Cervical Cancer

What is the cervix?
The cervix is the lower, narrow part of the uterus (womb) located between the bladder and the rectum. It forms a canal that opens into the vagina, which leads to the outside of the body.

What are precancerous conditions of the cervix?
Precancerous conditions of the cervix are identified as cells that appear to be abnormal, but are not cancerous at the present time. However, the appearance of these abnormal cells may be the first evidence of cancer that develops years later.

Precancerous changes of the cervix usually do not cause pain and, in general, do not cause any symptoms. They are detected with a pelvic exam or a Pap test. Squamous intraepithelial lesions (SIL) is a term that refers to abnormal changes in the cells on the surface of the cervix.

• squamous cells are the flat cells found on the surface (of the cervix)
• lesion refers to an area of abnormal tissue
• intraepithelial means that the abnormal cells are present only in the surface layer of cells

According to the National Cancer Institute, changes in these cells can be divided into two categories:

• Low-grade SIL refers to early changes in the size, shape, and number of cells that form the surface of the cervix. They may go away on their own, or, with time, may grow larger or become more abnormal, forming a high-grade lesion.
  
  These precancerous low-grade lesions may also be called mild dysplasia or cervical intraepithelial neoplasia 1 (CIN 1). These early changes most often occur in women between the ages of 25 and 35, but can appear in other age groups as well.

• High-grade SIL means there are a large number of precancerous cells, and, like low-grade SIL, these precancerous changes involve only cells on the surface of the cervix. The cells often do not become cancerous or invade deeper layers of the cervix for many months, perhaps years.
  
  High-grade lesions may also be called moderate or severe dysplasia, CIN 2 or 3, or carcinoma in situ. They develop most often in women between the ages of 30 and 40, but can occur in other age groups as well.

What is cancer of the cervix?
If abnormal cells on the surface of the cervix spread deeper into the cervix, or to other tissues or organs, the disease is then called cervical cancer, or invasive cervical cancer. Cervical cancer occurs most often in women over the age of 40. It is different from cancer that begins in other parts of the uterus and requires different treatment. Most cervical cancers are squamous cell carcinomas and adenocarcinomas.

• infection with the human papillomavirus (HPV), most often as the result of unprotected sex

• infection with the human immunodeficiency virus (HIV) -- the precursor to AIDS, or other conditions that weaken the immune system

• smoking

• low socioeconomic level

• poor diet

• having sexual intercourse before the age of 18

• having many sexual partners, and having partners who have had sexual intercourse at a young age and/or have had many partners themselves

Can cervical cancer be prevented?
Early detection of cervical problems is the best way to prevent cervical cancer. Routine, annual pelvic examinations and Pap tests can detect precancerous conditions that often can be treated before cancer develops. Invasive cancer that does occur would likely be found at an earlier stage. Pelvic examinations and Pap tests are the methods used to determine if there are cervical problems. Women who are or have been sexually active, or are age 18 or older, should have regular checkups, including a pelvic exam and Pap test.

According to the National Institutes of Health:

A pelvic exam and Pap test allow the physician to detect abnormal changes in the cervix. If an infection is present, it is treated and the Pap test is repeated at a later time. If the exam or Pap test suggests something other than an infection, a repeated Pap test and other tests are performed to determine the problem.

Women who have had a hysterectomy (surgery to remove the uterus, including the cervix) should ask their physician's advice about having pelvic exams and Pap tests.

What are symptoms of cervical cancer?
Symptoms of cervical cancer usually do not appear until abnormal cervical cells become cancerous and invade nearby tissue.

• The most common symptom is abnormal bleeding, which may:

• start and stop between regular menstrual periods.
• occur after sexual intercourse, douching, or a pelvic exam.

• Other symptoms may include:

• heavier menstrual bleeding, which may last longer than usual
• bleeding after menopause
• increased vaginal discharge
• pain during intercourse

These symptoms may be caused by cancer or other health problems. Only a physical examination can tell for sure. It is important for a woman to see her physician if she is having any of these symptoms.

How is cervical cancer diagnosed?
When cervical problems are found during a pelvic examination, or abnormal cells are found through a Pap test, the following procedures may be used to further diagnose the findings:

• colposcopy
• biopsy
• endocervical curettage (ECC)
• dilatation and curettage (D and C)

How may cervical cancer be treated?
Specific treatment for cervical cancer will be determined by your physician(s) based on:

• your overall health and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Generally, treatment options include:

• surgery, including:

• cryosurgery
• laser surgery
• hysterectomy

• radiation therapy
• chemotherapy
• other

LEEP or conization can also be used to remove the abnormal tissue. In some cases, a hysterectomy may be required, particularly if abnormal cells are found inside the opening of the cervix.