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Cancer developing in the cervix, the narrow lower portion of the uterus that leads into the vagina, is known as cervical cancer. It is a very common type of cancer of the reproductive system in women, especially in the developing countries, although its incidence in the USA has decreased significantly in recent years. It can be detected in the very early or precancerous stage by routine Pap smear, when treatment can successfully cure the disease.

Most cervical cancers are caused by the human papilloma virus (HPV), which is transmitted by sexual intercourse. Vaccines are available which can prevent infection with some strains of HPV responsible for cervical cancer. Practicing safe sex by using condoms can reduce the chance of HPV infection and other sexually transmitted diseases.

Early cases are treated by surgery, while more advanced cancer is treated better with radiation therapy, chemotherapy, or a combination therapy.

Anatomy, Physiology and Pathophysiology

The uterus is a hollow pear-shaped organ consisting of the body above and a narrow lower portion known as the cervix, which leads into the vagina. The upper portion of the cervix towards the uterus is the endocervix, while the portion protruding into the vagina is the exocervix.

The endocervix is lined by columnar cells while the exocervix is lined by squamous cells. The area where the 2 cell types meet, the squamocolumnar junction or transformation zone, is where most cervical cancers originate. 80% to 90% of cervical cancers are squamous cell carcinomas. Almost all other cervical cancers are adenocarcinomas, arising from the columnar cells of the endocervix.

In the precancerous stage the cells are in the transition phase from healthy to abnormal cells. This stage is known as carcinoma in situ, cervical intraepithelial neoplasia (CIN), dysplasia, or squamous intraepithelial lesion (SIL). If detected at this stage, timely treatment can prevent precancerous lesions from developing into cancer.

Invasive cervical cancer may present as cauliflower-like exophytic growths, firm nodular growths, infiltrative growths, or ulcerative growths.

Causes and Risk Factors of Cervical Cancer

• Infection with certain strains of HPV, which is spread through sexual intercourse, is a very important risk factor for development of cervical cancer.
• Age – precancerous lesions are more frequently detected in younger women, while invasive carcinoma is more commonly diagnosed in older women.
• Genetic – women with close relatives, such as mother or sister, who had cervical cancer.
• Race – African American women are at higher risk than Caucasians.
• Multiple sexual partners.
• Low socioeconomic status.
• Multiple childbirths.
• Smoking.
• Immunocompromised women, such as those suffering from HIV/AIDS.
• Sexually transmitted diseases, such as chlamydia.
• Long-term use of combined oral contraceptive pills.
• Daughters of women who took the drug diethylstilbestrol (DES) during pregnancy.

Signs and Symptoms

In the precancerous stage and in early invasive cervical cancer, symptoms are rarely present. Symptoms of cervical cancer are usually late to appear and even when it does, it is of a non-specific nature which may occur in other conditions such as uterine cancer, vaginal cancer, uterine fibroids, polyps, and other growths.

The common signs and symptoms are :

• The most common symptom of cervical cancer is abnormal vaginal bleeding, such as heavy bleeding, intermenstrual bleeding, post-coital bleeding or spotting. Also, postmenopausal bleeding in older women.
• Increased vaginal discharge, which may be watery, blood stained, or purulent, with a foul odor.
• Painful sexual intercourse.
• Lower abdominal or pelvic pain.
• Abnormal weight loss.
• Excessive fatigue.
• Loss of appetite.
• Anemia.
• Urinary problems.
• Rectal bleeding and pain.
• Constipation.
• Swelling of the legs.
• A lump felt in the cervix.
• Stony hard cervix.
• Cauliflower-like growth in the cervix which bleeds on touch.

Prevention

• Effective screening programs with regular Pap tests for all women starting from the age of 20.
• Screening tests for HPV.
• Vaccination against HPV.
• Use of condoms to prevent HPV and other sexually transmitted infections.
• Limiting number of sexual partners.

Outlook

Most cervical cancers are slow growing, so early detection and treatment can result in a high survival rate. Carcinoma in situ is totally curable.