What Is Cervical Cancer?
Cervical
cancer occurs when abnormal cells develop and spread in the cervix, the
lower part of the uterus. More than 12,000 new cases are diagnosed each
year in the U.S. A unique fact about cervical cancer is that most cases
are triggered by a type of virus. When found early, cervical cancer is
highly curable.
Symptoms of Cervical Cancer
When cervical cells first become abnormal, there are rarely any warning signs. As the cancer progresses,
symptoms may include:
- Unusual vaginal discharge
- Vaginal bleeding between periods
- Bleeding after menopause
- Bleeding or pain during sex
Top Cause of Cervical Cancer: HPV
The
human papillomavirus (HPV) is a large group of viruses. About 40 types
can infect the genital areas, and some have high risk for cervical
cancer. Genital HPV infections usually clear up on their own. If one
becomes chronic, it can cause changes in the cells of the cervix. And
it's these changes that may lead to cancer. Worldwide, over 90% of
cervical cancers are caused by an HPV infection.
Symptoms of HPV
HPV
infections usually have no symptoms and go away on their own. Some
types of the HPV virus may cause genital warts, but these are not the
same strains linked to cervical cancer. It's important to note that
genital warts will not turn into cancer, even if they are not treated.
The dangerous types of HPV can stay in the body for years without
causing any symptoms.
Who Is at Risk for HPV?
HPV
is so common that most people who have ever had sex -- both women and
men -- will get the virus at some point in life. Because HPV can linger
quietly, it's possible to carry the infection even if it has been years
since you had sex. Condoms can lower your risk of getting HPV, but they
do not fully protect against the virus. HPV is also linked to cancers of
the vulva, vagina, penis, and to anal and oral cancers in both sexes.
How HPV Causes Cervical Cancer
If
one of the high-risk strains of HPV lingers in the body, it can cause
abnormal cells to develop in the cervix. These precancerous changes do
not mean that you have cervical cancer. But over time, the abnormal
cells may give way to cancer cells. Once cancer appears, it tends to
spread in the cervix and surrounding areas.
What Else Raises Your Risk?
Hispanic
and African-American women have higher rates of cervical cancer than
white women. The risk is also higher in infected women who:
- Smoke
- Have many children
- Use birth control pills for a long time
- Are HIV positive or have a weakened immune system
Early Detection: Pap Test
The
Pap test is one of the great success stories in early detection. A swab
of the cervix can reveal abnormal cells, often before cancer appears.
At age 21, women should start having a Pap test every three years. From
age 30 to 65, women who get both a Pap test and an HPV test can go up to
five years between testing. But women at higher risk may need testing
more often, so it's best to check with your doctor. Skipping tests
raises your risk for invasive cervical cancer.
Of note: You'll still need Pap tests after getting the HPV vaccine because it doesn't prevent all cervical cancers.
What If Your Pap Test Is Abnormal?
If
test results show a minor abnormality, you may need a repeat Pap test.
Your doctor may schedule a colposcopy -- an exam with a lighted
magnifying device -- to get a better look at any changes in the cervical
tissue and also take a sample to be examined under a microscope. If
abnormal cells are precancerous, they can then be removed or destroyed.
Treatments are highly successful in preventing precancerous cells from
developing into cancer.
Early Detection: HPV DNA Test
In
some cases, doctors may offer the option of the HPV DNA test in
addition to a Pap test. This test checks for the presence of high-risk
forms of HPV. It may be used in combination with a Pap test to screen
for cervical cancer in women over 30. It may also be recommended for a
woman of any age after an abnormal Pap test result.
Diagnosing Cervical Cancer: Biopsy
A
biopsy involves the removal of cervical tissue for examination in a
lab. A pathologist will check the tissue sample for abnormal changes,
precancerous cells, and cancer cells. In most cases, a biopsy takes
place in a doctor's office during a colposcopy. A cone biopsy allows the
pathologist to check for abnormal cells beneath the surface of the
cervix, but this test may require anesthesia.
Stages of Cervical Cancer
Stage
0 describes cancer cells found only on the surface of the cervix. More
invasive cancers are separated into four stages. Stage I - the cancer
has grown beyond the cervix and uterus, but hasn't spread to the walls
of the pelvis or the lower part of the vagina. Stage II -the cancer has
spread to the lower part of the vagina or the walls of the pelvis. A
Stage III tumor extends to the lower part of the vagina and may block
urine flow. It hasn't spread to lymph nodes. In Stage IV - this is the
most advanced stage of cervical cancer. The cancer has spread to nearby
organs or other parts of the body.
Treatment: Surgery
If
the cancer has not progressed past Stage II, surgery is usually
recommended to remove any tissue that might contain cancer. Surgical
treatment options vary from cervical conization to simple hysterectomy
to radical hysterectomy. A radical hysterectomy includes, the removal of
the cervix and uterus as well as some of the surrounding tissue. The
surgeon may also remove the fallopian tubes, ovaries, and lymph nodes
near the tumor.
Treatment: Radiation
External
radiation therapy uses high-energy X-rays to kill cancer cells in a
targeted area. It can also help destroy any remaining cancer cells after
surgery. Internal radiation, or brachytherapy, uses radioactive
material that is inserted into the tumor. Women with cervical cancer are
often treated with a combination of radiation and chemotherapy. Side
effects can include low blood cell counts, feeling tired, upset stomach,
nausea, vomiting, and loose stools.
Treatment: Chemotherapy
Chemotherapy
uses drugs to reach cancer wherever it is in the body. When cervical
cancer has spread to distant organs, chemotherapy may be the main
treatment option. Depending on the specific drugs and dosages, side
effects may include fatigue, bruising easily, hair loss, nausea,
vomiting, and loss of appetite.
Coping With Cancer Treatments
Cancer
treatments may make you tired or uninterested in food. But it's
important to take in enough calories to maintain a healthy weight. Check
with a dietitian for tips on eating well during cancer treatment.
Staying active is also important. Gentle exercise can increase your
energy while reducing nausea and stress. Check with your doctor to find
out which activities are appropriate for you.
Cervical Cancer and Fertility
Treatment
for cervical cancer often involves removing the uterus and may also
involve removing the ovaries, ruling out a future pregnancy
.
However, if the cancer is caught very early, you still may be able to
have children after surgical treatment. A procedure called a radical
trachelectomy can remove the cervix and part of the vagina while leaving
the majority of the uterus intact.
Survival Rates for Cervical Cancer
The
odds of surviving cervical cancer are tied to how early it's found.
Almost 68% of women overall will survive for at least five years after
diagnosis. But statistics don't predict how well any one individual will
respond to treatment.
Vaccine to Help Prevent Cervical Cancer
Vaccines
are now available to ward off the two types of HPV most strongly linked
to cervical cancer. Both Cervarix and Gardasil require three doses over
a six-month period. Studies suggest the vaccines are effective at
preventing chronic infections with the two types of HPV that cause 70%
of cervical cancers. Gardasil also protects against two types of HPV
that cause genital warts. Gardasil-9 has been proven as effective as
Gardasil for the prevention of diseases caused by the four shared HPV
types (6, 11, 16, and 18). It also protects against five other strains
of HPV virus (31, 33, 45, 52, and 58).
Who Should Get the HPV Vaccine?
The
vaccines are only used to prevent, not treat, HPV infection. They are
most effective if administered before an individual becomes sexually
active. The CDC recommends boys and girls get an HPV vaccine series when
they are 9 to 26.
