Cervical Cancer

  Testing for HPV (human papillomavirus)

Definition of cervical cancer:
Cancer that forms in tissues of the cervix (the organ connecting the uterus and vagina). It is usually a slow-growing cancer that may not have symptoms but can be found with regular Pap tests.

Estimated new cases and deaths from cervical cancer in the United States in 2007:

New cases: 11,150 Deaths: 3,670

Between 60% and 80% of women diagnosed with cervical cancers have not had a Pap test in the past five years, and many have never had a Pap test at all. Approximately 50% of those women who die from cervical cancer each year have never had a Pap test. A fact that seems to be unknown by many men and women is that HPV has been detected in 90% to 100% of all cervical cancer cases. Approximately 20 million people are currently infected with HPV, with an estimated 6.2 million new genital HPV infections each year. Cervical Cancer begins in the lining of the cervix. Cervical Cancers does not form suddenly. Normal cervical cells gradually develop pre-cancerous changes that develop into cancer. Medical Professionals use several terms to describe these pre-cancerous changes, including; squamous intraepithelial lesion (SIL), cervical intraepithelial neoplasia (CIN), and dysplasia.

There are 2 main types of cervical cancers: squamous cell carcinoma and adenocarcinoma. Cervical cancers and cervical pre-cancers are staged by how they look under a microscope. About 80% to 90% of cervical cancers are squamous cell carcinomas, which are composed of cells that resemble the flat, thin cells called squamous cells that cover the surface of the endocervix. Squamous cell carcinomas most often begin where the ectocervix joins the endocervix.

The remaining 10% to 20% of cervical cancers are adenocarcinomas. Adenocarcinomas are becoming more common in women born in the last 20 to 30 years. Cervical adenocarcinoma develops from the mucus-producing gland cells of the endocervix. Less commonly, cervical cancers have features of both squamous cell carcinomas and adenocarcinomas. These are called adenosquamous carcinomas or mixed carcinomas.

Cervical cancer is a disease that is very serious; however, it is one that you can monitor and help prevent. The most important thing to remember is that HPV infections are very common, and are usually nothing to worry about! In most women, HPV infections go away or are suppressed by the body without causing any problems that need treatment. It is only when an HPV infection stays active that abnormal cells may form.

Infection with the human papillomavirus (HPV). Doctors believe that women must have been infected by this virus before they will develop cervical cancer. HPVs are a group of more than 100 types of viruses that can cause warts, or papillomas, which are non-cancerous (benign) tumors. Certain types, however, cause cancer of the cervix. These are called "high-risk" types of HPV and include HPV 16, HPV 18, HPV 31 HPV 33 and HPV 45.

There are about 15 types of high-risk HPV that can cause cervical cancer. Of those, 13 are considered the most important, and are known by the numbers assigned to them (in the order of their discovery): 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68. Remember, there are more than 100 different types of HPV all together.

Of these 13, two of them - 16 and 18 - have been shown to cause 70 percent of all cervical cancers. That's why the new HPV vaccine is designed to target those two types of HPV (along with two others that cause genital warts). However, the other 11 high-risk types of HPV may cause cervical cancer as well; thus, the vaccine alone will not be enough to fully protect women against the disease.

Too many women are still getting cervical cancer and are still dying. It's estimated that globally, one in every 123 women will develop cervical cancer, if screened only with the Pap test. More than twice as many African-American women die from cervical cancer as Caucasian women. Hispanic and Native-American women have higher rates of the disease than Caucasian women. Cervical cancer rates also are rising among Vietnamese women. The highest rate of cervical cancer is in underdeveloped countries.

This, however, can change for the better. In addition to regular Pap testing of all eligible women, cervical cancer prevention can be improved with the use of the HPV test (age 30 or older) and the new HPV vaccine (ages 9-26).

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Recently, the U.S. Food and Drug Administration (FDA) approved a vaccine that is highly effective in preventing HPV infection with types 16 and 18, two "high-risk" types that cause 70 percent of cervical cancers, and types 6 and 11, which cause 90 percent of genital warts. The HPV vaccine is recommended for 11- to 12-year-old girls, and if the doctor decides, the vaccine can be given to girls as young as 9. The vaccine also is recommended for 13- to 26-year-old girls/women who have not yet received or completed the vaccine series. The vaccine is given through a series of three shots over a six-month period. The vaccine should be given before sexual activity begins (before contact with the HPV virus). Those who have not been infected with any type of HPV will benefit the most from the vaccine. Girls/women who are sexually active should still be vaccinated because they can get protection from the HPV types that they haven't been infected with.

For further information go to www.cdc.gov/std/hpv/STDFact-HPV-vaccine.htm

Recognizing possible warning signs of cancer and taking prompt action leads to early diagnosis. Increased awareness of possible warning signs of cancer, among physicians, nurses and other health care providers as well as among the general public, can have a great impact on the disease.

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Cervical cancer can usually be found early by having regular Pap tests. Women should have regular checkups, including a pelvic exam and a Pap test. Pap tests should begin within three years after becoming sexually active or at 21 years of age, whichever happens first. If a woman has had three consecutive, negative pap tests within a five-year period, she may get screened every three years. Those who are at increased risk of developing cancer of the cervix should follow their doctor's advice about checkups. The benefits of the Pap test are clear: The overall death rate in the United States from the disease has declined by 74 percent since the introduction of the Pap test in the 1950s.

A Pap test is a procedure in which cells are scraped from the cervix and examined under a microscope. It is used to detect cancer or changes that may lead to cancer. A Pap test can also show non-cancerous conditions, such as infection or inflammation.

Getting regular Pap tests can save a woman's life. Cervical cancer can usually be prevented if precancerous cervical lesions are found by a Pap test and treated. Invasive cervical cancer can usually be cured if it is found early through regular Pap tests and treated promptly. About half of the women in the United States who develop cervical cancer have never had a Pap test. Regular Pap tests decrease a woman's risk for developing cervical cancer because they can detect precancerous cervical lesions at early, treatable stages.

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A Pap test is the first step in diagnosing cervical cancer. If the Pap test is abnormal, procedures may need to be done for further diagnosis:

• Colposcopy: the doctor applies a vinegar-like solution to the cervix and using a colposcope looks closely at the cervix

• Biopsy: the doctor removes tissue to look for precancerous cells or cancer cells

• Loop electrosurgical excision procedure (LEEP): the doctor uses an electric wire loop to shave off a thin, round piece of tissue

• Endocervical curettage: the doctor uses a curette (a small, spoon-shaped instrument) to get tissue from inside the cervical opening

• Conization (cone biopsy): the doctor removes a larger, cone-shaped sample of tissue

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.

Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.

Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.

Benign tumors are not cancer:

• Benign tumors are rarely life-threatening.

• Generally, benign tumors can be removed, and they usually do not grow back.

• Cells from benign tumors do not invade the tissues around them.

• Cells from benign tumors do not spread to other parts of the body.

• Polyps, cysts, and genital warts are types of benign growths on the cervix.

Malignant tumors are cancer:

• Malignant tumors are generally more serious than benign tumors. They may be life-threatening.

• Malignant tumors often can be removed. But sometimes they grow back.

• Malignant tumors often can be removed. But sometimes they grow back.

• Cells from malignant tumors can spread (metastasize) to other parts of the body. Cancer cells spread by breaking away from the original (primary) tumor and entering the bloodstream or lymphatic system. The cells invade other organs and form new tumors that damage these organs. The spread of cancer is called metastasis.

http://www.cancer.gov/cancertopics/wyntk/cervix/page4

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Treatment options can depend on the following and should be discussed with your doctor.

• The stage of the cancer.

• The size of the tumor.

• Your age.

• Your desire to have children.

Treatment typically involves one or more of the following:

• Surgery to remove the uterus (hysterectomy)

• Radiation therapy, in which high-energy x-rays or other types of radiation are used to kill the cancer cells. Radiation therapy can be delivered using a machine positioned outside the body to bombard the cancer, or through a radioactive substance sealed in a wire, catheter or other device and then placed in the body in or near the cancerous area.

• Chemotherapy, which uses drugs to stop the growth of cancer cells. Chemotherapy can be taken by mouth, or injected into a vein, muscle, spinal column, organ or body cavity.

Precancerous may be treated;

There are several factors, such as whether the lesion is low or high grade, whether the woman wants to have children in the future, the woman's age and general health. A low-grade lesion may not need further treatment especially if the abnormal area was completely removed during the biopsy and can be watched with regular Pap tests. Cryosurgery (freezing), cauterization (burning) or laser surgery can be used to destroy the abnormal area without harming healthy tissue. The doctor also can remove abnormal tissue by LEEP or conization.

Treatment depends on the location and size of the tumor, the stage (extent) of the disease, the woman's age, general health and other factors. Most often, the treatment involves surgery and radiation therapy. Sometimes, chemotherapy or biological therapy is used. The doctor may decide to use one treatment or a combination of treatments. Surgery may involve removing the tissue in or near the cervix, the cervix or the entire uterus (hysterectomy). Radiation therapy uses high-energy rays to damage cancer cells and stop them from growing. Chemotherapy is the use of drugs to kill cancer cells. It is most often used when cervical cancer has spread to other parts of the body. The doctor may use one drug or a combination of drugs. Biological therapy is treatment using substances to improve the way the body's immune system fights disease, and it may be used to treat cancer that has spread from the cervix to other parts of the body.

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Healing

After treatment for cervical cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests, such as a pelvic examination and Pap test, to monitor your recovery in the coming months and years.

Women recovering from cervical cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. For women who smoke, quitting smoking can help recovery and reduce the risk of cancer recurrence. Learn more about Quitting Smoking. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level.

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Support

Going to the doctor every time with your loved one is crucial. Having someone she knows and loves by her side will help boost her spirits and add a pair of ears. Sometimes absorbing all that information can be overwhelming. Remind them to write any question down to ask the doctor. Remember though to give your loved one the space she needs if she expresses a greater need for privacy.

The little things. Whether you are a next-door neighbor, relative or co-worker the patient will benefit from assistance with the basics. Offer to cook meals, drive her to appointments, baby-sit her children or pick up her groceries. She may be deeply touched by your simple offer to take care of her pets while she's in the hospital. Remember daily life goes on for everyone--even people battling cancer.

Consistent offers to help out or talk are not intrusive. Most women feel a sense of independence but are shadowed with a feeling of weakness inside. They might not take you up on your offer to help with simple chores until you make the offer a second or third time.

What you can do for yourself

Give yourself the best odds after treatment for cervical cancer or precancerous conditions.

If you smoke, look seriously for opportunities or resources to quit. Smoking exposes your body to cancer-causing chemicals that promote the growth of cervical cancer. The chemicals produced by tobacco smoke may damage the DNA in cells of the cervix and make cancer more likely to occur there. Also avoid drinking excessive alcohol and follow the dietary recommendations of your cancer care team. Assuming there's no reason for you to avoid these foods, eat plenty of dark green leafy vegetables, red, orange or yellow vegetables and whole grains. This will help you heal faster and give you a better chance of recovering completely. Exercise as soon as your condition permits. Know your recommended medical follow-ups and keep up with them.

Face your fertility issues

If you're concerned about your ability to have children, make this clear to your cancer care team. Ask how the medical and surgical procedures necessary for your care will affect your fertility. If you have early cervical cancer, it may be possible for you to be treated with a cone biopsy, a surgical procedure that allows some women to remain fertile. If your fertility can't be spared, you're entitled to your feelings and consideration from others. A good counselor or support group may help. You can also consider looking into emerging reproductive technologies, such as ovarian tissue banking.

Reclaim your sex life

During this stressful time, it is normal for you to be less interested in sex than before. Counseling can help you and your partner adjust and stay physically intimate in other ways as you return to intercourse at your own pace. If you are experiencing vaginal dryness, hormone creams and lubricating gels can help. To keep your vagina elastic and flexible after radiotherapy, use a vaginal dilator and talk to your partner about having regular sex. This won't make the cancer worse or hurt your partner. Make sure that penetrative sex is very gentle at first.

If you're going to have a hysterectomy

Ask your surgeon whether your ovaries will also be removed and research this decision carefully. Also ask whether you'll be having abdominal surgery or surgery through the vagina, since the procedures have different recovery rates. Also arrange for help at home; you'll be glad later, even if you don't need it for long. Freeze your favorite meals ahead of time, and prepare the room in which you'll be resting after surgery with reading materials and pictures or posters on the wall. Also have a supply of sanitary pads for post-operative drainage and large-size, comfortable panties.

After your hysterectomy

Cooperate when you're asked to get up and walk after surgery. You'll recover faster and won't have as many problems with gas. Once you're home, don't lift heavy objects or walk up stairs too soon after surgery. If you've had an abdominal incision, edema (swelling) may make your abdomen look like it sags; with time, this will subside. Stick to a healthy, nutritious diet, not a weight-loss diet, while recovering from surgery. After your surgeon has cleared you for normal activity, exercise to tighten your muscles, build up strength and endurance, and improve sleep.
 

http://www.prevention.com/cda/vendorarticle/cervical-cancer/NW118/health/conditions.treatments/0/0/lifestyle
 

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Learn more about Fred Hutchinson Cancer Research Center's work in cervical cancer at:

http://www.fhcrc.org/research/diseases/cervical_cancer/

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