Cervical Health Awareness Month is a chance to raise awareness about how women can protect themselves from HPV (human papillomavirus) and cervical cancer. HPV is a very common infection that spreads through sexual activity, and it causes almost all cases of cervical cancer. About 79 million Americans currently have HPV. What Is Cervical Cancer? Cervical cancer is cancer that starts in the cervix, the narrow opening into the uterus. The normal ectocervix is a healthy pink color and is covered with flat, thin cells called squamous cells. The endocervix or cervical canal is made up of another kind of cell called columnar cells. The area where these cells meet is called the transformation zone (T-zone) and is the most likely location for abnormal or precancerous cells to develop. Most cervical cancers (80 to 90 percent) are squamous cell cancers. Adenocarcinoma is the second most common type of cervical cancer, accounting for the remaining 10 to 20 percent of cases. Adenocarcinoma develops from the glands that produce mucus in the endocervix. While less common than squamous cell carcinoma, the incidence of adenocarcinoma is on the rise, particularly in younger women. More than 13,000 women in the United States will be diagnosed with cervical cancer each year, and more than 4,000 of women will die. Cervical cancer is the fourth most common type of cancer for women worldwide, but because it develops over time, it is also one of the most preventable types of cancer. Deaths from cervical cancer in the United States continue to decline by approximately 2 percent a year. This decline is primarily due to the widespread use of the Pap test to detect cervical abnormalities and allow for early treatment. Most women who have abnormal cervical cell changes that progress to cervical cancer have never had a Pap test or have not had one in the previous three to five years. Cervical cancer tends to occur during midlife. It is most frequently diagnosed in women between the ages of 35 and 44. It rarely affects women under age 20, and more than 15
percent of diagnoses are made in women older than 65. But in women over 65, cancer typical occurs in women who were not receiving regular screening. What Causes Cervical Cancer? Human papillomavirus (HPV) is found in about 99% of cervical cancers. There are over 100 different types of HPV, most of which are considered low-risk and do not cause cervical cancer. High-risk HPV types may cause cervical cell abnormalities or cancer. More than 70 percent of cervical cancer cases can be attributed to two types of the virus, HPV-16 and HPV-18, often referred to as high-risk HPV types. HPV is estimated to be the most common sexually transmitted infection in the United States. In fact, by age 50 approximately 80% of women have been infected with some type of HPV. The majority of women infected with the HPV virus do NOT develop cervical cancer. For most women the HPV infection does not last long; 90% of HPV infections resolve on their own within 2 years. A small number of women do not clear the HPV virus and are considered to have persistent infection. A woman with a persistent HPV infection is at greater risk of developing cervical cell abnormalities and cancer than a woman whose infection resolves on its own. Certain types of this virus are able to transform normal cervical cells into abnormal ones. In a small number of cases and usually over a long period of time (from several years to several decades), some of these abnormal cells may then develop into cervical cancer. Symptoms of Cervical Cancer Precancerous cervical cell changes and early cancers of the cervix generally do not cause symptoms. For this reason, regular screening through Pap and HPV tests can help catch precancerous cell changes early and prevent the development of cervical cancer. Possible symptoms of more advanced disease may include abnormal or irregular vaginal bleeding, pain during sex, or vaginal discharge. Notify your healthcare provider if you experience: Abnormal bleeding, such as o Bleeding between regular menstrual periods o Bleeding after sexual intercourse o Bleeding after douching o Bleeding after a pelvic exam o Bleeding after menopause Pelvic pain not related to your menstrual cycle Heavy or unusual discharge that may be watery, thick, and possibly have a foul odor Increased urinary frequency Pain during urination
These symptoms could also be signs of other health problems, not related to cervical cancer. If you experience any of the symptoms above, talk to a healthcare provider. Cervical Cancer Screening: Pap and HPV Tests Current guidelines for cervical cancer screening are: Women should start screening with the Pap test at age 21. (Screening is not recommended for women under age 21.) Starting at age 30, women have three options available for screening: A Pap test alone every three years Co-testing with a Pap and HPV test, every five years An HPV test alone, every five years Depending on the results of the Pap and/or HPV tests, a healthcare provider may recommend additional screening or procedures, so some women may be screened more often. After age 65, women older than 65 who have had adequate prior screening and are not otherwise at high risk can stop screening. Women who have had a hysterectomy (with removal of the cervix) also do not need to be screened, unless they have a have a history of a high-grade precancerous lesions. What if Pap test results are abnormal? If a Pap test shows abnormal cells, additional tests may be performed. These tests include: Colposcopy: A colposcopy is an examination of the cervix using a lighted magnifying instrument called a colposcope. Cervical biopsy: In a biopsy, the healthcare provider removes a small amount of tissue for examination under a microscope to look for precancerous cells or cancer cells. Most women have the biopsy in the doctor s office, and no anesthesia is needed Colposcopic biopsy: While viewing your cervix with a colposcope, the healthcare provider removes a tiny portion of abnormal tissue from the surface of the cervix with a special tweezers. The cells are then examined under a microscope. Endocervical curettage: A procedure in which the mucous membrane of the cervical canal is scraped using a spoon-shaped instrument called a curette. This can be done in your healthcare provider s office and does not require anesthesia. There may be some cramping and bleeding after the procedure. Cone biopsy: A cone-shaped sample of tissue is removed from the cervix to see if abnormal cells are in the tissue beneath the surface of the cervix. This specimen is much bigger than the biopsy done in the office without anesthesia. A sample of tissue can be removed for a cone biopsy using a LEEP cone procedure, which can be done under local
anesthesia, or a knife cone procedure, done in an operating room under local or general anesthesia. LEEP (Loop Electro-Surgical Excision Procedure): The LEEP is performed using a small heated wire to remove tissue and precancerous cells from the cervix. Treatment Treatment of cervical cancer depends on: The stage of the cancer The size and shape of the tumor The woman s age and general health Her desire to have children in the future Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. There are various surgical ways to do this without removing the uterus or damaging the cervix, so that a woman can still have children in the future. Types of surgery for early cervical cancer include: Loop electrosurgical excision procedure (LEEP) uses electricity to remove abnormal tissue Cryotherapy freezes abnormal cells Laser therapy uses light to burn abnormal tissue Different types of treatment are available for patients with cervical cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. Three types of standard treatment are used: 1. Surgery - (removing the cancer in an operation) is sometimes used to treat cervical cancer. The following surgical procedures may be used: a. Conization: A procedure to remove a cone-shaped piece of tissue from the cervix and cervical canal. b. Total hysterectomy: Surgery to remove the uterus, including the cervix c. Hysterectomy: The uterus is surgically removed with or without other organs or tissues. d. Radical hysterectomy: Surgery to remove the uterus, cervix, and a wide area of ligaments and tissues around these organs.
e. Modified radical hysterectomy: Surgery to remove the uterus, cervix, and ligaments and tissues that closely surround these organs. f. Pelvic exenteration: Surgery to remove the lower colon, rectum, and bladder. In women, the cervix, ovaries, and nearby lymph nodes are also removed. g. Cryosurgery: A treatment that uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ. h. Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor. i. Loop electrosurgical excision procedure (LEEP): A treatment that uses electrical current passed through a thin wire loop as a knife to remove abnormal tissue or cancer. 2. Radiation therapy - is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. a. External radiation therapy uses a machine outside the body to send radiation toward the cancer. b. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated. 3. Chemotherapy - is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.