Posted By: Pankaj Patel
Cervical is a very slow growing type of cancer and therefore; it can sometimes take up to several years before any noticeable signs or cervical cancer symptoms usually start to show. Normally, a pap smear should show any abnormal cells or dysplasia (abnormal changes in the cells); but finding abnormal cells doesn't actually mean you have cervical cancer. Sometimes a pap smear test does not pick abnormal cells or cancer, and they aren't always 100 percent accurate. Try to understand your body; realize if something seems peculiar.
What is cervical cancer?
Cervical cancer occurs when abnormal cells on the cervix grow out of control. The cervix is the lower part of the uterus that opens into the vagina. Cervical cancer can often be successfully treated when it's found early. It is usually found at a very early stage through a Pap test.
Causes of Cervical cancer:
Most cervical cancer is caused by a virus called human papillomavirus, or HPV. You can get HPV by having sexual contact with someone who has it. There are many types of the HPV virus. Not all types of HPV cause cervical cancer. Some of them cause genital warts, but other types may not cause any symptoms. You can have HPV for years and not know it. It stays in your body and can lead to cervical cancer years after you were infected. This is why it is important for you to have regular Pap tests. A Pap test can find changes in cervical cells before they turn into cancer. If you treat these cell changes, you may prevent cervical cancer.
There are several risk factors for the development of cervical cancer, both genetic and environmental. These include:
- Human Papillomavirus (HPV) Infection
- Family History of Cervical Cancer
- Sexual and Reproductive History
- Socioeconomic Status
- HIV Infection
- In Utero DES Exposure
- Long-term use of oral contraceptives
Human Papillomavirus (HPV) Infection:
Human papillomavirus (HPV) produces epithelial tumors of the skin and mucous membranes. More than 100 HPV types are known, and the genomes of more than 80 have been completely sequenced. People with multiple sexual partners and those who already have persistent HPV infection are at increased risk for acquiring additional HPV strains.[1, 2, 3, 4] The current classification system, which is based on similarities in genomic sequences, generally correlates with the 3 clinical categories applied to HPV:
- Anogenital or mucosal
- Nongenital cutaneous
- Epidermodysplasia verruciformis (EV)
Infections due to HPV are common and lead to a wide variety of clinical manifestations that involve the epidermal surfaces. Condylomata acuminata (genital warts) are generally recognized as benign proliferations of the anogenital skin and mucosa resulting from HPV infection. Genital warts are transmitted by sexual contact. Approximately two thirds of individuals who have sexual contact with an infected partner develop genital warts. The exact incubation time is unknown but estimated to be 3 weeks to 8 months.
There is no cure or treatment for HPV infection. Even without treatment, most infections are cleared by the immune system within two years. If the infection persists there is an increased chance of viral DNA integration and progression to cancer. Women can be tested to learn if they are infected with HPV. Even though there is currently no cure for HPV infection, the knowledge can help women make responsible choices regarding their sexual practices.
Family History of Cervical Cancer:
Women with a family history of cervical cancer, especially an affected mother or sister, have a two-fold risk of developing cervical cancer, suggesting an inherited susceptibility. However, there does not appear to be a correlation between a family history of other cancer types (i.e. colon cancer) and the risk of developing cervical cancer.
Very few women under the age of 20 are diagnosed with cervical cancer and more than half of those diagnosed are between the ages of 35 and 55. The risk decreases after age 55, but 20% of cases occur in women over 60 years old. The pattern seen is due to two conflicting factors,
1) changes in sexual behaviors and
2) the tendency of genetic mutations to accumulate over time.
Sexual and Reproductive History:
Epidemiological studies have shown an increased risk for invasive cervical cancer attributable to sexual and reproductive behavior. Increased numbers of sexual partners and lower age at first sexual act have both been associated with increased risk. Women who have had multiple pregnancies and are younger at the time of their first full-term pregnancy also demonstrate an increased risk. Long term use of oral contraceptives has been shown to increase risk in some studies, but this remains controversial. A 2007 study suggests that ongoing use of oral contraceptives raised the risk of cervical cancer but the risk diminishes when use of the contraceptives is stopped. Because HPV is a sexually transmitted disease, behaviors that increase sexual contacts are considered risk factors.
Low socioeconomic status has proven to be a significant risk factor for invasive cervical cancer due to its large impact on education and medical resources. Results of the analysis of several epidemiological studies indicate that Hispanic and African-American women have a higher risk of invasive cervical cancer than Caucasian women.
Decreased risk is associated with increased education--women without a college degree have an increased risk, regardless of race. Therefore, it is possible that if access to screening and medical education were equalized, race would not prove to be a significant risk factor. The increased risk with low socioeconomic status is attributed to a lack of screening, failure to treat precancerous conditions, and lack of knowledge about prevention of HPV infection.
Current smoking is a risk factor for the development cervical cancer due to the ability of carcinogens in cigarette smoke to cause mutations in DNA. In the epidemiological studies that have been conducted, smoking was associated with an increased risk of squamous cell carcinoma of the cervix, but not adenocarcinoma.
Human Immunodeficiency Virus (HIV):
Women infected with HIV have been shown to have a five-fold risk of developing cervical cancer. HIV weakens the immune system, decreasing the ability to fight infection; therefore HPV infections are more likely to persist. This is thought to provide more time for the HPV to induce cancer. The high correlation between HIV infection and HPV infection is also partly due to the fact that both are sexually transmitted diseases and behaviors that put women at risk for one also put them at risk for the other.
In Utero Diethylstilbestrol (DES) Exposure:
DES is a synthetic estrogen used from the 1930s to the 1970s to reduce complications during pregnancy. Use of this drug was discontinued after it was demonstrated that the drug could harm the developing baby. Elevated risk of cervical cancer is just one of the potential health effects for women who where exposed to DES while they were in their mothers womb; others include a variety of gynecological cancers, reproductive tract irregularities, infertility and complications during pregnancy.
- Bleeding from the vagina that is not normal, or a change in your menstrual cycle that you can't explain.
- Bleeding when something comes in contact with your cervix, such as during sex or when you put in a diaphragm.
- Pain during sex.
- Vaginal discharge that is tinged with blood.
Cervical cancer may spread to the bladder, intestines, lungs, and liver. Patients with cervical cancer do not usually have problems until the cancer is advanced and has spread. Symptoms of advanced cervical cancer may include:
- Back pain
- Bone pain or fractures
- Leaking of urine or feces from the vagina
- Leg pain
- Loss of appetite
- Pelvic pain
- Single swollen leg
- Weight loss
Exams and Tests:
Precancerous changes of the cervix and cervical cancer cannot be seen with the naked eye. Special tests and tools are needed to spot such conditions. Pap smears screen for precancers and cancer, but do not make a 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.
- Cone biopsy may also be done.
- 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:
- Chest x-ray
- CT scan of the pelvis
- Intravenous pyelogram (IVP)
- MRI of the pelvis
Treatment of cervical cancer depends on:
- The stage of the cancer
- The size and shape of the tumor
- The woman's age and general health
- Her desire to have children in the future
Early cervical cancer can be cured by removing or destroying the precancerous 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:
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.
Treatment for more advanced cervical cancer may include:
- Radical hysterectomy, which removes the uterus and much of the surrounding tissues, including lymph nodes and the upper part of the vagina.
- Pelvic exenteration, an extreme type of surgery in which 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.