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OBSTETRICS • GYNECOLOGY • FAMILY PRACTICE • MIDWIFERY CARE

Topic of the month : Cervical Cancer

 

Basic Information About Cervical Cancer

Cancer is a disease in which cells in the body grow out of control. Cancer is always named for the part of the body where it starts, even if it spreads to other body parts later.

When cancer starts in the cervix, it is called cervical cancer. The cervix is the lower, narrow end of the uterus. Also known as the womb, the uterus is where a baby grows when a woman is pregnant. The cervix connects the upper part of the uterus to the vagina (the birth canal).

Cervical cancer is the easiest female cancer to prevent, with regular screening tests and follow-up. It also is highly curable when found and treated early.

All women are at risk for cervical cancer. It occurs most often in women over age 30.1

It is important to get tested for cervical cancer because 6 out of 10 cervical cancers occur in women who have never received a Pap test or have not been tested in the past five years.2

Symptoms of Cervical Cancer

Early on, cervical cancer usually does not cause signs and symptoms. Advanced cervical cancer may cause bleeding or discharge from the vagina that is not normal for you, such as bleeding after sex. If you have any of these signs, talk to your doctor. They may be caused by something other than cancer, but the only way to know is to see your doctor.

Cervical Cancer Risk Factors

Almost all cervical cancers are caused by human papillomavirus (HPV), a common virus that can be passed from one person to another during sex. There are many types of HPV. Some HPV types can cause changes on a woman’s cervix that can lead to cervical cancer over time, while other types can cause genital warts.

HPV is so common that most people get it at some time in their lives, but HPV usually causes no symptoms so you can’t tell that you have it. For most women, HPV will go away on its own; however, if it does not, there is a chance that, over time, it may cause cervical cancer.

In addition to HPV, other things can increase your risk of cervical cancer. They include —

  • Not having regular Pap tests.
  • Not following up with your doctor if you had a Pap test result that is not normal.
  • Having HIV, the virus that causes AIDS, or another condition that weakens your immune system (making it hard for your body to fight off health problems).
  • Smoking.

Cervical Cancer Prevention

Two tests can help prevent cervical cancer —

  • The Pap test (or Pap smear) looks for precancerous, cell changes on the cervix that might become cervical cancer if they are not treated appropriately.
  • The HPV test looks for the virus that can cause these cell changes.

The Pap test is recommended for all women. Talk with your doctor, nurse, or other health care professional about whether the HPV test is right for you. The most important thing you can do to avoid getting cervical cancer is to have regular screening tests.

If you are 30 or older, and your screening tests are normal, your chance of getting cervical cancer in the next few years is very low. For that reason, your doctor may tell you that you will not need another screening test for up to three years. But you should still go to the doctor regularly for a check-up that may include a pelvic exam.

It also is important for you to continue getting a Pap test regularly—even if you think you are too old to have a child, or are not having sex anymore. If you are older than 65 and have had normal Pap test results for several years, or if you have had your cervix removed (during an operation called a hysterectomy), your doctor may tell you it is okay to stop getting regular Pap tests.

Getting the HPV Vaccine

If you are 11–26 years old, you can help prevent cervical cancer by getting the HPV vaccine. It protects against the types of HPV that most often cause cervical, vaginal, and vulvar cancers, and is given in a series of three shots. The vaccine is recommended for girls 11 to 12 years old. It also can be given to females 13–26 who did not get any or all of the shots when they were younger. Read CDC's recommendations on the use of the HPV vaccine among United States females aged 9 to 26 years.

More Steps to Help Prevent Cervical Cancer

These things may also help lower your risk for cervical cancer—

  • Don't smoke.
  • Use condoms during sex.*
  • Limit your number of sexual partners.

*HPV infection can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. While the effect of condoms in preventing HPV infection is unknown, condom use has been associated with a lower rate of cervical cancer.

Cervical Cancer Screening

Cervical cancer is the easiest female cancer to prevent, with regular screening tests and follow-up. Two tests can help prevent cervical cancer or find it early—

  • The Pap test (or Pap smear) looks for precancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately.
  • The HPV test looks for the virus that can cause these cell changes.

The Pap test is recommended for all women, and can be done in a doctor's office or clinic. During the Pap test, the doctor will use a plastic or metal instrument, called a speculum, to widen your vagina. This helps the doctor examine the vagina and the cervix, and collect a few cells and mucus from the cervix and the area around it. The cells are then placed on a slide or in a bottle of liquid and sent to a laboratory. The laboratory will check to be sure that the cells are normal.

If you are getting the HPV test in addition to the Pap test, the cells collected during the Pap test will be tested for HPV at the laboratory. Talk with your doctor, nurse, or other health care professional about whether the HPV test is right for you.

When you have your Pap test, your doctor also may perform a pelvic exam, checking your uterus, ovaries, and other organs to make sure there are no problems. There are times when your doctor may perform a pelvic exam without giving you a Pap test. Ask your doctor which tests you are having, if you are unsure.

When to Get Screened

You should start getting regular Pap tests at age 21, or within three years of the first time you have sex—which ever happens first. The Pap test is one of the most reliable and effective cancer screening tests available. It also can find other conditions that might need treatment, such as infection or inflammation.

In addition to the Pap test—the main test for cervical cancer—the HPV test may be used for screening women aged 30 years and older, or women of any age who have unclear Pap test results.

If you are 30 or older, and your screening tests are normal, your chance of getting cervical cancer in the next few years is very low. For that reason, your doctor may tell you that you will not need another screening test for up to three years. But you should still go to the doctor regularly for a check-up that may include a pelvic exam.

It also is important for you to continue getting a Pap test regularly—even if you think you are too old to have a child, or are not having sex anymore. If you are older than 65 and have had normal Pap test results for several years, or if you have had your cervix removed (during an operation called a hysterectomy), your doctor may tell you it is okay to stop getting regular Pap tests.

 

How to Prepare for Your Pap Test

If you are going to have a Pap test in the next two days, you should not—

  • Douche, which means rinsing the vagina with water or another fluid.
  • Use a tampon.
  • Have sex.
  • Use a birth control foam, cream, or jelly.
  • Use a medicine or cream in your vagina.

You should also schedule your Pap test for a time when you are not having your period.

Pap Test Results

It can take up to three weeks to receive your Pap test results. Most results are normal. But if your test shows that something might not be normal, your doctor will contact you and figure out how best to follow up. There are many reasons why your Pap test results might not be normal. It usually does not mean you have cancer.

If your Pap test results show cells that are not normal and may become cancer, your doctor will let you know if you need to be treated. In most cases, treatment prevents cervical cancer from developing. It is important to follow up with your doctor right away to learn more about your test results and receive any treatment that may be needed.

Cervical Cancer Diagnosis and Treatment

If your doctor says that you have cervical cancer, ask to be referred to a gynecologic oncologist—a doctor who has been trained to treat cancers of a woman's reproductive system. This doctor will work with you to create a treatment plan.

The extent of disease is referred to as the stage. Information about how big a cancer is or how far it has spread is often used to determine the stage. Doctors use information about stage to plan treatment and to monitor progress.

For more information about stages of cervical cancer, visit the National Cancer Institute's (NCI) Physician Data Query (PDQ) site on Stages of Cervical Cancer.

Types of Treatment

There are several ways to treat cervical cancer. The treatment depends on the type of cervical cancer and how far it has spread. Treatments include surgery, chemotherapy, and radiation. People with cervical cancer often get more than one kind of treatment.

  • Surgery: Doctors cut out and remove cancer tissue in an operation.
  • Chemotherapy: Chemotherapy involves the use of drugs to shrink or kill the cancer. The drugs could be pills or medicines given through an IV (intravenous) tube. Sometimes chemotherapy includes both IV drugs and pills.
  • Radiation: Radiation uses high-energy rays (similar to X-rays) to try to kill the cancer cells. The rays are aimed at the part of the body where the cancer is.

Visit NCI's PDQ for more information about treatments for Cervical Cancer.

These treatments may be provided by different doctors on your medical team. Gynecologic oncologists are doctors who have been trained to treat cancers of a woman's reproductive system. Surgeons are doctors who perform operations. Medical oncologists are doctors who are experts in cancer and treat cancers with medicines. Radiation oncologists are doctors who treat cancers with radiation.

 

Resources:

CDC