Cervical Cancer

"Cancer" is an umbrella term that denotes a group of more than 100 different diseases. They all affect the body's basic unit, the cell. Cancer occurs when cells become abnormal and divide without control.

All of the organs of the body are made up of many types of cells. Normally, cells divide to produce more cells only when the body needs them. This orderly process helps keep us healthy. If cells keep dividing when new cells are not needed, a mass of tissue forms. This mass of extra tissue, called a growth or tumor, can be either benign or malignant.

Benign tumors are not cancerous. They can usually be removed, and in most cases, they do not come back. The most important distinction is that cells from benign tumors do not spread to other parts of the body. Benign tumors are not a threat to life. Polyps, cysts and genital warts are types of benign growths of the cervix.

Malignant tumors are cancerous. Cancer cells can invade and damage tissues and organs near the tumor. Cancer cells can also break away from a malignant tumor and enter the lymph system or the bloodstream. This is how cancer of the cervix can spread to other parts of the body, such as nearby lymph nodes, the rectum, the bladder, the bones of the spine and the lungs. The spread of cancer is called metastasis.

Like all other organs of the body, the cervix is made up of many types of cells. Normally, cells divide to produce more cells only when the body needs them. This orderly process helps keep us healthy. Ninety percent of cervical cancers arise from the flattened or "squamous" cells covering the cervix. Most of the remaining 10 percent arise from the glandular, mucus-secreting cells of the cervical canal leading into the uterus.

Each year, about 15,000 women in the United States learn that they have cancer of the cervix.

The development of cervical cancer is gradual and begins as a pre-cancerous condition called dysplasia. In this form, it is 100 percent treatable, usually without the need for a hysterectomy.

Dysplasia, depending on its severity, can often resolve without treatment. More often, it eventually progresses to actual cancer--called “carcinoma in situ” (CIS) when it has not yet spread and “microinvasive” when it has spread only a few millimeters into the surrounding tissue and has not yet penetrated blood vessels and lymph channels.

This process may take many years, but once the cancer is established, it quickly spreads further into the nearby tissues or to other organs--usually the intestines, liver and lung. There are often no symptoms of cervical cancer until the disease is advanced.

The majority of women today diagnosed with cervical cancer have either not had regular Pap smears or have not followed up after having an abnormal smear. Not having regular Pap smears is the single greatest risk factor for a bad outcome in women who develop cervical cancer.

Risk factors for cervical cancer include:

--infection with human papilloma virus or HPV, the cause of genital warts (Not all women who have HPV infection develop cervical cancer. Scientists believe that certain other factors they call co-factors are involved in its development. One co-factor is smoking. Tobacco use damages the immune system and interferes with the body's ability to resist HPV infection in the cervix);

--multiple sexual partners and/or partners who have multiple partners;

--beginning sexual intercourse at an early age.

In the early 1970's, it was discovered that women whose mothers took an estrogen drug called DES (diethylstilbestrol) during pregnancy are at risk of a rare form of cervical and vaginal cancer. This drug was used from 1938 until 1971, and was sometimes combined with prenatal vitamins in the mistaken belief that it prevented miscarriages. If you are old enough to be a “DES baby,” ask your mother if she was ever given this drug. For more information, go to the DES Action web page.

There is a small increased risk of abnormal Pap smears among women who take birth-control pills. It is thought that this is because such women are more sexually active, are less likely to use condoms and have more frequent Pap smears in order to be prescribed the birth-control pill.

Women whose immune systems are weakened--such as those with HIV infection or women who have received organ transplants and are taking drugs to suppress the immune system--may be at a higher risk.

Infections with genital herpes or chronic Chlamydia infections, both STDs, may increase risk.

Poor women may be at higher risk because they are not able to afford regular Pap smears. Worldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the U.S., where it has been declining. This is due almost entirely to the use of the Pap smear, which has reduced the death rate from this disease by 70 percent since it was introduced in 1941. Yet according to the American Cancer Society, 12,800 women were diagnosed with cervical cancer in the year 2000, and there were 4,600 deaths from this disease.

Symptoms

Precancerous changes of the cervix usually do not cause pain. In fact, they generally do not cause any symptoms, and are not detected unless a woman has a pelvic exam and a Pap test.

Symptoms usually do not appear until abnormal cervical cells become cancerous and invade nearby tissue. When this happens, the most common symptom is abnormal bleeding. Bleeding may start and stop between regular menstrual periods, or it may occur after sexual intercourse, douching or a pelvic exam. Menstrual bleeding may last longer and be heavier than usual. Bleeding after menopause may also be a symptom of cervical cancer, as is Increased vaginal discharge.

These symptoms may be caused by cancer or by other health problems; only a doctor can tell for sure. It is important for a woman to see her doctor if she is experiencing any of these symptoms.

Prevention
The vast majority of cervical cancers can be prevented. Since the most common form of cervical cancer starts with preventable and easily detectable precancerous changes, there are ways to prevent this disease.