Definition

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

Causes

Cancer occurs when cells in the body divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant growths. These growths can invade nearby tissues. Cancer that has invaded nearby tissues can then spread to other parts of the body.

Research suggests that some sexually transmitted viruses, like human papillomavirus (HPV), can cause cervical cells to begin the changes that can lead to cancer.

It is not clear exactly what causes changes in the cells, but is probably a combination of genetics and environment.

Risk Factors

Cervical cancer is more common in women over 25 years old. Other factors that may increase your chance of cervical cancer include:

• HPV infection—the main risk factor for cervical cancer
• History of cervical dysplasia, which is a precancerous condition
• Daughter of a mother who took the drug diethylstilbestrol (DES) during pregnancy
• HIV infection
• Unprotected intercourse
• Multiple sexual partners
• Sexual activity prior to age 18
• Smoking
• Obesity
• 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 a backache.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. This will include an examination of the vagina and cervix.

Tests may include:

• Blood and urine tests
• Colposcopy —a lighted, magnifying instrument is used to examine the cervix
• Biopsy —removal of a sample of cervical tissue for testing
• A sentinel lymph node biopsy

Imaging tests may include:

• CT scan
• MRI scan
• PET scan

The physical exam combined with all of your test results, will help to determine the stage of cancer you have. Staging is used to guide your treatment plan. Like other cancers, cervical cancer is staged from I-IV. Stage I is a very localized cancer, while stage IV indicates a spread to other parts of the body.

Treatment

Treatment depends on the stage of the cancer and may include:

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 Pap tests done. Another good approach is to reduce your risk of exposure to the HPV virus. There are currently 2 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 4 types of HPV. Another vaccine, called Cervarix, is also approved for prevention by protecting against 2 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.

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

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