Cervical Cancer, malignancy in the cervix, the narrow opening at the lower end of the female uterus, or womb, that leads into the vagina. The disease accounts for about 6 percent of all cancers in women and commonly affects women between the ages of 40 and 55. About 12,800 cases of cervical cancer are discovered annually in the United States, and about 4,600 women die each year from the disease, according to the American Cancer Society. The Canadian Cancer Society estimates that each year 1,400 Canadian women are diagnosed with cervical cancer and 420 die from the disease.
An abnormally rapid growth of cells in the cervical epithelium, the outermost layer of cells, indicates a precancerous state. This condition often corrects itself, and the tissue returns to normal. But in some cases, cancerous cells take over most or all of the epithelium, creating a condition known as cancer in situ. If cancerous cells penetrate to deeper cell layers of the cervix, they are capable of spreading to other tissues and organs in the body, a malignancy called invasive cervical cancer. The rate of invasive cervical cancer has declined steadily in recent decades, although the incidence of cancer in situ has increased. Early detection and improved treatment may be largely responsible for the change. An increase in the number of hysterectomies (removal of the uterus and cervix) performed in older women may also be a factor.
Early Symptoms Of Cervical Cancer
In its early stages, the presence of cervical cancer may not create any noticeable symptoms. As the cancer progresses, the woman may experience a watery vaginal discharge and painless bleeding. Over time, the bleeding becomes heavier and more frequent, and pain becomes noticeable in the lower abdomen or back.
The best tool for diagnosing cervical cancer is the Pap smear, named after its developer George N. Papanicolaou. In this simple test, cells are removed from the cervical epithelium with a cotton swab or wooden scraper and examined under a microscope for precancerous cell changes and signs of malignancy.
If the Pap smear reveals epithelial abnormalities, a physician will recommend that the woman undergo a colposcopy. In this procedure, which may be performed in a physician’s office, a microscope-like instrument called a colposcope is used to provide the physician with a magnified view of the vaginal and cervical surfaces. If any abnormal or suspect tissues are noted, biopsy samples are removed using small forceps. If these samples reveal cancerous or precancerous lesions when examined under a microscope, a more extensive biopsy called a cone biopsy may be performed under general anesthesia for a definitive diagnosis.
Annual Pap smears are recommended for most women, beginning soon after they become sexually active. Women who have normal, consecutive Pap smears each year and are at low risk for cervical cancer, such as women who have had hysterectomies or are not sexually active, may decide with their health care providers to have Pap smears at two- or three-year intervals.
Unfortunately, a significant number of women, particularly women of low socioeconomic status and women over the age of 60, do not have regular Pap smears. One study reported that of 481 women diagnosed with advanced cervical cancer, more than 28 percent had never had a Pap smear; almost 33 percent had not had one for at least five years prior to detection; and 15 percent did not return for proper follow-up care after an abnormal or inconclusive test.
Gynecologists use a Pap test to detect abnormalities in cervical cells, which may signal cancer. Cells are scraped from the cervix, then spread on slides and studied with a microscope. Healthy cervical cells (left) are fairly uniform in size and shape, while diseased cervical cells (right) are irregular and disfigured.
Cervical cancer has been compared to sexually transmitted infections (STIs) because it is closely linked to certain types of human papilloma virus (HPV) spread by sexual intercourse. Up to 97 percent of women with cervical cancers are infected with HPV. Studies indicate that women who have intercourse at an early age, who have multiple sexual partners, or whose male partners have multiple sexual partners, are at particular risk. One study found that women are 5 to 11 times more likely to develop cervical cancer if their male partners frequent prostitutes or have numerous sexual partners. (Hpv cervical cancer)
Usually the body’s immune system fights HPV so successfully that the tissue returns to normal within 6 to 18 months. New exposures to HPV mean new infections, and the greater the number of exposures, the greater the risk of cancer. The correct use of condoms during intercourse lowers the risk of spreading HPV. (Hpv cervical cancer)
Some women may be genetically predisposed to cervical cancer. A 1999 study reviewed the health records of 127,000 relatives of 75,500 women with cervical cancer, tracking mothers and daughters and differentiating between biological and adoptive relatives. The study found a risk for cervical cancer among women in a family. The study also indicated that women are at risk for cervical cancer at a younger age if their mother or a sister had the disease.
Surgery may be used to remove tissues showing precancerous changes and cancers in situ. Cryotherapy, which uses extreme cold to destroy tissues, and electrocoagulation, which uses heat to remove tissue, may also be used. Surgery, radiation, chemotherapy (anticancer drugs), or a combination of techniques are used to treat invasive cervical cancer. The treatment of choice depends on the size of the tumor and the stage of the disease. Until recently, doctors treated advanced cervical cancer with radiation only. In 1999, however, five new studies found that combining radiation with the drug cisplatin, marketed under the brand name Platinol, improves the chance of survival by up to 50 percent.
About one-third of all women who have invasive cervical cancer will experience a recurrence of the disease, usually within two years after initial treatment. It is therefore critical that women who have had cervical cancer be monitored at frequent intervals.
According to the American Cancer Society, about 90 percent of the women diagnosed with invasive cervical cancer survive for at least one year after diagnosis. The five-year relative survival rate is about 70 percent. Women diagnosed with cervical cancer in situ have a five-year relative survival rate of about 90 percent. However, only about half of all cervical cancers are discovered at this stage. In general, survival rates are significantly lower for women of low socioeconomic status, probably because they are less likely to have access to health-care or screening programs that detect cervical cancer in its early stages.