What we all should know about cervical cancer

cervical-cancerDid you know that, According to the American Cancer Society (ACS), cervical cancer will be diagnosed in about 13,000 women in the United States this year, and approximately 4,100 women will die from it?  African-American women develop cervical cancer more often than white women and are twice as likely to die from it.  January is Cervical Cancer Awareness month – proper screening and medical management can protect the women we love, our mothers, daughters, sisters, grandmothers, and friends.

What is cervical cancer, and what causes it?
The cervix is the lower tip of the uterus, and it is visible within the vagina or birth canal.  Cervical cancer begins when normal cervical cells undergo changes that eventually become cancerous; these abnormal cells are called dysplasia. These abnormal cells can, over time, become cancerous and spread through the cervix and the surrounding tissues.   This process usually takes several years, but in some cases may occur more rapidly.

A virus, the Human Papilloma Virus (HPV), is the cause of most cases of cervical cancer.  Present in 70- 80% of cases, HPV is spread through sexual intercourse. Some strains of HPV can cause genital warts.  Often, the HPV infection causes no symptoms or signs at all.  Therefore women may be infected with the virus and not know it.  The HPV vaccine is recommended for girls AND boys starting at age 11 and can be given through age 26.  It is important to get the vaccine BEFORE becoming sexually active, so the body can develop an immune response to the virus. The vaccine protects against four types of HPV, including the two that cause most cervical cancers and genital warts. Condom use can also protect against HPV infection.  Not all cancers will be prevented by the vaccine, so it is important for all women to continue getting screened with regular Pap tests.

Other risk factors that may influence a woman’s chances of developing cervical cancer include:

  • Family history,
  • Long-term oral contraceptive use,
  • Having many sexual partners,
  • Having first sexual encounter at a young age, and/or
  • Having HIV/AIDS.
  • Cervical cancer rates are higher in women over the age of 40 years and in minorities including African Americans, Latinos and American Indians.
  • In addition, women who smoke are twice as likely to develop cervical cancer as non-smokers.

What are the symptoms of cervical cancer?

Often, there are no signs of early cervical cancer, which is why regular screening is essential. According to the ACS, when there are symptoms, they can include: vaginal bleeding (including after sex), unusual vaginal discharge, pelvic pain and/or pain during sex. These symptoms however, can also be caused by other conditions, so you should see your doctor if you are experiencing any of them.

Cervical cancer screening
In addition to regular pelvic exams, the Pap smear allows for detection of early, pre-cancerous changes that can be successfully treated.  This Pap test remains the most successful cancer prevention strategy for women. It involves a simple examination in which the healthcare provider swabs a sample of cells from the woman’s cervix. This sample is then examined under a microscope to detect the presence of pre-cancerous cells. A sample of cervical cells can also be examined for the presence of HPV infection.

Screening for cervical cancer should begin approximately 3 years after a woman becomes sexually active and no later than age 21 years.   It should be done every year with regular Pap tests and screening for HPV infection.  After the age of 30 years if a woman has normal tests for 3 consecutive years, screening may take place every 2-3 years.  However, your physician may advise more regular tests if you have certain risk factors.

What happens if I have an abnormal Pap Test?

If abnormal cells are found during a Pap smear, your health care provider will likely want to do further testing that could include:

  • Colposcopy: A procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas. Tissue samples may be taken to check for signs of any type of disease (this is called endocervical curettage).
  • Biopsy: If abnormal cells are found in a Pap test, the doctor may do a biopsy. A sample of tissue (usually more than with a colposcopy) is cut from the cervix and checked for signs of cancer. A biopsy that removes only a small amount of tissue is usually done in the doctor’s office. A woman may need to go to a hospital for a cervical cone biopsy (removal of a larger, cone-shaped sample of cervical tissue).

If you are diagnosed with cervical cancer, further tests will be done to determine if the cancer has spread to other parts of the body; these tests will also determine the stage of the cancer. These tests may include: X-ray, CT or PET scan, MRI, ultrasound, cystoscopy (procedure to look at the bladder) and/or laparoscopy (procedure to examine abdominal organs). Staging for cervical cancer is as follows:

  • Stage I – cancer is in cervix only;
  • Stage II – cancer has spread beyond the cervix but not to the pelvic wall;
  • Stage III – cancer has spread to the lower third of the vagina, and/or to the pelvic wall, and/or has caused kidney problems;
  • Stage IV – cancer has spread to the bladder, rectum, or other parts of the body.
  • Each stage is divided into A or B (example, Stage IA, Stage IB) depending on its size (for Stage I) or where it has spread (Stages II-IV).

What are the treatments for cervical cancer?

If you are diagnosed with cervical cancer, several factors will affect your prognosis (chance for recovering from the disease) and treatment. These factors include: the stage and type of the cancer, your general health, whether or not you have HPV or other sexually transmitted diseases (like HIV), and whether or not this is first diagnosis or recurrence of the cancer. Common treatments for cervical cancer are surgery, chemotherapy, radiation therapy and targeted pharmacological (drug-based) therapy. For surgery, there are multiple types of surgery for cervical cancer, and the type your provider recommends for you will depend on the location and stage of the cancer. This could mean removing one area of tissue in the cervix, or removal of the ovaries and/or uterus. There are also may be clinical trials which are developing new treatments for cervical cancer that may be available in your area. Talk with your provider to determine the best treatment plan for you. Don’t be afraid to ask any questions you may have.

What if I do not have health insurance/a healthcare provider?
For women without insurance, HPV vaccines, pap smears and cervical cancer testing is now available for free or at a very minimal cost through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).   More information on this service can be obtained from your local health department.  Early detection of cervical cancer can save lives!

Do you need further information or have questions about this article? Visit the American Cancer Society Cervical Cancer resource page at http://www.cancer.org/cancer/cervicalcancer/index or please call the Maya Angelou Center toll-free 1-877-530-1824. For more information about the Maya Angelou Center for Health Equity please visit http://www.wakehealth.edu/MACHE.

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