Cervical Cancer

Cervical cancer is one of those diseases that can be almost totally prevented by wise and healthy lifestyle choices. However, it is widespread because so many women (and men) do not avoid the behaviors that subject many folks to the risk of this cancer. Let’s look into this issue a bit further to clarify things a bit and perhaps bring back something that is not so common any more: common sense, especially as it relates to potentially life threatening diseases such as cervical cancer.

What is Cervical Cancer?

Cervical cancer is malignant growth of cancerous cells in the cervix, which is the lower part or “neck” of the uterus (womb). Cervical cancer is one of the most common cancers of the female reproductive tract, accounting for about 6% of all cancers in American females. Worldwide, cervical cancer is much more common, especially in developing countries. Over 400,000 new cases are diagnosed annually, making cervical cancer the second most common cancer found in females around the world. The incidence of cervical cancer in the United States has dropped dramatically in the last 50 years, with the U.S. death rate decreasing by about 75%. This is mainly due to the Pap test, which we will discuss in more detail. However, even with these improvements, over 11,000 women are diagnosed with invasive (advanced) cervical cancer each year, and the disease kills approximately 4,000 American women annually.

Almost all cases of cervical cancer, over 90%, are linked to a sexually transmitted disease (STD) called the human papillomavirus (HPV) that is a group of viruses that cause genital warts and in a small group of women, is a significant risk factor for cervical cancer. The immune system of most women with HPV infections will fight off the virus successfully. But for some it lingers for years and can contribute to changes in cells of the cervix that can eventually lead to cancer.

Most cervical cancer, about 50% of cases, is found in women between the ages of 35 and 55. It is typically a slow growing cancer that can take several years to develop, and there are not usually any discernable symptoms early in the disease process. Precancerous cells can be identified through screening such as the Pap test and others, so it is very important for women to regularly undergo such testing to nip the cancer in the bud if it is found. The prognosis is excellent for most cases of cervical cancer if they are detected in the precancerous stage.

What Causes Cervical Cancer?

As is the case for cancer in general, this illness occurs when genetic mutations cause normal cells to begin to behave abnormally. In a healthy person, cells will grow at a predetermined rate, regulated by DNA and other factors, and will die at the proper time as well. When cancerous changes take place, cells begin to grow out of control, and they don’t die off. Instead they grow into abnormal masses called tumors, and can then spread to other areas of the body (metastasize).

Most cases of cervical cancer begin in the thin flat cells that compose the lining of the bottom of the cervix. These types of cells are known as squamous cells, and squamous cell carcinomas are responsible for about 80% of all cervical cancer cases. The second most common form of cervical cancer, accounting for about 15% of cases, are called adenocarcinomas, and they form in the glandular-like cells that are found in the upper part of the cervix. In some cases, both types of cancer may form simultaneously. In a small number of cases, there are other cervix cell types involved, but this is very rare.

Cervical cancer typically occurs in stages. Normal cells will develop into a precancerous state, usually triggered by involvement of HPV. This precancerous condition is called dysplasia. Over time, these precancerous cells can develop to the next stage, which is cancerous. At this time, if left untreated, these cancerous cells may advance from the outer cells of the cervix, and invade the deeper layers of tissue. This is known as invasive cancer. The good news is that the Pap test and other diagnostic tools are excellent at identifying dysplasia before it becomes cancerous. Almost 100% of dysplasia cases can be stopped before advancing to the cancerous stage, if they are identified and intervention is taken.

The precise reason cervical cells change from healthy to precancerous or cancerous is not known for certain, but there are very well defined risk factors for cervical cancer that can be avoided and greatly reduce one’s chances of developing the disease. Some of the most common risk factors include:

• HPV infections: The presence of HPV significantly increases one’s risk for cervical cancer. HPV is very common, and most women who have HPV infections never get cervical cancer. However, over 90% of women with cervical cancer have HPV, so it definitely plays a role in the incidence of cervical cancer. HPV is contracted through sexual contact, and is thus classified as an STD.
• Early sexual activitity: Girls who become sexually active before the age of 18 are at increased risk for cervical cancer because they are much more likely to contract HPV than older women. The cells that line their cervix are not fully mature yet, and are much more susceptible to the precancerous damage that HPV can cause as well.
• Multiple sexual partners: Increased sexual contact increases your risk for contracting HPV. This is true if the female is promiscuous, and the number of other partners that the male has had is a factor as well, increasing the chance that he is carrying HPV. Male partners such as this are known as high-risk males.
• Other STDs: If you have contracted other sexually transmitted diseases such as gonorrhea, syphilis, chlamydia, or HIV/AIDS, the chances that you have HPV are very high, and thus your risk for cervical cancer is also increased.
• Compromised immune system: A weakened immune system increases your odds for contracting cervical cancer as well. Women with healthy immune systems are normally able to fight off HPV. Conditions that can cause immune system dysfunction include diabetes, lupus, chronic fatigue syndrome, and HIV/AIDS, among others.
• Smoking: Smoking increases your chances of developing many different kinds of cancers, but there are some clear links between precancerous changes and cancerous cells that develop in the cervix and cigarette smoking. Some researchers think there is a symbiotic relationship between tobacco smoke and HPV that makes the risk even greater.
• Oral contraceptives: Some studies have linked long-term use of these contraceptives to a slightly increased risk for cervical cancer.
• What Are the Symptoms of Cervical Cancer?

In the earliest stages, there may be no symptoms. This is why screening is so important. Later on, some women may experience:

• Irregular vaginal bleeding (between periods)
• Postmenopausal bleeding
• Bleeding after intercourse
• Pelvic pain
• Pain during intercourse
• Vaginal discharge (watery, bloody, or both) that may be malodorous
• If the cancer has advanced and spread beyond the cervix, signs may include:

• Significant pelvic pain
• Excessive vaginal bleeding
• Like most cancers, cervical cancer is rated based on how far it has spread in the body.

The stages are as follows:

• Stage 0: Small tumor(s) that are confined to the surface of the cervix. Also known as carcinoma in situ or noninvasive cancer.
• Stage I: Cancer has not spread beyond the cervix, but may have invaded deeper levels of the cervix.
• Stage II: Cancer in the cervix and uterus, but not in the pelvic wall or lower vagina.
• Stage III: Cancer has invaded the pelvic wall and lower vagina.
• Stage IV: Cancer has metastasized to other parts of the body such as the bladder, rectum, bones, lungs, or liver.

What Treatments Are Available for Cervical Cancer?

Early stage, noninvasive cervical cancer can often be successfully treated with a variety of surgical procedures. Options include:

• Cone biopsy: Also known as conization, a scalpel is used to remove a cone shaped wedge from the cervix where the offending cells are found.
• Loop electrosurgical excision procedure (LEEP): This technique employs an electrical current that is run through a loop-like device to burn off precancerous cells. It is most appropriate for use at or near the mouth of the cervix.
• Hysterectomy: This is a more major, invasive procedure that involves removal of precancerous or cancerous parts of the reproductive system. Hysterectomies can be partial or total, with total operations usually used when the cancer has invaded beyond the cervix.

Chemotherapy is not normally used extensively when treating cervical cancer, but radiation treatments are quite common. If you have cervical cancer and have to make the tough decisions involved with treatment, you should know that radiation treatments to the pelvic area can have significant negative side effects including impeding the ovaries from producing eggs and hormones, as well as a condition called vaginal stenosis, which involves narrowing of the vagina that can make intercourse painful.

How Important is Preventative Screening?

Its importance cannot be understated. The only thing that saves more lives, when it comes to cervical cancer, is the avoidance of foolish and promiscuous sexual behaviors. There are two main screening procedures that are critical:

The Pap test or Pap smear, as it is sometimes called, is primarily responsible for cutting the death rate from cervical cancer by 75% in the U.S. Your health provider simply inserts an instrument through the vagina and scrapes off a sample of cellular tissue from the surface of the cervix. It is analyzed under a microscope, and if the cells show any sign of precancerous activity, intervention can be made and in almost 100% of cases, assuming it is caught very early, no cancer will result. It is usually recommended that women who are sexually active have a Pap test every three years, starting at age 21.

HPV DNA test: This is not nearly as commonly used as the Pap test, but in some cases it can help to detect high-risk strains of HPV in cervix cell DNA that gives advance warning of potential precancerous or cancerous activity. It is normally not used on women under the age of 30.

The best way to avoid cervical cancer is to eliminate the major risk factors such as early sexual activity with multiple partners, and smoking. The answer is certainly not to give 11 and 12 year old girls dangerous vaccinations to prevent certain strains of HPV, as has been recklessly suggested by some. Not only does this expose these girls to the dangers of the side effects of the vaccines, which can be frighteningly significant, but it gives them the message that all young girls are going to have sex anyway, so you might as well be protected. Abstinence is the obvious answer here, and it doesn’t take a brain surgeon to figure that out.