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Introduction Cervical Cancer Essay

Cervical cancer affects the entrance to the uterus (womb). The cervix is the narrow part of the lower uterus, often referred to as the neck of the womb.

The American Cancer Society estimates that 12,280 diagnoses of cervical cancer will be made by the end of 2017 in the United States. More than 4,000 women in the U.S. will die from cervical cancer this year.

The majority of cervical cancer cases are caused by HPV (human papillomavirus). The HPV vaccine successfully prevents HPV and the Centers for Disease Control and Prevention (CDC) recommends the vaccine for all preteens.

Fast facts on cervical cancer

Here are some key points about cervical cancer. More detail and supporting information is in the main article.

  • In America, more than 11,000 women are diagnosed with invasive cervical cancer each year.
  • Having many sexual partners or becoming sexually active early is a risk factor.
  • Survival rates are good if cervical cancer is caught early.
  • Symptoms include bleeding between periods and after sex.

Symptoms and early signs


HPV can lead to cervical cancer.

In the early stages of cervical cancer, a person may experience no symptoms at all. As a result, women should have regular cervical smear, or Pap, tests.

A Pap test is preventive. It aims not to detect cancer but to reveal any cell changes that indicate that cancer could develop, so that early action can be taken.

The most common symptoms of cervical cancer are:

  • bleeding between periods
  • bleeding after sexual intercourse
  • bleeding in post-menopausal women
  • discomfort during sexual intercourse
  • smelly vaginal discharge
  • vaginal discharge tinged with blood
  • pelvic pain

These symptoms can have other causes, including infection. Anyone who experiences any of these symptoms should see a doctor.

Stages

Working out the stage of a cancer is important as it helps decide what kind of treatment can be effective.

Staging aims to assess how far the cancer has developed and whether it has reached nearby structures or more distant organs.

There are different ways of describing the stages, but a 4-stage system is commonly used.

Stage 0: Precancerous cells are present.

Stage 1: Cancer cells have grown from the surface into deeper tissues of the cervix, and possibly into the uterus and to nearby lymph nodes

Stage 2: The cancer has is now beyond the cervix and uterus, but not as far as the walls of the pelvis or the lower part of the vagina. It may or may not affect nearby lymph nodes.

Stage 3: Cancer cells are present in the lower part of the vagina or the walls of the pelvis, and it may be blocking the ureters, the tubes that carry urine from the bladder. It may or may not affect nearby lymph nodes.

Stage 4: The cancer affects the bladder or rectum and is growing out of the pelvis. It may or may not affect the lymph nodes. Later in stage 4, it will spread to distant organs, including the liver, bones, lungs, and lymph nodes.

It is important to undergo screening and to see a doctor if any symptoms occur, as early treatment increases the chance of survival.

Causes

Cancer is the result of the uncontrolled division and growth of abnormal cells. Most of the cells in our body have a set lifespan and when they die, new cells are produced to replace them.

Abnormal cells can have two problems:

  • they do not die
  • they continue dividing

This results in an excessive accumulation of cells, which eventually forms a lump, otherwise known as a tumor. Scientists are not completely sure why cells become cancerous.

However, there are some risk factors that are known to increase the risk of developing cervical cancer. These risk factors include:

HPV (human papillomavirus): A sexually transmitted virus. There are more than 100 different types of HPV, at least 13 of which can cause cervical cancer.

Having many sexual partners or becoming sexually active early: Cervical cancer-causing HPV types are nearly always transmitted as a result of sexual contact with an infected individual. Women who have had many sexual partners generally have a higher risk of becoming infected with HPV. This raises their risk of developing cervical cancer.

Smoking: This increases the risk of cervical and other cancers.

A weakened immune system: The risk is higher in those with HIV or AIDS, and people who have undergone a transplant, necessitating the use of immunosuppressive medications.

Long-term mental stress: High levels of stress over a sustained period may make it harder to fight off HPV. A study published in 2016 supported this. The reseachers found that: "Women who reported self-destructive coping strategies, like drinking, smoking cigarettes or taking drugs when stressed, were more likely to develop an active HPV infection."

Giving birth at a very young age: Women who give birth before the age of 17 years are significantly more likely to develop cervical cancer, compared with women who have their first baby after the age of 25 years.

Several pregnancies: Women who have had at least three children in separate pregnancies are more likely to develop cervical cancer, compared with women who have never had children.

Birth control pills: Long-term use of some common contraceptive pills slightly raises a woman's risk.

Other sexually transmitted diseases (STD): Chlamydia, gonorrhea, and syphilis increase the risk of developing cervical cancer.

Socio-economic status: Rates appear to be higher in areas where income are low.

Treatment

Cervical cancer treatment options include surgery, radiotherapy, chemotherapy, or combinations of these.

Deciding on the kind of treatment depends on several factors, such as the stage of the cancer, as well as the patient's age and state of health.

Treatment for early-stage cervical cancer, when it is confined to the cervix, has a good success rate. The further the cancer has spread out of the area it originated from, the lower the success rate tends to be.

Early stage cervical cancer treatment options

Surgery is commonly used when the cancer is confined to the cervix. Radiotherapy may be used after surgery if a doctor believes there may still be cancer cells inside the body.

Radiotherapy may also be used to reduce the risk of recurrence (cancer coming back). If the surgeon wants to shrink the tumor to make it easier to operate, the person may receive chemotherapy although this is not a very common approach.

Treatment for advanced cervical cancer

When the cancer has spread beyond the cervix, surgery is not usually an option.

Advanced cancer is also referred to as invasive cancer because it has invaded other areas of the body. This type of cancer requires more extensive treatment, which will typically involve either radiotherapy or a combination of radiotherapy and chemotherapy.

In the later stages of cancer, palliative therapy is administered to relieve symptoms and improve quality of life.

Radiotherapy


Radiotherapy is commonly used to treat advanced forms of cervical cancer. Around 40% of all cancer patients undergo some form of radiotherapy.

Radiotherapy is also known as radiation therapy, radiation oncology, and XRT. It involves the use of beams of high-energy X-rays or particles (radiation) to destroy cancer cells. Radiation that is aimed at the pelvic area may cause the following side effects, some of which may not emerge until after the treatment is over:

Chemotherapy

Chemotherapy is the use of chemicals (medication) to treat any disease. In this context, it refers to the destruction of cancer cells.

Chemotherapy for cervical cancer, as with most other cancers, is used to target cancer cells that surgery cannot or did not remove, or to help the symptoms of people with advanced cancer.

Side effects of chemotherapy can vary, and they depend on the specific drug being used. Below is a list of the more common side effects:

Cervical cancer clinical trials

Participating in a clinical trial may be the best treatment option for some people. Many of the current treatments that are available are the results of clinical trials.

Clinical trials are an integral part of the cancer research process. They are done to determine how safe and effective new treatments are, and whether they are better than existing ones. People who participate in clinical trials are contributing to cancer research and innovation.

Outlook

The stage at which cervical cancer is diagnosed can help indicate the chances that a person will survive for at least 5 years more years.

  • Stage 1: In early stage 1, the chance of surviving at least 5 years is 93 percent, and in late stage 1, it is 80 percent.
  • Stage 2: In early stage 2, the rate is 63 percent, falling to 58 percent by the end of stage 2.
  • Stage 3: During this stage, the chances fall from 35 percent to 32 percent.
  • Stage 4: There is a 15 to 16 percent chance of surviving another 5 years.

These are average survival rates and do not apply to everyone. In some cases, treatment is successful up to stage 4.

Prevention

There are a number of measures that can be taken to reduce the chances of developing cervical cancer.

Human papillomavirus (HPV) vaccine

The link between the development of cervical cancer and some types of HPV is clear. If every female adheres to current HPV vaccination programs, cervical cancer could potentially be reduced.

Safe sex and cervical cancer

The HPV vaccine only protects against two HPV strains. There are other strains which can cause cervical cancer. Using a condom during sex helps protect from HPV infection.

Cervical screening

Regular cervical screening will make it much more likely that signs of cancer are picked up early and dealt with before the condition can develop, or spread too far. Screening does not detect cancer but detects changes to the cells of the cervix.

Having fewer sexual partners

The more sexual partners a woman has, the higher the risk of transmitting the HPV virus, which can lead to a higher likelihood of developing cervical cancer.

Delaying first sexual intercourse

The younger a female is when she has her first sexual intercourse, the higher the risk of HPV infection. The longer she delays it, the lower her risk.

Stopping smoking

Women who smoke and are infected with HPV have a higher risk of developing cervical cancer than people who do not.

Diagnosis

The earlier cervical cancer is diagnosed, the more successful treatment for it can be.

Women aged 30 years and over are advised to undergo a regular Pap, or cervical smear, test, to detect early signs of cancer of the uterus and cervix. HPV testing can be done at the same time.

Cervical smear test

In the U.S. over 11,000 women receive a diagnosis of invasive cervical cancer each year, and around 4,000 die as a result of this disease.

Most of these deaths could be prevented through regular cervical screening.

Screening does not detect cancer, but it looks for abnormal changes in the cells of the cervix. If left untreated, some abnormal cells can eventually develop into cancer.

HPV DNA testing

This test determines whether the patient is infected with any of the HPV types that are the most likely to cause cervical cancer. It involves collecting cells from the cervix for lab testing.

The test can detect high-risk HPV strains in cell DNA before any cervix cell abnormalities appear.

If there are signs and symptoms of cervical cancer, or if the Pap test reveals abnormal cells, additional tests may be recommended.

These include:

  • Colposcopy: A visual examination of the vagina using a speculum and a coloscope, a lighted magnifying instrument.
  • Examination under anesthesia (EUA): The doctor can examine the vagina and cervix more thoroughly.
  • Biopsy: A small section of tissue is taken under general anesthesia.
  • Cone biopsy: Small, cone-shaped section of abnormal tissue is taken from the cervix for examination.
  • LLETZ: Diathermy, using a wire loop with an electric current, is used to remove abnormal tissue. The tissue is sent to the lab to be checked.
  • Blood tests: A blood cell count can help identify liver or kidney problems.
  • CT scan: A barium liquid may be used to show up any abnormalities.
  • MRI: Special types of MRI may be able to identify cervical cancer in its early stages.
  • Pelvic ultrasound: High-frequency sound waves create an image of the target area on a monitor.

Cervical Cancer - Introduction


The cervix is the lower portion of the uterus that connects the uterus to the vagina. The opening of the cervix remains small except during labor when it expands to allow the baby to pass from the uterus to the vagina. Cervical cancer occurs when cells in the cervix grow erratically and multiply out of control. As with other types of cancer, it often takes years for cervical cancer to develop. First, normal cervical cells change into pre-cancerous cells. Pre-cancerous abnormalities progress without symptoms and if left untreated, they eventually progress into cancer. When cervical abnormalities are detected and treated in pre-cancerous stages, cervical cancer is preventable.

Both pre-cancerous and cancer cells in the cervix can be detected with a Pap smear (also called Pap test). A Pap smear is a screening exam used to examine cells from the cervix and the vagina. If abnormal cells are found, they are classified according to their degree of abnormality.

Approximately 50 million Pap smears are performed each year in the United States. The increased use of Pap smear is largely responsible for a significant reduction in the number of deaths from cervical cancer over the years (a decrease of 74% from 1955 to 1992).

When detected early, the five-year survival rate for cervical cancer is approximately 92%. If cervical cancer is detected before it has invaded any surrounding tissues, the five-year survival rate is nearly 100%. Therefore, it is very important that all women begin receiving yearly Pap smears and pelvic examinations at age 21. Some physicians will not perform a Pap smear each year if a woman has had three negative (normal) Pap smears in the course of three years. However, a yearly pelvic exam should be continued even if Pap smears are not given each year.

Even with the increased use of the Pap smear, not all women receive yearly Pap smears. It is estimated that between 60% and 80% of American women who are newly diagnosed with cervical cancer have not had a Pap smear within the last five years, if ever. According to recent studies, elderly, African-American, and low-income women are the least likely to have annual Pap smears.

The American Cancer Society estimated that there are 11,000 new cases of invasive cervical cancer diagnosed in the United States each year and approximately 4,000 American women die from the disease each year. Researchers estimate that non-invasive cervical cancer is nearly four times as likely as invasive cervical cancer. The International Agency for Research on Cancer estimates that nearly 380,000 women are diagnosed with cervical cancer worldwide each year. The number of cases and number of deaths from cervical cancer are higher in less developed countries where routine screening is not widespread.

Estimated Cervical Cancer Cases/Deaths Worldwide
RegionNew Cases (2000)Deaths (2000)
Eastern Africa
Middle Africa
Northern Africa
Southern Africa
Western Africa
Caribbean
Central America
South America
Northern America
Eastern Asia
South-Eastern Asia
South Central Asia
Western Asia
Eastern Europe
Northern Europe
Southern Europe
Western Europe
Australia/New Zealand
Melanesia
Micronesia
Polynesia
Worldwide
More Developed Countries
Less Developed Countries
30,206
6,947
10,479
5,541
13,903
6,670
21,596
49,025
14,845
51,266
39,648
151,297
3,458
35,482
6,049
10,116
13,282
1,077
983
25
70
470,606
91,451
379,153
15,837
3,799
5,524
2,906
7,154
3,143
8,690
18,737
7,070
25,639
20,462
83,678
1,765
15,180
3,162
4,011
6,207
432
510
12
11
233,372
39,350
194,025

Source: J. Ferlay, F. Bray, P. Pisani and D.M. Parkin. GLOBOCAN 2000: Cancer Incidence, Mortality and Prevalence Worldwide, Version 1.0. IARC CancerBase No. 5. Lyon, IARCPress, 2001.

Risk factors for cervical cancer include age (the highest risk occurs between late teens and mid-thirties), early age at first sexual intercourse, multiple sexual partners, certain strains of the human papillomavirus (HPV, a sexually transmitted disease), smoking, and daughters of women who took DES (a hormonal drug prescribed between 1940 and 1971 to help prevent miscarriages). Because there are often no symptoms associated with early stages of cervical cancer, it is important that women receive annual Pap smears to screen for the disease. Symptoms that may be associated with cervical cancer include unusual vaginal discharge, vaginal bleeding, or bleeding or pain during sexual intercourse. In June 2006, the U.S. Food and Drug Administration approved a vaccine aimed at preventing cervical cancer and vulvar and vaginal pre-cancers. The vaccine, called Gardasil, had been shown to be effective at blocking cervical cancers caused by certain strains of HPV. To learn more about this vaccine, please visit FDA Advisory Panel Backs Cervical Cancer Vaccine

If Pap smear results suggest cervical cancer, a number of additional tests may be performed for confirmation, including colposcopy, cervical biopsy, or cone biopsy. Further imaging tests, such as CT scan or MRI may be performed if the cancer is suspected to have spread past the cervix to other areas of the body.

Treatment for cervical cancer depends on the stage of the cancer and other prognostic factors. The main types of treatment for cervical cancer include surgery (laser surgery, cone biopsy, hysterectomy) radiation therapy, and/or chemotherapy. The earlier cervical cancer is detected, the greater the chances for successful treatment and survival.

Cervical Cancer Topics:

Updated: May 2010

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