What is the cervix?

The cervix is the lower, narrow part of the uterus (womb) located between the bladder and the rectum. It forms a canal that opens into the vagina, which leads to the outside of the body.

What are precancerous conditions
of the cervix?

Precancerous conditions of the cervix are identified as cells that appear to be abnormal, but are not cancerous at the present time. However, the appearance of these abnormal cells may be the first evidence of cancer that develops years later.

Precancerous changes of the cervix usually do not cause pain and, in general, do not cause any symptoms. They are detected with a pelvic exam or a Pap test.

Squamous intraepithelial lesions (SIL) is a term that refers to abnormal changes in the cells on the surface of the cervix.

• squamous cells are the flat cells found on the surface (of the cervix)
• intraepithelial means that the abnormal cells are present only in the surface layer of cells
• lesion refers to an area of abnormal tissue

According to the National Cancer Institute (NCI), changes in these cells can be divided into two categories:

• Low-grade SIL refers to early changes in the size, shape, and number of cells that form the surface of the cervix. They may go away on their own, or, with time, may grow larger or become more abnormal, forming a high-grade lesion.

These precancerous low-grade lesions may also be called mild dysplasia or cervical intraepithelial neoplasia 1 (CIN 1). These early changes most often occur in women between the ages of 25 and 35, but can appear at any age.

• High-grade SIL means there are a large number of precancerous cells, and, like low-grade SIL, these precancerous changes involve only cells on the surface of the cervix. The cells often do not become cancerous for many months, sometimes years.

High-grade lesions may also be called moderate or severe dysplasia, CIN 2 or 3, or carcinoma in situ. They develop most often in women between the ages of 30 and 40, but can occur at any age.

What is cancer of the cervix?

If abnormal cells on the surface of the cervix spread deeper into the cervix, or to other tissues or organs, the disease is then called cervical cancer, or invasive cervical cancer. Cervical cancer occurs most often in women over the age of 40. It is different from cancer that begins in other parts of the uterus and requires different treatment. Most cervical cancers are squamous cell carcinomas and adenocarcinomas.

The mortality rates for cervical cancer have declined sharply as Pap screenings have become more prevalent. Some researchers estimate that noninvasive cervical cancer (also referred to as "carcinoma in situ") is nearly four times more common than invasive cervical cancer.

Chlamydia and Cervical Cancer

New research has shown that chlamydia, the most common sexually transmitted disease in the US, may increase a woman's risk of developing cervical cancer. In the study, published in the Journal of the American Medical Association (JAMA), women who showed signs of any type of chlamydial infection in their blood were two-and-a-half times more likely to develop cervical cancer, when compared to women with no sign of infection. Although the reason for this increased risk is still under investigation, researchers speculate that immune system cells that are activated at chlamydia infection sites may damage normal cells.

What are the risk factors for cervical cancer?

The following have been suggested as risk factors for cervical cancer:

• Infection with the human papillomavirus (HPV)
• Infection with the human immunodeficiency virus (HIV) or other conditions that weaken the immune system
• Smoking- Women who smoke are nearly twice as likely as nonsmokers to have cervical cancer.
• Age- The risk of cancer of the cervix increases between the late teens and mid-30s. However, cervical cancer can occur at any age.
• Having sexual intercourse before the age of 18
• Having many sexual partners, and having partners who have had sexual intercourse at a young age and/or have had many partners themselves

Can cervical cancer be prevented?

With the recent development of a vaccine to prevent infection with Human Papilloma Virus (HPV), the fight against cervical cancer has taken a giant leap forward. HPV infection, one of the most common sexually transmitted diseases, has been linked to the development of both cervical cancer and genital warts.

Approved by the Food and Drug Administration, the HPV vaccine provides immunity to four different types of HPV which, combined, account for approximatley 70 percent of all cervical cancers, 60 percent of pre-cancerous lesions, and more than 90 percent of genital warts. The vaccine is administered as three injections given over a six month period. It appears to be safe and well-tolerated. In each of four studies, the vaccine was found to be 100 percent effective. It is recommended for girls and women aged nine to 26 for the prevention of both genital warts and cervical cancer caused by HPV. It is not recommended for the treatment of active disease. Studies for the use of the vaccine in males are ongoing. The vaccine works best if administered before contact with HPV but can be given without being tested for the virus.

Still, early detection of cervical problems is the best way to prevent cervical cancer.

The Pap test, which is performed as part of a regular gynecological check-up, is a screening test for abnormalities of the cervix. It is a simple, painless test where cells are wiped from the cervix and sent to a laboratory to be examined under a microscope. Routine, annual pelvic examinations and Pap tests can detect precancerous conditions that often can be treated before cancer develops. Women who are or have been sexually active, or are age 18 or older, should have regular checkups,including a pelvic exam and Pap test.

What are the symptoms of cervical cancer?

Symptoms of cervical cancer usually do not appear until abnormal cervical cells become cancerous and invade nearby tissue.

The most common symptom is abnormal bleeding, which may:

start and stop between regular menstrual periods.
occur after sexual intercourse, douching, or a pelvic exam.

Other symptoms may include:

heavier menstrual bleeding, which may last longer than usual
bleeding after menopause
increased vaginal discharge
pain during intercourse

The symptoms of cervical cancer may resemble other conditions or medical problems. Consult a physician for diagnosis.

How is cervical cancer diagnosed?

When cervical problems are found during a pelvic examination, or abnormal cells are found through a Pap test, a cervical biopsy may be performed.

There are several types of cervical biopsies that may be used to diagnose cervical cancer, and some of these procedures that can completely remove areas of abnormal tissue may also be used for treatment of precancerous lesions. Some biopsy procedures only require local anesthesia, while others require a general anesthesia. Several types of cervical biopsies include:

• loop electrosurgical excision procedure (LEEP) - a procedure which uses an electric wire loop to obtain a piece of tissue.
• colposcopy - a procedure which uses an instrument with magnifying lenses, called a colposcope, to examine the cervix for abnormalities. If abnormal tissue is found, a biopsy is usually performed (colposcopic biopsy).
• endocervical curettage (ECC) - a procedure which uses a narrow instrument called a curette to scrape the lining of the endocervical canal. This type of biopsy is usually completed along with the colposcopic biopsy.
• cone biopsy (also called conization) - a biopsy in which a larger cone-shaped piece of tissue is removed from the cervix by using the loop electrosurgical excision procedure or the cold knife cone biopsy procedure. The cone biopsy procedure may be used as a treatment for precancerous lesions and early cancers.
• cold knife cone biopsy - a procedure in which a laser or a surgical scalpel is used to remove a piece of tissue. This procedure requires the use of general anesthesia.

Treatment for cervical cancer:

Specific treatment for cervical cancer will be determined by your physician based on:

• your overall health and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatment may include:

• Surgery, including:

  cryosurgery - use of liquid nitrogen, or a probe that is very cold, to freeze and kill cancer cells.
  laser surgery - use of a powerful beam of light, which can be directed to specific parts of the body without making a large incision, to destroy abnormal cells.
  hysterectomy - surgery to remove the uterus, including the cervix. In some cases, a hysterectomy may be required, particularly if abnormal cells are found inside the opening of the cervix.

• Radiation therapy (more info)
• Chemotherapy (more info)
• a combination of chemotherapy and radiation therapy may also be recommended

LEEP or conization may also be used to remove abnormal tissue.

The most important factor in the early detection of cervical cancer is continued surveillance with a regular schedule of Pap tests as recommended by your doctor.