This gynecological cancer can be serious if left untreated. Learn about human papillomavirus, the Pap smear, treatments, and the cervical cancer vaccine.
Cervical cancer is one of the most common cancers among women around the world. In developed countries, the incidence rates for this disease have decreased dramatically thanks to a widely accepted method of screening. Even so, it is not entirely nonexistent. There are several thousand new cases that still pop up each year.
Causes and Risk Factors
The cause of cervical cancer is the human papillomavirus. HPV invades cells of the cervix and causes them to be dysplastic, or disorganized in structure. The more dysplastic the cells are, the greater the risk for conversion into malignant cancer. Note that HPV comes in a variety of numbered subtypes and not all of them cause malignancy. The ones most associated with cervical cancer include subtypes 16 and 18, though numerous others may carry some inherent risk as well.
Where does this virus come from? Like HIV and syphilis, it is transmitted sexually. A woman who has unprotected sex with multiple partners is at risk for contracting HPV. The virus can often be cleared from the body spontaneously. At the same time, the high rate of transmission plus the risk of contracting a high-risk subtype of HPV are factors for cervical cancer.
Diagnosis and Screening
Dr. George Papanicolaou made medical history by developing the screening test bearing his name. The Pap smear, usually performed by a gynecologist, involves taking a sample of cells from the cervix to be analyzed microscopically. The tool involved is usually a brush that gently scrapes both the inside and the outside of the cervix. If the cells appear abnormal, then further evaluation includes colposcopy to get a magnified view of the cervix and biopsy of any abnormal areas. From there, clinicians use a grading system to categorize the level of cervical dysplasia. It can range from mild low-grade dysplasia to carcinoma in situ with cancer cells on the surface without any invasion. Screening for cervical cancer is generally done at age 21 or three years after the first episode of sexual intercourse, whichever comes first. The screening frequency is annually until three consecutive Pap smears are normal, after which screening can be done every three years instead.
If cervical dysplasia or cancer isn't diagnosed early by screening, then it can be diagnosed by symptoms. A woman may have vaginal bleeding, especially after sexual intercourse, or a sensation of vaginal discomfort. With tumor growth and invasion of nearby structures, she may also experience other symptoms, such as constipation if the tumor were to sufficiently press on the rectum. As a quick note, human papillomavirus is also the cause for genital warts and cancerous growths of the anus and genitals similar to cervical cancer.
Treatment and Prevention
The treatment of choice for early-stage cervical cancer is surgical. If it is carcinoma in situ or cancer with limited invasion, options include loop electrosurgical procedure (LEEP) involving cutting away the abnormal portion of the cervix with a hot wire loop, freezing (cryosurgery), and laser treatment. Later stages warrant a more major surgical operation, particularly removal of the uterus (hysterectomy). Chemotherapy and radiation are also options when the tumor is large or when there is spread of the tumor to the rest of the body (metastases).
In 2006, a vaccine for cervical cancer called Gardasil was made public after FDA approval. Current guidelines recommend administering the vaccine to girls as young as 9 to 12 years of age before any first sexual activity. Keep in mind that this is still relatively new. Though demonstrated favorably so far in clinical trials, the efficacy and safety of the vaccine must be monitored as it is used in the general population. Only time will tell if it, like the Pap smear, will be the next landmark in the treatment of cervical cancer.
