Cancer Information

What is Cervical Cancer?

Cervical cancer is in tissues of the cervix, an organ connecting the uterus and vagina, the part of the uterus or womb that opens to the vagina. Cervical cancer was once thenumber onecause of death from cancer in women. Thanks to the Pap test, the numberof women in the U.S. with cervical cancer has decreased dramatically. It is usually a slow-growing cancer that may not have symptoms, but can be found with regular Pap smears a procedure in which cells are scraped from the cervix and looked at under a microscope.

ANATOMY OF THE CERVIX

The cervix is the lower part of the uterus, a female reproductive organ. Both the uterus and the cervix are located in the woman’s pelvis, and are in close contact with other pelvic organs, such as the bladder, rectum, ovaries, and the upper part of the vagina. The cervix connects the uterus and the vagina, which leads to the outside of the body.

RISK FACTORS

The Human papillomavirus (HPV) infection is the major risk factor for development of cervical cancer.Infection of the cervix with human papillomavirus is the most common cause of cervical cancer. An HPV infection is usually harmless and temporary; most people with HPV never know they are infected because the virus tends to go away on its own. Not all women with HPV infection, however, will develop cervical cancer. Women who do not regularly have a Pap smear to detect HPV or abnormal cells in the cervix are at increased risk of cervical cancer. New research is on the horizon. An experimental vaccine preventing young women from becoming persistently infected with two types of the HPV that, together, cause more than two-thirds of all cases of cervical cancer.

Other possible risk factors include the following:

• Giving birth to many children
• Having many sexual partners
• Having first sexual intercourse at a young age
• Smoking cigarettes
• Lack of regular screening
  
• Oral contraceptive use
  
• Weakened immune system

SCREENING

Women found to have pre-cancerous changes on their cervix must be watched closely and/or treated to reduce their risk of developing cancer. Cervical pre-cancers are common and have no symptoms. Without Pap smear screening neither women nor their doctors can tell that a woman has early changes that could lead to cancer.

The Food and Drug Administration (FDA) has approved a new screening option for cervical cancer for women 30 and older. The new test combines the regular Pap test with a test for high-risk HPV. This combined test allows a woman and her physician to better understand her risk of developing cervical cancer. The Pap test can determine if there are any abnormal cells while the HPV test checks directly for high-risk HPV. The new combined test is not recommended for women under 30 because HPV is very common in women under age 30 and cervical cancer is very rare in this age group. In most women under 30 who have HPV, the virus will go away before it causes any cell changes or symptoms. Including an HPV test along the Pap test provides no real health benefit for younger women.

A Pap test is the standard way to see if there are any cell changes that cause concern. The Pap test looks at a sample of cells from the cervix under a microscope to see if there are any cells that are abnormal. The Pap test is simple and relatively painless. The best time for a woman to have a Pap test is 10 to 20 days after her period. The doctor uses a speculum, to examine the upper part of the vagina and the cervix. The doctor then uses a small, soft brush to collect cells from the cervix and vagina. These cells are sent to a medical laboratory to be looked at under a microscope.

DIAGNOSIS

Some early cervical cancers may be diagnosed during a pelvic exam. The doctor can see most invasive cancers during an examination. If the doctor or nurse notices something suspicious in the pelvic exam or Pap test, the following tests can help the doctor determine whether the woman has cervical cancer:

• Colposcopy. A colposcopy is a test that helps find abnormal areas in the cervix. A vinegar-like solution (3 to 5 percent acetic acid) is placed on the cervix. The cervix is then visually examined with a colposcope, which is like a microscope.
• Biopsy. In a biopsy, cervical tissues is removed so that a pathologist can look at it under the microscope.
• Endocervical curettage (ECC). In an endocervical curettage (ECC), the doctor will scrape tissue from the opening of the cervix in order to examine it more closely.
• Loop Electrosurgical Excision Procedure (LEEP) or Conization. The doctor may want to use this procedure to look at cells that are deeper in the tissue of the cervix. A LEEP is the most common office procedure used to detect and remove cervical intraepithelial neoplasia, CIN (a change in the surface cells of the cervix). The advantage of this procedure is that it can often be performed in the doctor's office after injection of an anesthetic into the cervix to cause numbing. The presence of CIN does not mean that you have cancer, but detection and treatment of CIN is important to avoid the possible development of cervical cancer.

SYMPTOMS of CERVICAL CANCER

Women with precancerous lesions in their cervix usually have no symptoms. That is why it is important that women have regular Pap tests. A woman usually does not have any symptoms until the cells turn into cancer and invade the deepest parts of the cervix or other pelvic organs.

In the early stages of cervical cancer a woman may have few symptoms and these may not be alarming to her. Some early symptoms may include:

• Vaginal discharge. Cervical cancer can cause more vaginal discharge than usual. This discharge is often bloody or foul-smelling.
• Abnormal vaginal bleeding. A woman with cervical cancer may have bleeding between her periods or following sexual intercourse. Blood flow during her period may be heavier and last longer than usual.
• Odor. A woman with cervical cancer may notice a strange or unpleasant odor.
• Pain. A woman who has cervical cancer may experience pain during sex, or spontaneous pain in the pelvic area.