HPV (human papilloma virus): Cervical cancer occurs when cells in the cervix become abnormal and multiply out of control. These changes are often caused by a human papilloma virus infection (HPV), which is most often spread as a sexually transmitted disease. There are many different types of HPV, but some types are a more likely cause of cervical cancer. The more harmful types are known as cancer-causing (oncogenic) HPV.
Pap smear: Pap smear, or Pap test, is a procedure that collects cells from the surface of the cervix and vagina. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to determine if they are abnormal.
Colposcopy: Colposcopy is a procedure to look inside the vagina and cervix for abnormal areas. A colposcope (a thin, lighted tube) is inserted through the vagina into the cervix, and tissue samples may be taken for biopsy.
Biopsy: If abnormal cells are found in a Pap smear, the doctor may perform a biopsy. A sample of tissue is cut from the cervix and viewed under a microscope by a pathologist checking for signs of cancer. A biopsy, removing only a small amount of tissue is usually done in the doctor's office. A woman may need to go to a hospital for a cervical cone biopsy (removal of a larger, cone-shaped sample of cervical tissue).
Pelvic exam: A pelvic exam involves examination of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and the other hand is placed over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. A speculum is also inserted into the vagina and the doctor or nurse examines the vagina and cervix for signs of disease. A Pap test or Pap smear of the cervix is usually done. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
Endocervical curettage: Endocervical curettage, using a curette (spoon-shaped instrument) is a procedure that collects cells or tissue from the cervical canal. Tissue samples may be taken for biopsy, and this procedure is sometimes done at the same time as a colposcopy.
Cystoscopy: Cytoscopy is a test that is done to see if the cancer has spread to the bladder. The doctor examines the inside of the bladder using a thin lighted tube. Small tissue samples can be removed and observed under a microscope.
Proctoscopy: Proctoscopy is a lighted tube used to determine if the cancer has spread to the rectum. A pelvic exam will be done at the same time to find out whether the cancer has spread beyond the cervix.
Chest x-ray: If a patient has cancer of the cervix, a chest x-ray may be done to see if the cancer has spread to the lungs.
Other imaging tests: Other imaging tests may include a lymphangiogram, CT (computed tomography) or MRI (magnetic resonance imaging) to see if the cancer has spread to other parts of the body.
HPV DNA test: A lab test called the human papilloma virus (HPV) DNA test may be used to determine whether an individual is infected with any of the 13 types of HPV that are most likely to lead to cervical cancer. Like the Pap test, the HPV DNA test involves collecting cells from the cervix for further lab testing. It may detect high-risk strains of HPV in DNA before changes to the cells of the cervix can be seen. The HPV DNA test isn't a substitute for regular Pap screening, and it's not used to screen women younger than 30 with normal Pap results. Most HPV infections in women of this age group clear up on their own and aren't associated with cervical cancer.
Staging: The process of finding out how far the cancer has spread is called staging. This is very important due to the treatment and outlook for recovery, which depend on the stage of the cancer. The system used to stage cervical cancer is the FIGO (International Federation of Gynecologists and Obstetricians) system. In this system, stages are labeled using Roman numerals 0 through IV (0-4). In general, the lower the number, the less the cancer has spread. A higher number, such as stage IV (4), means a more serious cancer. All stages (except for stage 0) are further sub-divided into smaller groups labeled with letters and numbers.
Stage 0 (Carcinoma
): In stage 0, cancer is found only in the first layer of cells lining the cervix and has not invaded the deeper tissues of the cervix. Stage 0 is also called carcinoma in situ.
Stage I: In stage I, cancer is found in the cervix only. Stage I is divided into stages IA and IB, based on the amount of cancer found.
Stage IA: A very small amount of cancer that can only be seen with a microscope is found in the tissues of the cervix. Stage IA is divided into stages IA1 and IA2, based on the size of the tumor. In stage IA1, the cancer is not more than three millimeters deep and not more than seven millimeters wide. In stage IA2, the cancer is between three and five millimeters deep, but not more than seven millimeters wide.
Stage IB: In stage IB, the cancer can most commonly be seen through a microscope, but can be seen without a microscope if it is more than five millimeters deep or more than seven millimeters wide. The cancer that can be seen without a microscope is divided into stages IB1 and IB2, based on the size of the tumor. In stage 1B1, the cancer can be seen without a microscope and is not larger than four centimeters. In stage 1B2, the cancer can be seen without a microscope and is larger than four centimeters.
Stage II: In stage II, cancer has spread beyond the cervix, but not to the pelvic wall (the tissues that line the part of the body between the hips) or to the lower third of the vagina. Stage II is divided into stages IIA and IIB, based on how far the cancer has spread.
Stage IIA: Cancer has spread beyond the cervix to the upper two thirds of the vagina, but not to tissues around the uterus.
Stage IIB: Cancer has spread beyond the cervix to the upper two thirds of the vagina as well as to the tissues around the uterus.
Stage III: In stage III, cancer has spread to the lower third of the vagina, may have spread to the pelvic wall, and/or has caused the kidney to stop working. Stage III is divided into stages IIIA and IIIB, based on how far the cancer has spread.
Stage IIIA: Cancer has spread to the lower third of the vagina, but not to the pelvic wall.
Stage IIIB: Cancer has spread to the pelvic wall and/or the tumor has become large enough to block the ureter (the tube that connects the kidneys to the bladder). This blockage can cause the kidneys to enlarge or stop working. Cancer cells may also have spread to lymph nodes in the pelvis.
Stage IV: In stage IV, cancer has spread to the bladder, rectum, or other parts of the body. Stage IV is divided into stages IVA and IVB, based on where the cancer is found.
Stage IVA: Cancer has spread to the bladder or rectal wall and may have spread to lymph nodes in the pelvis.
Stage IVB: Cancer has spread beyond the pelvis, pelvic lymph nodes, and to other places in the body such as the abdomen, liver, intestinal tract, or lungs.
Recurrent cervical cancer: Recurrent cervical cancer is cancer that comes back after it has been treated. The cancer may come back in the cervix or in other parts of the body. Cervical cancer is staged by the FIGO staging system, which is based on clinical examination, rather than surgical findings. It allows only the following diagnostic tests to be used in determining the stage: palpation, inspection, colposcopy, endocervical curettage, hysteroscopy, cystoscopy, proctoscopy, intravenous urography, and X-ray examination of the lungs, skeleton, and cervical colonization.
signs and symptoms
Early cervical cancer generally produces no signs or symptoms. Early signs may include abnormal vaginal bleeding, especially irregular heavy bleeding, bleeding after menopause, bleeding or spotting between periods, bleeding after sexual intercourse, pelvic (lower abdominal), pain or pressure on the bladder or rectum, unexplained bladder irritation, and unexplained vaginal discharge (particularly when it is thick or foul-smelling). As the cancer progresses, symptoms may include vaginal bleeding following intercourse, between periods or after menopause, watery, bloody vaginal discharge that may be heavy and foul smelling, and pelvic pain or pain during intercourse.
It is extremely important for women to have routine Pap tests to detect early, precancerous cellular changes. The American Cancer Society recommends that all women have a yearly Pap test starting at the age of 18 or the age they become sexually active. Some clinicians think that if the results are normal for three consecutive tests, then Pap tests can be performed every two to three years rather than annually. Older women should continue to have Pap tests because a large percentage of deaths from cervical cancer occur in women aged 65 and older.
Some types of cervical cancer do not respond well to treatment.
The cancer may come back (recur) after treatment.
Women who have treatment to save the uterus have a high risk of the cancer coming back (recurrence).
Surgery and radiation can cause problems with sexual, bowel, and bladder function.
Metastasis of cervical cancer to other organs can cause health problems and even death.
HPV (human papilloma virus): For cervical cancer, the most important risk factor is infection with HPV (human papilloma virus). HPV is a group of more than 100 types of viruses that may cause genital warts or cancers of the cervix. If the viruses cause cervical cancer, they are known as high risk HPVs. HPV is contracted during sexual intercourse. Having unprotected sex increases the risk of acquiring an HPV infection, and this occurs more often in the younger population. Women who have many sexual partners (or who have sex with men who have had many partners) have a greater chance of getting HPV and thereby developing cervical cancer.
Smoking: Women who smoke are twice as likely as to contract cervical cancer. Tobacco smoke can produce chemicals that may damage DNA in cells of the cervix, which makes the cancer more likely to occur.
HIV infection (human immunodeficiency virus): HIV is the virus that causes AIDS, and may also be a risk factor for cervical cancer. Being HIV positive makes a woman's immune system less able to fight both HPV and early cancers.
Many sexual partners: The larger the number of sexual partners, the greater the chances of acquiring HPV and possibly cervical cancer.
Early sexual activity: Having sex before the age of 18 may increase the risk of HPV infection. Immature cells are found in younger aged women, and seem to be more susceptible to the precancerous changes that HPV can cause.
infection: Chlamydia is a form of bacteria that can infect women's sex organs and spread during sexual intercourse. Many women are unaware that they have it unless samples are taken at the time of their Pap test. Some studies suggest that women who have this infection (or have had it in the past) are at greater risk for cervical cancer. While further studies are needed to determine if this is true, there are good reasons to avoid this infection or to have it treated. Long-term infections can cause other serious problems.
Dietary choices: Diet can play a role in its development as well. Diets low in fruits and vegetables are linked to an increased risk of cancers including cervical cancer. Women who are overweight have been reported to be at a higher risk.
Birth control pills: The long-term use of birth control pills increases the risk of cervical cancer. Some studies have shown a higher risk after five or more years of use.
Multiple pregnancies: Women who have had more than one full-term pregnancy have an increased risk of cervical cancer. The cause is not well understood, but has been proven to be true in large studies.
Low income: Women who are poor are at greater risk for contracting cancer of the cervix. This may be due to their inability to afford good healthcare, such as Pap tests.
DES (diethylstilbestrol): This drug is a hormone that was used between 1940 and 1971 for women who were in danger of miscarriages. Daughters of women who took this drug have been reported to have a slightly higher risk of vaginal and cervical cancer.
Family history: Studies suggest that women whose family member have had cervical cancer are at an increased risk to getting the disease themselves. This may be because they are less able to fight HPV, or a number of other factors could be involved.
Age: Because full-blown cervical cancer typically takes years to develop, women between the ages of 35 and 50 years are the ones who are most frequently diagnosed. However, women older than 50 or who are postmenopausal are not protected from cervical cancer. Women aged 65 years and older account for 25% of cervical cancer cases and 41% of deaths.