Definition

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 lining the cervical canal) 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

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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

Scientists believe several risk factors act together. These 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 usually do not appear until the abnormal cells become cancerous. They 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. It will also detect cervical dysplasia (a precancerous development). The doctor collects a sample of cells from the cervix to be tested.
    • If you are sexually active, you should have a yearly Pap test. If you have any abnormal results, follow-up with your doctor. New studies indicate that women aged 30 or older who have had three or more normal annual Pap tests can safely lengthen the Pap screening to once every three years. Talk to your doctor about what is right for you.
  • HPV test—The same cervical material obtained from the Pap test can be tested for the HPV virus.
  • Colposcopy —This is an exam of the vagina and cervix. The procedure uses a lighted magnifying instrument. It is needed if the Pap test suggests the presence of cervical dysplasia (precancer) or cancer.
  • Biopsy —This is done on any suspicious areas observed during the colposcopy. The removed tissue is tested for the presence of cancer cells.

Treatment

Once cervical cancer is found, further tests are performed to find out if the cancer has spread beyond the cervix, and, if so, to what extent. This process is called staging. Treatment depends on the stage of the cancer.

Treatments include:

Surgery

The cancerous tumor, nearby tissue, and possibly nearby lymph nodes may be removed. The doctor may remove only the tumor and surrounding normal tissue if the tumor is very localized within the cervix. In some cases, a hysterectomy is necessary.

If the cancer is at a high stage, more tissue must be removed. 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 given 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

Chemotherapy

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

This therapy may also be used to help control pain and bleeding when a cure is no longer possible.

Chemotherapy is usually combined with radiation therapy.

If you are diagnosed with cervical cancer, follow your doctor's instructions .

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 continue to receive regular Pap smears. Another effective approach is to reduce your risk of exposure to the HPV virus. There are currently two methods to accomplish this:

  • Safe sexual practice—Limit the number of sexual partners and use condoms.
  • HPV vaccination —In preliminary research this vaccine was 100% effective in preventing the HPV infection. 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.