Cancer of the Cervix

Cancer of the Cervix

This article is an overview of cervical cancer and to discuss its impact on women’s health. Unlike other most other cancers, cervical cancer is a cancer that is unique to women. The cervix is the “bridge” between the uterus and the vagina. This area undergoes a change in cell architecture as the lining moves from the vagina to the inside of the uterus. Any area of the body that undergoes a transition of lining is prone to getting cancer because of the changes that occur in cell type, cell DNA, and function of the cells. Other areas of changing in the lining are the border between the esophagus and stomach and the border between the anus and rectum.

Cancer of the cervix is a major health concern for women as it is not uncommon. Overall, about one in 10,000 women will be found to have cervical cancer each year. The average age of diagnosis with cervical cancer is 48 but it can occur in women much younger. Death from cervical cancer is rare, however, and occurs in about one in 50,000 women. The rates of cervical cancer and death from it are higher in persons of African descent or Hispanic.

The structure and function of the cervix

The cervix is a part of the female reproductive organ system. The uterus is shaped roughly like an upside-down pear. At the top of the uterus are two arms that end near an ovary on each side normally. The bottom of the uterus has a narrow thick portion of muscle that interfaces with the vagina. The cervix is a distinct structure/location, but it is also continuous with both the uterus and the vagina. The normal function of a healthy cervix is to act as a partial barrier from the outside world to the normally germ free (i.e. sterile) portions of the abdominal cavity.

About 50% of women are diagnosed with cervical cancer at an early stage when the cancer is fond only at the cervix. At this stage, the cancer is quite curable and greater than 90% have long term survival. When the cancer has spread outside of the cervix to regional lymph nodes or other areas of the body, the cancer becomes more difficult to treat and the risk of dying from the cancer rises dramatically. The best chance of cure and preventing complications of cervical cancer occur with early detection. This emphasizes the importance of understanding signs of cervical cancer and what can be done to help prevent or detect it.

The structure of the cervix can undergo dramatic changes throughout a woman’s life cycle. The cervix is the thickened end of the muscle that has a canal which runs through it with a tiny opening at each end. The opening to the uterus is known as the internal os. The opening to the vagina is known as the external os. The lining of the cervix changes as it moves from the uterus to the vagina. This occurs in the same way as the lining changes from the rectum to the external anal verge. The lining of the uterus has a columnar epithelium. The vagina is has a cell lining somewhat similar to skin in that it has a squamous cell lining. The main difference between the lining of the vagina and skin of the arm is that the external skin has keratinized squamous cells and the vagina is non-keratinized.

Risk factors for cervical cancer

A key part of maintaining health of the cervix (and thus helping to prevent a future cancer) is to be aware of risk factors for cervical cancer. Almost all cases of cervical cancer result from infection with a sexually transmitted virus called human papillomavirus.

Things that increase the risk of getting the virus as well as increasing the risk of cervical cancer include:

  • early age of first sexual contact
  • having had other sexually transmitted diseases
  • having multiple sexual partners
  • multiple pregnancies
  • prior cigarette smoking
  • dysfunction of the immune system
  • long periods of oral contraceptive pill use

There are several different kinds of human papillomavirus (HPV) but types 16 and 18 are more commonly associated with the development of cervical cancer.

Screening for cervical cancer

Another key part of maintaining cervical health is to undergo routine Pap smears as well as screening for HPV, especially types 16 and 18. A Pap smear is a test usually performed in a doctor’s office that takes a sample of cells from the cervix for examination under a microscope. If abnormal cells are found this might indicate the presence of cervical cancer. HPV can also be detected.

Some cancers such as ovarian cancer have few if any symptoms and do not have any accurate and specific screening test. Fortunately, cervical cancer does have an accurate screening test. The test should begin routinely at the age of 21 or when a woman begins to have sexual intercourse. Most doctors also test for HPV at the same time.

Women who have certain risk factors that place them at a higher risk such as HPV infection or prior pre-cancerous findings on a Pap smear should have more frequent testing performed.

Additionally, there are now vaccines available and recommended for both teenage girls (Gardasil® and Cervarix®) and boys (Gardasil®) that can prevent most cases of HPV that lead to cervical cancer. It is highly recommended that these vaccines be given before a girl becomes sexually active.

Symptoms of cervical cancer

Symptoms of cervical cancer are often absent early on. When the cancer is small or pre-invasive cervical cancer is often clinically silent. This is why screening, identification of those at high risk, and early detection is so important. When cervical cancer does cause symptoms, these are the most common ones:

  • Abnormal Vaginal Bleeding: Irregular menstruation is not uncommon and occurs more frequently in adolescents. Other factors such as weight gain or loss, recent pregnancy or some types of birth control can interfere with normal menstrual patterns.
  • Vaginal Bleeding after intercourse: This is usually abnormal and should prompt discussion with your doctor.
  • Abnormal Vaginal Discharge: Occasionally, cervical cancer will cause clear or unusual types of vaginal discharge. This symptom is very non-specific and most episodes of vaginal discharge do not indicate cancer.

The above symptoms are fairly non-specific and can occur with many other types of conditions. Less common symptoms of cervical cancer that suggest a more advanced stage and aggressive disease includes:

  • Pelvic Pain
  • Back Pain
  • Passage of urine from the vagina
  • Passage of stool from the vagina
  • Blood in the stool
  • Blood in the urine
  • Change in bowel habits such as severe constipation

Prognosis

Once cervical cancer has been diagnosed, the treatment depends upon what stage the cancer is and whether or not there is evidence that it has spread to surrounding areas or elsewhere in the body. Often, a pre-cancerous area can be treated by destroying those cells without surgery by something such as cryotherapy (freezing). When a cancer grows large or spreads elsewhere in the body, often multimodal therapy with a combination of surgery and chemotherapy is needed.

REFERENCES:

  1. www.cancer.gov/cancertopics/types/cervical
  2. seer.cancer.gov/statfacts/html/cervix.html
  3. Carey WD. (2010) Cleveland Clinic: Current Clinical Medicine, 2nd ed. Section 14. Cleveland, OH: Saunders.
  4. Goldman L, Schafer, AI; (2011) Goldman: Goldman’s Cecil Medicine, 24th ed. Chapter 205. New York, NY: Elsevier
  5. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.