Definition and Overview
Cervical cancer is one of the most common types of gynecological cancers (along with breast and colon cancer) affecting at least 11,000 women in the United States every year. Although more than 4,000 women die from the disease annually, it is preventable and treatable with a survival rate of around 93% if diagnosed in the early stages.
This type of cancer occurs in the cervix, a part of the female reproductive system that connects the vaginal canal and the uterus (womb). Several risk factors increase the risk of cancer, but about 70% of them are caused by certain strains of the human papillomavirus. They may also cause oral and bowel cancer, and other types of gynaecological cancer including endometrial cancer, colorectal cancer, and uterine cancer.
Cervical cancer is usually classified as either adenocarcinoma, wherein cancer begins in cells that create the mucus (gland cells) or squamous cell, when cancer starts as flat cells. In general, most of the cases are squamous cell, but over the last few years, adenocarcinomas have become more typical. Very rarely, other types of cancer affect the cervix. Examples under this category are chronic lymphocytic leukemia and lymphoma.
Different screenings and tests can be performed to prevent and diagnose cancer. Treatments also vary depending on the stage, aggressiveness, and spread of cancer, as well as the overall health condition of the patient. Meanwhile, cervical cancer can be prevented through HPV vaccine.
Causes of Condition
The primary cause of cervical cancer is HPV (human papillomavirus), a type of virus that causes warts, small benign overgrowths found on the top layer of the skin, including those in the genitals.
There are many different strains of the virus, and most of them do not have any significant impact on the person’s health. The body’s own immune system can already kill them before they can cause any infection. However, some cause cellular changes that ultimately lead to cervical cancer. These are HPV strains 16 and 18. A woman can be infected by any of these strains, which may then remain dormant. In fact, it may take as long as 10 years before the symptoms of cervical cancer start to appear.
Being infected with HPV does not immediately mean that the woman will develop cervical cancer—so is having genital warts—but it certainly increases the risk. Moreover, the cells do not transform into malignant ones immediately. First, they undergo a transformation stage where they are classified as pre-cancerous. These cells can already be detected by a pap exam and in turn, be treated early so they do not transform into malignant cells.
Other risk factors include:
Risky sexual activity. A woman who is engaged in risky sexual behaviors such as having multiple partners or unprotected sex should be regularly screened for the virus. HPV can be spread through skin-to-skin contact. Condoms, on the other hand, may reduce but not totally eliminate the risk.
Smoking. Studies show that women who smoke have two times more likely to develop cervical cancer than those who do not. Smoking introduces many harmful chemicals into the body, which are then transported to various cells through the bloodstream.
Compromised immune system (e.g., those who have AIDS, HIV, and hepatitis C)
Long-term use of birth control pills
Cervical Cancer Symptoms
Abnormal bleeding especially during menstruation
Discharge in the vagina
Bleeding after menopause
Heavier and longer menstruation
Spotting (small traces of blood) in between menstrual periods
Bleeding after a pelvic test
However, in the majority of cases, signs of cervical cancer are absent in the earliest stages.
Who to See and Treatments Available
Women, especially those who are sexually active, should see a gynaecologist for a regular screening of pre-cancerous and cancerous cells in the cervix. One of the most recommended tests is called the pap exam, in which the doctor scrapes cells from the cervix. Another type of screening is the HPV test, which looks for HPV strains in the DNA.
Under the new guidelines, women who are below 30 years old are recommended to undergo a pap test first every 3 years. An HPV test should be encouraged only if the results indicate abnormal cells. Meanwhile, women who are 30 years old and above but no more than 65, should be screened for cervical cancer every 5 years. They may also continue with their pap test every 3 years or undergo co-testing.
The gynaecologist may also perform other exams such as physical and pelvic tests.
If the results of either pap or HPV tests (or both) reveal the presence of abnormal cells, the doctor may proceed with:
Colposcopy – checking of the cervical and vaginal areas for any abnormality using a colposcope and collecting samples of tissue
Endocervicalcutterage – collecting sample tissues using a curette
Biopsy – cutting a cervical sample tissue
Any cellular changes will have to be confirmed as either benign or malignant. If they are malignant, the patient is then referred to an oncologist specializing in cervical or gynaecological cancer for a treatment plan.
Treatment modalities can be a combination of surgery, chemotherapy, medications, and radiotherapy. The protocol depends on the stage of cancer, the overall health of the patient, and whether there is already metastasis (cancer has already spread to the other organs).
Cervical cancer surgery may include:
The removal of the cervix and a part of the vagina (radical trachelectomy)
The removal of the entire reproductive system, as well as the rectum (pelvic exenteration)
The removal of the uterus, fallopian tubes, cervix, and ovaries (hysterectomy)
Usually during the early stages, surgery is enough to cure the disease. In the advanced stages, surgery may be followed by radiotherapy (internal and/or external) and chemotherapy (using a particular or combination of drugs) to kill cancerous cells.
Cervical cancer may also be prevented with a vaccine. HPV vaccines such as Cervarix and Gardasilcan reduce the risk by as much as 70% and protect against other strains of HPV.
Jhingran A, Russell AH, Seiden MV, et al. Cancers of the cervix, vulva, and vagina. In: Niederhuber JE, Armitage JO, Doroshow JH, et al., eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2013:chap 87.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Cervical cancer. Version 3.2013. Available at http://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf. Accessed November 12, 2013.
Noller KL. Intraepithelial neoplasia of the lower genital tract (cervix, vulva): Etiology, screening, diagnostic techniques, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 6th ed. Philadelphia, Pa: Elsevier Mosby; 2012:chap 28.
U.S. Preventive Services Task Force. Screening for Cervical Cancer: U.S. Preventive Services Task Force Recommendation Statement. AHRQ Publication No. 11-05156-EF-2, March 2012. Available at: http://www.uspreventiveservicestaskforce.org/uspstf11/cervcancer/cervcancerrs.htm. Accessed November 12, 2013.