The cervix is part of a woman's reproductive system. It's in the pelvis. The cervix is the lower, narrow part of the uterus (womb).
The cervix connects the uterus to the vagina. During a menstrual period, blood flows from the uterus through the cervix into the vagina. The vagina leads to the outside of the body.
This picture shows the cervix and nearby organs.
Cervical cancer begins in cells on the surface of the cervix. Over time, the cervical cancer can invade more deeply into the cervix and nearby tissues. The cancer cells can spread by breaking away from the original (primary) tumor. They enter blood vessels or lymph vessels, which branch into all the tissues of the body. The cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. The spread of cancer is called metastasis.
Incidence of Cervical Cancer
Cervical cancer used to be the most common gynaecological cancer in Singpore. However, recent trends show that it has been replaced by ovarian cancer. Now, cervical cancer is the third most common gynaecological cancer after ovarian and uterine cancers.
Risk Factors
HPV infection
HPV is a group of viruses that can infect the cervix. An HPV infection that doesn't go away can cause cervical cancer in some women. HPV is the cause of nearly all cervical cancers.
HPV infections are very common. These viruses are passed from person to person through sexual contact. Most adults have been infected with HPV at some time in their lives, but most infections clear up on their own.
Some types of HPV can cause changes to cells in the cervix. If these changes are found early, cervical cancer can be prevented by removing or killing the changed cells before they can become cancer cells.
A vaccine for females between the ages of nine to 26 protects against two types of HPV infection that cause cervical cancer.
Lack of regular Pap tests
Cervical cancer is more common among women who don't have regular Pap tests. The Pap test helps doctors find abnormal cells. Removing or killing the abnormal cells usually prevents cervical cancer.
Smoking
Among women who are infected with HPV, cigarette smoking increases the risk of cervical cancer slightly.
Weakened immune system (the body's natural defense system)
Infection with HIV (the virus that causes AIDS) or taking drugs that suppress the immune system increases the risk of cervical cancer.
Sexual history
Women who have had many sexual partners have a higher risk of developing cervical cancer. Also, a woman who has had sex with a man who has had many sexual partners may be at higher risk of developing cervical cancer. In both cases, the risk of developing cervical cancer is higher because these women have a higher risk of HPV infection.
Using birth control pills over long durations
Using birth control pills for over long durations (five or more years) may slightly increase the risk of cervical cancer among women with HPV infection. However, the risk decreases quickly when women stop using birth control pills. Also, the disadvantages of an unwanted pregnancy far exceed the small risk of developing cervical cancer.
Having many children
Studies suggest that giving birth to many children (five or more) may slightly increase the risk of cervical cancer among women with HPV infection.
DES (diethylstilbestrol)
DES may increase the risk of a rare form of cervical cancer in daughters exposed to this drug before birth. DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.)
Having an HPV infection or other risk factors does not mean that a woman will develop cervical cancer. Most women who have risk factors for cervical cancer never develop it.
Symptoms
There are usually no symptoms in the early stages of cervical cancers. When the cancer grows larger, women may notice one or more of these symptoms:
- Abnormal vaginal bleeding
- Bleeding that occurs between regular menstrual periods
- Bleeding after sexual intercourse, douching, or a pelvic exam
- Menstrual periods that last longer and are heavier than before
- Bleeding after going through menopause
- Increased vaginal discharge
- Pelvic pain
- Pain during sex
Infections or other health problems may also cause these symptoms. Only a doctor can tell for sure. A woman with any of these symptoms should tell her doctor so that problems can be diagnosed and treated as early as possible.
Detection and Diagnosis
The doctor may suspect that you may have cervical cancer if you have an abnormal pap smear or if you present with any of the symptoms mentioned above. Besides a clinical examination, the doctor may do any of the following:
Colposcopy
The doctor uses a colposcope to look at the cervix. The colposcope combines a bright light with a magnifying lens to make tissue easier to see. It is not inserted into the vagina. A colposcopy is usually done in the doctor's office or clinic.
Biopsy
Most women have tissue removed in the doctor's office. A pathologist checks the tissue under a microscope for abnormal cells.
Punch biopsy
The doctor uses a sharp tool to pinch off small samples of cervical tissue.
LEEP
The doctor uses an electric wire loop to slice off a thin, round piece of cervical tissue.
Endocervical curettage
The doctor uses a curette (a small, spoon-shaped instrument) to scrape a small sample of tissue from the cervix. Some doctors may use a thin, soft brush instead of a curette.
Conization
The doctor removes a cone-shaped sample of tissue. A conization, or cone biopsy, lets the pathologist see if abnormal cells are in the tissue beneath the surface of the cervix.
Removing tissue from the cervix may cause some bleeding or other discharge. The area usually heals quickly. Some women also feel some pain similar to menstrual cramps. Your doctor can suggest medicine that will help relieve your pain.
Staging
If the biopsy shows that you have cancer, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. Staging is a careful attempt to find out whether the tumor has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body. Cervical cancer spreads most often to nearby tissues in the pelvis, lymph nodes, or the lungs. It may also spread to the liver or bones.
Your doctor will do a pelvic exam, feel for swollen lymph nodes, and may remove additional tissue. To learn the extent of disease, the doctor may order some of the following tests: Chest xray, CT scan or MRI
Treatment
Women with cervical cancer have many treatment options. The options are surgery, radiation therapy, chemotherapy, or a combination of methods.
The choice of treatment depends mainly on the size of the tumor and whether the cancer has spread. The treatment choice may also depend on whether you would like to become pregnant someday.
Your doctor can describe your treatment choices, the expected results of each, and the possible side effects. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.
Your doctor may refer you to a specialist, or you may ask for a referral. You may want to see a gynecologic oncologist, a surgeon who specializes in treating female cancers. Other specialists who treat cervical cancer include gynecologists, medical oncologists, and radiation oncologists. Your health care team may also include an oncology nurse and a registered dietitian.
At any stage of the disease, supportive care is available to relieve the side effects of treatment, to control pain and other symptoms, and to help you cope with the feelings that a diagnosis of cancer can bring.
Nutrition and Physical Activity
It's important for you to take care of yourself by eating well and staying as active as you can.
You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.
However, you may not feel like eating during or soon after treatment. You may be uncomfortable or tired. You may find that foods don't taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth sores) can make it hard to eat well. Your doctor, a registered dietitian, or another health care provider can suggest ways to cope with these problems.
Research shows that people with cancer feel better when they stay active. Walking, yoga, swimming, and other activities can keep you strong and increase your energy. Exercise may reduce nausea and pain and make treatment easier to handle. It also can help relieve stress. Whatever physical activity you choose, be sure to talk to your doctor before you start. Also, if your activity causes you pain or other problems, be sure to let your doctor or nurse know about it.
Follow-up Care
You'll need regular checkups after treatment for cervical cancer. Checkups help ensure that any changes in your health are noted and treated if needed. If you have any health problems between checkups, you should contact your doctor.
Your doctor will check for the return of cancer. Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment. Checkups may include a physical exam, Pap tests, and chest x-rays.
Sources of Support
Learning you have cervical cancer can change your life and the lives of those close to you. These changes can be hard to handle. It's normal for you, your family, and your friends to have many different and sometimes confusing feelings.
Concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, keeping your job, or continuing daily activities.
Here's where you can go for support:
- Doctors, nurses, and other members of your health care team can answer questions about treatment, working, or other activities.
- Social workers, counsellors, or members of the clergy can be helpful if you want to talk about your feelings or concerns. Often, social workers can suggest resources for financial aid, transportation, home care, or emotional support.
- Support groups also can help. In these groups, patients or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. You may want to talk with a member of your health care team about finding a support group.
