Cervical cancer Health Article

Definition

Cervical cancer is cancer that starts in the cervix, the lower part of the uterus (womb) that opens at the top of the vagina. 

Alternative Names

Cancer - cervix

Causes, incidence, and risk factors

Worldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the United States because of routine use of Pap smears.

Cervical cancers start in the cells on the surface of the cervix. There are two types of cells on the cervix's surface: squamous and columnar. The majority of cervical cancers are from squamous cells.

The development of cervical cancer is very slow. It starts as a pre-cancerous condition called dysplasia. This pre-cancerous condition can be detected by a Pap smear and is 100% treatable. That is why it is so important for women to get regular Pap smears. Most women that are diagnosed with cervical cancer today have not had regular Pap smears or they have not followed up on abnormal results.

Undetected, pre-cancerous changes can develop into cervical cancer and spread to the bladder, intestines, lungs, and liver. It can take years for pre-cancerous changes to turn into cervical cancer. Patients with cervical cancer do not usually have problems until the cancer is advanced and has spread.

Almost all cervical cancers are caused by HPV (human papilloma virus). HPV is a common virus that is spread through sexual intercourse. There are many different types of HPV, and many do not cause problems. However, only certain strains of HPV actually lead to cervical cancer. (Other strains may cause genital warts.)

Other risk factors for cervical cancer include:

• Having sex at an early age
• Multiple sexual partners
• Sexual partners who have multiple partners or who participate in high-risk sexual activities
• Women whose mothers took the drug DES (diethylstilbestrol) during pregnancy in the early 1970s to prevent miscarriage
• Long-term use of birth control pills (more than 5 years)
• Weakened immune system
• Infections with genital herpes or chronic chlamydia infections
• Poor economic status (may not be able to afford regular Pap smears)

Symptoms

Most ot the time, early cervical cancer has no symptoms. Symptoms that may occur can include:

• Continuous vaginal discharge, which may be pale, watery, pink, brown, bloody, or foul-smelling
• Abnormal vaginal bleeding between periods, after intercourse, or after menopause
• Periods become heavier and last longer than usual

Symptoms of advanced cervical cancer may include:

• Loss of appetite
• Weight loss
• Fatigue
• Pelvic pain
• Back pain
• Leg pain
• Single swollen leg
• Heavy bleeding from the vagina
• Leaking of urine or feces from the vagina
• Bone fractures

Signs and tests

Pre-cancerous changes of the cervix and cervical cancer can not be seen with the naked eye. Special tests and tools are needed to spot such conditions.

Pap smears screen for pre-cancers and cancer, but do not offer the final diagnosis. If abnormal changes are found, the cervix is usually examined under magnification. This is called colposcopy. Pieces of tissue are surgically removed (biopsied) during this procedure and sent to a laboratory for examination.  

Other tests may include:

• Endocervical curettage (ECC) to examine the opening of the cervix
• Cone biopsy

If the woman is diagnosed with cervical cancer, the health care provider will order more tests to determine how far the cancer has spread. This is called staging. Tests may include:

• CT scan
• Cystoscopy
• MRI
• Chest x-ray
• Intravenous pyelogram (IVP)

Treatment

Treatment of cervical cancer depends on the stage of the cancer, the size and shape of the tumor, the age and general health of the woman, and her desire to have children in the future.

Early cervical cancer can be cured by removing or destroying the pre-cancerous or cancerous tissue. There are various surgical ways to do this without removing the uterus or damaging the cervix, so that a woman can still have children in the future.

Types of surgery for early cervical cancer include:

• LEEP (Loop Electrosurgical Excision Procedure) - uses electricity to remove abnormal tissue
• Cryotherapy - freezes abnormal cells
• Laser therapy  - uses light to burn abnormal tissue

A hysterectomy (removal of the uterus but not the ovaries) is not often performed for cervical cancer that has not spread. It may be done in women who have repeated LEEP procedures. However, in more advanced disease, a radical hysterectomy may be performed. This type of hysterectomy removes the uterus and much of the surrounding tissues, including internal lymph nodes and upper part of the vagina. In the most extreme surgery, called a pelvic exenteration, all of the organs of the pelvis, including the bladder and rectum, are removed.

Radiation may be used to treat cancer that has spread beyond the pelvis, or cancer that has returned. Radiation therapy is either external or internal. Internal radiation therapy uses a device filled with radioactive material, which is placed inside the woman's vagina next to the cervical cancer. The device is removed when she goes home. External radiation therapy beams radiation from a large machine onto the body where the cancer is located. It is similar to an x-ray.

Chemotherapy uses drugs to kill cancer. Some of the drugs used for chemotherapy for cervical cancer include 5-FU, Cisplatin, Carboplatin, Ifosfamide, Paclitaxel, and Cyclophosphamide. Sometimes radiation and chemotherapy are used before or after surgery.