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Cervical Cancer

What is Cervical Cancer?

Cancer of the cervix begins in the lining of the cervix. This cancer forms slowly. First, some cells begin to change from normal to pre-cancer and then to cancer. This can take many years, but sometimes it happens faster. These changes may be called dysplasia. The cell change can be found by a Papsmear test and may need to be treated to prevent cancer. There are 2 main types of cancer of the cervix. About 8 to 9 out of 10 are squamous cell carcinomas. Under the microscope, this type of cancer is made up of cells that are like squamous cells that cover the surface of the cervix. Most of the rest are adenocarcinomas. These cancers start in the gland cells that make mucus. Less often, the cancer has features of both types and is called mixed carcinoma.

Risk Factors for Cervical Cancer

In looking at risk factors, it helps to focus on those that can be changed. Still, those that can't be changed also serve to remind women about the importance of getting a Pap test. These risk factors increase a woman's chance of getting cervical cancer:

Human papilloma virus (HPV) infection:  For cervical cancer, the most important risk factor is infection with a virus known as HPV. HPV is passed from one person to another by skin-to-skin contact such as vaginal, anal, or oral sex. But sex isn't the only way to spread HPV from one person to person. All that is needed is for there to be skin-to-skin contact with an area of the body infected with HPV. Having unprotected sex, especially at a young age, makes HPV infection more likely. Also, women who have many sex partners have a greater chance of getting HPV. Even though HPV is an important risk factor for cervical cancer, most women with this infection do not get cervical cancer. Doctors believe other factors must come into play for this cancer to grow. Some of these factors are listed below.

Other Risk Factors

Smoking:  Women who smoke are about twice as likely to get cervical cancer as those who don't.

HIV infection:  HIV is the virus that causes AIDS -- it is not the same as HPV. Having HIV seems to make a woman's immune system less able to fight both HPV and early cancers.

Chlamydia infection

Diet:  What you eat can play a part as well. Diets low in fruits and vegetables are linked to an increased risk of cervical cancer. Also, women who are overweight are at a higher risk.

Birth control pills:  Long-term use of birth control pills increases the risk of this cancer.

Having many pregnancies:  Woman who have had 3 or more full-term pregnancies have an increased risk of this cancer.

Family history

Can Cervical Cancer be prevented?

A well-proven way to prevent cancer of the cervix is to have testing (screening) to find pre-cancers before they can turn into cancer. The Pap test (or Pap smear) is the most common way to do this. If a pre-cancer is found and treated, it can stop cervical cancer before it really starts. Most cervical cancers are found in women who have not had Pap tests when they should. The American Cancer Society Recommends the following:
  • All women should begin having the Pap test about 3 years after they start having sex, but no later than age 21.
  • The test should be done every year if the regular Pap test is used, or every 2 years if the liquid-based Pap test is used.
  • Beginning at age 30, many women who have had 3 normal test results in a row may get the Pap test every 2 to 3 years. Another option for women over 30 is to have a Pap test every 3 years plus the HPV DNA test. (See below for more information about this test.)
  • Women who have certain risk factors (like HIV infection or weak immune systems) should get a Pap test every year.
  • Women 70 years of age or older who have had 3 or more normal Pap tests in a row (and no abnormal tests in the last 10 years) may choose to stop having the test. But women who have had cervical cancer or who have other risk factors (as mentioned above) should keep on having the test as long as they are in good health.
  • Women who have had a total hysterectomy (removal of the uterus and cervix) may also choose to stop having the test unless the surgery was done as a treatment for cervical cancer or pre-cancer. Women who have had a simple hysterectomy (the cervix was not removed) should continue to follow the guidelines above.

Signs and Symptoms

Early cervical pre-cancers or cancers often have no signs or symptoms. That's why it's important for women to have regular Pap tests. Symptoms often do not start until the cancer is further along and has spread to nearby areas. You should report any of the following to your doctor right away:
  • Abnormal vaginal bleeding, such as bleeding after sex, bleeding after menopause, bleeding and spotting between periods, and having periods that are longer or heavier than usual. Bleeding after douching, or after a pelvic exam is a common symptom of cervical cancer but not pre-cancer.
  • An unusual discharge from the vagina (not your normal period)
  • Pain during sex

Of course, these symptoms do not mean that you have cancer. They can also be caused by something else. But you should check with a doctor to find out. It is best to not wait for symptoms to appear. Get regular Pap tests and pelvic exams

Test to Find Cervical Cancer

The doctor will ask you abut your health, your risk factors, and about the health of your family members. A complete physical exam will be done with special attention to your lymph nodes to look for any signs that cancer has spread.

Cystoscopy:  In cystoscopy a thin tube with a lens and a light is put into the bladder through the urethra. This lets the doctor check to see if cancer is growing into these areas. Biopsy samples can also be removed.

Proctoscopy:  For proctoscopy a thin, lighted tube is used to check for spread of cervical cancer into your rectum. Your doctor may also do a pelvic exam while you are under anesthesia to find out whether the cancer has spread beyond the cervix.

If your doctor finds that you have cervical cancer, imaging studies may be used to show the inside of your body. They can show whether the cancer has spread beyond the cervix.

Chest x-ray:  A plain x-ray of your chest will be done to see if your cancer has spread to your lungs. This is not likely unless your cancer is very advanced.

CT scan (computed tomography):  The CT scan is a special kind of x-ray. Instead of taking just one picture, a CT scanner takes many pictures as it moves around you. A computer then combines these pictures into an image of a slice of your body (think of a loaf of sliced bread).

MRI scans (magnetic resonance imaging):  MRI scans use radio waves and strong magnets instead of x-rays to take pictures. MRI images are very useful in looking at pelvic tumors.

PET scan (positron emission tomography):  PET scans use glucose (a form of sugar) that contains a radioactive atom. Cancer cells in the body absorb large amounts of the treated sugar and a special camera can spot the cells.

Treatment for Cervical Cancer

The treatment options for cervical cancer depend mostly on the stage of the cancer. After your cancer is staged, the doctor will tell you what choices you have. Factors other than the stage of the cancer that might have an impact on your treatment decision include your age, your overall health, and your own preferences.The 3 main types of treatment for cervical cancer are surgery, radiation, and chemotherapy. Sometimes the best approach is to use 2 or more of these methods.