Cervical cancer occurs when abnormal cells develop and spread in the cervix (the lower part of the uterus). A unique fact about cervical cancer is that most cases are triggered by a type of virus. When found early, cervical cancer is highly curable. Since the introduction of the National Cervical Screening Program in 1991, the number of new cases of cervical cancer for women of all ages almost halved to 2005, and mortality also halved from 1991 to 2006.
When cervical cells first become abnormal, there are rarely any warning signs. As the cancer progresses, symptoms may include:
- • Unusual vaginal discharge
- • Vaginal bleeding between periods
- • Bleeding after menopause
- • Bleeding or pain during sex
The human papillomavirus (HPV) is a large group of viruses. About 40 types can infect the genital areas, and some have high risk for cervical cancer. Genital HPV infections usually clear up on their own. If one becomes chronic, it can cause changes in the cells of the cervix and it's these changes that may lead to cancer. Worldwide, over 90% of cervical cancers are caused by an HPV infection. HPV infections usually have no symptoms and go away on their own. Some types of the HPV virus may cause genital warts, but these are not the same strains linked to cervical cancer. It's important to note that genital warts will not turn into cancer, even if they are not treated. The dangerous types of HPV can stay in the body for years without causing any symptoms. HPV is so common that most people who have ever had sex - both women and men - will get the virus at some point in life.
Because HPV can linger quietly, it's possible to carry the infection even if it has been years since you had sex. Condoms can lower your risk of getting HPV, but they do not fully protect against the virus. HPV is also linked to cancers of the vulva, vagina, penis, and to anal and oral cancers in both sexes. If one of the high-risk strains of HPV lingers in the body, it can cause abnormal cells to develop in the cervix. These precancerous changes do not mean that you have cervical cancer, but over time, the abnormal cells may give way to cancer cells. Once cancer appears, it tends to spread in the cervix and surrounding areas. The risk is also higher in infected women who:
- • Smoke
- • Have many children
- • Use birth control pills for a long time
- • Are HIV positive or have a weakened immune system
The Pap test is one of the great success stories in early detection. A painless swab of the cervix can reveal abnormal cells, often before cancer appears. At age 21, women should start having a Pap test every three years. From age 30 to 65, women who get both a Pap test and an HPV test can go up to five years between testing. Women at higher risk may need testing more often, so it's best to check with your doctor. Skipping tests raises your risk for invasive cervical cancer.
Of note: You'll still need Pap tests after getting the HPV vaccine because it doesn't prevent all cervical cancers.
What If Your Pap Test Is Abnormal?
If test results show a minor abnormality, you may need a repeat Pap test. Your doctor may schedule a colposcopy - an exam with a lighted magnifying device - or biopsy to get a better look at any changes in the cervical tissue. If abnormal cells are precancerous, they can then be removed or destroyed. Treatments are highly successful in preventing precancerous cells from developing into cancer.
Diagnosing Cervical Cancer: Biopsy
A biopsy involves the removal of cervical tissue for examination in a lab. A pathologist will check the tissue sample for abnormal changes, precancerous cells, and cancer cells. In most cases, a biopsy takes place in a doctor's office with local anaesthesia. A cone biopsy allows the pathologist to check for abnormal cells beneath the surface of the cervix, but this test may require general anaesthesia.
Stages of Cervical Cancer
Stage 0 describes cancer cells found only on the surface of the cervix. More invasive cancers are separated into four stages. Stage I is when the cancer has not spread beyond the cervix. Stage II means the tumour has spread to the upper part of the vagina. A Stage III tumour extends to the lower part of the vagina and may block urine flow. In Stage IV, the tumour has reached the bladder or rectum, or cancer cells have spread to other parts of the body and formed new tumours.
If the cancer has not progressed past Stage II, surgery is usually recommended to remove any tissue that might contain cancer. Typically this involves a hysterectomy, the removal of the cervix and uterus as well as some of the surrounding tissue. The surgeon may also remove the fallopian tubes, ovaries, and lymph nodes near the tumour.
External radiation therapy uses high-energy X-rays to kill cancer cells in a targeted area. It can also help destroy any remaining cancer cells after surgery. Internal radiation, or brachytherapy, uses radioactive material that is inserted into the tumour. Women with cervical cancer are often treated with a combination of radiation and chemotherapy. Side effects can include low blood cell counts, feeling tired, upset stomach, nausea, vomiting, and loose stools.
Chemotherapy uses drugs to reach cancer wherever it is in the body. When cervical cancer has spread to distant organs, chemotherapy may be the main treatment option. Depending on the specific drugs and dosages, side effects may include fatigue, bruising easily, hair loss, nausea, vomiting, and loss of appetite.
Vaccine to Help Prevent Cervical Cancer
Vaccines are now available to ward off the two types of HPV most strongly linked to cervical cancer. Both Cervarix and Gardasil require three doses over a six-month period. Studies suggest the vaccines are effective at preventing chronic infections with the two types of HPV that cause 70% of cervical cancers. Gardasil also protects against two types of HPV that cause genital warts
Who Should Get the HPV Vaccine?
The vaccines are only used to prevent, not treat, HPV infection. They are most effective if administered before an individual becomes sexually active. The recommendation is that girls get an HPV vaccine series when they are 11 or 12. It can also be given as a catch-up vaccine for girls and women from ages 13 to 26.
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