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Cervical Cancer

En Español (Spanish Version) More InDepth Information on This Condition

Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention

Definition

Cervical cancer is a disease in which cancer cells grow in the cervix. The cervix is the lower, narrow part of the uterus. It connects the uterus with the vagina.

Cervical Cancer

Copyright © Nucleus Medical Media, Inc.

Causes

Cancer occurs when cells in the body divide without control or order. Normally, cells divide in a regulated manner. If cells keep dividing uncontrollably when new cells are not needed, a mass of tissue forms, called a growth or tumor. The term cancer refers to malignant growths. These growths can invade nearby tissues. Cancer that has invaded nearby tissues can then spread to other parts of the body.

Research suggests that some sexually transmitted viruses, like human papillomavirus (HPV), can cause cervical cells to begin the changes that can lead to cancer.

It is not clear exactly what causes changes in the cells, but is probably a combination of genetics and environment.

Risk Factors

Cervical cancer is more common in women over 25 years old. Other factors that may increase your chance of cervical cancer include:

  • HPV infection—the main risk factor for cervical cancer
  • History of cervical dysplasia, which is a precancerous condition
  • Daughter of a mother who took the drug diethylstilbestrol (DES) during pregnancy
  • HIV infection
  • Unprotected intercourse
  • Multiple sexual partners
  • Sexual activity prior to age 18
  • Smoking
  • Obesity
  • First pregnancy prior to age 20
  • Breast cancer chemotherapy
  • Long-term use of hormonal contraceptives

Symptoms

Symptoms usually do not appear until the abnormal cells become cancerous. Then, they invade nearby tissue. When this happens, the most common symptom is abnormal bleeding, which may include:

  • Bleeding between regular menstrual periods
  • Bleeding after sexual intercourse, douching, or a pelvic exam
  • Menstrual bleeding that lasts longer and is heavier than usual
  • Vaginal bleeding after menopause
  • Increased vaginal discharge that is not blood

There may also be pelvic discomfort or a backache.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. This will include an examination of the vagina and cervix.

Tests may include:

  • Blood and urine tests
  • Colposcopy—a lighted, magnifying instrument is used to examine the cervix
  • Biopsy—removal of a sample of cervical tissue for testing
  • A sentinel lymph node biopsy

Imaging tests may include:

The physical exam combined with all of your test results, will help to determine the stage of cancer you have. Staging is used to guide your treatment plan. Like other cancers, cervical cancer is staged from I-IV. Stage I is a very localized cancer, while stage IV indicates a spread to other parts of the body.

Treatment

Treatment depends on the stage of the cancer and may include:

Surgery

The cancerous tumor, nearby tissue, and possibly nearby lymph nodes may be removed. The doctor may remove only the tumor and nearby normal tissue if the tumor is contained within the cervix. In some cases, a hysterectomy is necessary.

If the cancer is at a later stage, more tissue must be removed. This may include the ovaries and fallopian tubes.

Radiation Therapy

Radiation therapy is the use of radiation to kill cancer cells and shrink tumors. Radiation may be given in two ways:

  • External radiation therapy—radiation directed at the tumor from a source outside the body
  • Internal radiation therapy—radioactive materials placed in or near the cancer cells

Chemotherapy

Chemotherapy is the use of toxic drugs to kill cancer cells. It may be given in many forms, including: pill, injection, and by catheter. The drugs enter the bloodstream and travel through the body. It kills mostly cancer cells, but also some healthy cells. Chemotherapy alone rarely cures cervical cancer. It may be used with surgery and/or radiation.

This therapy may also be used to help control pain and bleeding when a cure is no longer possible.

Prevention

Finding and treating precancerous tissue in the cervix is the best way to prevent cervical cancer. Talk to your doctor about when you should have Pap tests done. Another good approach is to reduce your risk of exposure to the HPV virus. There are currently 2 methods to do this:

  • Safe sexual practice—Limit the number of sexual partners and use latex condoms.
  • HPV vaccines—The vaccines protect you against some types of HPV. One vaccine, called Gardasil, is used to prevent cervical cancer by protecting against 4 types of HPV. Another vaccine, called Cervarix, is also approved for prevention by protecting against 2 HPV types. The vaccines are routinely given to girls aged 11-12 years old. A catch-up vaccine is given to young women who haven't been vaccinated.

Screening

The Pap test is used to screen for cervical cancer. It is also used to detect cervical dysplasia. A sample of cells is collected from the cervix to be tested. HPV can also be screened by testing the same sample of cells.

If you are a healthy woman, many professional health organizations offer these recommendations for screening:

  • If you are aged 21-29 years—It is recommended that you have the Pap test every 3 years.
  • If you are aged 30-65—It is recommended that you have the Pap test and the HPV test every 5 years. Or, you can continue to have just the Pap test every 3 years.
  • If you are aged 65 or older—You may be able to stop having Pap and HPV tests if you have had normal results, such as 3 normal results in a row and no abnormal results in the past 10 years.

Note: You will need to have Pap tests done more often if you have abnormal results or certain conditions, like a weak immune system or a history of cervical dysplasia or cervical cancer. Talk to your doctor about the right screening schedule for you.

 

RESOURCES:

CANADIAN RESOURCES:

References:

  • American Congress of Obstetricians and Gynecologists. ACOG Practice Bulletin 76: Postpartum hemorrhage. Obstet Gynecol. 2006;108(4):1039-1047. Reaffirmed 2013.
  • Cervical cancer. American Cancer Society website. Available at: http://www.cancer.org/cancer/cervicalcancer/index. Accessed January 6, 2014.
  • Cervical cancer. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/cancer/cervical. Updated September 5, 2013. Accessed January 6, 2014.
  • Cervical cancer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 7, 2013. Accessed January 6, 2014.
  • Cervical cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/cervical. Accessed January 6, 2014.
  • Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin Number 131: Screening for cervical cancer. Obstet Gynecol. 2012;120(5):1222-1238.
  • Human papillomavirus (HPV) vaccines. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/factsheet/prevention/HPV-vaccine. Updated December 29, 2011. Accessed January 6, 2014.
  • Saslow D, Soloman D, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin. 2012;62(3):147-172.
  • Sawaya GF. Cervical-cancer screening: new guidelines and the balance between benefits and harms. N Engl J Med. 2009;361(26):2503-2505.
  • 5/18/2007 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: The FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007;356:1915-1927.
  • 3/19/2012 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Screening for cervical cancer. US Preventive Services Task Force website. Available at: http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm. Published March 2012. Accessed January 6, 2014.
  • 7/7/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Qaseem A, Humphrey LL, et al. Screening pelvic examination in adult women: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014 Jul 1;161(1):67-72.
  • 10/1/2014 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: Bhaskaran K, Douglas I, et al. Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5.24 million UK adults. Lancet. 2014;384(9945):755-765.

Last reviewed November 2014 by Michael Woods, MD

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This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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