Cervical Cancer FAQ
What is cervical cancer?
Cervical cancer is a slow, progressive disease. It usually starts as a small lesion or growth on the cervix. Abnormal cells have acquired the ability to leave their normal position on the surface and initially invade deeper tissues. They also acquire the ability to spread to distant sites by traveling through blood vessels or lymphatic channels. Local invasives and distant spread are life-threatening. There are two main types of cervical cancer:
Squamous cell carcinoma (most common cervical cancer) arises from the squamous cells found covering the ectocervix and at the squamous glandular cell border in the endocervix.
Endocervical adenocarcinoma (about 5-10% of all cervical cancers) arises from the glandular cells found in the endocervical canal.
Both types of cervical carcinomas follow the same medical recommendations.
What are the risk factors for cervical cancer?
Physicians cannot yet determine why one person gets cancer and another does not, but there are a number of risk factors that predisposes women to this disease. The main risk factors are:
- Human Papilloma Virus (HPV) infection (see HPV FAQ)
- Lack of regular Pap tests
The Pap test screens for abnormal cellular changes that may be precancerous. If a change is found early, there is a high likelihood the abnormalities can be treated and cured.
- Weakened immune system
The body’s inability to fight infection (such as HPV) can lead to a higher incidence of cervical cancer.
Cervical carcinoma is generally found in women over 40 years old. Natural carcinogenesis progression statistics show that women are exposed to HPV virus(es) at sexual debut and through their twenties. For most, the immune system works to clear the virus(es) within two years. For some reason not yet fully understood, some women are unable to clear the HPV virus(es), leaving to persistent HPV infection that leads to changes to the DNA, causing precancerous or cancerous lesions in the cervix.
- Early onset of sexual activity
Engaging in sexual activity before the age of 16 places a woman at greater risk of developing cervical cancer, likely due to increased exposure to HPV.
- Many sexual partners
A woman who has had many sexual partners, or whose partners have had many other partners, is at a higher risk of developing cervical cancer. Keep in mind that the sex partners of sex partners increase risk exponentially.
- Smoking cigarettes
It has been found that women who smoke have an increased risk of cervical cancer over women who don’t smoke.
- Using birth control pills for a long time
This risk factor is not fully understood, but studies have found that long-term usage of birth control pills is a risk factor for cervical cancer. Additionally, studies have also shown that birth control pills may decrease risk for ovarian cancer.
- Multiparous women
Some studies suggest that women who have a large number of births have an increased risk of cervical cancer.
What are precancerous lesions and what causes them?
Precancerous lesions result in part from an HPV infection. Abnormal cellular changes noted on a Pap test are categorized under this heading. Precancerous lesions are more specifically defined as high-grade squamous intraepithelial lesions (HSIL). A small percentage of these lesions, if left untreated, can become cancerous.
What are squamous intraepithelial lesions?
These squamous intraepithelial lesions (SIL) are diagnosed as low-grade (LSIL) or high-grade (HSIL):
Low-grade SIL represents microscopic changes in cells that reflect a low-risk HPV infection. These changes often resolve without treatment and never progress to a high-grade lesion. These changes may also be found in association with high-grade lesions (HSIL) due to high-risk HPV exposure. Therefore, it is important to follow-up LSIL with additional Pap tests and/or colposcopy and biopsy. Some laboratory reports and physicians refer to these changes as mild dysplasia, mild dysplasia with HPV, or CIN 1 (cervical intraepithelial neoplasia). The corresponding diagnostic results from a biopsy is CIN1 (cervical intrapeithelial neoplasia, mild dysplasia).
High-grade SIL represents cells with more severe abnormalities and have a greater chance of developing into cancer. If left untreated, HSIL usually develops into cancer. Therefore, it is imperative to follow your doctor’s order about treatment options. Some pathology reports and physicians refer to these changes as moderate or severe dysplasia, or carcinoma in situ. The corresponding tissue biopsy results are CIN2 or CIN3 respectively.
What are the symptoms of cervical cancer?
- Abnormal vaginal bleeding is the most common symptom
- Bleeding that occurs between regular menstrual periods
- Bleeding after intercourse
- Bleeding after douching
- Menstrual periods that become heavy and longer than before
- Post menopausal bleeding
- Profuse vaginal discharge
- Pelvic pain
- Pain during sexual intercourse
Can cervical cancer be prevented?
Cervical cancer can be prevented with screening and vaccination. The vaccine is a series of three shots that is most effective when given prior to sexual debut. The vaccine has been approved for both girls and boys, ages 9-26.
There are two vaccines on the market. Gardasil (Merck and Company) is a quadravalent vaccine providing immunity to two types of high-risk HPV genotypes (16 and 18) and two types of low-risk HPV genotypes (6 and 11, that are associated with genital warts). Cervarix (GSK) protects against two high-risk HPV viral types (16 and 18).
The National Institutes of Health advise that the best way to prevent cervical cancer is through early detection. Routine annual pelvic examination and Pap tests allow physicians to detect abnormal changes on the cervix.
Pap test screening to check for precancerous cervical changes before symptoms develop is very important. When these abnormal cells are found, treatment can begin and therefore prevent most cervical cancer. Also, screening can find cancer in its early stages when treatment is more likely to cure cancer.
Screening women with Pap tests has been very effective. Each year the number of women diagnosed with cervical cancer falls. Physicians believe this is largely due to the success of the Pap test.
Is cervical cancer curable?
Cervical cancer was once a leading cause in cancer deaths, but today cervical cancer is almost completely curable if it is caught in an early (precancerous) stage.
If cervical cancer is caught at an advanced stage it is more difficult to treat. There is still a 90% cure rate when the disease has not metastasized (spread) to the surrounding organs. If metastasis has occurred, the cure rate will then depend on how far the cancer has spread, i.e., the stage of the cancer.
Are there new technologies designed for cervical cancer screening?
The Pap smear in the hands of experienced, dedicated technologists is highly accurate and very effective in detecting abnormalities. The new technologies being introduced are designed to enhance the Pap test’s collection and evaluation technique, not replace it.
The Food and Drug Administration (FDA) has approved the use of liquid-based versions of the Pap test: ThinPrep® and Surepath™. The liquid-based test removes excessive inflammatory cells, blood mucus, and bacteria from the cellular sample and improves cellular processing. The removal of the obstructing material helps cytotechnologists identify a greater percentage of cells that exhibit subtle nuclear abnormalities. There are two FDA-approved automated screening devices: Hologic ThinPrep® Imaging Systems and BD Focal Point GS. Both use computer algorithmic development to assist cytotechnologists in evaluating Pap tests.
HPV testing is a relatively new molecular assay technology that assists in identifying women at high risk for developing cervical cancer. These include:
- Qiagen HC2—Using hybrid capture to identify 13 high-risk HPV viral types (16,18,31,33,35,39,45,51,52,56,58,59). Results are positive, negative or inconclusive.
- Hologic Cervista—Uses invader technology to identify 15 high-risk HPV viral types (16,18,31,33,35,39,45,51,52,56,58). This method also has a housekeeping gene to assess adequacy.
- Roche cobas® 4800—Tests for high-risk HPV viral types (16,18,31,33,35,39,45,51,52,56,58,59,66,68). Of these types, 12 are pooled to positive or negative. Viral types 16 and 18 are tested as individual positive or negative.
- Hologic/GenProbe Aptima HPV Assay—This second-generation method targets E61E7 MRNA for 14 high-risk HPV types (16,18,31,33,35,39,45,51,52,56,58,59,66,68).
- PCR—can specifically identify any high-risk HPV viral types, but it is not FDA approved, is expensive, and is not well reimbursed.