Definition

Cervical cancer is a disease in which cancer cells grow in the cervix. The cervix is the lower, narrow part of the uterus (womb) that connects the uterus with the vagina.

Cancer occurs when cells in the body (in this case, epithelial cervix cells lining the cervical canal) divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant tumors, which can invade nearby tissue and spread to other parts of the body. A benign tumor does not invade or spread.

Cervical Cancer


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Causes

Research suggests that some sexually transmitted viruses (eg, :: human papilloma virus ) can cause the nuclei in cervical cells to begin the changes that can lead to cancer.

Risk Factors

Scientists believe several risk factors act together. These include:

  • Infection of the cervix with the human papillomavirus (HPV)—the primary risk factor for cervical cancer
  • History of :: cervical dysplasia (a precancerous condition)
  • Being a woman whose mother took the drug :: diethylstilbestrol (DES) during pregnancy
  • :: HIV/AIDS
  • Age: over 25 years old
  • Multiple sexual partners
  • Sexual activity prior to age 18
  • First pregnancy prior to age 20
  • :: Smoking

Symptoms

Symptoms usually do not appear until the abnormal cells become cancerous. They invade nearby tissue. When this happens, the most common symptom is abnormal bleeding, which may include:

  • Bleeding between regular menstrual periods
  • Bleeding after sexual intercourse, douching, or a pelvic exam (most common)
  • Menstrual bleeding that lasts longer and is heavier than usual
  • Vaginal bleeding after :: menopause
  • Increased vaginal discharge that is not blood

These symptoms may also be caused by other, less serious health conditions. If you experience these symptoms, see you doctor.

Screening
  • Pap test—This is a test used to screen healthy women for cervical cancer. It will also detect cervical dysplasia. The doctor collects a sample of cells from the cervix to be tested.
    • If you are aged 21-29 years—It is recommended that you have the Pap test every two years.
    • If you are aged 30 or older—It is recommended that you have the Pap test every three years.
    • If you are aged 65 or older—You may be able to stop having Pap tests if you have had three normal results in a row and no abnormal results in the past 10 years.
    • Note: You will need to have Pap tests done more often if you have abnormal results or certain conditions, like a suppressed immune system or a history of cervical dysplasia or cervical cancer. Talk to your doctor about the right screening schedule for you.
  • HPV test—The same cervical sample obtained from the Pap test can be tested for the HPV virus.
Diagnosis

Tests to diagnose cervical cancer include:

  • :: Colposcopy —This is an exam of the vagina and cervix. The procedure uses a lighted magnifying instrument. It is needed if the Pap test suggests the presence of cervical dysplasia (precancer) or cancer.
  • :: Biopsy —This is done on any suspicious areas observed during the colposcopy. The removed tissue is tested for the presence of cancer cells.

Treatment

Once cervical cancer is found, further tests are performed to find out if the cancer has spread beyond the cervix, and, if so, to what extent. This process is called staging. Treatment depends on the stage of the cancer.

Treatments include:

Surgery

The cancerous tumor, nearby tissue, and possibly nearby lymph nodes may be removed. The doctor may remove only the tumor and surrounding normal tissue if the tumor is very localized within the cervix. In some cases, a :: hysterectomy is necessary.

If the cancer is at a high stage, more tissue must be removed. Sometimes the ovaries and fallopian tubes also are removed.

Radiation Therapy (Radiotherapy)

:: Radiation therapy is the use of radiation to kill cancer cells and shrink tumors. Radiation may be given in two ways:

  • External radiation therapy—radiation directed at the tumor from a source outside the body
  • Internal radiation therapy—radioactive materials placed in or near the cancer cells

Chemotherapy

:: Chemotherapy is the use of toxic drugs to kill cancer cells. It may be given in many forms including: pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body. It kills mostly cancer cells, but also some healthy cells. Chemotherapy alone rarely cures cervical cancer. It may be used in addition to surgery and/or radiation.

This therapy may also be used to help control pain and bleeding when a cure is no longer possible.

Chemotherapy is usually combined with radiation therapy.

If you are diagnosed with cervical cancer, follow your doctor's instructions .

Prevention

Finding and treating precancerous tissue in the cervix is the most effective way to prevent cervical cancer. Talk to your doctor about when you should have pelvic exams and Pap tests done. Another effective approach is to reduce your risk of exposure to the HPV virus. There are currently two methods to accomplish this:

  • Safe sexual practice—Limit the number of sexual partners and use condoms.
  • :: HPV vaccines —The vaccines protect you against some types of HPV. One vaccine, called Gardasil, is used to prevent cervical cancer by protecting against four types of HPV. Another vaccine, called Cervarix, is also approved for prevention by protecting against two HPV types. The vaccines are routinely given to girls aged 11-12 years old, and a "catch-up" vaccine is given to young women who haven't been vaccinated.

RESOURCES:

American Cancer Society
http://www.cancer.org/

National Cervical Cancer Coalition
http://www.nccc-online.org/

CANADIAN RESOURCES:

Canadian Cancer Society
http://www.cancer.ca/

Women's Health Matters
http://www.womenshealthmatters.ca/

References:

American College of Obstetricians and Gynecologists. First cervical cancer screening delayed until age 21 less frequent Pap tests recommended. American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/from_home/publications/press_releases/nr11-20-09.cfm . Published November 20, 2009. Accessed November 23, 2009.

American College of Obstetricians and Gynecologists. Postpartum hemorrhage. In: ACOG Practice Bulletin 76. October 2006.

Cervarix. GlaxoSmithKline Cervarix website. Available at: http://www.cervarix.com/. Accessed December 23, 2009.

Cervical cancer. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/cancer/cervical/ . Accessed July 11, 2008.

Cervical cancer homepage. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/cervical . Accessed July 11, 2008.

Grady D. Guidelines push back age for cervical cancer tests. The New York Times website. Available at: http://www.nytimes.com/2009/11/20/health/20pap.html?_r=1 . Published November 20, 2009. Accessed November 23, 2009.

What is cervical cancer? American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_cervical_cancer_8.asp . Accessed July 11, 2008.

5/18/2007 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : The FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007;356:1915-1927.



Last reviewed July 2010 by :: Mohei Abouzied, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.