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Cervical Cancer
Pap tests can detect cervical cancer in women before the disease causes any symptoms. And that can save lives, because, as with so many types of cancer, early treatment can mean a better chance for a cure. (Read about "Cancer: What It Is") In fact, according to the American Cancer Society, when cervical cancer is detected at an early stage, it's one of the most successfully treated cancers.
The cervix
The cervix is at the lower end of the uterus. According to the Centers for Disease Control and Prevention (CDC), cancer of the cervix is closely linked to:
- certain sexual behaviors, such as intercourse at an early age and multiple sex partners
- human papillomavirus (HPV) infection (Read about HPV in "STD's")
- immunosuppressive disorders such as HIV/AIDS (Read about "HIV / AIDS")
- failure to receive regular Pap test screening
- smoking (Read about "Quit Smoking")
Cervical cancer is not the same as uterine cancer, which starts in a different part of the uterus and is not easily detected by Pap tests. (Read about "Uterine Cancer")
HPV vaccine and Pap tests
A vaccine is now available that is aimed at HPV types 6, 11, 16 and 18. HPV is responsible for genital warts and the vast majority of precancerous genital lesions and cervical cancers. The vaccine is approved for use in females 9-26 years of age. FDA says the vaccine is effective against HPV types 16 and 18, which cause approximately 70 percent of cervical cancers and against HPV types 6 and 11, which cause approximately 90 percent of genital warts. The vaccine does not appear to help if someone is already infected. The American College of Obstetricians and Gynecologists says it is still valuable to get the vaccine to protect from the other viruses.
The National Cancer Institute (NCI) recommends that Pap tests should begin approximately three years after a woman begins having sexual intercourse, but no later than the age of 21. A woman's personal history, as well as her medical and family history (Read about "Family Health History"), can help a doctor determine if she needs to have Pap tests and pelvic exams done on an annual basis or on a different schedule. Talk with your doctor or healthcare practitioner.
During a Pap test, a healthcare professional scrapes some cells from the cervix. NCI says a woman should have this test when she is not menstruating; the best time is between 10 and 20 days after the first day of her menstrual period. In addition, for about 2 days before a Pap test, she should avoid douching or using foams, creams, jellies or vaginal medicines (except as directed by a physician), because these may wash away or hide any abnormal cells.
After the cells are taken, the sample is transferred to a slide and examined in a lab for signs of cancer. The American College of Obstetricians and Gynecologists (ACOG) says that, like any test, a Pap test isn't always accurate. It may not detect cells that are abnormal. This is called a "false negative." No one knows just how many Pap tests produce false negatives. NCI says that by getting regular Pap tests, a woman can reduce her risk of developing cancer because of a missed abnormality. Pap tests may also label normal cells as abnormal, what's called a "false positive." When a Pap test indicates an abnormality, a doctor may decide that the test needs to be repeated, or that different types of tests are required. A test for HPV infection has been approved by the Food and Drug Administration (FDA) for women 30 and older, for whom HPV infection is more likely to be linked to cervical cancer.
Tests Results
Most times the results of a Pap test are normal. A so-called abnormal result indicates a need for further testing. There can be many reasons for an abnormal result.
Sometimes, cells on the surface of the cervix appear abnormal but not cancerous. Scientists believe that some abnormal changes in cells on the cervix are the first step in a series of slow changes that can lead to cancer later on; in other words, they may be considered precancerous. CDC says cervical intraepithelial neoplasia (or CIN) is the name for a precursor lesion to cervical cancer. The term CIN, along with a number (1 to 3), is used to describe how much of the cervix contains abnormal cells. Abnormal or precancerous cells are also called dysplasia or squamous intraepithelial lesion (SIL). SIL is described as being low-grade (early changes in the size, shape, and number of cells) or high-grade (a large number of precancerous cells). High grade SIL can also be called carcinoma in situ. Cervical cancer, or invasive cervical cancer, is the term used when abnormal cells spread into the cervix or to other tissues or organs.
The American Society for Colposcopy and Cervical Pathology (ASCCP) says the most common type of abnormal Pap test is an inconclusive result referred to as ASC-US or atypical squamous cells of undetermined significance. There are now new national Consensus Guidelines for dealing with ASC-US. Before these guidelines, women with ASC-US would usually either get several repeat Pap tests or undergo a colposcopy, during which the cervix is examined using a special type of microscope and biopsies can be taken. (Read about "Biopsy") The new guidelines say the other approaches may still be used, but HPV testing is preferred whenever liquid-based Pap tests are used. If the liquid test is used, the laboratory can test the same sample used for the original Pap test for HPV. ASCCP calls HPV the primary cause of cervical cancer. The test quickly identifies those women who are HPV positive and need further evaluation. ASCCP says women who are HPV negative are less likely to have cervical cancer but that they still need regular annual Pap tests
The National Cancer Institute (NCI) says that if precancerous conditions are present, there may be no apparent symptoms or problems. In the early stages of cervical cancer, there may also be no symptoms. In its later stages, ACOG says cervical cancer can cause:
- abnormal vaginal bleeding or spotting
- abnormal discharge
- pain
If a woman experiences any of these problems, she should contact a doctor right away. These symptoms can indicate a number of different conditions, so a correct diagnosis is critical. (Read about "Menstrual Disorders")
If problems are suspected, NCI says colposcopy is a widely used method to check the cervix further by using a special solution and a microscope-like device to examine the cervix. A biopsy may also be performed to remove tissue for further examination. A procedure that removes a larger cone-shaped portion of tissue is called a conization. Another method used to do a biopsy is called loop electrosurgical excision procedure (LEEP). In this procedure, the doctor uses an electric wire loop to remove a thin piece of tissue. (Read about "Biopsy")
For precancerous conditions, treatment options can include cryosurgery (freezing), cauterization (burning) or laser surgery to destroy the abnormal area without harming nearby healthy tissue. The doctor also can remove the abnormal tissue by LEEP or conization.
If cancer is found, treatment depends on how advanced a stage the cancer has reached. The following stages are used for cervical cancer, according to NCI:
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Stage 0 (Carcinoma in Situ)
In stage 0, the cancer is found in the first layer of cells lining the cervix only and has not invaded the deeper tissues of the cervix. Stage 0 is also called carcinoma in situ.
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Stage I
In stage I, cancer is found in the cervix only. Stage I is divided into stages IA and IB, based on the amount of cancer that is found.
- Stage IA: A very small amount of cancer that can only be seen with a microscope is found in the tissues of the cervix. The cancer is not deeper than 5 millimeters (less than ¼ inch) and not wider than 7 millimeters (about ¼ inch).
- Stage IB: In stage IB, the tumor is still within the cervix and either: can only be seen with a microscope and is deeper than 5 millimeters (less than ¼ inch) or wider than 7 millimeters (about ¼ inch); or can be seen without a microscope and may be larger than 4 centimeters (about 1 ½ inches).
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Stage II
In stage II, cancer has spread beyond the cervix but not to the pelvic wall (the tissues that line the part of the body between the hips). Stage II is divided into stages IIA and IIB, based on how far the cancer has spread from the cervix into nearby tissue.
- Stage IIA: Cancer has spread beyond the cervix to the upper two thirds of the vagina but not to tissues around the uterus.
- Stage IIB: Cancer has spread beyond the cervix to the upper two thirds of the vagina and to the tissues around the uterus.
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Stage III
In stage III, cancer has spread to the lower third of the vagina and may have spread to the pelvic wall and nearby lymph nodes. (Read about "The Lymph System") Stage III is divided into stages IIIA and IIIB, based on how far the cancer has spread.
- Stage IIIA: Cancer cells have spread to the lower third of the vagina but not to the pelvic wall.
- Stage IIIB: Cancer cells have spread to the pelvic wall and/or the tumor has become large enough to block the ureters (the tubes that connect the kidneys to the bladder). This blockage can cause the kidneys to enlarge or stop working. Cancer cells may also have spread to lymph nodes in the pelvis. (Read about "The Urinary System")
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Stage IV
In stage IV, cancer has spread to the bladder, rectum or other parts of the body. Stage IV is divided into stages IVA and IVB, based on where the cancer is found.
- Stage IVA: Cancer has spread to the bladder or rectal wall and may have spread to lymph nodes in the pelvis.
- Stage IVB: Cancer has spread beyond the pelvis and pelvic lymph nodes to other places in the body, such as the abdomen, liver, intestinal tract or lungs.
Surgery treats the cancer in the cervix and the area close to the tumor. NCI says most women with early cervical cancer have surgery to remove the cervix and uterus, a procedure called total hysterectomy. (Read about "Hysterectomy") The surgery may be done conventionally or robotically. (Read about "Robotic Surgery") However, for very early (Stage 0) cervical cancer, NCI says a hysterectomy may not be needed. Other ways to remove the cancerous tissue include conization, cryosurgery, laser surgery or LEEP.
Some women need a radical hysterectomy. A radical hysterectomy is surgery to remove the uterus, cervix and part of the vagina.
With either total or radical hysterectomy, the surgeon may remove both fallopian tubes and ovaries. This procedure is a salpingo-oophorectomy.
The surgeon may also remove the lymph nodes near the tumor to see if they contain cancer. (Read about "The Lymph System") If cancer cells have reached the lymph nodes, it means the disease may have spread to other parts of the body. If the cancer has spread, other options that may be used are chemotherapy and radiation. (Read about chemo, radiation and other therapies in "Cancer Treatments")
But again, regular Pap tests can find problems early, before cancer has developed or progressed to an advanced stage. And that gives a woman the best chance of successful treatment.
More Cancer Information:
For a list of individual types of cancer, see Cancer: What It Is
All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.
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