Cervical Cancer
Why is cervical cancer a concern for American Indian women?
What are some of the types of cervical cancer?
What are the risk factors for cervical cancer?
What can you do to prevent cervical cancer?
What are the symptoms of cervical cancer?
How is cervical cancer detected?
The cervix is the lower part of the uterus (womb). It is sometimes called the uterine cervix. The body (upper part) of the uterus is where a fetus grows. The cervix connects the body of the uterus to the vagina (birth canal). The part of the cervix closest to the body of the uterus is called the endocervix. The part next to the vagina is the exocervix (or ectocervix). The place where these 2 parts meet is called the transformation zone. Most cervical cancers start in the transformation zone.
Cervical cancers and cervical pre-cancers are classified by how they look under a microscope. Cervical cancers start from cells with pre-cancerous changes (pre-cancers). Only some of the women with pre-cancers of the cervix will develop cancer. The change from pre-cancer to cancer usually takes several years - but it can happen in less than a year. For most women, pre-cancerous cells will go away without any treatment. Still, in some women pre-cancers turn into true (invasive) cancers. Treating all pre-cancers can prevent almost all true cancers.
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Why is cervical cancer a concern for American Indian women?
Native Americans have a high rate of cervical cancer because they are less likely to receive a Pap smear for early detection of cancerous cells.
Approximately 15,700 cases of cervical cancer and 4,900 deaths due to cervical cancer occur each year in the United States. Among all races in the United States, the rate is 2.5 per 100,000 women, and for Native Americans the rate is 3.8 per 100,000 women. Worldwide the number of new cases is 471,000 per year.
Cancers can be caused by DNA mutations (gene defects) that turn on oncogenes or turn off tumor suppressor genes. Scientists now think that HPV causes the production of 2 proteins known as E6 and E7. When these proteins are produced, they turn off some tumor suppressor genes. This may allow the cervical lining cells to grow uncontrollably, which in some cases will lead to cancer.
But HPV does not completely explain what causes cervical cancer. Most women with HPV don’t get cervical cancer, and certain other risk factors, like smoking and HIV infection, influence which women exposed to HPV are more likely to develop cervical cancer.
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What are some of the various types of cervical cancer?
There are 2 main types of cervical cancers: squamous cell carcinoma and adenocarcinoma. About 80% to 90% of cervical cancers are squamous cell carcinomas. These cancers are from the squamous cells that cover the surface of the exocervix. Under the microscope, this type of cancer is made up of cells that are like squamous cells. Squamous cell carcinomas most often begin where the exocervix joins the endocervix.
The remaining 10% to 20% of cervical cancers are adenocarcinomas. Adenocarcinomas are becoming more common in women born in the last 20 to 30 years. Cervical adenocarcinoma develops from the mucus-producing gland cells of the endocervix. Less commonly, cervical cancers have features of both squamous cell carcinomas and adenocarcinomas. These are called adenosquamous carcinomas or mixed carcinomas.
Although almost all cervical cancers are either squamous cell carcinomas or adenocarcinomas, other types of cancer also can start in the cervix. These other types, such as melanoma, sarcoma, and lymphoma, occur more commonly in other parts of the body. This document discusses the more common cervical cancer types, and will not further discuss these rare types.
What are the risk factors of cervical cancer?
Cervical cancer risk factors include:
- Human papilloma virus infection: The most important risk factor for cervical cancer is infection by the human papilloma virus (HPV). HPV is a group of more than 100 related viruses. They are called papilloma viruses because some of them cause a type of growth called a papilloma. Papillomas are not cancers, and are more commonly called warts. HPV is passed from one person to another during skin-to-skin contact. HPV can be spread during sex - including vaginal intercourse, anal intercourse, and even during oral sex.
- Smoking: Women who smoke are about twice as likely as non-smokers to get cervical cancer. Smoking exposes the body to many cancer-causing chemicals that affect more than the lungs. These harmful substances are absorbed by the lungs and carried in the bloodstream throughout the body. Tobacco by-products have been found in the cervical mucus of women who smoke. Researchers believe that these substances damage the DNA of cervix cells and may contribute to the development of cervical cancer.
- Immunosuppression: Human immunodeficiency virus (HIV), the virus that causes AIDS, damages the body's immune system and seems to make women more at risk for HPV infections. This may be what increases the risk of cervical cancer in women with AIDS.
- Chlamydia infection: Chlamydia is a relatively common kind of bacteria that can infect the reproductive system. It is spread by sexual contact. Some studies have seen a higher risk of cervical cancer in women whose blood test results show past or current Chlamydia infection (compared with women with normal test results).
- Diet: Women with diets low in fruits and vegetables may be at increased risk for cervical cancer. Also overweight women are more likely to develop this cancer.
- Oral contraceptives (birth control pills): There is evidence that taking oral contraceptives (OCs) for a long time increases the risk of cancer of the cervix. Research suggests that the risk of cervical cancer goes up the longer a woman takes OCs, but the risk goes back down again after the OCs are stopped.
- Multiple pregnancies: Women who have had many full-term pregnancies have an increased risk of developing cervical cancer. No one really knows why this is true.
- Low socioeconomic status: Poverty is also a risk factor for cervical cancer. Many women with low incomes do not have ready access to adequate health care services, including Pap tests. This means they may not get screened or treated for pre-cancerous cervical disease.
- Diethylstilbestrol (DES): DES is a hormonal drug that was given to some women to prevent miscarriage between 1940 and 1971. Women whose mothers took DES (when pregnant with them) develop clear-cell adenocarcinoma of the vagina or cervix more often than would normally be expected. There is about 1 case of this type of cancer in every 1,000 women whose mothers took DES during pregnancy. This means that about 99.9% of "DES daughters" do not develop these cancers.
- Family history of cervical cancer: Cervical cancer may run in some families. If your mother or sister had cervical cancer, your chances of developing the disease are increased by 2 to 3 times.
What can you do to prevent getting cervical cancer?
Since the most common form of cervical cancer starts with pre-cancerous changes, there are 2 ways to stop this disease from developing. The first way is to prevent the pre-cancers, and the second is to find and treat pre-cancers before they become cancerous.
Things to do to prevent pre-cancers:
- Avoid being exposed to HPV: You can prevent most pre-cancers of the cervix by avoiding exposure to HPV. Certain types of sexual behavior increase a woman's risk of getting HPV infection, such as:
- having sex at an early age
- having many sexual partners
- having a partner who has had many sex partners
- having sex with uncircumcised males
- Delay sex: Waiting to have sex until you are older can help you avoid HPV.
- Use condoms: Condoms provide some protection against HPV.
- Don’t smoke: Not smoking is another important way to reduce the risk of cervical precancer and cancer.
- Get vaccinated: Vaccines have been developed that can protect women from HPV infections.
What are the signs/symptoms of cervical cancer?
There are no obvious signs of cervical cancer. It tends to grow slowly over time which is why getting a Pap smear every year is so important. The Pap smear, also called a Pap Test can find cells on the cervix that may be changing or be early signs of cancer. If cervical cell changes progress to cervical cancer, symptoms may develop.
Symptoms of cervical cancer may include:
- Abnormal vaginal bleeding or a significant unexplained change in your menstrual cycle.
- Bleeding when something comes in contact with the cervix, such as during sexual intercourse or insertion of a diaphragm.
- Pain during sexual intercourse.
- Abnormal vaginal discharge containing mucus that may be tinged with blood.
Symptoms that may occur when your cervical cancer has progressed include:
- Anemia because of abnormal vaginal bleeding.
- Ongoing pelvic, leg, or back pain.
- Urinary problems because of blockage of a kidney or ureter.
- Leakage of urine or fecal content into the vagina because an abnormal opening (fistula) has developed between the vagina and the bladder or rectum.
- Weight loss.
How is cervical cancer detected?
Cervical cancer can usually be found early by having regular Pap tests. As Pap testing has become more common, pre-invasive lesions (pre-cancers) of the cervix are found far more frequently than invasive cancer. Being alert to any signs and symptoms of cervical cancer can also help avoid unnecessary delays in diagnosis. Early detection greatly improves the chances of successful treatment and prevents any early cervical cell changes from becoming cancerous.
What treatments are available for cervical cancer?
The options for treating each patient with cervical cancer depend on the stage of disease. The stage of a cancer describes its size, depth of invasion, and how far it has spread.
The 3 main methods of cancer treatment are surgery, radiation therapy, and chemotherapy. Sometimes the best treatment approach uses 2 or more of these methods. Your recovery is the goal of your cancer care team. If a cure is not possible, the goal may be to remove or destroy as much of the cancer as possible to prevent the tumor from growing, spreading, or returning for as long as possible. Sometimes treatment is aimed at relieving symptoms. This is called palliative treatment.