of HPV is present in almost all cases of cervical cancer. Attempts are currently underway to attack the HPV infection before it ever develops into cervical cancer. Other risk factors for cervical cancer include smoking and HIV infection.
Effects on Fertility
Depending on the treatment, your fertility (ability to have children) may be affected. If you wish to have children, talk with your doctor about your treatment options. A careful discussion between you and your gynecologic oncologist should occur. You will need to discuss the potential risks of the disease, evaluation procedures, and the treatment options available to you.
Effects on Sexuality
Cervical cancer can affect the way you feel about sex. You may feel uncomfortable having sex after cancer. Or, you may feel very "unsexy" or "unsexual" because your body has undergone intense medical procedures, especially in such an intimate and personal area. These are normal feelings. Don't be afraid or embarrassed to talk with your doctor about how you are feeling. Or, ask for a referral to a counselor so that you can discuss your feelings with a mental health professional. In addition, you may want to seek out a support group. Ask your doctor to suggest a support group.
This Report Covers the Following:
– factors that increase your chances of developing cervical cancer.
Reducing your risk
– steps you can take that may help decrease your risk of developing cervical cancer.
– when you don't have symptoms of cancer, screening tests offer a way to determine if you are at risk for or if you have cervical cancer.
– changes in your health that should prompt you to see your doctor for further evaluation.
Diagnosis and prognosis
– the steps your doctor will take to find out if you have cervical cancer. And if you do have cancer, the testing that will determine how far it has progressed.
– the goals and options for treatment of cervical cancer.
Living with cervical cancer
– one woman shares her experiences with cervical cancer
Talking with your doctor
– questions to ask your doctor about cervical cancer
– places to go for further information on cervical
Cancer Facts & Figures. American Cancer Society Web site.
Accessed November 19, 2002.
Cervical cancer. American Cancer Society Web Site.
Accessed November 19, 2002.
DeVita VT, Hellman S, Rosenberg SA, eds.
Cancer: Principles & Practice of Oncology
, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins;2001:1519-1549.
. 4th ed. St. Louis, MO: Mosby, Inc; 2001:248-257.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a