The cervix is the lower part of the uterus (womb) that connects the uterus to the vagina (birth canal). Cervical cancer develops when the cells in the cervix become abnormal and start to grow uncontrollably. The tissue that results from this growth is called a tumor.
According to the American Cancer Society, a viral infection called the human papillomavirus (HPV) causes about 90% of all cervical cancers. HPV describes a group of viruses that includes more than 100 different types. More than 30 of these viruses are sexually transmitted, and they can infect the genital area of both men and women. However, most people who have healthy immune systems experience no symptoms of the virus. Currently, there is no cure for HPV.
Since HIV weakens the body's immune system, women who are HIV-positive are more likely to develop HPV than women who are not HIV infected. Therefore, HIV-positive women have an increased risk of developing cervical cancer as well.
Before cervical cancer develops, cells in the cervix go through several changes over many years. Eventually, these pre-cancerous cells form a lesion called dysplasia (abnormal cellular growth), or a squamous intraepithelial lesion (SIL). These abnormal cells can also be described as CIN (cervical intraepithelial neoplasia). Moderate to severe dysplasia may be called carcinoma in situ or non-invasive cervical cancer.
Most women have no symptoms until the cancer invades healthy tissue. At this point, the cancer is described as invasive. Cervical cancer can be fatal, especially if it is not detected in the early stages.
Women are encouraged to have yearly pap smears at the doctor's office, which can detect pre-cancerous cells before the cancer is widespread.
Since 1993, cervical cancer has been classified as an AIDS-defining illness. This means that when HIV-infected patients develop cervical cancer, their condition has progressed to AIDS.
In June 2006, the U.S. Food and Drug Administration (FDA) approved the first HPV vaccine called Gardasil®. However, the safety and effectiveness of Gardasil® in HIV-positive people have not been determined. The drug, developed by Merck & Co., Inc., is a recombinant vaccine, which means that the vaccine does not contain the live virus, and there is no chance that patients who receive the vaccine can become infected HPV. The vaccine is given as three injections over the course of six months. The vaccine is expected to prevent most cases of cervical cancer due to HPV types included in the vaccine. However, patients will not be protected if they have been infected with the HPV type(s) prior to vaccination, and the drug does not protect against less common types of HPV.
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Vagina: The vagina, also known as the birth canal, is the female reproductive organ. This muscular canal leads from the uterus (womb) to the exterior of the female body.
Vulva: The term vulva refers to the female's external genitalia, including the labia, clitoris and vaginal opening.
Uterus: The uterus, also known as the womb, is the pear-shaped female reproductive organ in which a fertilized egg is implanted and a fetus develops. This hollow, thick-walled organ is about the size of a fist. The uterus has three parts - the body (upper part), the isthmus (narrow central area), and the cervix (the lower portion).
Cervix: The cervix is the lower portion of the uterus that protrudes like a bottleneck into the vagina and dilates during labor to allow the passage of the fetus.
Once a diagnosis of cervical cancer is confirmed, the healthcare provider will determine how much the cancer has spread. Treatment options and prognosis vary depending on the stage of the disease. This process is called staging. The International Federation of Gynecologists and Obstetricians (FIGO) system is usually used to stage cervical cancer.
Early cancer cells that are restricted to a very local area are present in the layer of cells that line the cervix. This type of cancer is called carcinoma in situ. These cells are non-invasive because they have not invaded healthy tissues.
The cancer has spread into the deeper tissues of the cervix, called the connective tissue. The cancer is limited to the uterus.
Stage IA: There is a very small cancerous area that is only visible with a microscope.
Stage IA1: The area containing cancer cells is less than 3mm deep and 7mm wide.
Stage IA2: The area containing cancer cells is 3-5mm deep and less than 7mm wide.
Stage IB: The cancer can be seen without a microscope, or it is deeper than 5mm or wider than 7mm.
Stage IB1: The cancer is no larger than 4cm.
Stage IB2: The cancer is larger than 4cm.
The cancer has spread from the cervix, but it is confined to the pelvic region (tissues surrounding the uterus). If treated, between 70-90% of patients who are diagnosed with Stage II cervical cancer will survive at least five years.
Stage IIA: The cancer has not spread into the uterus, but it may have spread down into upper region of the vagina. However, cancer is not present in the lower one-third of the vagina.
Stage IIB: The cancer has spread to the parametrial tissue (narrow, outer end of the uterus), which is adjacent to the cervix.
The cancer has spread to the lower one-third of the vagina, or it has entered the wall of the pelvis and may be blocking the ureters (tubes that carry urine from the kidneys to the bladder). If treated, between 30-50% of patients who are diagnosed with stage III cervical cancer survive at least five years.
Stage IIIA: The cancer has spread to the lower vagina, but it is not present in the pelvic wall.
Stage IIIB: The cancer has spread to the pelvic wall and/or is blocking the flow of urine through the ureters to the bladder.
: Stage IV cervical cancer is the most advanced stage. During this stage, the cancer has spread to other parts of the body. Between 15-30% of women who have stage IV cervical cancer survive at least five years after diagnosis.
Stage IVA: The cancer has spread to the bladder or rectum.
Stage IVB: The cancer has spread to distant organs, such as the lungs.
After cancer treatment is completed, the cancer has returned to the cervix or another part of the body.
Cervical cancer patients who are terminally ill may benefit from hospice care. Hospice care focuses on caring, not curing. Hospice services typically include psychological and spiritual guidance, pain and symptom management, short-term inpatient services when pain and symptoms become severe and bereavement care and counseling to surviving family members.
The goal of treatment is to make the patient as comfortable as possible during the final days of his or her life. Hospice may be provided when a patient no longer responds to treatment and has a life expectancy of six months or less.
Hospice care can be provided in the patient's home, a hospital, independently owned home or nursing facility. Hospices are equipped with trained professionals, including physicians, nurses, psychologists, social workers and members of the clergy.