CERVICAL CANCER
Easy Guide To: Cancer of The Cervix

Cervical Cancer Guide

Contents

• What Is Cervical Cancer?
• Cervical Cancer Explained
• What Are The Symptoms?
• What Are The Signs
• What Are The Causes & Risk Factors?
• How Is It Diagnosed?
• What Is The Treatment?
• Can Cervical Cancer Be Prevented?

OTHER TOPICS

Cancer Overview
Breast Cancer
Endometrial Cancer
Ovarian Cancer
Vaginal Cancer
Vulva Cancer

In This Section:

Symptoms
Causes
Diagnosis
Stages
Treatment
Survival Rates
Pap Test
Recurrence
Cancer Remission
Prevention Advice
Cancer in Pregnancy

Related Articles:

Female Reproductive System

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 Explained

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.

What Are The Symptoms?

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:

1. A watery blood-stained vaginal discharge which the woman may not even notice.
2. Spotting between monthly menstrual cycles.
3. Spotting after sexual intercourse.
4. Spotting while douching.

As the cancer grows, the spotting turns to bleeding, until eventually the bleeding is constant.

Signs of Advanced Cervical Cancer

1. Leg pain related to pressure from the tumor pressing on pelvic wall, uterus and nerves.
2. Swelling of one or both legs caused by blocked lymph and blood vessels.
3. Painful urination.
4. Blood in urine.

See also: Cervical cancer survival rates and cervical cancer stages. If you have any other questions on female topics, visit our section on womens health questions.

What Are The Causes & Risk Factors?

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)
It is accepted that nearly 95 percent of all cases of cervical cancer are now linked to HPV infections. HPV is a very common sexually transmitted disease. It is estimated that nearly one third of all female American college students are infected and 10 percent of men between the ages of 15 and 49. HPV increases a woman's chance of developing cervical cancer 15-fold. If she is under 21 years of age her risk increases 40-fold. HPV can be contracted through sexual intercourse, including oral sex - or simply by skin to skin contact with an area of the body infected with HPV. Genital warts are one form of HPV.

Smoking
Women who smoke are twice as likely to develop cervical cancer as non-smokers.

Chlamydia Infection
Chlamydia is STD which can lead to infertility. As it causes no symptoms a woman will not know if she is infected unless she is tested. Studies show that women whose blood test results show evidence of past or current chlamydia infection are also at higher risk of cervical cancer.

Diet
Women who do not include enough fruit and vegetables in their diet may be at increased risk of cervical cancer. Also overweight and obese women are more likely to develop adenocarcinoma of the cervix.

Oral Contraceptives
There is some evidence that taking oral contraceptives long-term (the pill) increases the risk of developing cervical cancer. In one recent study the risk of cancer of the cervix was double in women who took the pill for longer than 5 years, but the risks returned to normal when the pill was stopped for 10 years.

Multiple Pregnancies
Women who have had 3 or more full-term pregnancies are more likely to develop cervical cancer. The reasons are not clear but it may be because they have had more exposure to HPV through unprotected sexual intercourse. Women who were younger than 17 when they had their first full term pregnancy are twice as likely to develop cancer later in life than those who wait until after 25.

Genetics
Women with a mother or sister who has had cervical cancer have a 2 to 3 time’s higher chance of developing the disease. See Genetic testing.

HIV
The HIV virus, which causes AIDS, places the woman at higher risk for HPV infections. Any pre-cancer might also develop into invasive cancer faster as the body's immune system is impaired.

How Is It Diagnosed?

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).

What Is The Treatment?

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.

Can Cervical Cancer Be Prevented?

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.
2. Avoiding the pre-cancer risk factors such as wearing protection during sexual intercourse (to prevent HPV), avoid smoking and maintaining a healthy diet and body weight.
3. It is now recommended that all girls between 11 and 12 be vaccinated (before they become sexually active) against the HPV virus.
4. New research indicates that taking 400 micrograms of folic acid daily may help prevent the risk of cervix cancer.

Other Useful Guides

Development of the female body: Adolescence to postmenopause.
The Female Body: Visual guide to the workings of a woman's body.
Hospital Departments Explained: A to Z of departments.
Reproductive System Disorders: Symptoms of vaginal and vulva problems.

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