There are a few factors that increase a person’s chance of cervical cancer. Cigarette smoking, and even exposure to second-hand smoke, can triple a person’s risk of developing the condition. Having multiple sexual partners, especially those who have had multiple partners themselves, can increase the risk, though sometimes people can develop the condition from exposure to just one partner. People with compromised immune systems, such as those with HIV, transplant recipients or those taking immunosuppression drugs, also are at higher risk.

HPV infection and cervical dysplasia generally cause no symptoms. Regular gynecological visits including a pelvic exam and Pap test can identify the conditions. Then your physician can help manage them before they turn cancerous. In some cases, the body clears HPV infection on its own.

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 that starts and stops between regular menstrual periods, or that occurs 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

These symptoms may resemble other conditions or medical problems. Consult a physician for diagnosis.

Repeated conizations or multiple procedures can impact a woman’s ability to get pregnant or to carry a pregnancy to term. Studies have indicated that if a woman has three conizations, she will have a higher rate of preterm delivery.

Our mission is to help preserve fertility by removing as little tissue as possible when doing resections, and to err on the side of conservative management. To maximize outcomes, we ask that patients return to the center regularly for checkups.

We are continuously studying the best management techniques for women with cervical dysplasia. One of our studies has been tracking healthy women with CIN2/3. More than 300 patients have enrolled in the study over the past 10 years. In this study, we follow women diagnosed with CIN2/3 for 15 weeks. We perform an extra exam between weeks 6 to 8 to make sure that lesions are not growing. At week 15, if there is still CIN2/3, we remove it. Specimens collected during this study allow us to study immune responses to HPV in the cervix and the blood. No patients’ lesions have grown in this time frame. In fact, over 30 percent of CIN2/3 lesions regress in this time frame without further intervention. Determining what factors influence regression  may help us spare patients the need for surgery. In addition, studying the barriers to the immune response within cervical lesions will allow us to create a new generation of more effective immune therapies.

Some therapies for cervical cancer, including surgery or radiation, can be disfiguring to the vulva or vagina. As a result, some women may be self-conscious about their appearance, or afraid to have sexual relations because the virus is transmitted through direct contact. 

A nurse affiliated with our center is available for confidential counseling and advice to address these issues to best preserve sexual function.

For more information or to make an appointment, contact Linda Rogers at 410-550-0335.

Prophylactic vaccines

There are two commercially available vaccines that help protect adolescents and women from HPV: Gardisil and Cervarix. Gardasil, administered in three injections over six months, is recommended for 11- and 12-year-old girls, or for females aged 13 through 26 who have not yet been vaccinated or completed the vaccine series. This vaccine targets the types of HPV that most commonly cause cervical cancer (16 and 18), as well as the two strains of HPV that most commonly cause genital warts (6 and 11). Cervarix, which is FDA-approved for females aged 10 to 25, also is administered in a series of three shots and protects against two strains of HPV (16 and 18) that cause cervical cancer. Ideally, females should get the vaccine before they become sexually active, when they may be exposed to HPV.These vaccines do not protect against all types of HPV; about 30 percent of cervical cancers will not be prevented by the vaccine. The vaccines also do not protect against other sexually transmitted infections, and cannot treat existing HPV. Therefore, it is still important for those who get the vaccines to continue regular screenings for cervical cancer through gynecological checkups and Pap tests.

Pap Tests

Regular gynecological checkups, including a pelvic exam and Pap tests, will help detect any abnormal changes to the cervix as early as possible.

A pelvic exam is an internal exam of the uterus, vagina, ovaries, fallopian tubes, bladder and rectum. You will need to lie down on an examining table and put your feet in the stirrups. Next, an instrument called a speculum is inserted into your vagina to hold your vaginal walls open so your physician can view the inside of the vaginal walls and the cervix, and collect a sample of cervical tissue for your Pap test.

During a Pap exam, cells are collected with a cervical brush from the so-called “transformation zone” of the cervix (the most likely location for lesion development). The cells collected are used to detect any changes that may be cancerous or may lead to cancer, and to show noncancerous conditions such as infection or inflammation. The gynecologist or other health care practitioner performing the exam will spread the cells onto a slide and send them to a lab for further analysis.

If the Pap test shows an ambiguous or minor abnormality, the test is usually repeated to ensure accuracy. If the test shows a significant abnormality, your doctor may perform a procedure called a colposcopy to further examine the vagina and the cervix. For this test, performed in the gynecologist’s office, you will be positioned on the examining table like for a Pap smear, and an acetic acid will be placed on the cervix. The doctor will position an instrument called a colposcope – an electric microscope – close to your vagina. A bright light on the end of the colposcope lets the doctor clearly see the cervix. Abnormal cervical changes appear as white areas -- the whiter the area, the worse the cervical dysplasia. Your doctor may also perform a biopsy, in which a small amount of cervical tissue is removed and sent to a lab for analysis. This is the only sure way to determine whether the abnormal cells indicate cancer. You may want to take Motrin right before your appointment. Expect to have some spotting afterwards, so bring a sanitary napkin with you.

Depending on the results of your colposcopy exam and biopsies, your physician will discuss your treatment options.

A normal Pap smear shows healthy squamous cells (flat cells that look like fish scales) from the surface of the cervix. There are no signs of infection and no abnormal cells. Even if your Pap results are healthy, you should be tested regularly. The tests screen for infectious agents that may be harmful if allowed to persist. Early detection of any infection will allow for better treatment and will help you maintain your health.

Abnormal Pap test results include:

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 a colposcopy. The lab may test your Pap smear specimen for HPV.

LSIL ~ Low-grade squamous intraepithelial lesion

This diagnosis means there are early changes in the size and shape of the cells. LSILs are often associated with HPV, which may also cause genital warts. These lesions, in women with intact immune systems, often resolve without intervention within 18 to 24 months. Low-grade lesions may also be called mild dysplasia, or CIN1. If it is your first abnormal Pap smear, your doctor will likely recommend a colposcopy.

HSIL ~ High-grade squamous intraepithelial lesion

This diagnosis means the cells appear very different from normal cells. These precancerous lesions are more severe than with LSIL, but involve cells on the surface of the cervix. They may also be called moderate or severe dysplasia, or CIN 2 or 3. The treatment for HSIL is to remove the abnormal tissue. This can be done in several ways. See the treatment section for more information.

If your pap smear is abnormal, the first step is to have a colposcopy. The purpose of this exam is to determine whether there is evidence of a high-grade, pre-cancerous lesion. Pap smears are not 100%.

During a colposcopy, your provider will use a regular speculum to see your cervix. A very dilute vinegar solution is applied to the outside of your cervix with a big Q-tip. This will highlight potentially abnormal cells. A biopsy to determine your diagnosis may be taken. A biopsy is about the size of a sesame seed, and does not take a long time.  A sample of cells from the endocervix, or birth canal, may also be taken, because HPV can infect cells there. You may have some cramping during the procedure. Afterward, you may have very light spotting.

Information from the colposcopic exam helps to determine the best way to take care of you, going forward. If nothing untoward is found with a colposcopy, keep in mind that to have HPV detected in a normal pap smear is very common.

Adenocarcinoma In-Situ

A precancerous condition in which there are cancerous cells in the cervix that have not yet spread away from where they started or begun to grow into the deeper tissues of the cervix. The diagnosis is usually made by a biopsy or endocervical curettage (a gentle scraping of the cervical opening). The usual treatment is a cone biopsy. In some situations, your doctor may recommend a hysterectomy (surgical removal of the uterus).

Vulvar Dysplasia 

A condition in which tissues in the vulva, or external part of the vagina, begin to grow in an unusual way, causing itching or burning; the development of lesions or warts; and bleeding. If untreated, it could turn into vaginal cancer. Generally, surgical removal of the abnormal tissue is the most effective treatment. This can be done by scalpel or by laser depending on the specifics of the condition.

Patients with Compromised Immune Systems

Women with medical conditions that affect the immune system, like HIV or lupus; or who take immune-suppressing medications; or who are organ transplant recipients, are at greater risk for cervical dysplasia.