Cervical Cancer: The Cancer Women Can Avoid
Every year in the US sixteen thousand women are diagnosed with cervical cancer, or cancer of the cervix. It tends to strike between ages 30 and 55, and each year the disease kills almost five thousand women.
It does not have to be this way. Cervical cancer is often preventable through routine Pap smears, practicing safe sex, and not smoking. Since the disease is slow-growing, if caught in time, before it has reached beyond the cervix, it is almost 100 percent curable.
Cervical Cancer: Risk Factors
Primary risk factors for cervical cancer involve sexual habits and sexually transmitted diseases (STDs). In the cervix STDs such as human papillomavirus (HPV), herpes, gonorrhea and Chlamydia can disrupt cells and make them vulnerable to changes that contribute to cancer. Latex condoms, and a nonoxynol-9 spermicide can prevent the spread of HPV and other STDs and protection should always be used, but keep in mind that a disease like HPV might be on the male’s scrotum, on his thigh, or in a variety of areas that condoms can’t protect against. HPV is present in 93 % of all cases of cervical cancer or dysplasia.
Timing is important too. Sexually active adolescent females are at greater risk of developing cervical cancer than their non-sexually active peers.
Smoking is another risk factor for developing cervical cancer. There are many Benefits of Quitting Smoking Research suggests that poor dietary decisions are as well, such as diets short on folic acid (one of the B vitamins). One solution is to eat foods like leafy green vegetables, legumes, oranges and wheat germ (all rich in folic acid), or taking a multi-vitamin that offers 400 micrograms (mcg) of folic acid.
Cervical Cancer: Signs and Symptoms
Medicine has identified two symptoms that may indicate cervical cancer, and if you experience any of them contact your doctor immediately. But keep in mind, these symptoms may be caused by something other than cancer as well.
• Vaginal bleeding: Following intercourse, when you’re between periods, or after menopause;
• Vaginal discharge: A watery, bloody, and potentially heavy or unpleasant-smelling discharge.
Cervical Cancer: Pap Tests
The most effective weapon in a woman’s arsenal in fighting cervical cancer is the annual Pap test. A Pap Smear detects cervical cancer and precancerous cells. The test is so effective that it catches about 95 percent of cervical cancers very early on, and experts don’t hesitate to credit it for the massive drop in cervical cancer deaths among US women over the past decades.
Your gynecologist or family doctor can perform a pap screening test during an annual pelvic exam. The physician gathers a cell sample from the cervix (the opening to the uterus) by rubbing its surface with a brush or a cotton swab and take another sample from inside the cervical canal. A lab examines the cells. If you have never had a pap smear before, you may feel some discomfort and it won’t be the most enjoyable time you’ve ever had at the doctor’s office, but it could save your life. Simple as that.
Pap Test Preparation
Pap smears give the most accurate results when a woman has neither douched or used a feminine deodorant for three days prior to the test. A woman should also not have sex the night before the test, and she can not be on her period.
Pap Test Frequency
The American Cancer Society recommends an annual Pap test and pelvic examination for all women who are sexually active or who are over age 18. Now, following three or more consecutive annual exams with normal results, your physician may, at his or her discretion, perform the Pap test less frequently
However, some risk factors for women mean that annual Pap tests should continue regardless of results. Those risk factors are women who:
• became sexually active (intercourse) before age 18;
• have had multiple sex partners, or whose male sexual partners have had multiple sexual partners;
• have been infected with human papillomavirus, venereal warts or both;
• have been infected with herpes simplex virus; • are immunosuppressed;
• smoke, as well as women who use or abuse drugs or alcohol;
• have a history of cervical dysplasia or cervical cancer or endometrial, vaginal, or vulvar cancer;
• have mothers that were given the drug diethylstilbestrol (DES) during pregnancy.
Pap Test Results
A negative Pap smear is good news: it means results are normal. A positive Pap smear indicates cellular changes in your cervix. Interpretation, however, is not cut-and-dried. Abnormalities reported by the testing lab do not tell your doctor which of those abnormal cells might turn into cervical cancer and which will simply disappear. Consequently doctors might suggest surgical procedures in the wake of a positive Pap test despite the condition not requiring such drastic measures.
The American College of Obstetricians and Gynecologists and the National Cancer Institute have established guidelines saying that moderate changes in cells (dysplasia) require less aggressive treatment since the risk of cancer is low. Additionally, women of child-bearing age need to be especially cautious of some surgical treatments since they can lead to future miscarriages.
Pap Test Abnormalities
What follows is the range of possible Pap test results.
• Dysplasia (or Neoplasia) indicates nothing more than a change in the cells on the surface of the cervix. It may or may not indicate cancer. However, your doctor will most likely ask that you have another Pap test.
• Atypical Squamous Cells of Undetermined Significance (ASCUS) indicates a mild change in those cells and that the pathologist is unable to distinguish between the benign and neoplasia. Your doctor will likely ask for another Pap Test within six months of the first.
• Low-Grade Squamous Intraepithelial Lesion (LSIL) indicates that the lab has found potentially precancerous changes in those cells. LSIL is a confusing result, so your doctor will probably ask for either another Pap test in four to six months, or a colposcopy (see below).
• High-Grade Squamous Intraepithelial Lesions (HSIL) will require surgical treatment to remove lesions if a follow-up biopsy confirms the severity of the results. This category is also known as moderate or severe dysplasia or carcinoma in situ (CIS).
• Squamous cell carcinoma indicates the presence of a cancerous lesion. Remember, the cure rate is very high if caught early, and it is treated with radical hysterectomy, radiation therapy or chemotherapy.
Following an abnormal Pap test, your doctor will determine what must be done next, which could mean another Pap test within six months, or to perform a colposcopy.
In a colposcopy, the doctor uses a colposcope (an instrument with a light and a magnifying glass) to examine areas on the cervix looking for lesions. When found, a biopsy is performed (a biopsy is the removal of a tiny bit of cervical tissue) and if tests on the tissue come back normal (negative), you still will be asked to have another Pap test within six months to check for the presence of precancerous cells.
Cervical Cancer: Surgical Solutions to Dysplasia If your doctor decides that a mild form of dysplasia requires surgical intervention, there are several techniques to consider. They are:
Regarded as a very safe technique, cauterization uses heat, electricity or chemicals to destroy the abnormal tissue. It can be performed in a doctor’s office or in a hospital (on an outpatient basis) and generally anesthesia is not necessary. One drawback is that cauterization may cause scarring, which can make future Pap smears hard for a lab to interpret.
Using liquid nitrogen, cryosurgery uses extreme cold to destroy the abnormal tissue. Like cauterization, it can be performed at your doctor’s office.
Abnormal tissue is burned by the use of a high-energy beam of light, leaving little or no damage to surrounding tissue. Laser surgery is either performed at a hospital on an outpatient basis or sometimes in a doctor’s office.
In the case of advanced dysplasia, a cone biopsy may be required. Here, surgeons remove a cone-shaped wedge of the cervix and it is analyzed to determine whether or not all abnormal tissue has been removed. If they find this to be the case, it may signal the end of treatment, although you will probably be asked to have two Pap tests done for the next two years to check for recurrence. A cone biopsy is considered a major surgical procedure. It is only performed in a hospital and requires the use of general anesthesia.
This procedure may have serious consequences for women of child-bearing age, including extreme difficulty in getting pregnant as well as future miscarriages. If you have had a cone biopsy and you become pregnant, tell your doctor immediately.
Cervical Cancer: Stages and Treatments
If your biopsy results come back indicating cancer, your doctor may recommend one of two options. The first is the cone biopsy we just discussed, and the other is called Dilation and curettage (D&C). Doctors lightly scrape the uterine lining to gather tissue samples in an attempt to determine whether the cancer is contained in the cervix or has spread beyond it. Following the procedure the stage of the cancer can also be determined.
Treatment methods are contingent upon the stage of the cancer:
Here the cancer is localized on the surface of the cervix. The cure rate is almost 100 percent.
Methods that treat cervical dysplasia (cauterization, cryosurgery, laser surgery and conization) can also treat surface cancer. Radiation therapy may be recommended following conization to make certain the cancer cells do not grow and multiply. In extreme cases, either another conization may be performed, or a hysterectomy may be required
Locally advanced cancer
In locally advanced cancer, the cervical tumor has grow very large, or the cancer itself has spread to an area of the pelvis (such as the nearby lymph nodes). If it has reached the uterus, doctors will perform a radical hysterectomy: removal of the uterus, upper vagina, lymph nodes, and fallopian tubes.
In 1999 the National Cancer Institute announced the combination of radiation treatment and chemotherapy to be the recommended treatment, as opposed to standard treatment of only surgery and radiation, because studies had shown the combination was cutting mortality rates from the disease by as much as 50 percent.
Invasive cancer means the cancer has spread beyond the cervix and the pelvic area. Biological therapy may be applied, which aims to boost the methods of the body's immune system to fight disease. Interferon, the most common form of biological therapy for cervical cancer, is sometimes used along with chemotherapy.