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The cervix is the lower, narrow part of the uterus
(womb) located between the bladder and the rectum.
It forms a canal that opens into the vagina, which
leads to the outside of the body.
Cervical cancer, or invasive cervical
cancer, occurs when abnormal cells on the surface
of the cervix spread deeper into the cervix, or
to other tissues or organs. Cervical
cancer occurs most often in women over the age
of 40. It is different from cancer that begins
in other parts of the uterus and requires different
treatment. Most cervical cancers are squamous cell
carcinomas and adenocarcinomas.
The mortality rates for cervical cancer have declined
sharply as Pap screenings have become more prevalent.
About 15,000 cases of invasive cervical cancer
will be diagnosed in the US during 2000. Some researchers
estimate that noninvasive cervical cancer (also
referred to as "carcinoma in situ") is
nearly four times more common than invasive cervical
cancer.
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Symptoms of cervical cancer usually
do not appear until abnormal cervical cells become
cancerous and invade nearby tissue.
- The most common symptom is abnormal
bleeding, which may:
- start and stop between
regular menstrual periods.
- occur after sexual intercourse,
douching, or a pelvic exam.
- Other symptoms may include:
- heavier menstrual bleeding,
which may last longer than usual
- bleeding after menopause
- increased vaginal discharge
- pain during intercourse
The symptoms of cervical
cancer may resemble other conditions or medical
problems. Consult a physician for diagnosis.
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Cervical cancer is a sexually transmitted
disease and the second leading cause of cancer
death in women worldwide. In the US, despite the
availability of Pap smear testing, cervical cancer
remains the sixth most commonly diagnosed cancer.
More than half of all cancers are caused by Human
Papillomavirus (HPV) type 16. The
odds that a sexually active woman will be infected
at least once in her lifetime with HPV are approximately
80 percent.
Other suggested risk factors for cervical
cancer besides HPV16 include:
- having many sexual partners,
and having partners who have had sexual intercourse
at a young age and/or have had many partners
themselves
- having sexual intercourse before
the age of 18
- smoking
- infection with the human immunodeficiency
virus (HIV) — the precursor to AIDS,
or other conditions that weaken the immune
system
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Currently the screen for cervical
cancer is the Pap smear. If your Pap smear is abnormal
the next step is colposcopy. This procedure is
performed in the office. Your doctor will use a
special binocular instrument to examine your cervix.
Abnormal areas will be biopsied, and you may also
have an endocervical curettage. These procedures
are very fast. You may want to take Motrin right
before your appointment. Expect to have some spotting
afterwards. Depending on the results of your colposcopie
exam and biopsies your physician will discuss your
treatment options.
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ASCUS: Atypical squamous
cells of undetermined significance. This diagnosis
means that some of the cells on your Pap smear
did not look entirely normal, but did not meet
diagnostic criteria for a lesion. Your doctor may
either repeat your Pap smear, or perform colposcopy.
LSIL: Low-grade squamous intraepithelial
neoplasia. These lesions, in women with intact
immune systems, generally resolve without intervention
within 18 to 24 months.
HSIL: High-grade squamous intraepithelial
lesion. This lesion is the step right before cervical
cancer. Right now the treatment for HSIL is to
remove the tissue. This can be done in several
ways, most commonly by a cone procedure. There
are different kinds of obtaining a cone. The "cone"
refers to the shape of the piece or tissue removed.
The two most common methods of obtaining a cone
are:
- Loop Electrosurgical Excision Procedure
(LEEP) — This procedure is performed
in the office.
- Cold Knife Cone — This procedure
is done in the operating room, using a scalpel.
Other therapies are
- Laser Ablation — This procedure
is done in the operating room. A laser is
used to destroy the surface cells. The disadvantage
of ablation is that there is no tissue for
pathologic examination.
- Cryotherapy — This procedure is
done in the office. It is similar to freezing
off a wart. An instrument is held against
the cervix and freezes the surface. The disadvantage
of this procedure is that there is no tissue
for pathologic examination.
After undergoing any of the above procedures, you
will have mild crampy discomfort. You should expect
to have a discharge. You should shower and avoid
tub baths. Do not use tampons or douche.
For information about new treatments, please see
the section about our work.
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Early detection of cervical problems
is the best way to prevent cervical cancer. Routine,
annual pelvic examinations and Pap tests can detect
precancerous conditions that often can be treated
before cancer develops. Invasive cancer that does
occur would likely be found at an earlier stage.
Pelvic examinations and Pap tests are the methods
used to determine if there are cervical problems.
Women who are or have been sexually active, or
are age 18 or older, should have regular checkups,
including a pelvic exam and Pap test.
A pelvic exam and Pap test allow the
physician to detect abnormal changes in the cervix.
If an infection is present, it is treated and the
Pap test is repeated at a later time. If the exam
or Pap test suggests something other than an infection,
a repeated Pap test and other tests are performed
to determine the problem.
Women who have had a hysterectomy
(surgery to remove the uterus, including the cervix)
should ask their physician's advice about having
pelvic exams and Pap tests.
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The biology of cervical cancer is one of the best-characterized
of all malignancies. Its precursor, cervical intraepithelial
neoplasia, is both detectable and quantifiable,
which presents many opportunities for evaluation
of early treatment and intervention, and eventually,
for cancer prophylaxis.
Specific treatment for cervical cancer will be determined
by your physician(s) based on:
- your overall health and medical history
- extent of the disease
- your tolerance for specific medications, procedures,
or therapies
- expectations for the course of the disease
- your opinion or preference
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