Cervical Cancer

(Cancer of the Cervix)
  • Definition

    Cervical cancer is a disease in which cancer cells grow in the cervix. The cervix is the lower, narrow part of the uterus also known as the womb. It connects the uterus with the vagina.
    Cancer occurs when cells in the body divide without control or order. With cervical cancer, epithelial cervix cells that line the cervical canal divide without control or order. Normally, cells divide in a controlled manner. If cells keep dividing uncontrollably, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant tumors. Malignant tumors 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 like human papilloma virus (HPV) can cause cervical cells to begin the changes that can lead to cancer.
  • Risk Factors

    Cervical cancer is more common in women over 25 years old. Factors that may increase your risk of cervical cancer include:
    • Infection of the cervix with HPV—the main risk factor for cervical cancer
    • History of cervical dysplasia, which is a precancerous condition
    • Being a woman whose mother took the drug diethylstilbestrol (DES) during pregnancy
    • HIV/AIDS
    • Unprotected intercourse
    • Multiple sexual partners
    • Sexual activity prior to age 18
    • Smoking
    • First pregnancy prior to age 20
    • Breast cancer chemotherapy
    • Long-term use of hormonal contraceptives
  • Symptoms

    Symptoms usually do not appear until the abnormal cells become cancerous. Then, 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
    • Menstrual bleeding that lasts longer and is heavier than usual
    • Vaginal bleeding after menopause
    • Increased vaginal discharge that is not blood
    There may also be pelvic discomfort or backache.
  • Diagnosis

    Your doctor will need to examine your vagina and cervix. This can be done with:
    After cervical cancer is found, more tests are done to find out if the cancer has spread beyond the cervix, and, if so, to what extent. This process is called staging, which may be done with:
  • Treatment

    Treatment depends on the stage of the cancer and may include:
    Surgery
    The cancerous tumor, nearby tissue, and possibly nearby lymph nodes may be removed. The doctor may remove only the tumor and nearby normal tissue if the tumor is contained 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 are also 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 by 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 with surgery and/or radiation.
    This therapy may also be used to help control pain and bleeding when a cure is no longer possible.
    If you are diagnosed with cervical cancer, follow your doctor's instructions.
    If you are diagnosed with cervical cancer, follow your doctor's instructions.
  • Prevention

    Finding and treating precancerous tissue in the cervix is the best way to prevent cervical cancer. Talk to your doctor about when you should have pelvic exams and Pap tests done. Another good approach is to reduce your risk of exposure to the HPV virus. There are currently two methods to do this:
    • Safe sexual practice—Limit the number of sexual partners and use latex 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. A catch-up vaccine is given to young women who haven't been vaccinated.
    Screening
    The Pap test is used to screen for cervical cancer. It is also used to detect cervical dysplasia. A sample of cells is collected from the cervix to be tested. HPV can also be screened by testing the same sample of cells.
    If you are a healthy woman, many professional health organizations offer these recommendations for screening:
    • If you are aged 21-29 years—It is recommended that you have the Pap test every three years.
    • If you are aged 30-65—It is recommended that you have the Pap test and the HPV test every five years. Or, you can continue to have just the Pap test every three years.
    • If you are aged 65 or older—You may be able to stop having Pap and HPV tests if you have had normal results, such as 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 weak immune system or a history of cervical dysplasia or cervical cancer. Talk to your doctor about the right screening schedule for you.
  • RESOURCES

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

    National Cancer Institute http://www.cancer.gov

    CANADIAN RESOURCES

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

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

    References

    American College of Obstetricians and Gynecologists. ACOG Practice Bulletin 76: Postpartum hemorrhage. Obstet Gynecol. 2006;108(4):1039-47.

    American College of Obstetricians and Gynecologists. ACOG Practice Bulletin 109: Cervical cytology screening. Obstet Gynecol. 2009;114(6):1409-20.

    Cervical cancer. American Cancer Society website. Available at: http://www.cancer.org/cancer/cervicalcancer/index. Accessed January 6, 2014.

    Cervical cancer. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/cancer/cervical/. Updated September 5, 2013. Accessed January 6, 2014.

    Cervical cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 7, 2013. Accessed January 6, 2014.

    Cervical cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/cervical. Accessed January 6, 2014.

    Human papillomavirus (HPV) vaccines. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/factsheet/prevention/HPV-vaccine/. Updated December 29, 2011. Accessed January 6, 2014.

    Saslow D, Soloman D, Lawson H, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA: A Cancer Journal for Clinicians. 2012 Mar 14 early online.

    Sawaya GF. Cervical-cancer screening: new guidelines and the balance between benefits and harms. N Engl J Med. 2009;361(26):2503-2505.

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

    3/19/2012 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Screening for cervical cancer. US Preventive Services Task Force website. Available at: http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm. Published March 2012. Accessed January 6, 2014.

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