Cervical (SER-vi-kal) cancer is a highly curable condition that occurs in the female reproductive tract.
Cervical cancer develops in the part of a woman's reproductive tract called the cervix. The uterus is the hollow, pear-shaped organ in which the fetus develops when a woman is pregnant. The cervix is the lower, narrow part of the uterus (cervix is Latin for “neck”). The cervix lies between the main body of the uterus and the vagina (va-JY-na), or birth canal, which opens to the outside of the body.
Cancer * is a condition in which cells undergo abnormal changes and start dividing without control or order, usually forming tumors * . Scientists are not exactly sure why these changes happen, but they believe that something occurs in the abnormal cells that turns off certain genes * that control orderly cell growth. When these genes are turned off, abnormal cells are free to grow wildly. In some cases, these abnormal cells are cancerous; in other cases, they are not.
Cancers are named for the type of cell that becomes abnormal. There are two main types of cervical cancer. Between 80 and 90 percent of all cervical cancers are squamous cell carcinomas * . Squamous cells are a layer of cells that cover the outside of the body (such as skin cells) and the internal surface of the body (such as the lining of the cervix). The other type of cervical cancer is called adenocarcinoma. This type of cancer begins in cells of the mucus glands that line the cervix.
Cervical cancer generally develops slowly. At first, certain cells, called precancerous cells, begin to show abnormalities. These cells are not yet cancerous, and in many women, they change back into normal cells without any treatment. In some women, however, the precancerous cells continue to change and turn into cancer cells. This process usually takes several years, although it can happen in a shorter period. Precancerous cells look different from normal cells under the microscope and can be detected in a Pap smear, also called a Pap test or cervical smear.
About 6 percent of Pap tests show that abnormal cells are present. Not all of these abnormalities become cancer. However, if a Pap test comes back as abnormal, the doctor is inclined to do further tests. One test, called colposcopy (kol-POS-ko-pee), involves applying a vinegar-like solution to the cervix and then using a very thin, lighted instrument to examine the cervix closely. Doctors may also remove a small amount of tissue from the cervix and have it examined under a microscope, a procedure called biopsy (BY-op-see).
Having a Pap test is particularly important because even when cervical cells become cancerous, a woman often has no symptoms until the cancer is far advanced and has grown through the wall of the uterus or spread to other parts of the body. Symptoms of advanced cervical cancer are similar to symptoms caused by many other diseases and disorders. They include:
Scientists know that cancer is caused by the faulty regulation of cell growth. They are not exactly sure what happens to trigger cervical cancer, but they do know that it appears to be related to becoming infected with the human papillomavirus (HPV), a group of about 100 viruses, not all of which cause cancer. In fact, about two-thirds of all cancers are caused by only two viruses, HPV 16 and HPV 18. Most HPV infections occur in women between the teenage years and age 30.
What is confusing to scientists about the relationship between HPV and cervical cancer is that a great many women are infected with the HPV virus, but very few develop cancer. In most cases, the body's immune system * fights the HPV infection and the body shows no ill effects of the infection. In some women, however, infection with certain HPV viruses triggers a change in cervical cells, which then become cancerous. A test is available that can tell whether a woman has been infected with the HPV virus. This test is not routinely used, but may be done on women who have abnormal Pap tests.
The Centers for Diseases Control and Prevention estimated that in 2012 about 12,042 new cases of cervical cancer were diagnosed in the United States and that about 4,074 women died of the disease that year. Cervical cancer does not occur evenly throughout the population; some women are more likely to develop it than others. For example, in the United States, Hispanic women are twice as likely to develop cervical cancer as non-Hispanic women, and African American women are more likely to develop the disease than white women. This may be the result of decreased access to Pap testing or follow-up treatment. Most cervical cancers are diagnosed in women between the ages of 20 and 50, but 20 percent occur in women over the age of 65 years. Other factors that increase the chances of developing cervical cancer are as follows:
Cervical cancer is staged using an international system (Federation of International Gynecology and Obstetrics or FIGO system) that classifies cancer according to stages of its development, from stage 0 to stage IV. The stages are determined by the extent of the spread of malignant * cells from the primary lesion * to other locations in the body. The stage is determined primarily by a doctor's examination and the results of several tests. The lower the stage number, the less advanced and more curable the cancer is. The recommended treatment depends on the stage of the cancer. It is wise to get a second opinion from an independent doctor before beginning treatment. Some lesions that have a close-to-normal appearance do not require treatment, but they do need to be checked regularly. Other growths that appear likely to develop into cancer may need to be removed, which is often done by using a special instrument to freeze them off, a procedure called cryosurgery (KRY-o-sur-jer-ee), to burn them off by cauterization (kaw-ter-i-ZAY-shun), or to direct high-energy laser beams at them. These procedures can destroy the abnormal areas without affecting nearby healthy tissue.
These procedures also may be used to remove tumors that definitely are cancerous but have remained on the surface of the cervix. However, if the cancer has penetrated or grown into the wall of the cervix or has spread, surgeons either need to remove the tumor and the surrounding tissue, or they need to remove the entire uterus and cervix, an operation called a hysterectomy (his-ter-EK-to-mee). Surgery is the most common treatment for cervical cancer, but it also may be used together with radiation therapy and chemotherapy *
In 2006, the Food and Drug Administration approved a vaccine (Gardasil) that prevents infection against four types of HPV that cause about 90 percent of all cervical cancers. The vaccine is designed to be given to young women ages 9 to 26 years who are not pregnant or breastfeeding, but the vaccine has been proven effective only if given before infection. Immunization requires three injections of the vaccine over a six-month period. Two months after the first injection, a second injection is given. A third injection is given four months after the second injection. All three injections must be given for the vaccine to be effective.
Because cervical cancer is so closely connected with the sexually transmitted virus called HPV, not having sexual intercourse is an effective way to prevent cervical cancer. When engaged in sexual intercourse, men should always use a condom, which helps to protect their partner from possible infection. A condom offers good, but not total, protection against both the HPV virus and the HIV virus. Maintaining a healthy lifestyle by not smoking, eating a balanced diet, and maintaining a healthy weight also reduces the risk of developing cervical cancer.
See also Cancer: Overview • Genital Warts • Human Papillomavirus (HPV)
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* cancer is a condition characterized by abnormal overgrowth of certain cells, which may be fatal.
* tumors (TOO-morz) are abnormal growths of body tissue that have no known cause or physiologic purpose. Tumors may or may not be cancerous.
* genes (JEENS) are chemical structures composed of deoxyribonucleic acid (DNA) that help determine a person's body structure and physical characteristics. Inherited from a person's parents, genes are contained in the chromosomes found in the body's cells.
* carcinoma (kar-sih-NO-muh) is a cancerous tumor that arises in the epithelium (eh-puh-THEElee-um), the sheets of cells that line body surfaces, such as the insides of hollow organs and cavities.
* immune system (im-YOON SIStem) is the system of the body composed of specialized cells and the substances they produce that help protect the body against disease-causing germs.
* HIV or human immunodeficiency virus (HYOO-mun ih-myoono- dih-FIH-shen-see) is the virus that causes AIDS (acquired immunodeficiency syndrome).
* chlamydia (kla-MIH-dee-uh) are microorganisms that can infect the urinary tract, genitals, eye, and respiratory tract, including the lungs.
* malignant (ma-LIG-nant) refers to a condition that is severe and progressively worsening.
* lesion (LEE-zhun) is a general term referring to a sore or a damaged or irregular area of tissue.
* chemotherapy (KEE-mo-THER-apee) is the treatment of cancer with powerful drugs that kill cancer cells.