Cervical cancer is cancer that starts in the cervix, which is the lower part of the uterus. It starts in the cells on the surface of the cervix which is comprised of two types of cells: squalors and columnar. Most cervical cancers are from squamous cells. It is a slow growing cancer that usually starts as a pre-cancerous condition calls dysplasia. Cervical Cancer is comprised of four stages: carcinoma in Situ which is referred to as Stage 0, Stage I denotes the presence of abnormal cells that may become cancerous, Stage II is reached when cancer spreads just beyond the cervix, Stage III develops as cancer spreads to the vagina, pelvic wall and/or kidneys, Stage IV when cancer spread to the bladder rectum and other parts of the body (WHO).
What is the cervix?
The cervix is the lower part of the uterus, which is the female reproductive organ that holds a baby during pregnancy. The cervix connects the uterus and the vagina. The vagina leads to the outside of the body. Both the uterus and the cervix are located in the pelvis. They are in close contact with other pelvic organs, such as the ovaries, the upper part of the vagina, the bladder, and the rectum.
Black women and cervical cancer
While black women are not disproportionately affected by cervical cancer; however, they experience a higher mortality and morbidity from this cancer than any other ethnic group. According to the Centers for Disease Control and prevention (CDC), over 2,000 black women are diagnosed yearly with cervical cancer in the US; over 40% of them will die from it. A 2012 study by National Institute on Minority Health and Health Disparities reveals that black women seem to have more trouble clearing Human Papilloma Virus (HPV)—the virus that causes cervical cancer.
Cervical cancer occurs most often in women between the ages of 35 and 55. It accounts for more than 85% of cancer cases and deaths in developing countries (WHO, 2008). Another 2008 report from the World Health Organization states that cervical cancer is the third most commonly diagnosed cancer and the fourth leading cause of cancer death in women worldwide, accounting for 9% (529,800) of the total new cancer cases and 8% (275,100) of the total cancer deaths among females. Latin America and the Caribbean have some of the highest cervical cancer incidence and mortality rates in the world, surpassed only by East Africa and Melanesia (PAHO, 2004).
Cervical cancer is caused by persistent infection with certain high-risk, oncogenic types of Human Papilloma Viruses (HPVs), of which type16 is the most prevalent. HPV types 16 and 18 account for 65-70 percent of cervical cancers.
The Human Papilloma Virus (HPV) is known to cause most cervical cancer worldwide and is a common virus that is spread through sexual intercourse (Schiffman et al., 2000). HPV is the leading cause of almost all cervical cancers. Women generally are infected with HPV in their teens, 20s, or 30s; it can take as long as 20 years after HPV infection for the cancer to develop (Sherris et al., 2001). HPV is asymptomatic, without screening most women are unaware of it and its life-threatening consequences.
What are the Risk Factors of Cervical Cancer?
- Human Papillomavirus (HPV) infection: Certain strain of HPV put women at higher risk for cervical cancer. These viruses can be transmitted by sexual contact. HPV infection is a major risk factor for cervical cancer.
- Smoking: A woman who smokes has a higher chance of getting cervical cancer.
- Weak immune systems. Women who have the virus HIV, which causes AIDS, have a greater risk of getting cervical cancer. This is because HIV makes the immune system weaker, so the body will not effectively clear the HPV infection.
- Family history of cervical cancer: If your mother or sister has or had cervical cancer your risk is higher than a woman without a family history.
- Chlamydia infection: This is a sexually-transmitted bacterial infection that may increase your risk of developing cervical cancer.
- Diet. A diet low in fruits and vegetables, as well as obesity, may increase the risk for cervical cancer.
- Oral contraceptives: A woman who has taken oral contraceptives for a long time may have a higher risk.
- Multiple pregnancies: A woman who has had many full-term pregnancies may be at greater risk.
- DES: If a woman's mother took the drug diethylstilbestrol (DES) when she was pregnant, she has a greater chance of getting cervical cancer.
- Socioeconomic status: Many low income or uninsured women still lack or have limited access to healthcare which may prevent regular screenings and increase their risk of cervical cancer.
What Can a Woman Do to Decrease her Risk of Getting Cervical Cancer?
- Regular Pap tests are very important in detecting cancerous cervical cells, when they are more treatable.
- Talk to a doctor about when to go for checkups. It is generally recommended for women who are sexually active or 18 years and older to have a regular Pap test and a gynecologic exam each year.
- Quit smoking.
- Avoid intercourse at a young age.
- Use condoms during intercourse.
- Limit the number of sexual partners.
- Get vaccinated with the HPV vaccines.
- The HPV vaccines offer the greatest health benefits to individuals who receive all three doses before having any type of sexual activity. That’s why HPV vaccination is recommended for preteen girls and boys at age 11 or 12 years. HPV vaccines are recommended for all teen girls and women through age 26, who did not get all three doses of the vaccine when they were younger. The HPV vaccine is recommended for all teen boys and men through age 21, who did not get all three doses of the vaccine when they were younger (CDC).
What is the Pap test?
The Pap test is a very simple and important test. The doctor uses the Pap test to see if there are any changes in the cervix. The best time for a woman to have a Pap test is 10 to 20 days after her period. A Pap test can be done in a doctor's office or a health clinic. The doctor or nurse practitioner uses a tool called a speculum to hold the vagina open to see the upper part of the vagina and the cervix. Then the doctor uses a wooden scraper or a small brush to get some cells from the cervix and vagina. He or she puts these cells on a glass slide or in a solution and sends it to a laboratory to be looked at under a microscope to check for abnormal cells.
Who should get the Pap Tests and how Often?
Women should begin the test when they turn 21. The Pap test is recommended every 2-3 years until a woman has 3 or more normal exams. Then, a doctor may recommend doing the test less often. Women should talk to their doctors about how often they need the test.
What are the Symptoms of Cervical Cancer?
Cervical cancer and cervical pre-cancers usually have no symptoms. That is why it is important to have Pap tests. A woman usually does not have any symptoms until the cells turn into cancer and invade the deepest parts of the cervix or other pelvic organs.
Here some are common symptoms in women with fully developed cervical cancer:
- Vaginal discharge
- Abnormal vaginal bleeding
- Vaginal odor
These symptoms may be caused by the cancer or by other health problems. It is important for a woman to see her doctor if she is having any of these symptoms.
How Should I prepare for my Cervical Cancer Screening Tests?
- Don't take the tests if you're having your menstrual period
- Don't douche for 2 days before the tests
- Don't have sexual intercourse for 2 days before the test
- Don't use tampons or birth control foams, jellies, or other vaginal creams or vaginal medicines for 2 days before the test
How is Cervical Cancer Diagnosed?
The doctor asks questions about the woman's medical history and family history. The doctor will also do a pelvic exam and Pap test. If the doctor finds something suspicious, other tests can help determine if the woman has cervical cancer. It is very important to know the extent of the cancer--how deeply it has invaded tissues. The treatment can be quite different depending upon this.
A doctor may order one or more of these tests to help make a diagnosis:
Depending upon the extent or location of the cancer, the biopsy may be done in a variety of ways.
Should Everyone Get a Second Opinion?
Many people with cancer get a second opinion from another doctor. There are many reasons to get a second opinion, including:
- Not feeling comfortable with the treatment decision
- Being diagnosed with a rare type of cancer
- Having several options for how to treat the cancer
- Not being able to see a cancer expert
When do I Need to See a Specialist?
If you have cervical cancer, you'll likely be treated by one or more of the following specialists: a gynecologic oncologist, a radiation oncologist and a medical oncologist. An oncologist is a doctor specially trained in diagnosing and treating cancer.
If you have been diagnosed with precancerous changes, it's not essential that you see an oncologist. Depending on the degree of the change seen, your gynecologist or your primary care doctor may monitor your condition and provide treatment.
How Can Someone Get a Second Opinion?
These are some of the many ways to get a second opinion.
- Ask a primary care doctor. He or she may be able to suggest a specialist. This may be a gynecologic oncologist, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or hospitals. Never be afraid to ask for a second opinion.
- Call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237). They have information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.
- Consult The Official ABMS Directory of Board Certified Medical Specialists. This book, from the American Board of Medical Specialists, lists doctors by state. It gives their specialty, background, and training. It is available at most public libraries and you can also view it online atwww.abms.org.
- Seek other options. Check with a local medical society, a nearby hospital/medical school, or support group to get names of doctors who can give you a second opinion. Or ask other people who've had cancer for their recommendations.
What are the Treatments for Cervical Cancer?
Treatment for cervical cancer is often surgery, especially for cancers that have not spread. Surgery is used to remove as much cancer cells as possible. It is called a local treatment. Local treatments fight cancer cells in one area. Another type of local treatment used for cervical cancer is high-energy X-rays, called radiation therapy. Chemotherapy is the use of drugs to kill cancer. It is called systemic treatment. It travels throughout the body. It may be combined with radiation, either before or after surgery.
What Check-ups should a Woman Have after Treatment for Cervical Cancer?
In the first year after treatment, most women are advised to see their doctors every 3 months. Pap tests may be performed every 3 months. Also, women may have chest X-rays and computed tomography (CT scans) regularly. Until the fifth year, women may have check-ups regularly, at least every 6 months. After 5 years, a woman will most likely go back to yearly checkups. Women who have been treated for cervical cancer should tell their doctors about any vaginal discharge, bleeding, bone pain, weight loss, bowel or bladder problems. They should quit smoking and use protection during intercourse to prevent further problems.
What's New in Cervical Cancer Research?
Researchers are working on many fronts to better prevent, diagnose, and treat cervical cancer. For example, researchers have recently developed vaccines to prevent HPV infection. They are also working on vaccines to treat cervical cancer. And they are developing surgical techniques that will cure localized cancers while preserving as much tissue as possible.
What Are Clinical Trials?
Clinical trials are studies of new kinds of cancer treatments. Doctors use clinical trials to learn how well new treatments work and what their side effects are. Promising treatments are the ones that work better or have fewer side effects than the current treatments. People who participate in these studies have access to these treatments before the U.S. Food and Drug Administration (FDA) approves them. People who join trials also help researchers learn more about cancer and help future cancer patients.
*Squamous cell carcinoma is cancer of cells that line the outer part of the cervix. These cells are squamous epithelial cells. They line the outer part of the cervix that is closest to the vagina, called the ectocervix. Squamous cell cancers have flat, thin cells. They cover the surface of the ectocervix. This type of cancer most commonly occurs where the ectocervix meets the endocervix, which is the inner part of the cervix.
*Adenocarcinoma is cancer of the cells lining the inner part of the cervix. These cells are * columnar epithelial cells. They are some of the most prolific cells in the body, mainly because they can fulfill so many functions. They are found throughout the body's organ system, including the digestive tract and the female reproductive system. They line the inner part of the cervix that is closest to the uterus, called the endocervix.
Resources and References:
World health Organization (WHO): www.who.int/
Womenshealth.gov: 800-994-9662 (TDD: 888-220-5446)
American Cancer Society
Gynecologic Cancer Foundation
National Breast and Cervical Cancer Early Detection Program, CDC, NIH
National Cancer Institute, NIH, HHS
*Schiffman M and Castle PE. 2005. The promise of global cervical-cancer prevention. New England Journal of Medicine. Vol. 17;353(20):2101-4.
*Sherris, Jacqueline et al. 2001. Beyond Our Borders: Cervical cancer in the developing world.
Western Journal of Medicine. Volume 175;231-233.
The information provided to our readers regarding these diseases is not intended to be a substitute for professional medical advice, diagnosis or treatment. We strongly encourage our readers to use this information only as a preliminary resource, and we disclaim any liability for the decisions made by anyone based on this information.