Cervical Cancer

Cervical Cancer (Q & A)

What is cervical cancer?
Cervical cancer is cancer of the cervix, which is part of a woman’s reproductive organ. Cancer occurs when cells are dividing rapidly and abnormally. Eventually, it becomes a tumor. Cancer cells can spread to other organs such as liver, lungs and bones by traveling through the blood vessels.

There are two types of cell in the cervix and the name of the cancer indicates which type of cells is involved. The middle and right images showed how cervix looks from the vagina.

Where is cervix located?
Cervix is located in the pelvic and it is the lower end of the uterus (womb), connected to the vagina. Uterus is where the baby grows during pregnancy. During pregnancy, the cervix is tightly closed and it is opened at childbirth.

How common is cervical cancer?
In the U.S and developed countries, cervical cancer is declining due to preventative screening test. However, in the developing countries, cervical cancer is still the second most common cancer in women.

What are the names of the cervical cancer?
Squamous cells, which are on the outer layer of the cervix, are involved in squamous cell carcinoma of the cervix. Columnar cells are involved in adenocarcinoma of the cervix and they are the lining of the cervical canal. Squamous cell carcinoma of the cervix is a more common one.

What causes cervical cancer?
Cervical cancer is associated with human papilloma virus or HPV infection. While there are many strains of HPV, only infection with HPV 16 and 18 are high risk for developing cervical cancer. HPV is passed from one person to another via sexual intercourse. There are many women who are infected with HPV but not all of them will develop cervical cancer. In some women, the infection goes away on its own. HPV infection can also cause genital warts, which is a non-cancerous condition.

Who are at risk for cervical cancer?
All women who are sexually active are at risk for HPV infection. But it does not necessarily mean they are at risk for cervical cancer. The following are risk factors for cervical cancer.

• Having multiple sexual partners
• Engaging in sexual activity before the age of 18
• Having a history of sexually transmitted infections (STIs) such as gonorrhea, chlamydia, HIV and syphilis
• Having a dysplasia of the cervix
• Having a weak immune system
• Having a family history of cervical cancer
• Having a mother who took a medication called DES (diethylstilbestrol) during pregnancy
• Smoking

What is dysplasia of the cervix?
Dysplasia refers to the changes in the cells before they become cancerous. It takes several years in order for dysplasia to progress into cervical cancer. There are a number of treatments available for dysplasia. Therefore, early detection via routine screening is an important step in preventing cervical cancer.

What are the signs and symptoms of cervical cancer?
Early cervical cancer does not present with any signs or symptoms. As the cancer advances, a woman may have abnormal period that lasted longer or heavier than usual. Some women may experience bleeding between periods or having period after menopause or bleeding after sexual intercourse. Some may notice abnormal bloody discharge, pelvic pain, back pain and fatigue.

What is the screening test for cervical cancer?
Pap Smear is the screening test for cervical cancer and it detects abnormal cells in the cervix. During Pap Smear exam, your doctor will take a small sample of cells from the cervix and send it to the lab for examination under the microscope. HPV test is also available for women over 30. It may be ordered along with Pap Smear or some doctors may order it after Pap Smear came back abnormal. HPV test is to see if a woman has been infected with certain strains of HPV.

How is cervical cancer diagnosed?
After the abnormal Pap Smear, the doctor will do more tests to see if it is cervical cancer or not. He or she will perform a pelvic exam to see if there is any abnormality in the uterus (womb), ovaries (eggs) and vagina.

Colposcopy is a procedure in which the doctor looks at your cervix with a colposcope (magnifying lens) and takes small sample of tissues from the abnormal area for biopsy. Then, the tissue sample will be sent to the lab for examination under the microscope. Colposcopy is often done in the doctor’s office. Some doctors may do cone biopsy where cone-shaped tissue is taken for biopsy and it contains deeper layer of cells. Once the diagnosis of cervical cancer is made, your doctor will refer you to a cancer specialist.

What is staging?
Once the cervical cancer is diagnosed, your doctor will do staging to determine the extent of the cancer. Staging is based on the size of the cancer, whether it has spread to the surrounding tissues and other organs or not. Staging helps doctors to formulate treatment plan.

Cervical cancer has stage I to stage IV. In stage I, cancer is only in the cervix. Stage II cancer has spread beyond the cervix and it may include uterus. In stage III, cancer has spread to the lower part of the vagina and may include pelvic wall (tissues that line the body). In stage IV, cancer has spread to bladder, rectum or other parts of the body. As part of the staging, your doctor will order other imaging tests such as chest X-ray, CT scan of the pelvis, MRI of the pelvis, cystoscopy to see inside of the bladder, colonoscopy to look at the entire colon and etc.

How is cervical cancer treated? 
Treatment of cervical cancer depends on a number of factors such as your age, staging of the cancer and your health condition. There are several surgical options, radiation therapy and chemotherapy available to treat cervical cancer. It is important to have family members and close friends for emotional support during the treatment. Counseling and support groups available for you to meet other women who have been diagnosed with cervical cancer.

What types of surgery are available?
If the cancer is in very early stage, simple hysterectomy can be done. It is a procedure to remove the cervix and uterus. A lot of doctors prefer radical hysterectomy even in early stages of cervical cancer. In this procedure, the doctor removes the cervix, uterus and part of the vaginal, leaving the ovaries (eggs) in place. It can either be done by incision in the belly or laparoscopic procedure in which only small incisions are made to insert the instruments and camera.

What is radiation therapy?
Radiation therapy (RT) uses high energy X-ray to stop the cancer cells from growing and there are two ways to give radiation therapy. In brachytherapy, the device is placed in the cervix and it gives high dose of radiation to the cancerous area. In external beam radiation therapy (EBRT), the radiation is given from outside of the body and it is given five days a week for about 5 to 6 weeks in a clinic setting. In early stages of cancer, your doctor will use one of the radiation methods. For advanced cancer stages, both methods may be used.

What is chemotherapy?
Chemotherapy uses medicines to stop or slow the cancer cells from growing and it is used to enhance the effect of radiation therapy. Medicines are usually injected into a vein once a week. For advanced cancer stages, chemotherapy and radiation are used before the surgery to shrink the tumor.

Is cervical cancer preventable?
Yes, cervical cancer is very much preventable with a routine Pap Smear exam. Also, HPV vaccines are available for girls 9 years of age to 26 years old women who have not been sexually active yet.

How can I prevent myself from getting cervical cancer?
Practice safe sex by using condom, limit the number of sexual partners, do not engage in sexual activity at early ages, get Pap Smear exam routinely, get HPV vaccination and quit smoking if you smoke.

What are the names of the HPV vaccines?
The vaccine called Gardasil prevents infection from HPV strains (6, 11, 16 and 18). Another vaccine called Cervarix prevents infection from HPV strains 16 and 18. Both vaccines are given in a series of three shots over six months.

What are the recommendations for Pap Smear?
You should get your first Pap Smear at the age of 21 or three years after your first sexual intercourse. For women between 21 and 29 years of age, most organizations recommended to have Pap Smear every two years. If you are between 30 and 65 years of age, the recommendation is every three years or every five years with HPV test. If your Pap Smear shows abnormal cells, you may need more frequent Pap Smear. Once you are 65 or older, you can stop having Pap Smear if you have had three normal results within the last ten years. Your last Pap Smear exam must be in the last five years.

​Contributed by Patricia Hsiao M.D.