What You Weren’t told About Cervical Cancer.

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Overview

Cervical cancer is a type of cancer that develops in the cervix, which is a part of the female reproductive system. It can develop in any woman who has sex and/or becomes infected with human papillomavirus (HPV). Women who have been sexually active since age 18 have twice as much chance of developing cervical cancer as those who were less sexually active. Because HPV infection and cervical cancer are common, it’s important to get vaccinated with Gardasil for girls and boys before they become sexually active.

It usually starts in the cells that line the cervical canal. The vagina (a hole at the end of the reproductive system) is excluded. With early cervix cancer, the cancer cells are usually contained within these cells and in later stages, the tumor may be found outside the cell, where it’s more likely to spread. Cervical cancer is not a contagious disease and does not spread from person to person.

Primary prevention of cervical cancer is by the HPV vaccine (Gardasil), which can prevent infections of 70% of cervical cancer and 90% of genital warts. Combined with screening, this has been considered to be an important advance in controlling this cancer worldwide.

Cervical screening or Pap smear is when a sample is taken from the lining of the cervix and analyzed for pre-cancerous cells. Screening allows early detection of cancer and thereby prevents death. In countries such as Australia that have national screening programs for cervical cancer, the mortality rate is about 1 per 100,000 women per year as opposed to about 10 per 100,000 women per year in countries without screening programs.

Cervical cancer is the second most common cancer in women worldwide with almost 580,000 new cases and 260,000 deaths per year. Cervical cancer is responsible for almost 20% of all female deaths due to invasive cancers. Worldwide it is estimated that 584,000 new cases of the cancer were diagnosed in 2005 and 260,000 people died from the disease. It is the second most common cause of uterine cancer worldwide, after adenocarcinoma. Approximately 75% of the cases are in the developing world.

Globally, It is the fourth most common cancer in women. It is estimated that about 323,000 new cases occur worldwide each year. Cervical cancer ranks as the thirteenth most common cause of death from cancer among women worldwide. In Africa and Northern America, it is the most common cause of death from cancers in women between 15 and 44 years of age. In 2007, about 469,000 women were diagnosed with cervical cancer with about 930,000 people living with the disease worldwide.

Although most cervical cancer cases develop in women aged 20 to 34 years, the disease can occur as early as 10 years of age and as late as 65 years of age. It is uncommon in males due to lower rates of infection with HPV. This may be attributed to the fact that males produce less HPV DNA than females or that less HPV DNA reaches the uterus through semen compared with vaginal intercourse.

Cervical cancer is defined by the WHO as “cancer of the cervix (neck of the womb), also called cervix uteri.” The cervical canal is located in the lower third of the uterus. The remaining two-thirds are filled with tissue from the vagina, including most of the fallopian tubes. The cervical canal is about 8–10 cm long and 2.5–5 cm wide and has a roof formed by the endocervical glands (one on each side of the neck), which drain secretions that come from the glands in the walls of the uterus.

There are two phases of cervical cancer development.

• The first phase occurs with normal cell changes that occur over time due to infection by a virus, known as human papillomavirus (HPV).

• The second phase occurs when cells become precancerous and then malignant.

Causes Of Cervical Cancer

HPV infection is caused by an infection with human papillomavirus (HPV). The most common types of HPV that cause cervical cancer are HPV 16, 18, and 31. HPV 16 is the second most common cause of cervical cancer behind HPV 18. The presence of HPV does not necessarily mean that cancer will develop. Women with HPV may never be diagnosed and can die from other causes.

Cervical cancer is almost always caused by persistent infection with high-risk types of the HPV virus over a number of years. The time between infection and the development of cervical cancer may be as short as 10 years or as long as 40 years. HPV infection is usually acquired in childhood or early adulthood, the time when most young women are first sexually active.

Signs And Symptoms That Indicate Cervical Cancer.

• Blood spots or light bleeding between or following periods.

• Menstrual bleeding that is longer and heavier than usual.

• Bleeding after intercourse, douching, or a pelvic examination.

• Increased vaginal discharge.

• Vaginal discharge with a strong odor.

• Pain during sexual intercourse.

• Bleeding after menopause.

• Unexplained, persistent pelvic and/or back pain.

• Needing to urinate more often.

• Pain during urination.

How Cervical Cancer Is Diagnosed.

• The Pap smear is a screening test for cervical cancer that uses human papillomavirus as the marker for the presence of abnormal cell changes. The smear is also used to examine other cervical conditions, including inflammatory and non-inflammatory conditions. A Pap smear is used with the HPV test to detect pre-cancerous changes that cannot be seen on a Pap smear alone.

• In the United States, as of 2011, a “new technology” was being offered in conjunction with standard screening which utilized HPV testing together with liquid-based cytology (LBC). LBC has been around for many years using conventional Pap smears. Proponents of LBC point to evidence that it is more accurate than conventional Pap smears in identifying precancerous lesions. LBC has not been evaluated in randomized controlled trials.
  There is some controversy as to whether an HPV test in conjunction with a Pap smear improves the sensitivity of detecting abnormal lesions, and reduces the number of unnecessary additional procedures. This would suggest that it improves screening effectiveness while reducing costs and anxiety for women because fewer biopsies are performed, and that it could be a more cost-effective way to screen for cervical cancer.
  In the United Kingdom, where cervical cancer screening is not free, a 2008 cost-effectiveness analysis in the context of current practice concluded that “The addition of HPV testing to cervical cytology appears to be a cost effective approach that reduces both the financial and the behavioural costs associated with follow up testing and allows women to be notified about their test results at an earlier time point”. A later study concluded that HPV testing after a normal Pap smear detected more CIN3 lesions than cytology alone. However, the association of cervical cancer with HPV was not significantly increased in the HPV group.

• In order to test for DNA from this virus, modern cytometers use a hybridization approach. A sample of cervical cells is treated with cross-linking agents and labelled with fluorescent probes. After fixation, the hybridization is performed. If no specific signals are found by one or both probes, then the cells are negative for HPV DNA and can be discarded as normal tissue. The test is most useful for detecting cervical intraepithelial neoplasia (CIN) in women who present with abnormal cytology or have a history of the disease. For this reason, it is the preferred type of screening test performed by American and Canadian health establishments. Cytology, on the other hand, is used in many countries in Europe to test for HPV infections.

• In addition, in the United States, a new type of Pap smear is being launched called the nucleic acid test (NAT). This test uses DNA analysis to find a specific virus present in HPV tests. It was developed by Dr. Barry Richman of the National Cancer Institute and Dr. Paul Melnikow of the University of Washington–Seattle Cancer Care Alliance’s Clinical Research Center. Dr. Richman stated that this NAT would be sent out at the same time as the standard Pap test.

Risk Factors

• Human papillomavirus (HPV) infection. 

• Immune system deficiency. 

• Having HIV (the virus that causes AIDS) or another condition that makes it hard for your body to fight off health problems.

• Smoking.

• Herpes.

• Using birth control pills for a long time (five or more years).

• Having given birth to three or more children.

• Exposure to diethylstilbestrol (DES).

• Having several sexual partners.

Treatment For Cervical Cancer.

There is no one standard treatment for cervical cancer, though most treatments attempt to cure the disease. The goal is also to prevent metastasis as early as possible in order to prevent recurrence and secondary malignancy.

• Many cervical cancers can be treated with chemotherapy alone.

• Hormone therapy such as tamoxifen (a selective estrogen receptor modulator), hormonal therapy in general with or without radiotherapy, and combination chemotherapy.

• Radiation therapy for stage IV cervical cancer.

• A surgical approach known as “modified radical cystectomy” can be used to treat stage IVB cervical cancer.

• Radical hysterectomy for stage II and III cervical cancer.

• A surgical treatment consisting of radical trachelectomy with systemic therapy for stage IVC cervical cancer.

• Total abdominal hysterectomy for stage IIIB cervical cancer.

How To Prevent Cervical Cancer.

• Regular screenings with Pap tests and HPV tests.

• Receiving the HPV vaccine shot, for preteens aged 11 to 12 years and adult at maximum age of 26, if they are not vaccinated already. HPV vaccination is not recommended for everyone older than age 26 years,HPV vaccination in this age range provides less benefit.

• Eat varieties of fruits and vegetables, they help protect you from developing cervical cancer.

• Eat foods rich in folate, for example Avocados, Chickpeas, Fortified cereals and breads, Lentils, Orange juice, Romaine lettuce, Strawberries.

• Don’t smoke.

• Use condoms during sex.

• Limit your number of sexual partners.