Cancers of the cervix also are named for the type of cell in which they begin. Most cervical cancers are squamous cell carcinomas. Squamous cells are thin, flat cells that form the surface of the cervix.

When cancer spreads to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the original (primary) cancer. For example, if cervical cancer spreads to the bones, the cancer cells in the bones are cervical cancer cells. The disease is called metastatic cervical cancer (it is not bone cancer).

Cancer of the cervix is different from cancer that begins in other parts of the uterus and requires different treatment. The most common type of cancer of the uterus begins in the endometrium, the lining of this organ.

Causes

There is significant evidence that cervical carcinoma is sexually transmitted. Most researchers believe that the human papilloma virus (HPV) is the cause or a strong co-factor in the development of pre-invasive and invasive carcinomas of the cervix, as well as pre-invasive and invasive squamous cell cancer of the vagina and vulva.

Ninety-five percent of squamous cell carcinomas of the cervix contain human papilloma virus DNA. There are many types of human papilloma virus (HPV) that infect humans. Types 6 and 11 usually cause genital warts, while types 16, 18, 31, and 33 usually result in high-grade SIL (dysplasia, CIN-2 and 3) and carcinomas. Genital warts are associated with cervical, vaginal, and vulvar dysplasia and invasive carcinoma in about 25 percent of cases.

Detecting Cervical Cancer

If all women had pelvic exams and Pap tests regularly, most pre-cancerous conditions would be detected and treated before cancer develops. Most invasive cancers could be prevented as well. Any invasive cancer that occurs would likely be found at an early, curable stage.

In a pelvic exam, the doctor checks the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum. The doctor feels these organs for any abnormality in their shape or size. A speculum is used to widen the vagina so that the doctor can see the upper part of the vagina and the cervix.

The Pap test is a simple, painless test to detect abnormal cells in and around the cervix. 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. For about two days before a Pap test, she should avoid douching or using spermicidal foams, creams, or jellies or vaginal medicines (except as directed by a physician), which may wash away or hide any abnormal cells.

A Pap test can be done in a doctor's office or a health clinic. A wooden scraper (spatula) and/or a small brush is used to collect a sample of cells from the cervix and upper vagina. The cells are placed on a glass slide and sent to a medical laboratory to be checked for abnormal changes.

Another screening test for cervix cancer is VIA or aided visual inspection of the cervix, a simple test using 4% vinegar to cotton-swab wash the cervix to highlight lesions (aceto-whitening) which will tell the health care giver on the spot to inform the patient to go for cervix biopsy and or further evaluation.  This is in contrast to Pap smear which needs pathology slide review first before definitive instructions for the patient to go for further evaluation.

Women should have regular checkups, including a pelvic exam, a Pap test and or VIA, if they are or have been sexually active, or if they are age 18 or older. Those who are at increased risk of developing cancer of the cervix should be especially careful to follow their doctor's advice about checkups. Women who have had a hysterectomy (surgery to remove the uterus, including the cervix) should ask their doctor's advice about having pelvic exams and Pap tests.

Symptoms
 
Pre-cancerous changes of the cervix usually do not cause pain. In fact, they generally do not cause any symptoms and are not detected unless a woman has a pelvic exam and a Pap test.

Symptoms usually do not appear until abnormal cervical cells become cancerous and invade nearby tissue. When this happens, the most common symptom is abnormal bleeding. Bleeding may start and stop between regular menstrual periods, or it may occur after sexual intercourse, douching, or a pelvic exam. Menstrual bleeding may last longer and be heavier than usual. Bleeding after menopause also may be a symptom of cervical cancer. Increased vaginal discharge is another symptom of cervical cancer.

These symptoms may be caused by cancer or by other health problems. Only a doctor can tell for sure. It is important for a woman to see her physician and/or gynecologist if she is having any of these symptoms.

Risk Factors

The average age of women with invasive cervical cancer is between 40 and 50, while the average age of women with carcinoma in situ is between 25 and 35. The difference is attributed to the long latent period of progression of a lesion confined to the cervical skin to an invasive cervical cancer.

The risk factors for pre-invasive cervical cancer (cervical dysplasia) and cervical cancer are the same. Circumcision is no longer believed to lower the risk of cervical carcinoma.

• Suppression of the immune system from corticosteroids, kidney transplants, therapy for other cancers, or HIV.
• A history of genital warts.
• A history of herpes simplex virus infection.
• Early age at first intercourse.
• Multiple sexual partners.
• Women whose male partner(s) either have had penile warts, have had multiple sexual partners or whose previous partners had cervical cancer.
• Multiple pregnancies.
• Cigarette smoking.
 

Back to top