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Healthy Living

January is Cervical Health Awareness Month

Cervical Cancer

woman

Cancer of the cervix is one of the most common cancers that affect a woman's reproductive organs. Various strains of the human papillomavirus (HPV), a sexually transmitted infection, are responsible for at least 95 percent of cases of cervical cancer.

When exposed to HPV, the immune system response in most women prevents the virus from doing harm. In a small group of women, however, the virus survives for years before it eventually converts cells on the surface of the cervix into cancer cells. Cervical cancer is most likely to occur between the ages of 30 and 55.

Thanks largely to Pap test screening, the death rate from cervical cancer has decreased significantly over the last 40 years. Still, every year an estimated 12,900 women in the United States find out that they have invasive cervical cancer, and approximately 4,400 die of the disease.

Signs and Symptoms

Early cervical cancer generally produces no signs or symptoms. As the cancer progresses, these signs and symptoms may appear:

  • Bleeding from your vagina after intercourse, between periods or after menopause

  • Watery, bloody discharge from your vagina that may be heavy and have a foul odor

Risk Factors

These factors increase your risk of cervical cancer:

  • Many sexual partners. The greater the number of sexual partners you have had -- and the number of partners that your partners have had -- the greater your chance of acquiring HPV.

  • Early sexual activity. Having first sexual intercourse before age 18 increases your risk because less mature cells seem to be more susceptible to precancerous changes that HPV can cause.

  • Other sexually transmitted diseases (STDs). If you have other STDs, such as chlamydia, gonorrhea, syphilis or HIV/AIDS, you have a greater chance of having been exposed to HPV.

Studies indicate that at least half of women who have ever engaged in intercourse have been exposed to at least one strain of HPV. Cigarette smoking also seems to affect a woman's ability to respond to the virus. The exact mechanism that links cigarette smoking to cervical cancer isn't known, but tobacco use increases the risk of precancerous changes as well as cancer of the cervix.

Screening and Diagnosis

There isn't a way to determine which women have immune systems that make them more susceptible to cervical cancer. That's why simple and inexpensive Pap tests are important.

During a Pap test, your doctor brushes cells from your cervix, smears them onto a glass slide and sends the slide to a lab. A technician called a cytotechnologist examines the slide for abnormal cells. A doctor (pathologist) further reviews slides that contain abnormal cells before making a final diagnosis.

In nearly all cases, the Pap test allows for the detection of abnormal cells. This is the precancerous stage, when the abnormal cells (dysplasia) exist only in the outer layer of the cervix and haven't invaded deeper tissues. If untreated, the abnormal cells may convert to cancer cells, which may spread in various stages into the cervix, the upper vagina, the pelvic areas and to other parts of your body. Cancer or precancerous conditions that are caught at the pre-invasive stage are rarely life-threatening and typically require only outpatient treatment.

Treatment

Pre-invasive stage

Treatment of cervical cancer in the pre-invasive stage, when it has affected only the first layer of the lining of the cervix, may include:

  • Simple surgery. This involves removing with a scalpel a cone-shaped piece of cervix tissue where the abnormality is found.

  • Laser surgery. This operation uses a narrow beam of intense light to kill cancerous and precancerous cells.

  • Loop electrosurgical excision procedure (LEEP). This technique uses a wire loop to pass electrical current, which cuts like a surgeon's knife and removes cells from the mouth of the cervix.

  • Cryosurgery. This technique involves freezing and killing cancerous and precancerous cells.

  • Hysterectomy. This major surgery involves removal of the cancerous and precancerous areas, the cervix and the uterus.

Invasive stage

Many women are treated successfully for invasive cervical cancer and live full, productive lives. When the cancer is caught when it's still confined to the cervix, the 5-year survival rate is 91 percent, according to the American Cancer Society.

Treatment may involve:

  • Hysterectomy. Surgery is the best option for younger women because it often can preserve one or both ovaries and estrogen production, which is important in maintaining bone strength. A simple hysterectomy -- removal of the cancer, the cervix and the uterus -- is typically an option only when there is an invasion of less than 3 millimeters (mm) into the cervix. A radical hysterectomy -- removal of the cervix, uterus, part of the vagina and lymph nodes in the area -- is the standard surgical treatment when there is an invasion of greater than 3 mm into the cervix and no evidence of tumor on the side walls of the pelvis. Side effects include a slight risk of damage to your bowel or bladder, or damage to the nerves that serve the bladder. The surgery results in a somewhat shortened vagina, but most women report normal sexual function after surgery.

  • Radiation. Radiation therapy is the standard of care for more advanced stages of the disease. High energy rays shrink tumors by killing the cancer cells. The radiation destroys the ability of cancer cells to reproduce. Radiation can cause some difficult side effects, although not everyone experiences them. The short-term side effects may include fatigue, diarrhea, irritation of the rectum, irritation of the bladder, and some narrowing, shortening, and drying of the vagina, often requiring the use of a lubricating jelly before intercourse. Long-term, rare side effects may include bowel and rectum problems, greater susceptibility to bone fractures and a risk of a secondary malignancy -- when the radiation itself causes a different form of cancer, such as bone cancer. Premenopausal women will experience menopause because the ovaries are destroyed by the radiation.

  • Chemotherapy. Using drugs to kill cancer may enhance the effects of radiation. Tumors tend to shrink rapidly with aggressive chemotherapy, but the drugs can be toxic to people with cervical cancer. Chemotherapy has been shown to improve survival rates in women with more advanced forms of cervical cancer and is often used in conjunction with radiation therapy.

Treatment often requires a radical hysterectomy or radiation therapy, and sometimes both. Surgery is usually best for smaller tumors, and radiation is a more effective treatment for bigger tumors or for tumors that have spread beyond the cervix but remain in the pelvic area. However, there is a debate over the precise dividing line between what constitutes a "small" and a "big" tumor.

Prevention

The best ways to fight cervical cancer are to:

  • Delay first intercourse.
  • Have fewer sexual partners.
  • Use condoms.
  • Have routine Pap tests.

Routine Pap tests are the most successful and accurate method of early detection. Work with your doctor to figure out the best schedule for Pap tests. Current guidelines suggest:

  • An initial Pap test when you first begin having sexual relations or at age 18 if you haven't been sexually active.

  • Less frequent testing after three consecutive annual normal Pap tests.

  • Subsequent Pap tests at least every 3 years and continued for life, because the risk of invasive cervical cancer increases with age.

If you're at high risk of cervical cancer, you'll need to have more frequent Pap tests. If you've had a hysterectomy, talk with your doctor about needing to continue getting Pap tests. If the hysterectomy was done for a noncancerous condition, such as fibroids, you may discontinue routine Pap tests, but not pelvic exams. If the hysterectomy was done for a precancerous or cancerous condition, your vaginal canal still needs to be checked for abnormal changes.

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