CERVICAL CANCER

 

 

Key Points

• Cervical cancer is a disease in which malignant (cancer) cells form in the tissues of the cervix.
• Human papillomavirus (HPV) infection is the major risk factor for cervical cancer.
• There are usually no signs or symptoms of early cervical cancer but it can be detected early with regular check-ups.
• Signs and symptoms of cervical cancer include vaginal bleeding and pelvic pain.
• Tests that examine the cervix are used to detect (find) and diagnose cervical cancer.
• Certain factors affect prognosis (chance of recovery) and treatment options.

Cervical cancer is a disease in which malignant (cancer) cells form in the tissues of the cervix.

The cervix is the lower, narrow end of the uterus (the hollow, pear-shaped organ where a fetus grows). The cervix leads from the uterus to the vagina (birth canal).

Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia, in which abnormal cells begin to appear in the cervical tissue. Over time, the abnormal cells may become cancer cells and start to grow and spread more deeply into the cervix and to surrounding areas.

Cervical cancer in children is rare.

Human papillomavirus (HPV) infection is the major risk factor for cervical cancer.

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk to your doctor if you think you may be at risk for cervical cancer.

Risk factors for cervical cancer include the following:

• Being infected with human papillomavirus (HPV). This is the most important risk factor for cervical cancer.
• Being exposed to the drug DES (diethylstilbestrol) while in the mother's womb.

In women who are infected with HPV, the following risk factors add to the increased risk of cervical cancer:

• Giving birth to many children.
• Smoking cigarettes.
• Using oral contraceptives ("the Pill") for a long time.

There are also risk factors that increase the risk of HPV infection:

• Having a weakened immune system caused by immunosuppression. Immunosuppression weakens the body’s ability to fight infections and other diseases. The body's ability to fight HPV infection may be lowered by long-term immunosuppression from:
  • being infected with human immunodeficiency virus (HIV).
  • taking medicine to help prevent organ rejection after a transplant.
• Being sexually active at a young age.
• Having many sexual partners.

Older age is a main risk factor for most cancers. The chance of getting cancer increases as you get older.

There are usually no signs or symptoms of early cervical cancer but it can be detected early with regular check-ups.

Early cervical cancer may not cause signs or symptoms. Women should have regular check-ups, including tests to check for human papillomavirus (HPV) or abnormal cells in the cervix. The prognosis (chance of recovery) is better when the cancer is found early.

Signs and symptoms of cervical cancer include vaginal bleeding and pelvic pain.

These and other signs and symptoms may be caused by cervical cancer or by other conditions. Check with your doctor if you have any of the following:

• Vaginal bleeding (including bleeding after sexual intercourse).
• Unusual vaginal discharge.
• Pelvic pain.
• Pain during sexual intercourse.

Tests that examine the cervix are used to detect (find) and diagnose cervical cancer.

The following procedures may be used:

• Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. A speculum is inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test of the cervix is usually done. The doctor or nurse also inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
• Pap test: A procedure to collect cells from the surface of the cervix and vagina. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to find out if they are abnormal. This procedure is also called a Pap smear.

• Human papillomavirus (HPV) test: A laboratory test used to check DNA or RNA for certain types of HPV infection. Cells are collected from the cervix and DNA or RNA from the cells is checked to find out if an infection is caused by a type of HPV that is linked to cervical cancer. This test may be done using the sample of cells removed during a Pap test. This test may also be done if the results of a Pap test show certain abnormal cervical cells.
• Endocervical curettage: A procedure to collect cells or tissue from the cervical canal using a curette (spoon-shaped instrument). Tissue samples are taken and checked under a microscope for signs of cancer. This procedure is sometimes done at the same time as a colposcopy.
• Colposcopy: A procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas. Tissue samples may be taken using a curette (spoon-shaped instrument) or a brush and checked under a microscope for signs of disease.
• Biopsy: If abnormal cells are found in a Pap test, the doctor may do a biopsy. A sample of tissue is cut from the cervix and viewed under a microscope by a pathologist to check for signs of cancer. A biopsy that removes only a small amount of tissue is usually done in the doctor’s office. A woman may need to go to a hospital for a cervical cone biopsy (removal of a larger, cone-shaped sample of cervical tissue).

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on the following:

• The stage of the cancer (the size of the tumor and whether it affects part of the cervix or the whole cervix, or has spread to the lymph nodes or other places in the body).
• The type of cervical cancer.
• The patient's age and general health.
• Whether the patient has a certain type of human papillomavirus (HPV).
• Whether the patient has human immunodeficiency virus (HIV).
• Whether the cancer has just been diagnosed or has recurred (come back).

Treatment options depend on the following:

• The stage of the cancer.
• The type of cervical cancer.
• The patient's desire to have children.
• The patient’s age.

Treatment of cervical cancer during pregnancy depends on the stage of the cancer and the stage of the pregnancy. For cervical cancer found early or for cancer found during the last trimester of pregnancy, treatment may be delayed until after the baby is born. For more information, see the section on Cervical Cancer During Pregnancy.