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Cervical Cancer (Cervix)

What is the Cervix?

The cervix is part of a woman's reproductive system. It's in the pelvis. The cervix is the lower, narrow part of the uterus (womb).
The cervix is a passageway:

  • The cervix connects the uterus to the vagina. During a menstrual period, blood flows from the uterus through the cervix into the vagina. The vagina leads to the outside of the body.

  • The cervix makes mucus. During sex, mucus helps sperm move from the vagina through the cervix into the uterus.

  • During pregnancy, the cervix is tightly closed to help keep the baby inside the uterus. During childbirth, the cervix opens to allow the baby to pass through the vagina.


Cervical Cancer

Cervical cancer, or cancer of the cervix, is cancer of the entrance to the uterus (womb). Cervical cancer begins in cells on the surface of the cervix. Over time, the cervical cancer can invade more deeply into the cervix and nearby tissues. The cancer cells can spread by breaking away from the original (primary) tumor. They enter blood vessels or lymph vessels, which branch into all the tissues of the body. The cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. The spread of cancer is called metastasis.


Types of Cancer of the Cervix

There are two main types of cervical cancer:

  • Squamous cell carcinoma – This is the most common type of cervical cancer. It develops from the flat cells which cover the outer surface of the cervix at the top of the vagina.

  • Adenocarcinoma – This type develops from the glandular cells which line the cervical canal (endocervix). As adenocarcinoma starts in the cervical canal it can be more difficult to detect with cervical screening tests. 

  • There are other, less common types of cancer of the cervix known as adenosquamous carcinoma , clear-cell and small-cell carcinomas .

Cervical cancer can be microinvasive or invasive:

  • Microinvasive cancer -- cancer cells have broken through the boundary between the epithelium and stroma. Cells haven't spread more than 5mm into the cervix tissue.

  • Invasive cancer -- cancer cells have spread into the stroma to a depth of more than 5mm. Cancer may have spread to nearby tissues (like the vagina, rectum or bladder).

Cervical cancer can spread to other parts of the body through the lymphatic system.


Cervical Cancer Stages

The stage of a cancer tells the doctor how far it has spread. It is important because treatment is often decided according to the stage of a cancer. Remember - if you have had an abnormal cervical screening test and your doctor has said you have carcinoma in situ (CIN) you can find information on the cervical screening page. Carcinoma in situ is not a cancer but in some women it will develop into cancer if left untreated. 

The stages of cervical cancer are numbered from 1 to 4. Each stage is sometimes divided into A and B.

  • Stage 0

This is also known as cervical pre-cancer or Cervical Intraepithelial Neoplasia (CIN). This is not true cancer but a pre-cancerous stage where the abnormal cancer cells are still limited to the superficial skin and do not invade the deeper tissues of the cervix.

  • Stage I

Cancer is limited to the cervix itself.

    • Stage IA: a very small amount of cancer is present only visible with a microscope.

    • Stage IB: a larger amount of cancer is present and can be seen with the naked eye.

  • Stage II

Cancer has spread to nearby areas immediately next to the cervix.

    • Stage IIA: cancer has spread beyond the cervix to somewhere in the upper 2/3 of the vagina.

    • Stage IIB: cancer has spread to the tissues beside the cervix but not as far as the side of the pelvis.

  • Stage III

Cancer has spread further than in stage II but is still limited within the pelvis.

    • Stage IIIA: cancer has spread to the lower 1/3 of the vagina.

    • Stage IIIB: cancer has spread to the side of the pelvis.

  • Stage IV

Cancer has spread to other parts of the body.

    • Stage IVA: cancer has spread to the bladder or rectum.

    • Stage IVB: cancer has spread to areas outside the pelvis.

Symptoms

Most of the time, early cervical cancer has no symptoms. Symptoms that may occur can include:

  • Abnormal vaginal bleeding between periods, after intercourse, or after menopause

  • Any bleeding after menopause

  • Continuous vaginal discharge, which may be pale, watery, pink, brown, bloody, or foul-smelling

  • Periods become heavier and last longer than usual


Symptoms of advanced cervical cancer may include:

  • Back pain

  • Bone fractures

  • Fatigue

  • Heavy bleeding from the vagina

  • Leaking of urine or feces from the vagina

  • Leg pain

  • Loss of appetite

  • Pelvic pain

  • Single swollen leg

  • Weight loss


Exams and Tests

Precancerous changes of the cervix and cervical cancer cannot be seen with the naked eye. Special tests and tools are needed to spot such conditions.

  • Pap smears screen for precancers and cancer, but do not make a final diagnosis.

  • If abnormal changes are found, the cervix is usually examined under magnification. This is called colposcopy. Pieces of tissue are surgically removed (biopsied) during this procedure and sent to a laboratory for examination.

  • Other tests may include:

  • Endocervical curettage (ECC) to examine the opening of the cervix

  • Cone biopsy

If the woman is diagnosed with cervical cancer, the health care provider will order more tests to determine how far the cancer has spread. This is called staging. Tests may include:

  • Chest x-ray

  • CT scan

  • Cystoscopy

  • Intravenous pyelogram (IVP)

  • MRI

 

Causes of Cancer of the Cervix

So far, it is not fully understood what causes cells to become abnormal and to grow without control. Some factors have been observed to increase the risk of developing cancer of the cervix.

  • HPV - The most important risk factor is the infection of the cervix with HPV.HPV is one of the most common sexually transmitted infections (STIs). It is estimated that 75% of individuals who are sexually active will have at least one HPV infection in their lifetime. While some types of HPV cause genital warts, other strains of the virus can infect the cervix and then cause abnormal changes within the cells that may slowly progress to cancer. It is important to note that most women diagnosed with cervical cancer had a previous HPV infection; however, not all women with an HPV infection will develop this type of cancer.

  • Sexual Activity - Becoming sexually active at an early age (before 18) is linked to a higher risk of cervical cancer. Also, certain sexual behaviours (such as having multiple sex partners and partners who have multiple partners) can increase a woman's likelihood of becoming infected with HPV, thereby increasing the risk of cervical cancer.

  • Smoking - People who smoke are at higher risk of cervical cancer, as well as other cancers. Both tobacco smoking and exposure to secondhand smoke (environmental tobacco smoke) have been associated with the development of cervical cancer. In fact, the risk increases with the length of time a woman smokes and the number of cigarettes consumed per day.

  • Weakened Immune System - Our immune system helps our body fight infections. Therefore, medications and diseases that diminish the immune system can increase a woman's risk of HPV infections, thereby increasing the risk of cervical cancer. Examples of medications that suppress the immune systems are corticosteroids (used over a long period of time) and chemotherapy drugs. Women infected with the human immunodeficiency virus (HIV) have an increased risk of developing precancerous cervical changes with an HPV infection.

  • Diethylstilbestrol (DES) - DES was a form of estrogen used during pregnancy between 1940 and 1971. Some studies have suggested that DES-exposed daughters may be at increased risk of developing precancerous cervical cancer and squamous cell carcinoma of the cervix.

  • Age - Most cases of cervical cancer tend to occur in women younger than 50 years of age.

  • Socioeconomic Status - Women with lower incomes are at higher risk of developing cervical cancer because they are less likely to receive regular Pap test screenings.

  • Other Risk Factors - Other possible factors have been associated with increased risk of cervical cancer. However, there is currently not enough evidence to consider them as main risk factors. These factors include prolonged used of oral contraceptives (more than 10 years), a family history of cervical cancer, and history of STIs.


Treatment of Cervical Cancer

Your treatment will depend on the stage of your cervical cancer and your general health. You may have a combination of treatments. Your surgeon or oncologist will advise you which treatment is best for you. Three treatments methods are commonly used to treat cervical cancer: surgery, chemotherapy, and radiation therapy. Sometimes they are used alone, and there are times when they are used in conjunction with one another. 


Surgery

Surgery is a common method used to treat cervical cancer. Many times, surgery is combined with other treatment methods, like chemotherapy or radiation therapy. The type of surgery chosen to treat cervical cancer depends on the stage and other factors.
Surgical treatments for cervical cancer include:

  • Lymphadenectomy - Surgical removal of the lymph nodes. It is common in treating women with cervical cancer. 

  • Radical Trachelectom - Removal of the cervix and its surrounding tissue while leaving the body of the uterus intact. A radical trachelectomy with lymphadenectomy is an option for young women with early stage disease who wish to maintain fertility.

  • Radical Hysterectomy - Surgical removal of the uterus, cervix, and part of the vagina. In some cases, the ovaries, fallopian tubes, and lymph nodes are removed. A radical hysterectomy may be combine with chemotherapy or radiation therapy. 

  • Bilateral Salpingo-Oophorectomy - Surgical removal of both ovaries and the fallopian tubes. This type of surgery accompanies a hysterectomy is some cases.


Chemotherapy

This is the treatment of cancer with anti-cancer drugs. The aim is to destroy all cancer cells while doing the least possible damage to normal cells. The drugs work by stopping cancer cells from growing and reproducing themselves.Chemotherapy is usually given to women with more advanced cancer or together with radiotherapy. You will probably have chemotherapy through a vein. You will probably have a number of treatments, usually six, every three to four weeks over several months. This depends on the disease and other treatments being used. You will have blood tests before your next treatment to make sure your body's normal cells have had time to recover.


Radiation Therapy

Radiation therapy uses high energy beams to reduce the size of a tumor or to kill cancer cells. This type of treatment can be done internally with radioactive materials that are implanted in the uterus or externally with the use of a radiation therapy machines. Often prescribed with chemotherapy, radiation therapy is an effective method of treating cervical cancer. It can however, be prescribed alone or before or after chemotherapy. Radiation treatment plans depend on stage of cervical cancer, other treatment methods used, and the general health of the patient. 


Prognosis (Chance of Recovery) and Treatment Options

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

  • The patient's age and general health.

  • Whether or not the patient has a certain type of human papillomavirus.

  • The stage of the cancer (whether it affects part of the cervix, involves the whole cervix, or has spread to the lymph nodes or other places in the body).

  • The type of cervical cancer.

  • The size of the tumor.

Treatment options depend on the following:

  • The stage of the cancer.

  • The size of the tumor.

  • 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.


How can I Prevent Cervical Cancer?

Fortunately, there are several actions that women can take to decrease the risk of dying from cervix cancer. The first of these is undergoing regular Pap testing. Pap tests will be discussed further in the next section, but the reason that women have had such a drastic drop in cervical cancer cases and deaths in this country has been because of the Pap test and annual screening.

Recently, two vaccines, called Gardasil and Ceravix have been developed. These vaccines have been demonstrated to be effective in preventing infection with some strains of HPV, when given before a person is exposed to HPV.

For further prevention, women should try to reduce risk factors as much as possible. Don't start smoking, and if you are already a smoker, it is time to quit. Smoking has been shown to decrease the immune system’s ability to clear an HPV infection. Women can limit their numbers of sexual partners, and delay the onset of sexual activity to reduce risk, as more partners increases the likelihood of infection. Unfortunately, condoms do not protect you from developing HPV, so even though they can protect you from other sexually transmitted diseases and HIV, they cannot help lower your risk for being infected with HPV.


Facts About Cervical Cancer

  • Cervical cancer is the second most common cancer of the female reproductive system. It accounts for 6% of all cancers in women.

  • Early-stage cervical cancer and precancerous (tending to become cancerous) cervical conditions are almost 100% curable.

  • The five-year relative survival rate for earliest-stage cervical cancer is 91%.

  • Cervical cancer death rates fell by 74% between 1955 and 1992 and continue to drop by about 2% a year.

  • The increased use of the Pap test is mostly responsible for the decrease in the number of cervical cancer deaths. This simple, highly effective screening procedure can detect precancerous conditions of the cervix and more than 90% of all cervical cancers.

  • About one-third of women who should have regular Pap tests do not. Women who don't have Pap tests at recommended intervals are far more likely to develop cervical cancer than women who regularly undergo the procedure.

  • Between 60% and 80% of women newly diagnosed with cervical cancer have not had a Pap test within five years. Some of these women have never had a Pap test.

  • Researchers are investigating new methods of preventing, detecting, and treating cervical cancer and the precancerous conditions that can lead to it.

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