Cervical Cancer

Q. What is the Cervix?

A. The cervix is the name for the lowest part of the uterus. The uterus is an organ that only women have, and it is where a baby grows and develops when a woman is pregnant. During pregnancy, the uterus has an enormous increase in size. When a woman is not pregnant, the uterus is a small, pear-shaped organ that sits between a womans rectum and her bladder. The cervix connects the uterus with the birth canal (the vagina). The cervix can both be visualized and sampled by your doctor during a routine pelvic examination in his or her office.

Q. What is Cervical Cancer?

A. Cervical cancer happens when cells in the cervix begin to grow out of control and can then invade nearby tissues or spread throughout the body. Large collections of this out of control tissue are called tumors. However, some tumors are not really cancer because they cannot spread or threaten someones life. These are called benign tumors. The tumors that can spread throughout the body or invade nearby tissues are considered cancer and are called malignant tumors. Usually, cervix cancer is very slow growing although in certain circumstances it can grow and spread quickly. Cancers are characterized by the cells that they originally form from. The most common type of cervical cancer is called squamous cell carcinoma; it comes from cells that lie on the surface of the cervix known as squamous cells. Squamous cell cervical cancer compromises majority of all cervical cancers. The second most common form is adenocarcinoma; it comes from cells that make up glands in the cervix. The percentage of cervical cancers that are adenocarcinomas has risen since the 1970s, although no one knows exactly why. Very few of cervical cancers have characteristics of both squamous and adenocarcinomas and are called adenosquamous carcinomas. There are a few other very rare types like small cell and neuroendocrine carcinoma that are so infrequent they will not be discussed further.

Q. Am I at risk for Cervical Cancer?

A. Cervical cancer is vastly more common in developing nations than it is in developed nations, particularly the United States. However, cervical cancer is the 2nd most common cause of cancer death in developing nations, Most of this decrease is attributed to the effective institution of cervical cancer screening programs in the wealthier nations. Although there are several known risk factors for getting cervical cancer, no one knows exactly why one woman gets it and another doesnt. One of the most important risk factors for cervical cancer is infection with a virus called HPV (human papillomavirus). HPV is a sexually transmitted disease that is incredibly common in the population. HPV is the virus that causes genital warts, but having genital warts doesnt necessarily mean you are going to get cervical cancer. There are different subtypes, or strains, of HPV. Only certain subtypes are likely to cause cervical cancer, and the subtypes that cause warts are unlikely to cause a cancer. Often, infection with HPV causes no symptoms at all, until a woman develops a pre-cancerous lesion of the cervix. It should be stressed that only a very small percentage of women who have HPV will develop cervical cancer; so simply having HPV doesnt mean that you will get sick. However, almost all cervical cancers have evidence of HPV virus in them, so infection is a major risk factor for developing it. Because infection with a sexually transmitted disease is a risk factor for cervical cancer, any risk factors for developing sexually transmitted diseases are also risk factors for developing cervical cancer. Women who have had multiple male sexual partners, began having sexual intercourse at an early age, or have had male sexual partners who are considered high risk (meaning that they have had many sexual partners and/or began having sexual intercourse at an early age) are at a higher risk for developing cervical cancer. Also, contracting any other sexually transmitted diseases (like herpes, gonorrhea, syphilis, or chlamydia) increases a woman risk. HIV infection is another risk factor for cervical cancer, but it may be so for a slightly different reason. It seems that any condition that weakens your immune system also increases your risk for developing cervical cancer. Conditions that weaken your immune system include HIV, having had an organ transplantation, and Hodgkin disease. There also seems to be slightly increased risk of developing cervical cancer if your male sexual partners are uncircumcised. Another important risk factor for developing cervical cancer is smoking. Smokers are at least twice as likely as non-smokers to develop cervix tumors. Smoking may also increase the importance of the other risk factors for cancer. Finally, being in a low socioeconomic group seems to increase your likelihood for developing and dying from cervical cancer. This may be because of increased smoking rates, or perhaps because there are more barriers to getting annual screening exams. Cervical cancer is one of the few cancers that affects young women (in their twenties and even their teens), so no one who is sexually active is really too young to begin screening. Also, the risk for cervical cancer ever decline, so no one is too old to continue screening. Remember that all risk factors are based on probabilities, and even someone without any risk factors can still get cervical cancer. Proper screening and early detection are our best weapons in reducing the mortality associated with this disease, says Dr. tarang Krishna, cancer Physician treating cervical cancers with Cancer Healer

Q. How can I prevent Cervical Cancer?

A. Right now, the most important thing any woman can do to decrease her risk of dying from cervix cancer is to undergo regular Pap testing. Pap tests will be discussed further in the next section, but the reason that women have had such a drastic drop in cervical cancer cases and deaths in this country has been because of the Pap test and annual screening. In terms of prevention, the next most important thing to do is to modify the risk factors that you have control over. Dont start smoking, and if you are already a smoker, it is time to quit. Women can limit their numbers of sexual partners, and delay the onset of sexual activity. Unfortunately, condoms do not protect you from developing HPV, so even though they can protect you from other sexually transmitted diseases and HIV, they cannot help lower your risk for developing cervical cancer. Many people are interested in preventing cervical cancer with vitamins or diets. Studies looking at beta-carotene and folic acid for preventing cervical cancer have shown no benefit. Some people think that anti-oxidants (like vitamin A and vitamin E) may play a role in cervical cancer prevention, but there is currently no convincing data that would suggest so. Further studies need to be performed before any nutritional recommendations can be made regarding cervix cancer prevention. Finally, there is hope that one day there will be an effective vaccine against HPV. If we were able to stop HPV infection, then rates of cervical cancer should plummet. This is an especially appealing strategy in third-world nations that dont have the resources to implement Pap screening like developed countries. However, an effective vaccine does not currently exist. The future may show this idea bear fruit, but for right now, the most important thing anyone can do to prevent cervical cancer is to get their annual screening exams with Pap tests.

Q. What screening tests are available?

A. Cervical cancer is considered a preventable disease. It usually takes a very long time for pre-cancerous lesions to progress to invasive cancers and we have effective screening methods that can detect pre-cancerous lesions that can generally be treated without serious side effects. Effective screening programs in the United States have led to the drastic decline in the numbers of cervical cancer deaths in the last 50 years. For women who do end up with cervical cancer in developed nations, most of them either have never been screened or have not been screened in the last five years. The importance of regular cervical cancer screening cannot be overstated.

Q. What are the signs of Cervical Cancer?

A. Unfortunately, the early stages of cervical cancer usually do not have any symptoms. This is why it is important to have screening Pap tests. As a tumor grows in size, it can produce a variety of symptoms including: abnormal bleeding (including bleeding after sexual intercourse, in between periods, heavier/longer lasting menstrual bleeding, or bleeding after menopause) abnormal vaginal discharge (may be foul smelling) pelvic or back pain pain on urination blood in the stool or urine Many of these symptoms are non-specific, and could represent a variety of different conditions; however, your doctor needs to see you if you have any of these problems.

Q. How is cervical cancer diagnosed and staged?

A. The most common reason for your doctor to pursue the diagnosis of cervical cancer is if you have an abnormal Pap test. Pap tests exist to find pre-cancerous lesions in your cervix. A pre-cancerous lesion means that there are abnormal appearing cancer cells, but they have not invaded past a tissue barrier in your cervix; thus a pre-cancerous lesion cannot spread or harm you. However, if left untreated, a pre-cancerous lesion can evolve to an invasive cancer. Pap tests are reported as no abnormal cells, abnormal cells of undetermined significance, low risk abnormal cells or high risk abnormal cells. Depending on your specific case, your doctor will decide how to proceed.