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Cervical Cancer
General Information Understanding Cervical Cancer Who's at Risk? Recognizing Symptoms Detection Treatment Prevention More Information Cervical cancer is the number one killer of women in underdeveloped countries because women in those countries lack the medical treatment (the Pap test) that is readily available for women in the United States and other developed countries. According to the American Cancer Society, 10,370 new cases of cervical cancer will be diagnosed in 2005 in the U.S. and 3, 710 women will die as a result of this disease. However, cervical cancer can be treated and cured if detected early. There has been a significant decline in deaths related to cervical cancer since 1995 because women are getting Pap tests done with more regularity. Cervical cancer develops within the cervix, a reproductive organ that connects the body of the uterus to the vagina. The disease develops over several years as cells in the lining of the cervix begin to change into pre-cancerous cells and eventually, to cancerous cells. There are two main types of cervical cancer. The first, squamous cell carcinomas, make up 80%-90% of diagnosed cervical cancer. The other 10% is called adenocarcinomas. Cervical cancer can be either non-invasive, whereby cancer has not spread beyond the layers of tissue where it originated, or invasive, where the cancer has spread beyond the original tissue. According to the American Cancer Society, non-invasive cervical cancer is 4 times more likely than invasive cervical cancer. This means, if detected early, non-invasive cervical cancer can be treated with a good chance of success as the cancer will not have spread to other tissue. There are several factors that contribute to the likelihood of developing cervical cancer. Some of these factors can be prevented, others cannot. HPV, Chlamydia, and HIV are sexually transmitted diseases (STDs). All three diseases are risk factors for developing cervical cancer. While a Pap test screens for changes in cervical cells, it is not a detection method for these diseases. These STDs have symptoms that are not always apparent and that can take years to become present. Women who engage in high risk sexual behavior, such as unsafe sex and multiple partners, especially young women, are at a risk of contracting these diseases. It is extremely important to get tested for sexually transmitted diseases, aside from just having a Pap test done annually/semi-annually). Infection with HPV is a significant risk factor for cervical cancer. There are 100 viruses that are categorized as HPV, not all of which can cause cervical cancer. Those HPV strains that are deemed “high risk” are those that cause cervical cells to change, and possibly, develop into cancer cells. HPV is spread through sexual intercourse and is not prevented with condom use (although it is important to continue using condoms to prevent from other sexually transmitted diseases). Unprotected sex as well as sex with many partners increases the risk of contacting HPV. While HPV does not guarantee cervical cancer, it is important to have a Pap test conducted to detect if the cells in the cervix have been changed as a result of the HPV. For more information about HPV, go to the U.S. FDA Office of Women's Health HPV Facts Page or the National Cervical Cancer Public Education Campaign. Chlamydia is a bacterial sexually transmitted disease that often goes unnoticed by women who have it. This bacteria can damage a woman’s sex organs. This STD is spread during sex. Women who have, or have had, Chlamydia are susceptible to cervical cancer. Chlamydia often infects the body without noticeable symptoms. HIV weakens the body’s immune system that fights against infection. Having HIV means that there is a greater chance for precancerous cervical cells to progress to cancerous cells. According to the American Cancer Society, smoking increases the risk of developing cervical cancer dramatically, as the chemicals contained in cigarettes damage the DNA in the cells of the cervix. Women who smoke are 50% more likely to develop cervical cancer than women who do not smoke. Women whose diets are low in fruits and vegetables are at risk for developing cervical and other forms of cancer. Long term use of birth control pills is believed to increase the risk of cervical cancer, especially if taken for over 5 years. Many full term pregnancies make a woman more susceptible to cervical cancer. Women whose mothers or sisters who have had cervical cancer area at a greater risk for developing cervical cancer. *The American Cancer Society provided information for “Who is at Risk?” There are few symptoms for cervical cancer and none are specific to cervical cancer. For this reason, it is extremely important that women get regular Pap tests, as advised by their doctors. The three symptoms that generally accompany cervical cancer: unusual discharge from the vagina that is not a period, blood spots or light bleeding that is not a period, and bleeding or pain during sexual intercourse. Once again, these symptoms are not specific to cervical cancer. They may indicate some other problem. If a doctor suspects cervical cancer, he/she will suggest a method of testing to determine if cervical cancer is present. A biopsy involves removing a sample of tissue to be examined under a microscope for any abnormalities of cells. A biopsy is a definitive answer to determine if the existence of abnormal cells is cancerous, precancerous, or benign. There are many types of biopsies, so consult your doctor about biopsy options. A colposcopy is generally administered after a biopsy has been performed. This procedure is painless and requires no anesthesia. During the procedure a doctor examines the cervix with a colposcope. If during the exam he/she notices abnormalities, a few methods can be used to treat the cells immediately. Cells can be removed using either a heated instrument or frozen off with nitrogen. Lasers can also be used to remove abnormal cells. This procedure effectively locates and removes the cells immediately. If cancer is detected through these tests, your doctor will want to run other tests to determine the progression of the cancer. There are several other diagnostic tests that can see if and how far the cancer may have spread. There are three primary treatments available for cervical cancer. They include surgery, chemotherapy, and radiation therapy. Some treatments include a combination of two or all three of these methods. All forms of treatments include risk factors and side effects, therefore, it is important that you discuss all options with your doctor and don’t be afraid to get a second opinion. The type and extent of surgery depends on the progression of the cancer. In some cases, the type of biopsy employed may remove the affected area and will be the extent of the surgery. In more developed cases, the doctor may opt to remove just the cervix, complete a simple or radical hysterectomy (removing the uterus, cervix and perhaps other organs), or in very serious cases, a complete hysterectomy plus a pelvic exenteration (removing organs such as the bladder, rectum, colon; this is done primarily recurrent cases of cervical cancer). There are many types of surgery related to cervical cancer; some surgeries even allow women to continue bearing children if the cancer is not threatening to a pregnancy. It is important that you talk to your doctor in depth about surgical options. Abundant research shows that survival rates and quality of life are vastly improved by having reproductive cancer surgery performed by a gynecologic oncologist. Gynecologic Oncologists specialize in treating reproductive cancers and performing surgery on them. For more information about gynecologic oncologists, talk to your doctor or visit the Society of Gynecologic Oncologists. Chemotherapy is the use of drugs to combat and kill cancer cells. Drugs are given intravenously (through the veins) or by mouth and are often used in combination. Chemotherapy takes place in cycles with rest periods included. These drugs, while attacking and killing cancer cells, also can do damage to normal healthy cells. This leads to certain side effects such as reduced ability to fight off other infections or diseases, fatigue, nausea, shortness of breath, bleeding, increased bruising, hair loss, and loss of appetite. Side effects generally end when treatment concludes. Remedies do exist for many of these temporary side effects. Radiation Therapy uses high energy x-rays to shrink and kill cancer cells. It can be completed externally from the body or small capsule of radioactive material is inserted near the cancer cells (brachytherapy). External radiation takes 6-7 weeks to complete while the insertion procedure takes a few days and the patient is put under anesthesia. Radiation therapy has several side effects that last temporarily. Skin will appear to be sunburned and eventually tanned. This coloration will subside after several months. If internal radiation is completed in the pelvic area, the vagina may narrow due to scar tissue. This narrowing may make sex more difficult and/or painful. Also, urination may become more difficult and menopause may take place sooner that natural. There are methods of treating side effects. Smoking increases the side effects of this treatment! The most important method of prevention is to get a Pap test (smear) as recommended by your doctor. Young women should begin having the Pap test done three years after beginning sexual intercourse, but no later than 21 years of age. Women under the age of 30 should have annual Pap exams if the regular Pap test is being administered; if the new liquid based Pap is being used, women should have the test done every 2-3 years. For women over the age of 30 who have had three normal sets of results in a row can have the test completed every 2-3 years. However, those women with certain risk factors (such as a weakened immune system) should continue to get a Pap done every year. Because HPV is such a risk factor for cervical cancer, there is a test called the HPV DNA test which enables doctors to examine the DNA of cervical cells. This test is helpful because it allows doctors to determine if a woman’s cervical cells are infected with a “high risk” strain of HPV which can develop cervical cancer. This test can be used along with the Pap test on women over the age of 30. It can also be used for women who receive abnormal results on Pap exams to determine if more tests need to be run. Other ways to prevent cervical cancer, according to the American Cancer Society, include: young women waiting to have sex until they are older, not smoking, and limiting the number of sexual partners. Your doctor is a great source of information and it is very important that you feel comfortable talking to your doctor about all your health issues, including cervical and other reproductive cancers.
The American Cancer Society is a great resource for any individual interested in learning more about all types of cancer. The American Cancer Society provides information and support to patients, survivors, families, doctors and everyday individuals. The information shared is easy to understand and is extremely thorough. The Wisconsin Well Woman Program is a program administered by the Wisconsin Department of Health and Family Services. It allows women in Wisconsin who are uninsured or who have little insurance coverage to receive preventative screenings for certain health problems, including free mammograms and Pap tests. Other links include:
For information about ongoing clinical trials related to cervical cancer, visit the National Cancer Institute website. |
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