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A Normal Cervix
Cervical Cancer
Cervical cancer is cancer that starts in
the cervix, the lower part of the uterus (womb) that opens at the top of the
vagina.
Causes
Worldwide, cervical cancer is the third most common type of cancer in women.
It is much less common in the United States because of routine use of Pap
smears.
Cervical cancers start in the cells on the surface of the cervix. There are
two types of cells on the cervix's surface: squamous and columnar. The
majority of cervical cancers are from squamous cells.
The development of cervical cancer is usually very slow. It starts as a
pre-cancerous condition called dysplasia. This pre-cancerous condition can
be detected by a Pap smear and is 100% treatable. That is why it is so
important for women to get regular Pap smears. Most women that are diagnosed
with cervical cancer today have not had regular Pap smears or they have not
followed up on abnormal results.
Undetected, pre-cancerous changes can develop into cervical cancer and
spread to the bladder, intestines, lungs, and liver. It can take years for
pre-cancerous changes to turn into cervical cancer. Patients with cervical
cancer do not usually have problems until the cancer is advanced and has
spread.
Almost all cervical cancers are caused by HPV (human papilloma virus). HPV
is a common virus that is spread through sexual intercourse. There are many
different types of HPV, and many do not cause problems. However, only
certain strains of HPV actually lead to cervical cancer. (Other strains may
cause genital warts.)
Other risk factors for cervical cancer include:
* Having sex at an early age
* Multiple sexual partners
* Sexual partners who have multiple partners or who participate in high-risk
sexual activities
* Women whose mothers took the drug DES (diethylstilbestrol) during
pregnancy in the early 1970s to prevent miscarriage
* Long-term use of birth control pills (more than 5 years)
* Weakened immune system
* Infections with genital herpes or chronic chlamydia infections
* Poor economic status (may not be able to afford regular Pap smears)
Symptoms
Most ot the time, early cervical cancer has no symptoms. Symptoms that may
occur can include:
* Continuous vaginal discharge, which may be pale, watery, pink, brown,
bloody, or foul-smelling
* Abnormal vaginal bleeding between periods, after intercourse, or after
menopause
* Periods become heavier and last longer than usual
* Any bleeding after menopause
Symptoms of advanced cervical cancer may include:
* Loss of appetite
* Weight loss
* Fatigue
* Pelvic pain
* Back pain
* Leg pain
* Single swollen leg
* Heavy bleeding from the vagina
* Leaking of urine or feces from the vagina
* Bone fractures
Exams and Tests
Pre-cancerous changes of the cervix and cervical cancer can not be seen with
the naked eye. Special tests and tools are needed to spot such conditions.
Pap smears screen for pre-cancers and cancer, but do not offer the 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:
* CT scan
* Cystoscopy
* MRI
* Chest x-ray
* Intravenous pyelogram (IVP)
Treatment
Treatment of cervical cancer depends on the stage of the cancer, the size
and shape of the tumor, the age and general health of the woman, and her
desire to have children in the future.
Early cervical cancer can be cured by removing or destroying the
pre-cancerous or cancerous tissue. There are various surgical ways to do
this without removing the uterus or damaging the cervix, so that a woman can
still have children in the future.
Types of surgery for early cervical cancer include:
* LEEP (Loop Electrosurgical Excision Procedure) -- uses electricity to
remove abnormal tissue
* Cryotherapy -- freezes abnormal cells
* Laser therapy -- uses light to burn abnormal tissue
A hysterectomy (removal of the uterus but not the ovaries) is not often
performed for cervical cancer that has not spread. It may be done in women
who have repeated LEEP procedures. However, in more advanced disease, a
radical hysterectomy may be performed. This type of hysterectomy removes the
uterus and much of the surrounding tissues, including internal lymph nodes
and upper part of the vagina. In the most extreme surgery, called a pelvic
exenteration, all of the organs of the pelvis, including the bladder and
rectum, are removed.
Radiation may be used to treat cancer that has spread beyond the pelvis, or
cancer that has returned. Radiation therapy is either external or internal.
Internal radiation therapy uses a device filled with radioactive material,
which is placed inside the woman's vagina next to the cervical cancer. The
device is removed when she goes home. External radiation therapy beams
radiation from a large machine onto the body where the cancer is located. It
is similar to an x-ray.
Chemotherapy uses drugs to kill cancer. Some of the drugs used for
chemotherapy for cervical cancer include 5-FU, Cisplatin, Carboplatin,
Ifosfamide, Paclitaxel, and Cyclophosphamide. Sometimes radiation and
chemotherapy are used before or after surgery.
Support Groups
National Cervical Cancer Coalition - http://www.nccc-online.org/
Outlook (Prognosis)
Many factors influence the outcome of cervical cancer. These include:
* The type of cancer
* The stage of the disease
* The age and general physical condition of the woman
Pre-cancer conditions are completely curable when followed up and treated
properly. The chance of being alive in 5 years (5-year survival rate) for
cancer that has spread to the inside of the cervix walls but not outside the
cervix area is 92%.
However, the 5-year survival rate falls steadily as the cancer spreads into
other areas.
Possible Complications
* Some types of cervical cancer do not respond well to treatment.
* The cancer may come back (recur) after treatment.
* Women who have treatment to save the uterus have a high risk of the cancer
coming back (recurrence).
* Surgery and radiation can cause problems with sexual, bowel, and bladder
function.
When to Contact a Medical Professional
Call your health care provider if you:
* Are a sexually active woman who has not had a Pap smear in the past year
* Are at least 20 years old and have never had a pelvic examination and Pap
smear
* Think your mother may have taken DES when she was pregnant with you
* Have not had regular Pap smears (ask your health care provider how often
you should have one performed)
Prevention
A new vaccine to prevent cervical cancer is now available. In June 2006, the
U.S. Food and Drug Administration approved the vaccine called Gardasil,
which prevents infection against the two types of HPV responsible for the
majority of cervical cancer cases. Studies have shown that the vaccine
appears to prevent early-stage cervical cancer and precancerous lesions.
Gardasil is the first approved vaccine targeted specifically to prevent any
type of cancer.
Practicing safe sex (using condoms) also reduces your risk of HPV and other
sexually-transmitted diseases. HPV infection causes genital warts. These may
be barely visible or several inches wide. If a woman sees warts on her
partner's genitals, she should avoid intercourse with that person.
To further reduce the risk of cervical cancer, women should limit their
number of sexual partners and avoid partners who participate in high-risk
sexual activities.
Getting regular Pap smears can help detect pre-cancerous changes, which can
be treated before they turn into cervical cancer. Pap smears work very well
in spotting such changes, but they must be done regularly. Annual pelvic
examinations, including a pap smear, should start when a woman becomes
sexually active, or by the age of 20 in a non-sexually active woman. If
abnormal changes are seen, a colposcopy with biopsy should be performed.
See also: Physical exam frequency.
If you smoke, quit. Cigarette smoking is associated with an increased risk
of cervical cancer.
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Cervical Cancer
Cervical Inflammation
Definition
Cervicitis is swelling (inflammation) of the end of the uterus (cervix).
Causes
Cervicitis is most often caused by an infection. However, in a few cases it
may be due to:
* A device inserted into the pelvic area such as:
o Cervical cap
o Device to support the uterus (pessary)
o Diaphragm
* An allergy to spermicides used for birth control or to latex in condoms
* Exposure to a chemical
Cervicitis is very common, affecting more than half of all women at some
point during their adult lives. Risks include:
* High-risk sexual behavior
* History of sexually transmitted disease (STD)
* Many sexual partners
* Sex (intercourse) at an early age
* Sexual partner(s) who have engaged in high-risk sexual behavior or have
had an STD
STDs that can cause cervicitis include:
* Chlamydia
* Gonorrhea
* Herpes virus (genital herpes)
* Human papilloma virus (genital warts)
* Trichomoniasis
Bacteria (such as staphylococcus and streptococcus) and too much growth of
normal bacteria in the vagina (bacterial vaginosis), can also cause
cervicitis.
Symptoms
* Abnormal vaginal bleeding
o After intercourse
o After menopause
o Between periods
* Unusual vaginal discharge
o Does not go away
o Gray, white, or yellow color
o May have an odor
* Painful sexual intercourse
* Pain in the vagina
* Pressure or heaviness in the pelvis
Note: There may be no symptoms.
Exams and Tests
A pelvic examination may show:
* Discharge from the cervix
* Redness of the cervix
* Swelling (inflammation) of the walls of the vagina
Tests:
* Inspection of the discharge under a microscope (may show candidiasis,
trichomoniasis, or bacterial vaginosis)
* Pap smear
* Tests for gonorrhea or chlamydia
Treatment
Treatments include:
* Cryosurgery
* Electrocauterization
* Hormonal therapy (especially in postmenopausal women)
* Laser therapy
* Medication (antibiotics or antifungals)
Outlook (Prognosis)
Simple cervicitis usually heals with treatment if the cause is found and
there is a treatment for that cause.
Possible Complications
Cervicitis may last for months to years. Cervicitis may lead to pain with
intercourse (dyspareunia).
When to Contact a Medical Professional
Call your health care provider if you have symptoms of cervicitis.
Prevention
Ways to reduce the risk of cervicitis include:
* Avoid chemical irritants such as douches and deodorant tampons.
* Avoid using spermicidal contraceptives, if possible (however, if they are
the only form of contraceptive available to you, it is better to practice
safer sex by using them). If you use a barrier method of birth control
(diaphragm, condoms, cervical caps) with spermicidal jelly, see your health
care provider to discuss other methods of birth control before stopping your
current method.
* Begin sexual activity at a later age.
* Have sex with just one person (monogamy).
* Make sure that any foreign objects that you insert into your vagina (such
as tampons) are placed properly. Be sure to follow the guidelines as to how
long to leave the object in, how often to change it, or how often to clean
it.
Cervical Inflammation
Cervical Dysplasia
Cervical dysplasia is the abnormal growth
of cells on the surface of the cervix. Although this is not cancer, this is
considered a precancerous condition.
Cervical dysplasia is grouped into three categories:
* CIN I -- mild dysplasia (a few cells are abnormal)
* CIN II -- moderate to marked dysplasia
* CIN III -- severe dysplasia to carcinoma-in-situ (precancerous cells only
in the top layer of the cervix)
Causes
Most cases of cervical dysplasia occur in women aged 25 to 35.
The cause is unknown. However, the following may increase your risk:
* Multiple sexual partners
* Becoming sexually active before age 18
* Giving birth before age 16
* If your mother took a drug called diethylstilbestrol (DES) during
pregnancy
* Sexually transmitted infections, especially HIV or HPV (genital warts)
Symptoms
There are usually no symptoms.
Exams and Tests
A pelvic examination is usually normal.
A Pap smear shows abnormal cells. A colposcopy-directed biopsy is done to
confirm the condition and determine its severity.
Other tests may be done to find out if the abnormal cells have spread
outside the cervix:
* Endocervical curettage
* Cone biopsy
Treatment
Treatment depends on the degree of dysplasia. Mild dysplasia may go away on
its own . You may only need careful observation by your doctor with repeat
Pap smears every 3 to 6 months.
Treatment for moderate to severe dysplasia or dysplasia that does not go
away may include:
* Cryosurgery
* Electrocauterization
* Laser vaporization to destroy the abnormal tissue
* Surgery to remove the abnormal tissue
Women with dysplasia need consistent follow-up, usually every 3 to 6 months
or as recommended by their provider.
Outlook (Prognosis)
Early diagnosis and prompt treatment cures nearly all cases of cervical
dysplasia.
Without treatment, 30-50% of cases of severe cervical dysplasia may lead to
invasive cancer. The risk of cancer is lower for mild dysplasia.
Possible Complications
The condition may return.
When to Contact a Medical Professional
Call for an appointment with your health care provider if you are a woman
who is sexually active or aged 20 or older and you have never had a pelvic
examination and Pap smear.
See: Physical exam frequency
Prevention
To reduce the chance of developing cervical dysplasia:
* Wait until you are 18 or older before becoming sexually active
* Practice monogamy and use condoms during intercourse
Cervical Dysplasia
Cervical Polyps
Cervical polyps are fingerlike growths on
the lower part of the uterus that connects with the vagina (cervix).
Causes
The cause of cervical polyps is not completely understood. They may occur
with:
* An abnormal response to increased levels of the female hormone, estrogen
* Chronic inflammation
* Clogged blood vessels in the cervix
Cervical polyps are common, especially in women over age 20 who have had
children. Polyps are rare in young women who have not started their period
(menstruation).
Most women have only one polyp, but some women have two or three.
Symptoms
* Abnormally heavy periods (menorrhagia)
* Abnormal vaginal bleeding
o After douching
o After intercourse
o After menopause
o Between periods
* White or yellow mucus (leukorrhea)
Polyps may not cause symptoms.
Exams and Tests
During a pelvic examination, the health care provider will see smooth, red
or purple, fingerlike growths on the cervix. A cervical biopsy will show
cells that are mildly abnormal and signs of infection.
Treatment
The health care provider can remove polyps during a simple, outpatient
procedure. Gentle twisting of a cervical polyp may remove it, but normally a
polyp is taken out by tying a surgical string around the base and cutting it
off. The polyp's base is removed with electrocautery or a laser.
Because many polyps are infected, you may have to take an antibiotic after
the removal, even if there are no signs of infection. Although most cervical
polyps are not cancerous (benign), the removed tissue should be sent to a
laboratory and checked further.
Outlook (Prognosis)
Typically, polyps are not cancerous (benign) and easy to remove. Polyps do
not usually grow back.
Possible Complications
Some cervical cancers may first appear as a polyp. Infections may occur
after removal.
Cervical Polyp
