The cervix is a small structure in the shape of a donut. It is situated at the top of the vagina. It constitutes the entrance to the uterus. We can talk of the beginning of the cervical cancer when observing abnormal, microscopic changes in cells in the outer layer of the cervix, known as the epithelium. This initial stage is known as dysplasia. If these modifications keep on occurring, the cells may turn out to be cancerous and increase of control.
Normally, cervical cancer grows rather slowly. It may remain in an early stage, limited to the cervical covering, for two to ten years. But when cancer starts moving beyond this layer, it quickly invades nearby tissue, together with the main body of the uterus, the vagina, bladder and rectum.
Almost all cervical cancer results from infection with particular kind of human papilloma virus (HPV) that gradually destroys the cells lining the cervix. HPV is a very widespread infection among women that are sexually active, however very few women who get infected experience cervical cancer. Smoking women and those who are infected with HIV are at greater risk of developing cervical irregularities if they are infected with HPV.
Symptoms of Cervical Cancer
In the initial stages, cervical cancer does not reveal any particular symptoms. As soon as it starts spreading, it may lead to a blood-tinged or discolored vaginal discharge, spotting after sexual interaction or unusual bleeding. The symptoms mentioned above are not unique to cervical cancer and may appear as a result of various health problems of the female reproductive tract.
Further stages of cervical cancer may result in pelvic pain, appetite loss, weight loss and even anemia.
Diagnosis
In the majority of cases the diagnosis of cervical cancer starts with a pelvic examination. The healthcare provider uses a speculum, an instrument holding the walls of the vagina open to simplify the examination of your cervix and vagina, and do a Pap test. It is a quick, painless method in which the physician gently brushes the surface and the canal of your cervix in order to get a sample of your cells. Later on, these cells are sent to a laboratory for detailed examination.
If the Pap test suggests asymmetrically shaped cells (dysplasia) or even cancerous cells, a gynecologist will scrutinize your cervix and vagina with a special tool known as a colposcope and will perform a biopsy to further inspect the abnormal cells. A colposcope comprises a magnifying lens, thanks to which the cervix looks larger. During a biopsy, a small piece of tissue is removed from the cervix to be tested in a laboratory. Furthermore, a vinegar solution can be applied to the cervix and vagina. As a result abnormal areas appear white temporarily. This helps the gynecologist find out where to remove tissue for the biopsy.
Another examination is known as endocervical curettage or endocervical scraping. It may also be performed by the doctor. In this procedure, a thin instrument is used in order to take a scraping of the cells inside the inner opening of the cervix. These cells can be hidden from view in the course of colposcopy. The physician may use a local painkiller in order to numb the cervix in the course of this and other kinds of biopsies.
DNA examination may also be performed in order to find out if there exists HPV infection in cervical secretions, and to discover the type of HPV. Some kinds of HPV are more probable to cause cancer. A lot of healthcare providers use this examination in women with unusual Pap smears so that women at greater risk of experiencing cancer may have colposcopies and biopsies earlier, while patients at a lower risk can simply have a follow-up Pap smear in several months. Additional research is in progress to find out whether HPV examination provides any benefit over routine Pap smears.
Expected Duration
Cervical cancer develops rather slowly and can take years to invade nearby tissues. Nevertheless, it will keep on developing until it is treated.
Means of Prevention
Nearly all cervical cancer results from HPV infection. In June 2006, a vaccine against HPV for use in women was approved by the Food and Drug Administration. The vaccine available at present (several pharmaceutical companies are developing a version) targets HPV strains 6 and 11, that cause 90 per cent of genital warts as well as the main cervical cancer causing strains, 16 and 18. Given as a set of three shots within a half a year, the vaccine will protect against only those four strains.
In July 2006, the Centers for Disease Control and Prevention (CDC) have added the HPV vaccine to its official vaccination recommendations. It suggested that all 11- and 12-year-old American women receive the shots, even though girls at the age of nine could get it if they are sexually active. For “catch-up” the CDC also suggests that girls and women between thirteen and twenty six years old be vaccinated against HPV, in spite of their Pap test results. In ordr to prevent this disease, you also ought to have regular pelvic examinations and Pap tests — at least once a year if you are eighteen or older or if you are under eighteen but sexually active. If your first three Pap smear tests are normal, talk to your healthcare provider whether you can undergo Pap smears not so often.
Other steps that can be helpful in preventing cervical cancer include:
* Restrict the number of sexual partners you have in order to decrease potential exposure to HPV. This will also decrease likelihood of experiencing HIV and other sexually transmitted diseases.
* Always use condoms in the course of vaginal interaction to reduce your risk of HPV infection (unless you have only one uninfected sexual partner).
* Give up smoking cigarettes.
Identifying cervical cancer very early radically increases your chances of survival. If the cancer is noticed and treated early, 99 per cent women survive. If it is not diagnosed until it achieves the most advanced stage, only seven per cent women usually survive.
Thanks to Pap smear testing, cervical cancer is much more probable to be diagnosed at the noninvasive stage than later on. From 1955 to 1992, increased Pap smear testing resulted in a decrease of nearly 75 per cent in the rate of death due to cervical cancer.
Treatment
How far the cancer has already managed to spread is called the ‘cancer’s stage’. This stage determines the treatment that is applied.
* Stage 0 cancer is limited to the superficial layer. This includes: dysplasia and carcinoma in situ, a cancer restricted to the cervix epithelium.
* Stage I cancer is limited to the cervix.
* Stage II cancer extends beyond the cervix, however not to the pelvic wall or into the lower portion of the vagina.
* Stage III cancer enlarges into the pelvic wall, the lower portion of the vagina or the ureters (the tubes connecting the kidneys to the bladder).
* Stage IV cancer enlarges beyond the pelvis or involves the bladder, the rectum or both of them.
When suggesting treatments for Stage 0 or Stage I cancer, your healthcare provider will also consider whether you are willing to have children. When Stage 0 or Stage I cervical cancer is diagnosed in the course of pregnancy, it may be achievable to put off treatment until after delivery. A woman with Stage 0 cancer who is still willing to have children is normally treated with one of the following methods:
* Laser surgery, in which the superficial tissue layer is heated and vaporized
* Cryosurgery, where the tissue to be removed is frozen
* Conization, surgical removal of a cone of cervical tissue
* Loop electrosurgical excision procedure (LEEP), where low-voltage, high-frequency radio waves are run through a thin loop of wire, that is used as a cutting device in order to remove the unusual cells from the cervix
After all these procedures, a Pap test ought to be performed about every four months for one year period and every half a year for a second year to check for abnormal cells.
Conization may be performed for Stage I cancer in patients who plan to get pregnant. For women who are not interested in becoming pregnant, the treatment for minimally invasive cancers in Stage I is normally a total hysterectomy (removal of uterus and cervix). This procedure removes the cancer and prevents it from coming back. This leaves the ovaries in place. Larger Stage I and Stage II cancers need either a radical hysterectomy (removal of the uterus, cervix, and the ovaries, fallopian tubes and regional lymph nodes in the pelvis) or radiation therapy together with chemotherapy. The choice between surgery and radiation therapy depends partly on the age of a woman and her health and also a woman’s concerns about the potential side effects or complications.
Stage III and Stage IV cancer need to be treated with radiation. Research has proven that combining chemotherapy with radiation therapy can help improve survival in these later stages.
When To Contact a Specialist
Notify your physician of any of the following symptoms:
* Abdominal pain
* Rapid weight loss
* A strange discharge from the vagina
* Blood spots or light bleeding outside the time of your normal menstruation
* Considerable pain or bleeding during sexual intercourse
Be aware that the symptoms do not always mean that you have cancer. For women suffering from advanced cervical cancer, considerable vaginal bleeding could suggest that the cancer has broken into nearby blood vessels, such as an artery. This requires urgent medical attention at the hospital.
Prognosis
The rate of survival is dependent on the stage at which the cancer is discovered and treated. The percentage of women who survive five years or more at each stage is:
* Stage 0 — 99 per cent to 100 per cent
* Stage I — 85 per cent to 95 per cent
* Stage II — 65 per cent to 70 per cent
* Stage III and early Stage IV — 40 per cent to 50 per cent
* Late Stage IV — Below 10 per cent to 15 per cent
