Cervical Cancer Guide
• What Is Cervical Cancer?
|What Is Cervical Cancer?
Cervical cancer means that cancer cells have been found in the tissue of the cervix. The cervix is the lower part of the womb and it separates the cavity of the womb (the empty space where a baby grows) from the vagina. It is made up of smooth muscle tissue which forms a circular shape which can stretch open during pregnancy and childbirth. It allows the passage of period blood out of the body during menstruation and it allows sperm to move into the womb (also called uterus) from the vagina after sexual intercourse. It even secretes a special type of mucus to help energize sperm as they pass through to help them reach their final destination. Most cervical cancers begin with changes in the cells that line the cervix. These cells do not just suddenly become cancerous. Rather they gradually make pre-cancerous changes that later turn into cancer. Clinicians use various terms to describe these pre-cancerous changes including cervical intraepithelial neoplasia (CIN), cervical dysplasia and squamous intraepithelial lesion (SIL). CIN affects nearly 50,000 American women a year. Some women with CIN will develop cancer while for others it will not. There is no way to predict if cancer will occur or in what time frame it may do so. If pre-cancerous cells change to cancer it usually take a few years, although it may happen in less than a year. All these changes can be detected with a Pap Smear. Once spotted, they can be treated to prevent the possible development of cancer.
If cervical cancer has developed, it will be classified by how it looks under a microscope. There are 2 main types of cancer: squamous cell carcinoma and adenocarcinoma. The former accounts for nearly 90 percent of cases and most commonly occurs in older women. However cervical adenocarcinoma is becoming more common in the past few decades, despite the reduction in incidences of squamous cell carcinomas.
Cervical cancer is the second most common cancer in women (after breast cancer). It is the leading cause of cancer deaths worldwide and yet it is one of the most preventable diseases. About 13,000 new cases are diagnosed every year in America, and of those, about 4,000 will die from it. Fortunately cervical cancer deaths in the United States have declined by nearly 70 per cent in the past few decades and continue to decline by about 3 percent a year. This is largely due to the increased use of the Pap smear test which screens for cell changes before they become cancerous. Yet despite the Pap test being endorsed by the American Cancer Society since 1957, nearly one third of American women still do not get tested, and nearly 50 percent of those diagnosed with later stages of cervical cancer have never had a Pap smear. In America, American-Vietnamese women have the highest rate of occurrences and Japanese-American the lowest. Hispanic women living in the States have twice the rate as non-Hispanic white women. African-Americans have 50 percent more chance of developing cervical cancer than white women.
Generally there are no signs or symptoms of cervical cancer. Early stage pre-cancer like CIN do not cause symptoms. If cancer develops and grows without detection or treatment, the first symptoms may include:
As the cancer grows, the spotting turns to bleeding, until eventually the bleeding is constant.
1. Leg pain related to pressure from the tumor pressing on pelvic wall, uterus and nerves.
The causes of cervical cancer are still unclear, as is the case for most cancers (see cancer causes). However several risk factors specific to cervix tumors have been identified. Women without these risk factors rarely develop the disease. If cancer does occur it is not possible to say with certainty which particular risk factor was the cause.
Cervical risk factors include:
Human Papilloma Virus Infection (HPV)
Finding CIN or receiving a cervical cancer diagnosis usually starts with an abnormal Pap smear result. Accurate diagnosis involves a step by step process which includes a colposcopy to look inside the cervix, a biopsy to examine the cells more closely and a physical examination. A cystoscopy or proctoscopy may be carried out if the tumor is large and more diagnostic procedures are needed. A thin lighted tube is put through the urethra and rectum respectively to check for the spread of cancer. A chest X-ray, CT scan, MRI scan or PET scan may also be carried out if it is suspected that cancer has spread beyond the cervix. The process of how far the cancer has spread is called staging (image). Figuring out the size of the tumor, how deeply it has grown into the tissues surrounding it and if is has spread to lymph nodes (metastasis) or distant organs is important for determining treatment and prognosis. (See cervical cancer stages).
Cervical cancer treatment options will depend mainly on the staging of the cancer. The 3 most common types of treatment are surgery, radiation therapy and chemo (see chemotherapy guide). Surgery can effectively remove small tumors. If a tumor is large then radiation may be used as it can cause fewer problems than surgery. Chemotherapy is sometimes used in combination with radiation to kill any cancer cells which may have strayed from their point of origin. Sometimes treatment is only aimed at relieving symptoms because the cancer has progressed too far. This is known as palliative treatment. Read also about cervical cancer recurrence and treatment, and cervical cancer in pregnancy.
What About CIN or Dysplasia?
Any pre-cancerous cell changes will need to be discussed with a clinician. One option may be just to monitor the cell changes with regular Pap smears or colposcopies. Because many low grade CIN revert to normal without treatment, this wait and see option may be reasonable. High grade CIN cells can be removed via several techniques, all of which can be done on an out-patient basis. These procedures include cryosurgery, laser surgery, electrosurgical loop excision (LEEP) and less commonly cone biopsy.
Yes, cervical cancer prevention is possible in many cases by:
1. Finding pre-cancer cells before they turn cancerous. The best way to do this is to have a regular Pap smear test. All women should have a Pap smear test 3 years from when they start having sexual intercourse (or after the age of 21). This test should be carried out every year or every 2 years if the liquid based Pap smear test is used. Read about recommended screenings for women.
| Other Useful Guides
Development of the female body: Adolescence to postmenopause.
Return to Homepage: Womens Health Advice