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Cancer (Oncology)

Cervical Cancer

Cervical cancer affects the cervix, or the lower part of the uterus that connects to the vagina. The two main types of cervical cancer are squamous cell carcinomas (80 to 90 percent of cervical cancers), that start in the squamous cells near the vagina and adenocarcinomas, which develop in the glandular cells near the body of the uterus.

Cervical cancer develops over time. First, the normal cells of the cervix will gradually develop pre-cancerous changes that will eventually turn into cancer. Only some women with pre-cancers of the cervix will develop cancer; in most women, the pre-cancerous cells will disappear without treatment.

Cervical cancer was once one of the most common causes of cancer-related death for American women. Thankfully, the introduction of the Pap smear test, created to detect pre-cancerous changes, reduced the death rate by an astonishing 70 percent, from 1955 - 1992 – that rate is still dropping.

Most cases of cervical cancer occur in women between the ages of 20 and 50. But nearly 20 percent of women are over 65 when they are diagnosed, highlighting the importance of continuing Pap tests as you age. In the United States, cervical cancer affects Hispanic women most often; African-American women are at a higher risk than Caucasian women.

Risk Factors

The strongest risk factor for cervical cancer is infection by the human papilloma virus (HPV). HPV is a group of more than 100 related viruses that cause wart-like growths on the skin, genitals, anus, mouth and throat. HPV is a common infection, spread by skin-to-skin contact (including sex); HPV usually goes away on its own. When HPV does not go away, it can lead to several types of cancer – especially cervical cancer.

Other risk factors include smoking; having a family history of cervical cancer; being infected with chlamydia, HIV or AIDS; being overweight; taking oral contraceptives for a prolonged period; having three or more full term pregnancies; and experiencing pregnancy before age 17.

Symptoms

There are usually no symptoms for pre-cancers and early stage cervical cancer. As the cancer progresses, common symptoms are abnormal vaginal bleeding, unusual vaginal discharge and pain during intercourse. Such symptoms do not necessarily indicate cancer but warrant immediate examination by a health-care professional.

Screening and Prevention

Pap test screening is a very effective way of preventing cervical cancer. The American Cancer Society recommends that all women begin cervical cancer testing three years after they start having sexual intercourse. You should continue testing annually (or every two years if the newer, liquid-based Pap test is used) until age 30. After that, you should follow the guidelines for your specific risk category, especially women at higher risk for the disease.

The best way to prevent the pre-cancerous conditions that lead to cervical cancer is to avoid HPV exposure. That can be accomplished by delaying first intercourse, having few sex partners, and avoiding sex with uncircumcised males. In the U.S., another option – for both girls and boys – is to get vaccinated against HPV infections. Vaccines like Gardasil® and Cervarix® are FDA approved, and offer protection against the viruses that lead to the most severe strains of cervical cancer. Both vaccines are most effective when given to pre-teens who have not yet become sexually active.

Treatment

Cervical cancer is usually treated by surgery (and lymph node dissection), often combined with radiation and chemotherapy. Surgical options for pre-cancerous cells include cryosurgery (freezing the abnormal cells); laser surgery (burning the cells), and conization (removing a cone-shaped section). For more advanced cancers (Stage I or later) and for some pre-cancers as well, a hysterectomy is performed. That involves removing the entire uterus, but generally not the ovaries and fallopian tubes. A procedure known as a radical trachelectomy removes the cervix and the upper part of the vagina; the body of the uterus remains, allowing younger women to retain their childbearing ability.

In cases where lymph nodes test positive for cancer, low-dose or high-dose radiation may be used. Radiation often works better when applied with chemotherapy, but the combination tends to worsen the side effects.

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