What is the cervix?

The cervix is the lower, narrow part of the uterus (womb) located between the bladder and the rectum. It forms a canal that opens into the vagina, which leads to the outside of the body.

What are precancerous conditions of the cervix?

Precancerous conditions of the cervix are identified as cells that appear to be abnormal, but are not cancerous at the present time. However, the appearance of these abnormal cells may be the first evidence of cancer that develops years later.

Precancerous changes of the cervix usually do not cause pain and, in general, do not cause any symptoms. They are detected with a pelvic exam or a Pap test.

Squamous intraepithelial lesions (SIL) is aterm that refers to abnormal changes in the cells on the surface of the cervix.

• squamous cells are the flat cells found on the surface (of the cervix)
• intraepithelial means that the abnormal cells are present only in the surface layer of cells
• lesion refers to an area of abnormal tissue

According to the National Cancer Institute (NCI), changes in these cells can be divided into two categories:

Low-grade SIL refers to early changes in the size, shape, and number of cells that form the surface of the cervix. They may go away on their own, or, with time, may grow larger or become more abnormal, forming a high-grade lesion. These precancerous low-grade lesions may also be called mild dysplasia or cervical intraepithelial neoplasia 1 (CIN 1). These early changes most often occur in women between the ages of 25 and 35, but can appear at any age.

High-grade SIL means there are a large number of precancerous cells, and, like low-grade SIL, these precancerous changes involve only cells on the surface of the cervix. The cells often do not become cancerous for many months, perhaps years. High-grade lesions may also be called moderate or severe dysplasia, CIN 2 or 3, or carcinoma in situ. They develop most often in women between the ages of 30 and 40, but can occur at any age.

What is cancer of the cervix?

If abnormal cells on the surface of the cervix spread deeper into the cervix, or to other tissues or organs, the disease is then called cervical cancer, or invasive cervical cancer. Cervical cancer occurs most often in women over the age of 40. It is different from cancer that begins in other parts of the uterus and requires different treatment. Most cervical cancers are squamous cell carcinomas and adenocarcinomas.

The mortality rates for cervical cancer have declined sharply as Pap screenings have become more prevalent. About 12,900 cases of invasive cervical cancer will be diagnosed in the US during 2001. Some researchers estimate that noninvasive cervical cancer (also referred to as "carcinoma in situ") is nearly four times more common than invasive cervical cancer.

What are risk factors for cervical cancer?

The following have been suggested as risk factors for cervical cancer:

• infection with the human papillomavirus (HPV), most often as the result of unprotected sex
• infection with the human immunodeficiency virus (HIV) - the precursor to AIDS, or other conditions that weaken the immune system
  
• age - After age 25, the risk for invasive cervical cancer increases, including the risk of dying from cervical cancer.
• smoking
• low socioeconomic level
• poor diet - lacking in fruits and vegetables
• having sexual intercourse before the age of 18
• having many sexual partners, and having partners who have had sexual intercourse at a young age and/or have had many partners themselves

Chlamydia and Cervical Cancer

New research has shown that chlamydia, the most common sexually transmitted disease in the US, may increase a woman's risk of developing cervical cancer. In the study, published in the Journal of the American Medical Association (JAMA), women who showed signs of any type of chlamydial infection in their blood were two-and-a-half times more likely to develop cervical cancer, when compared to women with no sign of infection. Although the reason for this increased risk is still under investigation, researchers speculate that immune system cells that are activated at chlamydia infection sites may damage normal cells.

Can cervical cancer be prevented?

Early detection of cervical problems is the best way to prevent cervical cancer. Routine, annual pelvic examinations and Pap tests can detect precancerous conditions that often can be treated before cancer develops. Invasive cancer that does occur would likely be found at an earlier stage. Pelvic examinations and Pap tests are the methods used to determine if there are cervical problems. Women who are or have been sexually active, or are age 18 or older, should have regular checkups, including a pelvic exam and Pap test.

According to the National Institutes of Health (NIH):

A pelvic exam and Pap test allow the physician to detect abnormal changes in the cervix. If an infection is present, it is treated and the Pap test is repeated at a later time. If the exam or Pap test suggests something other than an infection, a repeated Pap test and other tests are performed to determine the problem.

Women who have had a hysterectomy (surgery to remove the uterus, including the cervix) should ask their physician's advice about having pelvic exams and Pap tests.

What are the symptoms of cervical cancer?

Symptoms of cervical cancer usually do not appear until abnormal cervical cells become cancerous and invade nearby tissue.

• The most common symptom is abnormal bleeding, which may:
  
  
  • start and stop between regular menstrual periods.
  • occur after sexual intercourse, douching, or a pelvic exam.
• Other symptoms may include:
  • heavier menstrual bleeding, which may last longer than usual
  • bleeding after menopause
  • increased vaginal discharge
  • pain during intercourse

The symptoms of cervical cancer may resemble other conditions or medical problems. Consult a physician for diagnosis.

How is cervical cancer diagnosed?

When cervical problems are found during a pelvic examination, or abnormal cells are found through a Pap test, a cervical biopsy may be performed.

There are several types of cervical biopsies that may be used to diagnose cervical cancer, and some of these procedures that can completely remove areas of abnormal tissue may also be used for treatment of precancerous lesions. Some biopsy procedures only require local anesthesia, while others require a general anesthesia. Several types of cervical biopsies include:

• loop electrosurgical excision procedure (LEEP) - a procedure which uses an electric wire loop to obtain a piece of tissue.
• colposcopy - a procedure which uses an instrument with magnifying lenses, called a colposcope, to examine the cervix for abnormalities. If abnormal tissue is found, a biopsy is usually performed (colposcopic biopsy).
• endocervical curettage (ECC) - a procedure which uses a narrow instrument called a curette to scrape the lining of the endocervical canal. This type of biopsy is usually completed along with the colposcopic biopsy.
• cone biopsy (Also called conization.) - a biopsy in which a larger cone-shaped piece of tissue is removed from the cervix by using the loop electrosurgical excision procedure or the cold knife cone biopsy procedure. The cone biopsy procedure may be used as a treatment for precancerous lesions and early cancers.
• cold knife cone biopsy - a procedure in which a laser or a surgical scalpel is used to remove a piece of tissue. This procedure requires the use of general anesthesia.

Treatment for cervical cancer:

Specific treatment for cervical cancer will be determined by your physician based on:

• your overall health and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatment may include:

• surgery, including:
  • cryosurgery - use of liquid nitrogen, or a probe that is very cold, to freeze and kill cancer cells.
  • laser surgery - use of a powerful beam of light, which can be directed to specific parts of the body without making a large incision, to destroy abnormal cells.
  • hysterectomy - surgery to remove the uterus, including the cervix. In some cases, a hysterectomy may be required, particularly if abnormal cells are found inside the opening of the cervix.
• radiation therapy
• chemotherapy

LEEP or conization may also be used to remove abnormal tissue.