Cervical Cancer

Cervical Cancer Overview

The uterine cervix is the lowest portion of a woman's uterus (womb). Most of the uterus lies in the pelvis, but part of the cervix is located in the vagina, where it connects the uterus with the vagina.
Cancer of the cervix occurs when the cells of the cervix change in a way that leads to abnormal growth and invasion of other tissues or organs of the body.
Like all cancers, cancer of the cervix is much more likely to be cured if it is detected early and treated immediately.

• One of the key features of cervical cancer is its slow progression from normal cervical tissue, to precancerous (or dysplastic) changes in the tissue, to invasive cancer.
• The slow progression through numerous precancerous changes is very important because it provides opportunities for prevention and early detection (through Pap test) and treatment.
• These opportunities have caused a decline in the incidence of cervical cancer over the past decades in the United States. Still, over 12,000 new cases of cervical cancer occur each year in the U.S., and over 4,000 women die each year from the disease.

Invasive cancer means that the cancer affects the deeper tissues of the cervix and may have spread to other parts of the body. This spread is called metastasis. Cervical cancers don't always spread, but those that do most often spread to the lungs, the liver, the bladder, the vagina, and/or the rectum.

Cervical Cancer Causes

Cervical cancer begins with abnormal changes in the cervical tissue. Infection with human papillomavirus (HPV) is the cause of almost all cervical cancers. Other known risk factors for cervical cancer include early sexual contact, multiple sexual partners, cigarette smoking, HIV infection and a weakened immune system, and taking oral contraceptives (birth control pills).

• Forms of HPV, a virus whose different types cause skin warts, genital warts, and other abnormal skin and body surface disorders, have been shown to lead to many of the changes in cervical cells that may eventually lead to cancer.
• Because HPV can be transmitted by sexual contact, early sexual contact and having multiple sexual partners have been identified as risk factors for the development of cervical lesions that may progress to cancer.
• Cigarette smoking is another risk factor for the development of cervical cancer. The chemicals in cigarette smoke interact with the cells of the cervix, causing precancerous changes that may over time progress to cancer.
• Oral contraceptives ("the pill") may increase the risk for cervical cancer, especially in women who use oral contraceptives for longer than five years.
• Women who have weakened immune systems, such as HIV-infected women, are also at greater risk for cervical cancer.

HPV infection is very common and does not lead to cancer in the majority of cases. Genital infections with HPVs typically cause no symptoms and go away on their own. Sometimes, however, the infection persists. Precancerous changes or ultimately cervical cancer only arises when there is a persistent infection by one of the HPV types associated with cervical and other cancers.

Cervical Cancer Symptoms

As in many cancers, there may be no signs or symptoms of cervical cancer until it has progressed to a dangerous stage.

• Cervical cancer does not usually cause pain, although it may in very advanced stages.
• The most common symptom is abnormal vaginal bleeding. This is any bleeding from the vagina other than during menstruation.
• Abnormal vaginal discharge also may occur with cervical cancer.

When to Seek Medical Care

The range of conditions that can cause vaginal bleeding are diverse, range in seriousness, and vary based on the age, fertility, and medical history of the patient.
Vaginal bleeding after menopause is never normal. If a woman has gone through menopause and has vaginal bleeding, she should see her health care professional as soon as possible.
Very heavy bleeding during a woman's period or frequent bleeding between periods warrants evaluation by a health care professional.
Bleeding after intercourse should be evaluated by a health care professional.
If a woman has vaginal bleeding that is associated with weakness or feeling faint or light-headed, or if a woman actually faints, she should go to a hospital emergency department for care.

Cervical Cancer Diagnosis

As with all cancers, early diagnosis is key to successful treatment and cure. Treating precancerous changes that affect only the surface of a small part of the cervix is much more likely to be successful than treating invasive cancer that affects a large portion of the cervix and has spread to other tissues.
The most important progress that has been made in early detection of cervical cancer is widespread use of the Papanicolaou test (Pap smear).

• The Pap smear is done as part of a regular pelvic examination.
• Named after the pathologist who developed the test, the Pap smear is a quick, painless, and relatively inexpensive way of screening women for precancerous or cancerous changes in their cervix.
• Cells from the surface of the cervix are collected on a slide and examined. Any abnormality found on a Pap smear mandates further evaluation.

Diagnosis of cervical cancer requires that a sample of cervical tissue (called a biopsy) be taken and analyzed under a microscope.

• This tissue sample can be obtained in a number of ways.
• A cervical biopsy is usually done by a specialist in diseases of women's reproductive and sexual organs (a gynecologist).
• The biopsy is examined by a physician who specializes in diagnosing diseases by looking at cells and tissues under a microscope (a pathologist).

Colposcopy is a procedure similar to a pelvic examination.

• The examination uses a type of microscope called a colposcope to inspect the cervix. The entire area of the cervix is stained with a harmless dye to make abnormal cells easier to see.
• The colposcope magnifies the cervix by 8-10 times, allowing easier identification of any abnormal-appearing tissue that may need biopsy.
• This procedure can usually be done in a gynecologist's office.
• These abnormalities may be an early step in the slow series of changes that can lead to cancer.

Sometimes a larger biopsy is needed to fully check for invasive cervical cancer.

• The loop electrosurgical excision procedure (LEEP) technique uses an electrified loop of wire to take a sample of tissue from the cervix.
• This procedure can often be performed in your gynecologist's office.

A cone biopsy is performed in the operating room while a woman is under anesthesia.

• A small cone-shaped sample of the cervix is removed for examination.
• Like LEEP, cone biopsy procedures result in tissue samples in which the types of cells and how much they have spread to underlying areas can be more fully determined.

Cervical Cancer: Abnormal Cells

Precancerous changes Over the years, different terms have been used to refer to abnormal changes in the cells on the surface of the cervix. These changes are now most often called squamous intraepithelial lesion (SIL). "Lesion" refers to an area of abnormal tissue; intraepithelial means that the abnormal cells are present only in the surface layer of cells. Changes in these cells can be divided into two categories.

• Low-grade SIL: Early, subtle changes in the size and shape of cells that form the surface of the cervix are considered low grade.
• These lesions may go away on their own, but over time, they may become more abnormal, eventually becoming a high-grade lesion.
• SIL is also called mild dysplasia or cervical intraepithelial neoplasia 1 (CIN 1).
• These early changes in the cervix most often occur in women aged 25-35 years but can appear in women of any age.
• High-grade SIL: A large number of precancerous cells, which look very different from normal cells, constitute a high-grade lesion.
• Like low-grade SIL, these precancerous changes involve only cells on the surface of the cervix.
• These lesions are also called moderate or severe dysplasia, CIN 2 or 3, or carcinoma in situ.
• They develop most often in women aged 30-40 years but can occur at any age.

Precancerous cells, even high-grade lesions, usually do not become cancerous and invade deeper layers of the cervix for many months, perhaps years.
A woman should ask her health care professional if she does not understand the way the result of her Pap smear is reported.
Invasive cancer
If abnormal cells spread deeper into the cervix or to other tissues or organs, the disease is then called cervical cancer, or invasive cervical cancer. Cervical cancer occurs most often in women aged 40 years or older.
If the biopsy results show invasive cancer, a series of tests will be performed, all designed to see whether the cancer has spread and, if so, how far. The extent of spread of a cancer is referred to as the stage of the cancer.

• A chest X-ray looks for spread to the lungs.
• Blood tests can indicate whether the liver is involved. A CT scan may be necessary if results are not definitive.
• Special X-rays or a CT scan can be used to look at the bladder and orther organs.
• The vagina and rectum are also examined, sometimes under anesthesia.

These tests are used to "stage" the cancer.

• By finding out how far it has spread, a health care professional can make a reasonable guess about a woman's prognosis and the kind of treatment she will need.
• Cervical cancer is staged from stage 0 (least severe) to stage IV (metastatic disease, the most severe).
• Staging is based on size and depth of the cancerous lesion, as well as degree of spread.

Cervical Cancer Treatment

Treatment of cervical cancer is directed at preventing precancerous cells from becoming cancerous cells.

• This is usually a step-by-step process, involving the removal of cells or tissue to diagnose cancer and to find out how far it has invaded.
• If the deepest cells removed by biopsy were normal, no further treatment may be needed.
• If the deepest cells removed by biopsy were cancerous or precancerous, this means the cancer has invaded farther than the biopsy. In these cases, treatment generally starts with removal of additional tissues. As these tissues are removed, they are checked for dysplastic change to be sure all the precancerous or cancerous cells have been removed from the body or are otherwise destroyed.

Cervical Cancer Self-Care at Home

Self-treatment is not appropriate for cancer under most circumstances. Without medical treatment, the cancer will continue to grow and spread. Eventually vital body organs will not be able to function properly because the cancer will take their oxygen and nutrients, crowd them out, or injure them. The result is very often death.
Although self-treatment is inappropriate, there are things a woman can do to reduce the physical and mental stresses of cancer and its treatment.
Maintaining good nutrition is one of the best things a woman can do.

• A woman may lose her appetite during treatment.
• Common side effects of chemotherapy, such as nausea, vomiting, and sores inside the mouth, can make eating difficult.
• However, people who eat well, taking in enough calories and protein, will have an easier time keeping their strength and energy up during the therapy. They are also better able to tolerate the side effects of therapy.
• A cancer specialist (oncologist) or gynecologist may be able to recommend a nutritionist who can provide suggestions for keeping up calorie and protein intake.

The following lifestyle changes may help keep a woman stronger and more comfortable during treatment:

• Physical activity will also help keep strength and energy level up. A woman should engage in mild physical activity that is comfortable but doesn't wear her out.
• Rest is equally important. A woman should get plenty of sleep each night and rest during the day if she needs to.
• A woman should quit smoking.
• A woman should avoid alcohol. She may not be able to drink alcohol with some of the medications she is taking. She should ask her health care professional.