Cervical Cancer

Proper screening can detect cervical cancer in women before the disease causes any symptoms. And that can save lives, because, as with so many types of cancer, early treatment can mean a better chance for a cure. (Read about "Cancer: What It Is") In fact, according to the American Cancer Society (ACS), when cervical cancer is detected at an early stage, it's one of the most successfully treated cancers.

The cervix

The cervix is at the lower end of the uterus. According to the Centers for Disease Control and Prevention (CDC), cancer of the cervix is closely linked to:

• certain sexual behaviors, such as intercourse at an early age and multiple sex partners
• human papillomavirus (HPV) infection (Read about HPV in "STD's")
• immunosuppressive disorders such as HIV/AIDS (Read about "HIV / AIDS")
• failure to receive regular Pap test screening
• smoking (Read about "Quit Smoking")

Cervical cancer is not the same as uterine cancer, which starts in a different part of the uterus and is not easily detected by Pap tests. (Read about "Uterine Cancer")

HPV and Pap tests

HPV is responsible for genital warts and the vast majority of precancerous genital lesions and cervical cancers, as well as other cancers. A vaccine is available. The vaccine is approved for people from age nine to 45. The Food and Drug Administration (FDA) says the vaccine is effective against nine HPV types which cause the vast majority of cervical cancers and genital warts. If someone is already infected with one type, the vaccine won't be as effective. However, the American College of Obstetricians and Gynecologists (ACOG) says it is still valuable to get the vaccine to protect from the other types.

Women ages 21 to 29 should have a Pap smear every three years, according to guidelines from the United States Preventive Services Task Force (USPSTF). USPSTF says based on the evidence, women between the ages of 30 and 65 can be screened for cervical cancer with a test for "high risk" strains of the human papillomavirus (HPV) every five years, without undergoing a simultaneous Pap test. Or they can choose to be screened every three years with a Pap test alone. Or they can choose to be screened with both tests every five years. Women should talk to their doctors about what is best for them.

HPV screening in women under the age of 30 is not recommended. Though the infection is common in younger women, it often clears up on its own. Women who have had the HPV vaccine should continue to follow the screening recommendations for their age group. Women who are at high risk for cervical cancer may need to be screened more often.

No screening is recommended for women over age 65 who have had at least three consecutive negative Pap tests or at least two negative HPV tests the last 10 years, with the most recent test in the last 5 years, according to ACS.

A woman's personal history, as well as her medical and family history (Read about "Family Health History"), can help a doctor determine when she needs to have Pap tests and/or HPV screening done. Talk with your doctor or healthcare practitioner.

Both the HPV test and the Pap test look at cells from a woman's cervix, according to the National Cancer Institute (NCI).

In an HPV test, the cells are tested for HPV infection. If the test is positive, it does not mean that you necessarily have cancer. It means that you need to be followed closely with additional tests to see if the infection goes away and to make sure that you do not develop abnormal cells or cancer.

In a Pap test, the cells are analyzed to see if they are cancerous. During a Pap test, a healthcare professional scrapes some cells from the cervix. NCI says a woman should have this test when she is not menstruating; the best time is between 10 and 20 days after the first day of her menstrual period. In addition, for about 2 days before a Pap test, she should avoid douching or using foams, creams, jellies or vaginal medicines (except as directed by a physician), because these may wash away or hide any abnormal cells.

After the cells are taken, the sample is transferred to a slide and examined in a lab for signs of cancer. (Read about "Laboratory Testing") ACOG says that, like any test, a Pap test isn't always accurate. It may not detect cells that are abnormal. This is called a "false negative." No one knows just how many Pap tests produce false negatives. NCI says that by getting regular Pap tests, a woman can reduce her risk of developing cancer because of a missed abnormality. Pap tests may also label normal cells as abnormal, what's called a "false positive." When a Pap test indicates an abnormality, a doctor may decide that the test needs to be repeated or that different types of tests are required.

Most times the results of a Pap test are normal. A so-called abnormal result indicates a need for further testing. There can be many reasons for an abnormal result.

Sometimes, cells on the surface of the cervix appear abnormal but not cancerous. Scientists believe that some abnormal changes in cells on the cervix are the first step in a series of slow changes that can lead to cancer later on; in other words, they may be considered precancerous. CDC says cervical intraepithelial neoplasia (or CIN) is the name for a precursor lesion to cervical cancer. The term CIN, along with a number (1 to 3), is used to describe how much of the cervix contains abnormal cells. Abnormal or precancerous cells are also called dysplasia or squamous intraepithelial lesion (SIL). SIL is described as being low-grade (early changes in the size, shape and number of cells) or high-grade (a large number of precancerous cells). High grade SIL can also be called carcinoma in situ. Cervical cancer or invasive cervical cancer, is the term used when abnormal cells spread into the cervix or to other tissues or organs.

The American Society for Colposcopy and Cervical Pathology (ASCCP) says the most common type of abnormal Pap test is an inconclusive result referred to as ASC-US or atypical squamous cells of undetermined significance. There are now new national Consensus Guidelines for dealing with ASC-US. Before these guidelines, women with ASC-US would usually either get several repeat Pap tests or undergo a colposcopy, during which the cervix is examined using a special type of microscope and biopsies can be taken. (Read about "Biopsy") The new guidelines say the other approaches may still be used, but HPV testing is preferred whenever liquid-based Pap tests are used. If the liquid test is used, the laboratory can test the same sample used for the original Pap test for HPV. ASCCP calls HPV the primary cause of cervical cancer. The test quickly identifies those women who are HPV positive and need further evaluation. ASCCP says women who are HPV negative are less likely to have cervical cancer but that they still need regular annual Pap tests

The National Cancer Institute (NCI) says that if precancerous conditions are present, there may be no apparent symptoms or problems. In the early stages of cervical cancer, there may also be no symptoms. In its later stages, ACOG says cervical cancer can cause:

• abnormal vaginal bleeding or spotting
• abnormal discharge
• pain

If a woman experiences any of these problems, she should contact a doctor right away. These symptoms can indicate a number of different conditions, so a correct diagnosis is critical. (Read about "Menstrual Disorders")

If problems are suspected, NCI says colposcopy is a widely used method to check the cervix further by using a special solution and a microscope-like device to examine the cervix. A biopsy may also be performed to remove tissue for further examination. A procedure that removes a larger cone-shaped portion of tissue is called a conization. Another method used to do a biopsy is called loop electrosurgical excision procedure (LEEP). In this procedure, the doctor uses an electric wire loop to remove a thin piece of tissue. (Read about "Biopsy")

Treatment

For precancerous conditions, treatment options can include cryosurgery (freezing), cauterization (burning) or laser surgery to destroy the abnormal area without harming nearby healthy tissue. The doctor also can remove the abnormal tissue by LEEP or conization.

It is important to know the stage of the disease in order to plan the best treatment. The following stages are used, according to NCI:

• Stage 0 (Carcinoma in Situ)

  In carcinoma in situ (stage 0), abnormal cells are found in the innermost lining of the cervix. These abnormal cells may become cancer and spread into nearby normal tissue.

• Stage I

  In stage I, cancer is found in the cervix only. Stage I is divided into stages IA and IB, based on the amount of cancer that is found.

• Stage II

  In stage II, cancer has spread beyond the cervix but not to the pelvic wall (the tissues that line the part of the body between the hips). Stage II is divided into stages IIA and IIB, based on how far the cancer has spread from the cervix into nearby tissue.

  • Stage IIA: Cancer has spread beyond the cervix to the upper two thirds of the vagina but not to tissues around the uterus.
  • Stage IIB: Cancer has spread beyond the cervix to the upper two thirds of the vagina and to the tissues around the uterus.

• Stage III

  In stage III, cancer has spread to the lower third of the vagina and may have spread to the pelvic wall or is causing kidney problems. Stage III is divided into stages IIIA and IIIB, based on how far the cancer has spread.

• Stage IV

  In stage IV, cancer has spread to the bladder, rectum or other parts of the body. Stage IV is divided into stages IVA and IVB, based on where the cancer is found.

Surgery treats the cancer in the cervix and the area close to the tumor. NCI says most women with early cervical cancer have surgery to remove the cervix and uterus, a procedure called total hysterectomy. (Read about "Hysterectomy") The surgery may be done conventionally or robotically. (Read about "Robotic Surgery") However, for very early (Stage 0) cervical cancer, NCI says a hysterectomy may not be needed. Other ways to remove the cancerous tissue include conization, cryosurgery, laser surgery or LEEP.

Some women need a radical hysterectomy. A radical hysterectomy is surgery to remove the uterus, cervix and part of the vagina.

With either total or radical hysterectomy, the surgeon may remove both fallopian tubes and ovaries. This procedure is a salpingo-oophorectomy.

The surgeon may also remove the lymph nodes near the tumor to see if they contain cancer. (Read about "The Lymph System") If cancer cells have reached the lymph nodes, it means the disease may have spread to other parts of the body. If the cancer has spread, other options that may be used are chemotherapy and radiation. (Read about "Radiation Therapy" "Cancer Treatments")

But again, regular Pap tests can find problems early, before cancer has developed or progressed to an advanced stage. And that gives a woman the best chance of successful treatment.

More Cancer Information:

    Ovarian Cancer

    Uterine Cancer

    Vaginal Cancer

    Cancer Check-ups

    Cancer Support

    Cancer Treatments

    Reduce Cancer Risks

    Cancer Glossary

For a list of individual types of cancer, see Cancer: What It Is

Related Information:

    Microorganisms

    Genital Health - Female

    Woman's Health Terms Glossary

    Learn About Your Procedure

    At the Hospital: For Patients

    Anesthesia