Cervical Cancer
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Cervical cancer develops in the lining of the cervix, the lower part of the uterus that enters the vagina. Normal cervical cells gradually undergo changes to become precancerous and then cancerous. Doctors can effectively treat cervical cancer when it is detected early.
80-90% of invasive cervical cancer develops in flat, scaly surface cells that line the cervix (called squamous cell carcinomas). Approximately 10-15% of cases develop in glandular surface cells (called adenocarcinomas).
Invasive cervical cancer is more common in middle aged and older women. Cancer of the cervix can often be cured if it is detected and treated early.
Age
Cervical cancer is rare in women younger than 15.
Human Papilloma virus (HPV)
Infection with two types of human papilloma virus (HPV), is strongly associated with cervical and vulvar cancer. HPV is a sexually transmitted virus and lives under the male foreskin. Evidence of HPV is found in over 90% of cervical cancers.
Multiple partners
Having multiple partners or having sex with a promiscuous partner can increase the chances of infection of the HPV virus.
History of STDs (sexually transmitted diseases)
A history of STD's can increase the chances of infection of the HPV virus.
Sexual intercourse at a young age
Having sexual intercourse at a young age can increase the chances of infection of the HPV virus.
Race
Jewish women who marry Jewish men have a low rate of cervical cancer, as long as both partners maintain an exclusive relationship and were virgins at marriage. Studies show that circumcised men (customary in Judaism) do not carry the HPV virus.
Smoking
Chemicals in cigarette smoke may increase the risk of cervical cancer by damaging cervical cells and lowering immunity to HPV locally in the cervix. Women who smoke cigarettes are twice as likely to develop cervical cancer.
Human immunodeficiency virus (HIV)
HIV infection reduces the immune system's ability to fight infection including HPV infection and increases the likelihood that precancerous cells will progress to cancer.
Protected sex
Avoiding sexual activity that increases the risk of HPV infection can help prevent most cases of cervical cancer. Using barrier contraception (e.g. condoms) and limiting the number of sexual partners may prevent HPV infection.
Regular Pap smears
Regular smears will pick up any changes to the cells in the cervix and treatment can then prevent cervical cancer.
Stop smoking
Stopping smoking will decrease the risk of cervical cancer.
The NHS Cervical Screening programme in the UK will automatically call women between the ages of 20 and 64 for a Pap smear or cervical screening every 3-5 years. A Pap smear (Papanicolaou test) detects precancerous changes in cervical cells and can also detect the HPV virus. If any abnormalities are detected that could go on to become cancer, further tests and possible treatment will be arranged.
The smear involves the GP or nurse removing cells from the surface of the cervix using a spatula, cotton swab, or brush. The cells are placed on a glass slide so that they can be examined under a microscope. For accurate results, the test should be performed 2 weeks after the end of a menstrual period and at least 48 hours after sexual intercourse.
All women who are sexually active should have a yearly Pap smear.
Early cervical cancer does not usually produce symptoms. In women who receive regular screening, the first sign of the disease is usually an abnormal Pap test result. Symptoms that may occur include the following:
- Abnormal vaginal bleeding (e.g. spotting after sexual intercourse, bleeding between menstrual periods, increased menstrual bleeding)
- Abnormal (yellow, odorous) vaginal discharge
- Low back pain
- Painful sexual intercourse
- Painful urination
Cervical cancer that has spread to other organs may cause constipation, blood in the urine, abnormal opening in the cervix and ureteral obstruction (blockage in the tube that carries urine from the kidney to the bladder).
Diagnosis of cervical cancer includes a Pap smear and pelvic examination.
Pelvic examination
The vagina and adjacent organs are examined by the doctor using both hands. Visual examination is performed using a speculum (instrument that is warmed and used to separate tissue) inserted into the vagina. Next, the organs are felt with the fingers by inserting gloved fingers of one hand into the vagina and placing the other hand on the abdomen.
CIN (Cervical intraepithelial neoplasia)
CIN (Cervical intraepithelial neoplasia) is the term used to describe abnormal changes in cells. Low-grade CIN indicates a minimal change in the cells and high-grade CIN indicates a greater degree of abnormality. CIN may progress to SIL.
SIL (Squamous intraepithelial lesion)
SIL (Squamous intraepithelial lesion) is the condition that precedes cervical cancer. SIL is also classified as low-grade or high-grade. High-grade SIL may progress to cancer that has spread to healthy tissue.
Other Diagnostic Tests
If low-grade CIN is detected, the Pap smear is repeated in 3-6 months time and the patient is tested for HPV infection. If high-grade CIN is detected, colposcopy and biopsy may be performed.
Colposcopy
This test can confirm the presence of cervical lesions. The cervix is washed with a diluted vinegar solution and examined for abnormalities using a light and a magnifying device (a colposcope). If abnormal areas are detected, further evaluation is necessary.
Biopsy
Cells are removed for microscopic examination.
If invasive cervical cancer is suspected, or if the colposcopy and Pap smear results differ, cone biopsy or endocervical curettage may be performed.
Cone biopsy
A larger, cone-shaped sample of cervical tissue is removed and examined for cancer cells.
Endocervical curettage
The lining of the cervical canal is scraped and examined for cancer cells.
Once a diagnosis of cervical cancer is made, the cancer is staged. Staging involves a pelvic examination, blood tests, and imaging procedures. Blood tests may include a blood count and serum chemistry to evaluate kidney and liver function.
Imaging procedures may include the following:
- Chest x-ray (to detect lung metastasis)
- CT scan of the pelvis and abdomen (to detect metastasis to the liver, lymph nodes, and other organs)
- Cystoscopy and proctoscopy (to detect metastasis to the bladder or colon)
Treatment for cervical cancer depends on the type and location of the cancer.
Non invasive cervical cancer
Abnormal tissue may be removed using loop electrode excision, wire loops heated by electric current. Cone biopsy can also be an option. Cancer cells in situ may be removed using loop electrode excision, cryosurgery, or laser ablation.
Cryosurgery
Liquid nitrogen is circulated through a probe, which is applied to cancerous tissue. Freezing temperatures destroy the cancer cells.
Laser ablation
This involves using a laser that emits intense heat and light at close range to remove cancerous tissue.
Invasive Cervical Cancer
Invasive cervical cancer and metastatic disease are usually treated with surgery, radiation, and chemotherapy.
Surgery
If the cancer is small, the doctor may be able to remove it completely during colposcopy. Otherwise, the doctor may remove part or all of the cervix through surgery to remove as much of the cancer as possible.
Radical hysterectomy
A hysterectomy can remove invasive cervical cancer. The surgeon removes the uterus, fallopian tubes, ovaries, adjacent lymph nodes, and part of the vagina. If cancer has spread to the lymph nodes in the abdomen, lymphadenectomy (surgical removal of lymph nodes) may also be performed.
Radiation
Radiation may be used alone, or after surgery, or chemotherapy. Radiation can be delivered by external beam radiation from a machine outside the body or by radioactive “seeds” implanted in the uterus and vagina (called brachytherapy).
After surgery, radiation may be used to decrease the risk of the cancer returning.
Side effects of radiation
fatigue, swelling, and skin reddening.
Chemotherapy
Chemotherapy uses toxic drugs to destroy cancer cells. Cisplatin and fluorouracil are often used in combination and in addition to radiation to treat invasive cervical cancer. Chemotherapy is administered intravenously, through injection, or in pill form.
Side effects
Can be severe and include nausea, vomiting, diarrhoea, and leukopenia (low white blood cell count).
Worldwide
- Cervical cancer is the second most common cancer in women worldwide.
- Approximately 471,000 women are diagnosed with invasive cervical cancer each year.
- 233,000 women die each year from the disease.
- There is a wide variation in cervical cancer incidence rates around the world.
- 80% of new cervical cancer cases occur in the less developed world.
- In many less developed countries eg. India, cervical cancer is the most common cancer in woman.
- High rates are found in eastern and southern Africa, central and south America and the Caribbean.
Europe
- European countries have a relatively low incidence rate of cervical cancer.
- Luxembourg and Finland have the lowest incidence and mortality rates.
- Portugal and Denmark have the have the highest incidence and mortality rates.
UK
- Each year, there are over 3,200 new cases of cervical cancer in the UK, just 2% of new cancer cases diagnosed.
- Approximately 1,250 woman die each year in the UK.
- It is the second most common cancer in women under the age of 35 after breast cancer.
Trends
Generally across Europe incidence rates of invasive cervical cancer have decreased for all age groups since 1990. Although there have been some increases of mortality in some of the Eastern European countries, notably Romania and Bulgaria.
Socio-Economic
Cervical cancer is more common in women of poor socioeconomic status, who are less likely to receive regular screening and early treatment.
Survival
Cancer of the cervix can often be cured if it is detected and treated early. Survival rates continue to improve with early detection and better treatments.
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