Cervical Cancer: The Facts

What is it?

Cervical Cancer begins in the part of the female reproductive system known as the cervix. The cervix is the lower, narrow part of the uterus, or womb. The cervix forms a small, cone-shaped opening that links the vaginal canal to the inside of the uterus. Cervical Cancer is a slowly developing disease. It begins as a small, abnormal growth of cells on the surface of the cervix. While not all abnormal cell growths lead to cancer, some are considered to be pre-cancerous lesions. These lesions, known as squamous intraepithelial lesions (SIL), can eventually form tumors if they are not treated. Doctors generally describe SIL's based on their stage of progression:

Low-Grade SIL describes very early changes in cell size, shape, or growth. These slight abnormalities may resolve on their own and may never progress to a harmful stage. However, some may develop into the High-Grade, pre-cancerous stage. Low-Grade SIL's are also sometimes referred to as mild dysplasia or cervical intraepithelial neoplasia 1 (CIN 1).

High-Grade SIL describes a condition where there are large numbers of pre-cancerous cells that have developed more significant abnormalities. Upon microscopic examination, these cells are very distinct in appearance when compared to ordinary healthy cells. These abnormal cells are, however, still located on the surface of the cervix and have not yet spread to deeper layers of cells. If untreated, high-Grade SIL's eventually develop into cancer. High-Grade SIL's are also sometimes referred to as severe dysplasia or CIN 2 or 3.

Untreated SIL's can develop into cancer after a number of months or years. This type of cancer first affects the surface layer of cells, or squamous cells. The cancer can eventually spread to deeper cell layers and even nearby organs. Advanced stages of Cervical Cancer can also involve cancer that has spread to distant organs such as the lungs or liver.

Who gets it?

About 15,000 women in the U.S. develop Cervical Cancer each year. Most women who are diagnosed with pre-cancerous Low-Grade SIL's are between the ages of 25 and 35. High-Grade SIL's are mostly found in women between the ages of 30 and 40. Women in Rhode Island develop Cervical Cancer at a rate 15% higher than the national average. African-American women are about twice as likely as white women to develop Cervical Cancer. Hispanic and Native American women are also at a higher risk.

There are certain risk factors that are associated with a higher chance of developing Cervical Cancer. The primary risk factors are:

• HPV: Human Papillomavirus is the most important risk factor. This sexually transmitted disease is associated with genital warts and greatly increases the chances of developing Cervical Cancer.
  
  
• Genital Herpes Virus: This sexually transmitted disease forms lesions that can potentially develop into cancer.
  
  
• Age: Girls under 15 are rarely affected, but the risk increases significantly beginning in the early teens or late 20's. Women over 40 are at no higher risk than women in their 20's or 30's.
  
  
• Smoking: More than doubles your odds of developing Cervical Cancer.
  
  
• Weakened Immune System: A weak immune system makes it harder for the body to fight off viruses or early cancers. HIV infections and immunosuppressive drugs both weaken the body's immune system.
  

How is it detected?

The pre-cancerous lesions (SIL's) that lead to Cervical Cancer have no noticeable symptoms. The only way for these lesions to be detected is for a doctor to perform a Pap test. All women who are or have been sexually active (at any age), and women over the age of 18 should have a yearly pelvic exam and Pap Test. Check with your doctor, the RI Department of Health or the RI Cancer Council to find the location of a nearby clinic that performs Pap tests and pelvic exams.

• Pap Test: This quick, painless procedure is performed in a gynecologist's office or in a clinic. An instrument is used to widen the vagina and then a sample of cells and mucus is gently scraped from the cervix. The sample is then analyzed under the microscope at a lab.
  
  
• Pelvic Exam: During this exam, the doctor feels and presses against the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum for unusual changes in shape and size.

If a pelvic exam or Pap test reveals anything unusual, the doctor may use one or more of the following tests to determine the exact problem:

• Colposcopy - A vinegar-like solution is put on the cervix, and the doctor uses an instrument called a colposcope (something like a microscope) to look at the cells of the cervix.
  
  
• Schiller Test - In a Schiller test, a solution of iodine is applied to the cervix and upper vagina. Healthy cells will turn brown, while cancer cells or other abnormal cells turn white or yellow.
  
  
• Biopsy** - In a biopsy, the doctor takes a small sample of tissue from the cervix and sends it to a laboratory for a pathologist to examine under a microscope. The tissue sample can be taken by the following methods:
  
  
  --Loop Electrosurgical Excision Procedure (LEEP) - An electrical wire loop is used to slice off a thin round area of tissue.
  
  --Endocervical Curettage - A spoon-like instrument called a curette is used to scrape off some of the cervical tissue.
  
  --Cone Biopsy - A cone shaped sample of tissue is removed from the cervix in order to examine deeper layers of the tissue.
  
  --Dilation and Currettage (D&C) - If the doctor is not sure whether the problem is in the cervix or deeper in the uterus, he or she may use this test. The cervix is opened slightly to allow the doctor to scrape tissue from both the inner and outer cervix and from the walls of the uterus.

**All biopsy tests are done under local or general anesthetic. Side effects of the tests may include some bleeding or vaginal discharge and pain like menstrual cramps. However, the area usually heals very quickly and the side effects should disappear.

If Cervical Cancer is not detected early, it can spread to other organs. There are certain symptoms that have been associated with cancer at this stage.

Symptoms Associated With Advanced Cervical Cancer:

• Bleeding- abnormal bleeding that occurs between menstrual periods, after menopause, after sexual intercourse, after douching, and/or after a pelvic exam. Menstrual periods may last longer with heavier bleeding.
  
• Increased vaginal discharge
  
• Abdominal pains
  

These symptoms may be caused by many health problems and may NOT be Cancer, but should be checked by a doctor.

Is it curable?

Although it was once a devastating killer, today Cervical Cancer is almost completely curable if caught early. Cervical Cancer develops slowly from pre-cancerous lesions. For this reason, a yearly Pap test can almost always identify these abnormalities when they are still at an easily curable stage.

More advanced stages of Cervical Cancer are more difficult to treat, but in many cases are still curable. If the cancer has not spread to other organs, the cure rate is still over 90%. When the cancer has spread to other organs, the cure rate varies depending on the extent of the cancer.

It's easier to prevent cancer than to treat it....

Certain lifestyle and dietary habits can greatly reduce a woman's risk of developing Cervical Cancer (as well as other cancers). Some of these include:

• Have a yearly pelvic exam and Pap test
  
• Not smoking
  
• Protecting yourself against sexually transmitted diseases
  
• Regular exercise
  
• Moderate, if any, consumption of alcohol
  
• Low fat, high fiber diet
  

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