Cervical Cancer

Cervical cancer accounts for about 4% of all cancers found in women. Each year, about 15,000 women in the United States learn that they have this type of cancer.

Cancer of the cervix, the lower, narrow part of the uterus, can occur at any age, but is found most often in women over the age of 40.

Cells on the surface of the cervix sometimes appear abnormal but are not cancerous. It is thought that these abnormal changes are the first step in a slow series of changes that can lead to cervical cancer many years later. That is, some abnormal changes are precancerous.

Causes


Certain risk factors have been identified that increase the chance that cells in the cervix will become abnormal or cancerous. It is believed, in many cases, that cervical cancer develops when two or more of these risk factors act together:

• Having a history of the sexually transmitted human papilloma virus (HPV). There are many types of this virus. Some types put women at greater risk than others. {Note: Not all women who are infected with HPV develop cervical cancer, and the virus is not present in all women who have this disease.}
  
• Having had frequent sexual intercourse before age 18
  
• Having multiple sex partners. The greater the number of partners, the greater the risk.
  
• Having sex partners who:
  
  
  
  • Began having sexual intercourse at a young age
    
  • Have had many sexual partners
    
  • Were previously sexually active with a woman who had cervical cancer
    
  
  
• Having had a sex partner with HPV
  
• Smoking
  
• Being the daughter of a mother who took a drug known as DES during pregnancy. This drug was used from about 1940 to 1970, mostly to prevent miscarriage.
  
• Having a weakened immune system due to such things as:
  
  
  
  • Having human immunodeficiency virus (HIV)
    
  • Having taken drugs to prevent rejection with an organ transplant
    
  
  

Signs and Symptoms


Any abnormal pap test can be an early sign of cervical cancer. There are often no symptoms, though, especially in the early stages. In very late stages the symptoms include:

• Vaginal bleeding or spotting between periods
  
• Bleeding after intercourse
  
• Thick vaginal discharge that may have an odor
  
• Watery vaginal discharge
  
• Pain in the pelvic area
  

The final stages can result in:

• Anemia
  
• Appetite and weight loss
  
• Pain in the abdomen
  Leakage of urine and feces through the vagina
  

Detection


Early diagnosis of cervical cancer is important. If the cancer is found early, most women can be cured. The best way to find it early is to have pap tests and pelvic exams on a regular basis. These should start when a female begins having sex or is over 18. Ask your doctor how often you should have pap tests and pelvic exams. His or her advice will be based on your age, medical history, and your risk factors for cervical cancer. Also ask your doctor about tests for sexually transmitted diseases (STDs), especially if you or your sex partner have or have had multiple sex partners.

Pap tests are the initial screening tool for cervical cancer. During this test, the doctor or nurse collects cells from the opening of the cervix and surfaces that surround it. The pap test is then checked to see:

• Whether or not the sample taken is adequate
  
• If the cells are normal or abnormal
  
• If there is an infection, inflammation, or cancer
  

In addition to your pap test or if an abnormal pap test is found, your doctor may use a special magnifying instrument called a colposcope. This will allow your doctor to look for any abnormal cells on the surface of the cervix. If your doctor notices a suspicious area on your cervix during this procedure, he/she may choose to take a biopsy of the area. These small pieces of cervical tissue will give your doctor an accurate diagnosis of your problem.

Treatment


Treatment will depend on the exact diagnosis. The precancerous form of cervical cancer is known as dysplasia. This can be treated with laser, conization (removal of a portion of the cervix), or cryotherapy (freezing). Surgery and/or radiation therapy may be required for cervical cancer. Chemotherapy is used in late stages. Sometimes more than one form of treatment is necessary. If the cervical cancer has not spread and a woman wants to become pregnant in the future, a conization may be done. If a woman does not want a future pregnancy, removal of the uterus may be chosen (a hysterectomy).

Questions to Ask

Do you have these problems? A leakage of urine and feces through the vagina Pain in the abdomen Anemia (noted by paleness, weakness, fatigue) Appetite and weight loss
Do you have any or these problems? Constant vaginal bleeding Spotting between periods or bleeding after intercourse Pelvic pain Thick or watery vaginal discharge
Do you have 2 or more risk factors for cervical cancer? (See risk factors under “Causes” on page 226.) And, have you not had a pap test and pelvic exam for more than a year?

Self-Care Tips

• Remember to schedule and have pap tests and pelvic exams as often as your doctor suggests. Schedule these near your birthday to help you remember that they need to be done.
  
• Take measures to prevent getting HPV and other sexually transmitted diseases (STDs) (see “Self-Care/Prevention Tips” on page 275)
  
• Avoid douching. If you do, don’t do so more than once a month.
  
• Don’t smoke.
  
• Unless you are in a monogamous relationship in which you and your partner are free of STDs, use a latex condom every time you have sexual intercourse. Do this especially if your sex partner has a history of multiple sex partners.