Cervical cancer

Cervical cancer

Cervical cancer

Introduction

Cervical cancer is uncontrolled growth of abnormal cells and tissue within the cervix (the neck of the uterus). The uterus is the womb where babies are grown. There is then an abnormal growth of cells presenting with hypertrophy (increase of cell size), hyperplasia (the increase of the numbers of cervical cells), anaplasia (formation of atypical shapes of cervical cell shape), and poor cervical cell function.The increasing cell size and numbers lead to an increase in the size of the surrounding tissues with the invasion of more abnormal cells from the cervix.

The cells are so aggressive and invade the surrounding tissues by competing for blood supply to the tissues. These cells are easily detected by a Pap smear test as they are shed from the.

Cervical cancer causes

There are several know causes of cervical cancer. The main cause of cervical cancer is an infection with Human papilloma virus (HPV) serotypes 16, 18, 31, 33, 45, and 56 which account for more than 80% of all invasive cervical cancers.

However most of the causes are associated with specific risk factors that women face. A regular Pap smear tests is important as a screening tool and a preventive measure for cervical cancer among women.

What are the risk factors for cervical cancer?

  • Associated risk factors include
  • Having multiple sexual partners
  • Women living in lower socioeconomic status
  • Cigarette smoking
  • A history of sexually transmitted diseases such as chlamydia, HPV infection
  • Immunosuppression
  • Oral contraceptive use.
  • Certain types of sexual behavior such as
    1. Women who have sex at an early age
    2. Women who have multiple sexual partners
    3. Women who have partners who have many other sex partners
    4. Women who have sex with uncircumcised men
  • Smoking or nicotine
  • Infections with Human immunodeficiency virus (HIV)
  • Diet with increased levels of homocysteine has been associated with increased risk of having cervical cancer. Vitamin deficiency has also been implicated in development of cervical cancer. Lack of
  • Prolonged use of oral contraceptives (birth control pills)
  • Women who have multiple pregnancies
  • Women living in low socioeconomic status
  • Injection with diethylstilbestrol (DES) drugs
  • Women who have relatives who had cervical cancer
  • Exposure to radiation of any type especially these on treatment for other cancers
  • Exposure to compounds that may affect nuclear genetic material such as benzene
  • Prolonged stressful conditions

Screening for cervical cancer

From the evidence obtained from large control studies, it is recommended that:

Screening for cervical cancer with a Pap smear test can achieve an 80% reduction in death rates from the cancer in the target population of women aged between 25 to 60 years.

It is also recommended that women have a screening interval of one year with conventional Pap smear tests or every 2 years using liquid-based cytology.

After the age of 30, women who have had three consecutive, technically satisfactory screening results may be screened every 2-3 years.

The American Cancer society recommend that cervical cancer screening should begin 3 years after the onset of vaginal intercourse and no later than age 21 years of age

Women who are age 70 years or older with an intact cervix and who have had 3 or more documented satisfactory cervical screening test results within the 10-yr period before age 70 may cease to have the routine cervical cancer screening tests

Those who have had uterus removal (with removal of the cervix need not undergo screening tests.

Cervical cancer epidemiology

Although cervical cancer is the third most common gynecologic cancer in the United States, it is the most common malignancy worldwide.

Cervical cancer is the second most common cancer in women in the world, with an estimated 500,000 cases in 2003.

Screening for cervical cancer with follow up and treatment has helped reduce the incidences of cancer. How ever this may not be true in some countries or regions such as the Latin America, the Caribbean, and Africa, where cervical cancer is the most common cause of cancer-related death in women

The incidences are high among the whites in the United States with an estimated 8.1 new cases per 100,000 each year as compared with 11 per 100,000 in African-American women and 14.4 per 100,000 in Hispanic populations.
Symptoms of cervical cancer

  • There are no symptoms in those in precancerous stage
  • There is an unusual vaginal bleeding, particularly after sex
  • A vaginal discharge with odor
  • Early invasive cancers may also present with no symptoms although some women will notice postcoital (after sex), between menses, or postmenopausal spotting.
  • Some women will present with malodorous vaginal discharge
  • Painful coitus (dyspareunia)
  • Cramping pelvic pain from uterine contractions
  • Chronic blood loss may result in symptoms of anemia in some patients
  • There may be pelvic pain
  • In advanced stages, there may b lower limb swelling (from occlusion of pelvic lymph vessels or thrombosis of the external iliac vein)
  • Advanced stages of disease may lead to anorexia, dysgeusia and unintentional weight loss

Diagnosing cervical cancer

  • The following tests may be performed to help in diagnosis of cervical cancer.
  • The healthcare provider will perform a detailed history and physical examination
  • Pelvic examination which includes examination of the vagina, cervical and related organs
  • Pap smear test.
  • Test for human papilloma virus (HPV) DNA. There is a high sensitivity for the detection of cervical intraepithelial neoplasia with these tests. This test helps to reduce the incidence of grade 2 or 3 cervical intraepithelial neoplasia (CIN) or cancer detected by subsequent screening examinations.
  • Colposcopy The method of examining the vagina and by means of a binocular instrument known as the colposcope, to screen for cancer of the cervix. The clinician may also use this test to do biopsy and endocervical curettage.
  • Complete blood count
  • A squamous cell carcinoma (SCC) antigen test
  • Carcinoembryonic antigen (CEA)
  • Chest x-ray examination

Continue reading about Treatment of Cervical cancer.