The Basics of Cervical Cancer

First things first, what exactly is cancer?

What is Cervical Cancer?    

Cervical cancer is cancer in the cervix, which is found only in females. The cervix is the organ that connects the uterus (where a fetus grows) to the vagina (the birth canal).  

How it Begins  

Cervical cancer originates in the cells that line the cervix. Like any cancer, cervical cancer begins when a cell with damaged DNA begins to duplicate at a rapid rate due to the damage. These cells continue to divide unchecked, and eventually form a tumor. If left untreated, these cells will continue to grow into surrounding tissues, damaging them. These cells also can metastasize, or travel to other parts of the body and begin growing there.     

  

Cervical anatomy (pictured above) may appear complicated; however, the cervix is composed of just two parts.

The endocervix comprises the opening of the cervix, which leads to the uterus. This tissue is comprised of glandular cells. The exocervix is the out portion of the cervix that can be examined by a doctor during a pelvic exam.

This tissue is comprised of squamous cells. The place where these two portions of the cervix meet is called the transformation zone, which is where most cervical cancers develop. This area contains both glandular cells as well as squamous cells.  

Pre-Cancers of the Cervix  

Cells in the transformation zone take time to develop into cancer, which means that before cervical cancer is present, the cells are pre-cancerous. Pre-cancerous cells have developed abnormal changes, which are evaluated by doctors and graded by how changed the cells are from normal. This scale ranges from one to three, which indicates how abnormal the cells are.  

Not all females with pre-cancers of the cervix will develop cervical cancer. In most cases, these cells do not progress into cervical cancer, and will resolve themselves without treatment. In some cases, however, these cells continue to mature abnormally and will develop into cervical cancer. All cases of cervical cancer were once cases of pre-cancer, which is why regular cervical screening is imperative to catch this cancer early on. Treating cervical pre-cancers can prevent almost all cervical cancers.  

Types of Cervical Cancer

The two main types of cervical cancer are squamous cell carcinomas and adenocarcinomas.  

  • Squamous cell carcinomas are the most common form of cervical cancer; 9 out of 10 cervical cancer cases are this type. This type often begins in the transformation zone and is composed of abnormal squamous cells from the endocervix. 
  • Most other cases of cervical cancer are adenocarcinomas. This type of cervical cancer develops from abnormal glandular cells found in the mucus-producing gland cells in the endocervix.   
  • Some unique cases of cervical cancer show attributes of both squamous cell carcinoma and adenocarcinoma. This type is often called adenosquamous carcinoma, or mixed carcinoma.  

These types of cervical cancers are the most common, but there are other rare types, such as melanoma, sarcoma, and lymphoma. These types of cancer are most found in other portions of the body but can develop in the cervix.  

Signs and Symptoms  

Pre-cervical cancer and early cervical cancer develops typically with no symptoms, making it imperative that women attend their routine screenings to assess for the presence of cervical cancer. Symptoms become noticed when the cancer has become large, and grows into nearby tissues disrupting their function. The most common symptoms are: 

  • Abnormal vaginal bleeding, such as bleeding after sex, bleeding after menopause, irregular bleeding/spotting between periods, having long menstrual periods, or bleeding after douching 
  • Unusual discharge from the vagina that may contain blood 
  • Pain during intercourse 
  • Pelvic pain 
  • Leg swelling 
  • Disrupted urination or defecation 
  • Blood in the urine 

While these symptoms are symptoms of cervical cancer, they are also symptoms of other conditions. If you are experiencing any of these symptoms, it is important to visit your physician so that you may discuss your symptoms and be screened if they deem it necessary. Ignoring symptoms may allow the cancer time to develop into a more severe case, which makes treatment more complicated and less likely to succeed.  

Risk Factors   

In a short sense, any female has a chance of developing cervical cancer. Cervical cancer has many risk factors that are, unfortunately, unable to be changed. On the bright side, however, there are many risk factors that are directly influenced by your behavior.   

Human Papillomavirus

The most prevalent risk factor for cervical cancer is infection with HPV.

HPV is short for human papillomavirus. HPVs are a large group of related viruses. Each virus in the group is given a number, which is called an HPV type.

HPV can be passed from one person to another by skin-to-skin contact, such as occurs with sexual activity. The main way HPV is spread is through sexual activity, including vaginal, anal, and oral sex. HPV can be spread even when an infected person has no visible signs or symptoms.

HPV infection is very common. Most men and women who have ever had sex get at least one type of genital HPV at some time in their lives. Anyone who has had sex can get HPV, even if it was only with only one person, but infections are more likely in people who have had many sex partners.  Even if a person delays sexual activity until marriage, or only has one partner, they are still at risk of HPV infection if their partner has been exposed.

Human papillomavirus infection is the most important risk factor when considering cervical cancer, because nearly all cervical cancers are caused by HPV.

HPV vaccines can prevent infection with certain types of HPV and is the best way to prevent it.

Vaccines are approved for use in males and females. They can only be used to prevent HPV infection – they don’t help treat an existing infection.

To work best, the HPV vaccines should be given between the ages of 9 and 12. Teens and young adults ages 13 through 26 years who have not been vaccinated or who have not received all of their shots should get the vaccine as soon as possible. Vaccination of young adults will not prevent as many cancers as vaccination of children and teens. HPV vaccination is not recommended for persons older than 26 years.

Other Risk Factors

•Sexual history has an influence on cervical health. Becoming sexually active at a young age could lead to cervical damage, especially if this occurred prior to puberty.

•Developing STDs and STIs increases your risk, which is a product of unprotected sex.

•Chlamydia infection increases your risk for cervical cancer. Some studies suggest that chlamydia infection may aid in HPV growth in the cervix.  

•Smoking is a risk factor that is entirely preventable. Smoking not only elevates your risk for developing lung cancer, but it also has a negative impact on your health overall and increases your risk for developing cancer in general.   

•Having a weakened immune system elevates your risk of developing an HPV infection. This is particularly the case in individuals that have human immunodeficiency virus, HIV. In women with HIV, pre-cancer may develop more rapidly into cancer than normal.  

•Long term use of oral contraceptives. Some evidence suggests that taking oral birth control for a long period of time increases the risk of cervical cancer. However, once stopping oral birth control, the risk does decrease again.  

•Women who have had 3 or more full-term pregnancies are at an elevated risk of developing cervical cancer. This is speculated to be caused by a combination of three factors. Firstly, because there is increased exposure to HPV with sexual activity. The second possibility is that the hormonal changes during pregnancy potentially make women more susceptible to HPV infection. Lastly, this could be because pregnant women may have weakened immune systems, allowing for HPV infection and cancer growth under the weakened conditions.  

•Full-term pregnancy at a young age. Women who are younger than twenty when they deliver their first child are more likely to develop cervical cancer later in life when compared to women who waited until 25.  

•Not getting screened or ignoring symptoms. It is best to be screened regularly, every two to three years, to ensure that any pre-cancer cells or early cancer is caught before they develop into a more severe case.  

•Family history of cervical cancer increases your risk. If your mother or sister developed/develops cervical cancer, your risk of developing it is elevated.  

•Exposure to diethylstilbestrol (DES). This was given to pregnant women between 1940 and 1971 in the United States to prevent miscarriage. Women who took DES, or those whose mothers did while pregnant with them, are at increased risk of developing cervical cancer.   

Screenings    

You might be thinking, what is a screening, and how can it help?    

The goal of a screening is to detect cancer early, so that it can be taken care of early. The later cancer is detected, the more likely it has developed into a stage that is more detrimental to your health. Screenings mitigate the likelihood of you developing a late-stage cancer, because screenings are typically conducted before the patient has any symptoms of the disease.     

This is particularly the case with cervical cancer, as there are three stages of pre-cancers that are able to be detected with cervical cancer screening. Discovering cervical cancer early, or while the cells are pre-cancerous, is most beneficial as finding these developments early allows for treatment earlier on.  

Individuals that are showing symptoms of cervical cancer should schedule a screening immediately. Showing symptoms of cervical cancer can be scary but scheduling a screening will allow the soonest possible diagnoses and the highest shot you have at survival, should the symptoms be caused by it.     

Screening Methods

There are two methods of screening for cervical cancer.  

Pap Test

The Pap Test is a procedure where your healthcare provider collects a sample of cells from the cervix so they can be examined closely in a lab to assess for cancerous and pre-cancerous cells. The pap test is completed during a visit to the gynecologist; your gynecologist will insert a speculum indie the vagina, which is a metal or plastic instrument that is used to keep the vagina open so that the cervix can be seen clearly and that the sample can be collected. Once opened, the gynecologist will collect a sample of cells and mucous from the endocervix using a small spatula or a brush. In addition, a small brush or cotton tipped swab is inserted into the opening of the cervix to collect a cell sample of the endocervix itself. These samples are then sent into a lab for assessment.  

Tips for scheduling your pap test to increase the accuracy of the test: 

  • Try not to schedule your appointment during your period. It is best to have these samples collected at least five days past the end of your period. 
  • Avoid using tampons, foams, jellies, creams, moisturizers, lubricants, or vaginal medicines for two to three days prior to the test.  
  • Do not douche for two to three days prior.  
  • Avoid vaginal sex for two days prior.  

HPV Test

Another method of screening for cervical cancer is the HPV test. This is because infection with HPV, or human papillomavirus, is the most important risk factor for developing cervical cancer. Doctors can test for the presence of HPV by collecting a sample of cells from the cervix and assessing them for the presence of the virus. The collection process is similar to that of the pap test and can be completed by itself as a primary HPV test, or alongside a pap test as a co-test. The HPV test is commonly used as the preferred test for cervical cancer screenings for those aged 25-65 years old. In addition, the HPV vaccine can help prevent cervical cancer and is highly encouraged.  

If your result from the HPV test is positive, this does not mean that you are diagnosed with cervical cancer or pre-cancer, however, it does indicate that you are at an increased risk for developing cervical cancer.  

Coverage 

Coverage of cervical cancer screenings is mandated by the Affordable Care Act, but if your insurance plan was in place prior to September 23, 2010, you need to check with your insurance plan to see what is covered. Most insurance policies since this date are required to include coverage for cervical cancer screenings.  Those with Medicaid, Medicare, and many self-insured plans are covered by their policies for routine cervical cancer screenings.  

If you are without health insurance, the National Breast and Cervical Cancer Early Detection Program provides breast and cervical cancer screening to women without health insurance for free, or little cost.