Cervical Cancer

Introduction

This page has important information about cancer* of the cervix. Cancer of the cervix is also called cervical cancer. You will read about causes, screening, symptoms, diagnosis, and treatment. You will also find ideas about how to cope with the disease.

Scientists are studying cervical cancer to find out more about how it develops. And they are looking at better ways to detect and treat it.

The Cervix

The cervix is part of a woman's reproductive system. It is the lower, narrow part of the uterus (womb). The uterus is a hollow, pear-shaped organ in the lower abdomen. The cervix connects the uterus to the vagina. The vagina leads to the outside of the body. The cervical canal is a passageway. Blood flows from the uterus through the canal into the vagina during a woman's menstrual period. The cervix also produces mucus. The mucus helps sperm move from the vagina into the uterus. During pregnancy, the cervix is tightly closed to help keep the baby inside the uterus. During childbirth, the cervix dilates(opens) to allow the baby to pass through the.

Understanding Cancer

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.

Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.

Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.

Tumors can be benign or malignant:

• Benign tumors are rarely life threatening.
• Generally, benign tumors can be removed, and they usually do not grow back.
• Cells from benign tumors do not invade the tissues around them.
• Cells from benign tumors do not spread to other parts of the body.
• Polyps, cysts, and genital warts are types of benign growths on the cervix.

Malignant tumors are cancer:

• Malignant tumors are generally more serious than benign tumors. They may be life threatening.
• Malignant tumors often can be removed. But sometimes they grow back.
• Cells from malignant tumors can invade and damage nearby tissues and organs.
• Cells from malignant tumors can spread (metastasize) to other parts of the body. Cancer cells spread by breaking away from the original (primary) tumor and entering the bloodstream or lymphatic system. The cells invade other organs and form new tumors that damage these organs. The spread of cancer is called metastasis.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if cervical cancer spreads to the lungs, the cancer cells in the lungs are actually cervical cancer cells. The disease is metastatic cervical cancer, not lung cancer. For that reason, it is treated as cervical cancer, not lung cancer. Doctors call the new tumor "distant" or metastatic disease.

Risk Factors

Doctors cannot always explain why one woman develops cervical cancer and another does not. However, we do know that a woman with certain risk factors may be more likely than others to develop cervical cancer. A risk factor is something that may increase the chance of developing a disease.

Studies have found a number of factors that may increase the risk of cervical cancer. These factors may act together to increase the risk even more:

• Human papillomaviruses (HPVs): HPV infection is the main risk factor for cervical cancer. HPV is a group of viruses that can infect the cervix. HPV infections are very common. These viruses can be passed from person to person through sexual contact. Most adults have been infected with HPV at some time in their lives. Some types of HPV can cause changes to cells in the cervix. These changes can lead to genital warts, cancer, and other problems. Doctors may check for HPV even if there are no warts or other symptoms.

If a woman has an HPV infection, her doctor can discuss ways to avoid infecting other people. The Pap test can detect cell changes in the cervix caused by HPV. (See the "Screening" section to learn more about the Pap test.) Treatment of these cell changes can prevent cervical cancer. There are several treatment methods, including freezing or burning the infected tissue. Sometimes medicine also helps.

The NCI offers a fact sheet called "Human Papillomaviruses and Cancer: Questions and Answers."

• Lack of regular Pap tests: Cervical cancer is more common among women who do not have regular Pap tests. The Pap test helps doctors find precancerous cells. Treating precancerous cervical changes often prevents cancer.
• Weakened immune system (the body's natural defense system): Women with HIV (the virus that causes AIDS) infection or who take drugs that suppress the immune system have a higher-than-average risk of developing cervical cancer. For these women, doctors suggest regular screening for cervical cancer.
• Age: Cancer of the cervix occurs most often in women over the age of 40.
• Sexual history: Women who have had many sexual partners have a higher-than-average risk of developing cervical cancer. Also, a woman who has had sexual intercourse with a man who has had many sexual partners may be at higher risk of developing cervical cancer. In both cases, the risk of developing cervical cancer is higher because these women have a higher-than-average risk of HPV infection.
• Smoking cigarettes: Women with an HPV infection who smoke cigarettes have a higher risk of cervical cancer than women with HPV infection who do not smoke.
• Using birth control pills for a long time: Using birth control pills for a long time (5 or more years) may increase the risk of cervical cancer among women with HPV infection.
• Having many children: Studies suggest that giving birth to many children may increase the risk of cervical cancer among women with HPV infection.

Diethylstilbestrol (DES) may increase the risk of a rare form of cervical cancer and certain other cancers of the reproductive system in daughters exposed to this drug before birth. DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.)

Women who think they may be at risk for cancer of the cervix should discuss this concern with their doctor. They may want to ask about a schedule for checkups. For more information about risk factors, see the NCI booklet Understanding Cervical Changes.

Screening

Screening to check for cervical changes before there are symptoms is very important. Screening can help the doctor find abnormal cells before cancer develops. Finding and treating abnormal cells can prevent most cervical cancer. Also, screening can help find cancer early, when treatment is more likely to be effective.

For the past several decades, the number of women diagnosed each year with cervical cancer has been falling. Doctors believe this is mainly because of the success of screening.

Doctors recommend that women help reduce their risk of cervical cancer by having regular Pap tests. A Pap test (sometimes called Pap smear or cervical smear) is a simple test used to look at cervical cells. For most women, the test is not painful. A Pap test is done in a doctor's office or clinic during a pelvic exam. The doctor or nurse scrapes a sample of cells from the cervix, and then smears the cells on a glass slide. In a new type of Pap test (liquid-based Pap test), the cells are rinsed into a small container of liquid. A special machine puts the cells onto slides. For both types of Pap test, a lab checks the cells on the slides under a microscope for abnormalities.

Pap tests can find cervical cancer or abnormal cells that can lead to cervical cancer. Doctors generally recommend that:

• Women should begin having Pap tests 3 years after they begin having sexual intercourse, or when they reach age 21 (whichever comes first).
• Most women should have a Pap test at least once every 3 years.
• Women aged 65 to 70 who have had at least three normal Pap tests and no abnormal Pap tests in the past 10 years may decide, after speaking with their doctor, to stop cervical cancer screening.
• Women who have had a hysterectomy (surgery) to remove the uterus and cervix, also called a total hysterectomy, do not need to have cervical cancer screening.
• However, if the surgery was treatment for precancerous cells or cancer, the woman should continue with screening.

Women should talk with their doctor about when they should begin having Pap tests, how often to have them, and when they can stop having them. This is especially important for women at higher-than-average risk of cervical cancer.

Some activities can hide abnormal cells and affect Pap test results. Doctors suggest the following tips:

• Do not douche for 48 hours before the test.
• Do not have sexual intercourse for 48 hours before the test.
• Do not use vaginal medicines (except as directed by a doctor) or birth control foams, creams, or jellies for 48 hours before the test.

Doctors also suggest that a woman schedule her Pap test for a time that is 10 to 20 days after the first day of her menstrual period.

Most often, abnormal cells found by a Pap test are not cancerous. However, some abnormal conditions may become cancer over time:

• LSIL (low-grade squamous intraepithelial lesion): LSILs are mild cell changes on the surface of the cervix. Such changes often are caused by HPV infections. LSILs are common, especially in young women. LSILs are not cancer. Even without treatment, most LSILs stay the same or go away. However, some turn into high-grade lesions, which may lead to cancer.
• HSIL (high-grade squamous intraepithelial lesion): HSILs are not cancer, but without treatment they may lead to cancer. The precancerous cells are only on the surface of the cervix. They look very different from normal cells.

Symptoms

Precancerous changes and early cancers of the cervix generally do not cause pain or other symptoms. It is important not to wait to feel pain before seeing a doctor.

When the disease gets worse, women may notice one or more of these symptoms:

• Abnormal vaginal bleeding
  • Bleeding that occurs between regular menstrual periods
  • Bleeding after sexual intercourse, douching, or a pelvic exam
  • Menstrual periods that last longer and are heavier than before Bleeding after menopause
• Increased vaginal discharge
• Pelvic pain
• Pain during sexual intercourse

Infections or other health problems may also cause these symptoms. Only a doctor can tell for sure. A woman with any of these symptoms should tell her doctor so that problems can be diagnosed and treated as early as possible.

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