What is cervical cancer?
The cervix is the opening of the uterus, and cervical cancer means malignant cells are found in tissues there. In the United States, it's one of the most common cancers, with around 11,270 new cases a year; it's also one of the most detectable cancers. This is because the pap smear, which gynecologists urge women to get regularly, checks the cervix for abnormal cells that could lead to the disease. It's estimated that pap screening can detect about 90 percent of cervical cancers.
The cancer generally grows slowly. In untreated patients with cervical cancer in situ (meaning it developed there and hasn't yet spread elsewhere in the body), 30 to 70 percent will develop invasive cancer, but this will take 10 to 12 years. In one in 10 cases, however, the cancer will invade another area of the body in less than a year. The good news is that early detection will probably save your life: When noninvasive cervical cancers are treated properly, the success rate is almost 100 percent.
The pap smear, which was introduced in the 1940s, made great inroads against the disease. Newer tests, such as a liquid-based cytology screen, have helped to improve the sensitivity of the testing process. As a result of these screening techniques, cervical cancer has dropped from the number one cancer killer of U.S. women to number 14.
The American Congress of Obstetricians and Gynecologists (ACOG) recommends women between the ages of 21 and 30 get screened every two years, and that women over the age of 30 be rescreened once every three years (so long as they've tested negatively three times in a row with a cytology screen). Some women with certain risk factors for cervical cancer, including women with HIV, may need more frequent testing. ACOG also recommends women stop cervical cancer screening by the age of 65 or 70 if they have had at least three negative cytology screens in a row and have not had an abnormal test result in the previous 10 years.
In spite of the fact that these tests have helped to reduce cervical cancer rates by more than 50 percent over the past 30 years, many women still don't get screened regularly. According to the American Cancer Society, the annual death rate of roughly 4,070 is far higher than it should be. In fact, between 60 and 80 percent of cervical cancer cases occur in women who haven't had a pap test in the previous five years.
What causes cervical cancer?
No one knows exactly what sets it off, but research shows that carrying the human papillomavirus, which can cause genital warts, is the greatest risk factor. HPV far outweighs other risk factors, which include:
- Having had more than one sex partner or a male partner who had multiple partners
- Having sexual intercourse before age 18
- Being HIV-positive
- A history of abnormal pap test results
- A smoking habit
- A history of uterine, vaginal, or vulvar cancer
- Your mother having taken the hormone diethylstilbestrol (DES) when she was pregnant with you
A recent study indicates that even the granddaughters of women who took DES during pregnancy are at a higher risk for cervical cancer.
US women who are poor and uninsured may also be at greater risk, in part because they are less likely to be screened for the cancer. Between 60 and 80 percent of the 11,270 women diagnosed with cervical cancer each year haven't had the test in the five years prior to their diagnosis, with many of them never even having had a pap smear to begin with. According to a consensus panel for the National Institutes of Health, better screening efforts could prevent virtually all of the 4,070 annual deaths from cervical cancer. The panel recommended that health agencies make special efforts to reach and screen uninsured women, women over the age of 65, and women who live in rural areas or are poor.
Additionally, the development of the HPV vaccine shows promise in potentially wiping out one of the key risk factors in developing cervical cancer. In 2005, the American Society of Clinical Oncologists lauded several studies showing the HPV vaccine to be 90 to 100 percent effective in preventing the virus. Then in June 2006, the U.S. Food and Drug Administration approved the vaccine -- the first to be developed to protect against certain types of HPV that are responsible for 70 percent of cervical cancers and 90 percent of genital warts. The Advisory Committee on Immunization Practices recommends the vaccine for all women aged 9-26. The Centers for Disease Control cautions that since the vaccine does not work against all HPV types, it is still important to get regular pap smears even after getting the vaccine.
Is there more than one kind of cervical cancer?
Yes. Most cervical cancers are squamous carcinomas, but about 10 percent are clear cell adenocarcinomas - a cancer of cells that produce mucus. The latter may be linked to having a mother who took DES, which was prescribed for certain pregnancy complications from the 1940s until the early 1970s.
What are the signs of cervical cancer?
In the early stages, you might notice bleeding after sexual intercourse, or a bloody, watery, or bad-smelling discharge between menstrual periods. (These can also be signs of a precancerous condition known as CIN, or cervical intraepithelial neoplasia.)
If the cancer is more advanced, you might experience difficulty or pain during urination, possibly with blood in the urine; a dull backache and swelling in the legs; diarrhea, pain, or bleeding from the rectum after a bowel movement; fatigue and weight loss; or general malaise.
What are the treatment options?
If a pap smear indicates cancer or CIN, your doctor will need to confirm the finding with a second pap smear as well as a biopsy. During the biopsy, your doctor will use a colposcope to view your cervix and vagina and will remove a small sample of tissue from your cervix to be examined in a laboratory. If you have CIN, or a growth of abnormal cells in the cervix, your doctor may hold off on treatment for a period of months while doing regular tests to see if those cells return to normal. Abnormal cells frequently disappear on their own. If that doesn't happen, your doctor may decide to remove them through cryotherapy (freezing them off), laser therapy, or other forms of surgery.
The treatments for cervical cancer depend on its severity and type. For carcinoma in situ, or very early cancer, your doctor may kill the malignant growth through cryosurgery, laser surgery, electrosurgery, or conization (a process in which a cone-shaped piece of cervical tissue is removed).
For more advanced cancers, doctors will usually remove the tumor and surrounding tissues, and sometimes reproductive organs (the ovaries are rarely removed in younger women who may want to have children). This surgery may be coupled with chemotherapy, radiation therapy (in which a radioactive beam is aimed at the cancerous area or radioactive beads are temporarily implanted), or both. Recent clinical trials showed an overall advantage for patients treated with the drug cisplatin in conjunction with radiation therapy.
The earlier the cancer is detected, the better the chances that treatment will succeed. Doctors can essentially cure nearly all cervical cancers confined to the cervix, which are Stage I cancers. As the cancer spreads beyond the confines of the cervix and becomes a Stage II, III, or IV cancer, the cure rates are lower with each stage.
If you've been diagnosed with cervical cancer and you're unsure about what treatment to pursue, consult more than one doctor. It's important to learn which options are available to you and what methods are favored by different doctors.
Where can I learn more about the standard treatments?
To get more general information on cervical cancer and its treatments, contact the National Cervical Cancer Coalition, http://www.nccc-online.org/ . You may also want to call the National Cancer Institute's Cancer Information Service at (800) 422-6237.
Where can I learn more about complementary treatments?
People with cancer often seek to enhance their medical treatments by following special diets, practicing yoga, taking certain herbs, or getting psychological or "mind-body" therapies. If you'd like to learn about such options, the book Choices in Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer, by Michael Lerner, might be a good place to start.
Before trying any alternative approach, discuss it with your doctor or oncologist. Some herbs, for example, can interact dangerously with prescription medicines; so it's important to keep your doctor informed about what you're taking.
Research shows cancer support groups can increase both the quality of patients' lives and their long-term survival rates. The American Cancer Society can tell you how to get in touch with support groups in your area; you can contact the ACS at (800) ACS-2345.
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