Cervical Cancer

What is cervical cancer?

Cancer is a disease in which certain body cells don’t function right, divide very fast, and produce too much tissue that forms a tumor. Cervical cancer is cancer in the cervix, the lower, narrow part of the uterus (womb).

Various strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cases of cervical cancer.

When exposed to HPV, a woman’s immune system typically prevents the virus from doing harm. In a small group of women, however, the virus survives for years before it eventually converts some cells on the surface of the cervix into cancer cells. Half of cervical cancer cases occur in women between ages 35 and 55.

Signs and symptoms

• Vaginal bleeding after intercourse, between periods or after menopause
• Watery, bloody vaginal discharge that may be heavy and have a foul odor
• Pelvic pain or pain during intercourse

Risk factors

These factors may increase your risk of cervical cancer:

• Many sexual partners. The greater your number of sexual partners – and the greater your partner’s number of sexual partners – the greater your chance of acquiring HPV.
• Early sexual activity. Having sex before age 18 increases your risk of HPV. Immature cells seem to be more susceptible to the precancerous changes that HPV can cause. 
• Other sexually transmitted diseases (STDs). If you have other STDs – such as Chlamydia, gonorrhea, syphilis or HIV/AIDS – you have a greater chance of also having acquired HPV.
• A weak immune system. Most women who are infected with HPV never develop cervical cancer. However, if you have an HPV infection and your immune system is weakened by another health condition, you may be more likely to develop cervical cancer.
• Cigarette smoking. The exact mechanism that links cigarette smoking to cervical cancer isn’t known, but tobacco use increases the risk of precancerous changes as well as cancer of the cervix. Smoking and HPV infection may work together to cause cervical cancer.

Screening and diagnosis

Screening

When cervical cancer is detected in its earliest stages, treatment is more likely to be successful. Regular screening for cervical cancer and precancerous changes in the cervix is recommended for all women. Most guidelines suggest beginning screening within three years of becoming sexually active, or no later than age 21.

Screening may include:

• Pap test. During a Pap test, your doctor brushes cells from your cervix – the narrow neck of the uterus – and sends the sample to a lab. The cells are to be examined for abnormalities.
• HPV DNA test. Your doctor also may use a lab test called the HPV DNA test to determine whether you are infected with any of the 13 types of HPV that are most likely to lead to cervical cancer. Like the Pap test, the HPV DNA test involves collecting cells from the cervix for lab testing. It can detect high-risk strains of HPV in cell DNA before changes to the cells of the cervix can be seen.

The HPV DNA test isn’t a substitute for regular Pap screening, and it’s not used to screen women younger than 30 with normal Pap results. Most HPV infections in women of this age group clear up on their own and aren’t associated with cervical cancer.

Diagnosis

If you experience signs and symptoms of cervical cancer or if a Pap test has revealed cancerous cells or HPV DNA Test is positive (+), you may undergo further tests to diagnose your cancer. To make a diagnosis, your doctor may:

• Colposcopy is an examination of your cervix. During the exam, your doctor uses a special microscope (colposcope) to examine your cervix for abnormal cells. If your doctor identifies unusual areas, he or she may take a small sample of cells for analysis (biopsy).

Treatment

Limited, noninvasive cancer

Treatment of cervical cancer that’s confined to the outside layer of the cervix typically requires treatment to remove the abnormal area of cells. For most women in this situation, no additional treatments are needed. Procedures to remove noninvasive cancer include:

• Loop electrosurgical excision procedure (LEEP). This technique uses a wire loop to pass electrical current, which cuts like a surgeon’s knife, and remove cells from the mouth of the cervix.
• Cryosurgery. This technique involves freezing and killing cancerous and precancerous cells.
• Hysterectomy. This major surgery involves removal of the cancerous and precancerous areas, the cervix and the uterus. Hysterectomy is usually done only in certain selected cases of noninvasive cervical cancer.

Invasive cancers

Cervical cancer that invades deeper than the outside layer of cells on the cervix is referred to as invasive cancer and requires more extensive treatment. Treatment for cervical cancer depends on several factors, such as the stage of the cancer, other health problems you may have and your own preferences about treatment. Treatment options may include:

• Surgery. A radical hysterectomy – removal of the cervix, uterus, part of the vagina and lymph nodes in the area – is the standard surgical treatment when there’s an invasion of greater than 3 mm into the cervix and no evidence of tumor on the walls of the pelvis.
• Radiation. Radiation therapy uses high-powered energy to kill cancer cells. Radiation therapy can be given externally using external beam radiation or internally (picture of LINA and BRACHY) (brachytherapy) by placing devices filled with radioactive material near your cervix. Radiation therapy is as effective as surgery for early-stage cervical cancer. For women with more advanced cervical cancer, radiation is often the best treatment.
• Chemotherapy. Chemotherapy uses strong anti-cancer chemicals to kill cancer cells. Chemotherapy drugs, which can be used along or in combination with each other, are usually injected into a vein and they travel throughout your body killing quickly growing cells, including cancer cells. Low doses of chemotherapy are often combined with radiation therapy, since chemotherapy may enhance the effects of the radiation. Higher doses of chemotherapy are used to control advanced cervical cancer that may not be curable. Side effects of chemotherapy depend on the drugs being administered, but generally include diarrhea, fatigue, nausea and hair loss. Certain chemotherapy drugs may cause infertility and early menopause in premenopausal women.

Prevention

You can reduce your risk of cervical cancer by taking measures to prevent HPV infection. HPV spreads through skin-to-skin contact with any infected part of the body - not just intercourse. Use a condom every time you have sex in order to reduce your risk of contracting HPV.

In addition to using condoms, the best ways to prevent cervical cancer are to:<
• Delay first intercourse
• Have fewer sexual partners
• Avoid smoking

Get vaccinated against HPV

A new vaccine offers protection from the most dangerous types of HPV - the virus that causes most cervical cancers. The routine vaccination for girls

• ages 11 and 12, as well as girls
• women ages 13 to 26 if they haven't received the vaccine already.

The vaccine is most effective if given to girls before they become sexually active.

Have routine Pap tests

An initial Pap test within three years of when you begin having sex or at age 21, whichever comes first.

References:

https://womenshealth.gov/faq/ccervix.htm
https://www.nlm.nih.gov/medlineplus/cervicalcancer.html

Note: This information is not intended to be used as a substitute for professional medical advice, diagnosis or treatment. If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.

The Medical City offers a roster of competent physicians who may assess and treat people with cervical cancer. For any inquiries please call:

CANCER CENTER
Tel. No.: (632) 988-1000 / (632) 988-7000 ext. 6214

WOMEN’S HEALTH CARE CENTER

Tel. No.: (632) 988-1000 / (632) 988-7000 ext. 6336

CENTER FOR PATIENT PARTNERSHIP
Tel. No.: (632) 988-1000 / (632) 988-7000 Ext. 6444