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Cancer of the cervix is a gradual disease that usually begins with abnormal cell growth in the uterus; if left untreated, it can develop into cancer of the cervix. Human papillomavirus, or HPV, is an extremely common infection that is transmitted sexually. Certain strains of HPV have been connected to the development of cervical cancer. The good news is that with regular Pap screening, women have a good chance of detecting pre-cancerous cell growth before it becomes cancer. Early detection is the key to prevention and successful treatment; talk with your doctor about how often you should be screened.
What is Cervical Cancer?
A woman’s uterus can be divided into two realms. The upper part—the body of the uterus—contains the fallopian tubes and ovaries, while the lower part consists of the vaginal canal. The cervix connects the body of the uterus to the vagina. The upper part of the cervix is known as endocervix and the lower portion is called the ectocervix. It is in these two regions that cervical cancers develop.
The cervix passes blood from the uterus to the vagina during a woman’s menstrual cycle. It also produces mucus that aids sperm movement, allowing easier travel from the vaginal canal to the upper uterus. When a woman is pregnant, the cervix closes tightly to keep the fetus in place, and during the birthing process, opens to allow the baby to pass through.
The cervix is constructed of three layers of tissue: an outer lining, a middle muscular layer, and an inner lining known as the mucous membrane. This inner layer contains tiny glands that secrete lubricating mucous.
Cancer occurs when cells reproduce in an unregulated fashion, causing the formation of abnormal cells within the bodily tissue. Normally, DNA is programmed with instructions, telling the cells to grow when the body needs them and to die when they have grown old. If the genes are defective, however, new cells form when they are not needed, or do not die when they should. This mass of growth is called a tumor. Tumors can be either benign or malignant.
Benign tumors are not cancerous, and are rarely life threatening. Because benign cells have not spread to surrounding tissue or organs, they are easier to remove. And once removed, there is a good chance that they will not return. Polyps, cysts, and genital warts are examples of benign tumors that affect the cervix.
Conversely, malignant tumors are cancerous, and may spread (metastasize) to other parts of the body. By breaking away from the original tumor, cancer cells can enter the bloodstream or lymphatic channels, forming new tumors on other organs.
The Two Basic Types of Cervical Cancer:
Cancer of the cervix usually develops over time. It begins with abnormal cell growth within the lining of the cervix, which can eventually develop into cancer. Known as pre-cancerous changes, cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL), and dysplasia are conditions that denote this transitional period from normal cell formation to cancerous cell growth.
Squamous cell carcinoma (SCC) is by far the most prevalent type, affecting 80-90% of women with cervical cancer. SCC changes the cells that cover the outer surface layer of the cervix, known as the squamous cells. Generally, it begins in the region where the ectocervix connects to the endocervix.
Adenocarcinoma occurs in the cells that line the mucous-producing glands of the inner layer of the cervix.
Occasionally, cervical cancer can be a combination of these two types, known as adenosquamous carcinomas or mixed carcinomas.
What Causes Cancer of the Cervix?
As of yet, the medical community does not know what causes cervical cancer. However, studies have shown that certain factors come into to play to increase one’s risk for this type of cancer, and may act alone or in conjunction with each other.
Human papillomaviruses (HPVs) are the main precursors for cervical cancer. HPVs are a common infection and can be passed through sexual contact. There are over 100 different types of HPVs; of these, 30 to 40 can infect the genital tract, the external genitals, and the area around the anus. The changes to the cervix caused by HPVs can lead to genital warts, cancer, or other physical ailments. The virus may survive for years before eventually developing into cancer cells.
There is no cure or treatment for HPV, and typically there are no symptoms to serve as an indication of infection. Although these infections are quite common, very few women will develop cervical cancer because of them. Generally, the infection is warded off if the immune system can successfully fight the infection. Vaccines are currently being developed to protect against certain types of HPVs.
Using condoms during sexual intercourse does not completely protect against HPVs. Although condoms do provide some protection, HPVs can be transmitted through skin-to-skin contact around the genital zone, in the area that is not covered by the condom.
Other Risk Factors:
Papanicolaou screening—otherwise known as “Pap smear testing”—is an effective way for a doctor to determine whether pre-cancerous cells or abnormal cell growth has occurred. Women who do not get regular Pap smears are at a higher risk for undetected HPVs and cervical cancer. Between 60 to 80% of women diagnosed with cervical cancer have not had a Pap test in at least five years.
Women with a weakened immune system are at a higher risk of HPVs that can in turn lead to cancer. Those who have contracted HIV, or are taking drugs that suppress the immune system, are at a much greater risk.
Studies show that women who have used oral contraceptives for more than five years, have had many children, or have had many sexual partners, are also at an increased risk. A family history of cervical cancer increases the odds of developing this disease 2 to 3 times.
Symptoms of Cervical Cancer:
Unfortunately, the early stages of cervical cancer tend to be asymptomatic. It can be difficult to detect the Stages of Cervical Cancer but generally when the disease progresses, these symptoms of cervical cancer may be present.
Abnormal vaginal bleeding—such as bleeding between normal menstrual cycles, bleeding after sexual intercourse, during douching or a pelvic exam, as well as experiencing heavier and longer menstrual periods, are all typical symptoms of cervical cancer. Bleeding after menopause is another indication. Pelvic pain, pain during intercourse, and heavier vaginal discharge could be signs as well.
Experiencing these symptoms does not necessarily mean cervical cancer. Other health conditions and infections can cause these symptoms, so seek the help of a health care professional immediately.
Screening & Prevention:
Pap tests are the most common way to determine whether abnormal cell growth has occurred within the uterus. The doctor will scrape a sampling of cells from the surface of the cervix and send them to a lab for screening. A Pap smear will determine if you have cervical cancer, or whether abnormal cells are present in the uterus.
Your first Pap test should be scheduled within three years of having sex for the first time, or by the age of 21. It is recommended that a woman receive Pap tests at least once every year between the ages of 21 to 29. If you have had a normal pap test three years in a row, women from the ages of 30 to 69 may opt for a Pap once every two years. Beyond the age of 70, women may stop having Paps entirely if they have had normal Pap results for over ten years. However, if you are at a higher-than-average risk for cervical cancer, you should consult with your doctor to determine how often you should be screened.
A similar procedure, known as an HPV DNA test, involves collecting cervical cells to determine if you have one of the HPVs linked to the development of cervical cancer. Colposcopies and biopsies are other procedures that will help diagnose this disease.
Cervical Cancer Vaccine:
A recent development in the fight against cervical cancer, HPV vaccines have been formulated in order to provide protection against the most dangerous strains of this virus. Approved by the FDA in June of 2006, Gardasil could prevent 70% of cases of cervical cancer. Another vaccine, Cervarix, is still undergoing clinical trials.
Gardasil is most effective for girls who have not yet become sexually active, but may still be administered to women between 13 and 26 who have not received vaccination. It works by specifically blocking two types of HPV—type 16 and 18—that have been strongly linked to cancer; in effect, it prevents cervical cancer before it can even start. It involves a series of three injections over a six-month period. HPV vaccinations are not intended to replace Pap tests; regular screening accompanied by vaccination is the best way to prevent cervical cancer to date.