Cervical Cancer Facts

Cervical Cancer Facts

Significance

High Risk and Underscreened Groups

Older women (age 60 and above) are at increased risk for cervical cancer as they are less willing or able to seek medical care for screening for this disease and participate in treatment.
Minorities including African Americans, Native Americans, and Hispanics (but not Asian Americans) have a higher risk than Caucasians. Much of the difference can be explained by socioeconomic factors and associated risk factors.
Decreased mortality secondary to cytological screening for cervical abnormalities has been demonstrated in multiple, broad-based population studies. Unscreened or underscreened high-risk groups should be identified and targeted for screening programs.
Educational efforts, transportation, efforts to establish a regular health care provider, and screening convenient to the work place have been shown to have a positive impact on women participating in screening.
In communities where English is a second language, healthcare providers fluent in the native language can effectively facilitate these efforts.
Frequently, the high-risk individual is seen at a medical facility for unrelated health issues and is not provided with cytologic screening. Provision of a modality by which hospitals and emergency services could identify and screen these women could potentially further reduce mortality.

Incidence and Mortality

An estimated 12,200 new cervical cancers and 4,100 cervical cancer deaths will occur in the United States in 2003.
An additional 1,250,000 women will be diagnosed yearly with changes referred to as squamous intraepithelial lesions (SIL) or cervical intraepithelial neoplasia (CIN). These changes form a continuum divided into low-grade or high-grade SIL or CIN 1, 2, and 3 that reflects increasingly abnormal changes of the affected epithelium. These lesions can persist, regress, or progress to an invasive malignancy.
High-grade SIL (CIN 2-3) is more likely to persist or progress and less often regresses spontaneously, while low-grade SIL (CIN 1) often regresses without treatment.
The average time for progression of CIN 3 to invasive cancer has been estimated to be 10 to 15 years, based on the mean age of diagnosis of these 2 conditions. There is a small subset of rapidly progressive cervical cancers which are diagnosed within 3 years of a confirmed negative Pap test.
These tumors occur in younger women with higher socioeconomic status as compared to a control cervical cancer group. One third of these cancers are adenocarcinomas of endocervical origin which may not be adequately screened by conventional Pap test methods.

Pap Test

The Pap test is a screening tool that identifies women likely to have premalignant disease and at high risk for cervical cancer. The widely used Bethesda System of reporting Pap tests was developed in 1988. The cytologic terms, low-grade and high-grade squamous intraepithelial lesions (LSIL and HSIL), correlate with the histopathologic diagnoses of CIN 1, and CIN 2-3, respectively. Strengths of this system are that it requires an evaluation of the adequacy of the specimen and encourages a descriptive diagnosis of abnormalities. Abnormalities that do not fulfill the criteria for SIL are termed atypical squamous cells of undetermined significance (ASCUS). Persistent atypical smears should be evaluated colposcopically. An estimated 5% to 10% of patients with this cytologic finding will subsequently be shown to have HSIL or rarely, invasive cancer.

Reliability of the smear depends on the technique employed to obtain the cytologic specimen and the adequacy of its review by the cytologist. Pap test failure rate in diagnosing invasive cancer can be as high as 50%emphasizing the need to biopsy any visible lesions of the cervix, even if associated with a normal Pap test. Careful inspection of the cervix and lower genital tract for areas of nodularity and friability should be part of each exam.

The accessibility of the cervix to examination provides a unique opportunity to evaluate the disease status and response to intervention. Commonly employed methods of treatment for premalignant lesions include laser vaporization or excision, cryosurgery, cold knife conization, loop electrosurgical excision, or simple hysterectomy. Strategies to combine diagnosis and treatment such as loop electrosurgical excision procedure (LEEP) may be appropriate, particularly in women for whom follow-up is not effective. Despite the efficacy of excisional treatment of intraepithelial lesions in reducing the risk of developing invasive cervical cancer, the risk of cancer remains elevated above that of the general population and warrants careful follow-up for at least 8 to 10 years. The slow progression of preinvasive disease into invasive cancer and the easy access to visual and cytologic investigation makes squamous intraepithelial lesions an ideal disease for chemoprevention clinical trials.

General Information About Cervical Cancer

Cervical cancer is a disease in which malignant (cancer) cells form in the tissues of the cervix
The cervix is the lower, narrow end of the uterus (the hollow, pear-shaped organ where a fetus grows). The cervix leads from the uterus to the vagina (birth canal).
Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia, in which cells that are not normal begin to appear in the cervical tissue. Later, cancer cells start to grow and spread more deeply into the cervix and to surrounding areas.
Human papillomavirus (HPV) infection is the major risk factor for development of cervical cancer.
Infection of the cervix with human papillomavirus (HPV) is the most common cause of cervical cancer. Not all women with HPV infection, however, will develop cervical cancer. Women who do not regularly have a Pap smear to detect HPV or abnormal cells in the cervix are at increased risk of cervical cancer.

Other possible risk factors include the following:

Giving birth to many children.
Having many sexual partners.
Having first sexual intercourse at a young age.
Smoking cigarettes.
A diet lacking in vitamins A and C.
Oral contraceptive use (�the Pill�).
Weakened immune system.

Symptoms

There are usually no noticeable signs of early cervical cancer but it can be detected early with yearly check-ups.
Early cervical cancer may not cause noticeable signs or symptoms. Women should have yearly check-ups, including a Pap smear to check for abnormal cells in the cervix. The prognosis (chance of recovery) is better when the cancer is found early.
Possible signs of cervical cancer include vaginal bleeding and pelvic pain.

These and other symptoms may be caused by cervical cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

Vaginal bleeding.
Unusual vaginal discharge.
Pelvic pain.
Pain during sexual intercourse.

Tests that examine the cervix are used to detect (find) and diagnose cervical cancer.

The following procedures may be used:

Pap smear: A piece of cotton, a brush, or a small wooden stick is used to collect cells from the cervix and vagina. The cells are viewed under a microscope. Abnormal (precancerous) cells in the tissues of the cervix can usually be found by a Pap smear.
Colposcopy: The tissues of the vagina and cervix are examined using a lighted magnifying instrument called a colposcope.
Biopsy: If abnormal cells are found in a Pap smear, the doctor may do a biopsy. A sample of tissue is cut from the cervix and viewed under a microscope. 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).
Pelvic exam: A procedure to check the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum to find any abnormality in their shape or size.
Endocervical curettage: A curette (a spoon-shaped instrument) is used to collect cells from the cervical canal. The cells are viewed under a microscope. This procedure is sometimes done at the same time as the colposcopy.

Certain factors affect treatment options and prognosis (chance of recovery).

The treatment options and prognosis (chance of recovery) depend on the stage of the cancer (whether it affects part of the cervix, involves the whole cervix, or has spread to the lymph nodes or other places in the body), the type of cervical cancer, the size of the tumor, and the patient�s desire to have children. Lymph nodes are small, bean-shaped structures found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease.

Treatment of cervical cancer during pregnancy depends on the stage of the cancer and the stage of the pregnancy. For cervical cancer found early or for cancer found during the last trimester of pregnancy, treatment may be delayed until after the baby is born.

Source: Healthwise