Cervical cancer

Alternative names:

cancer of the cervix; cervical neoplasm

Definition:

Cancer of the uterine cervix.

Causes, incidence, and risk factors:

Cervical cancer is the third most common type of cancer in women. Approximately 2-3% of all women over age 40 years will develop some form of cervical cancer. The average age at diagnosis is 45 years, but it has been noted in women 20-30 years old. The cause of cervical cancer is unknown; however, a number of predisposing factors (risk factors) have been identified. These include: multiple sexual partners, early onset of sexual activity (less than 18 years), or early childbearing (less than 16 years). Sexually transmitted diseases, specifically HPV (Human papilloma virus - genital warts), HIV infection, and genital herpes also appear to increase the risk of cervical cancer.

It is now known that women who were exposed to the drug DES (Diethylstilbestrol) in utero are at risk for developing certain rare vaginal and cervical cancers along with many other abnormalities of the uterine, cervical and vaginal tissues. DES is a drug that was once thought to prevent miscarriages. Unfortunately, the risks of taking DES were not known and between 1940 and the early 1970's many pregnant women received the drug in hopes of preventing any suspected miscarriages. Clinical studies have shown the risk of cancer among the daughters born to women who were taking the drug to be around 4 in 1,000.

The development of cervical cancer is gradual and may take many years. Initially, subtle changes occur in the superficial cells of the cervix. As these changes become even more abnormal they cause dysplasia, which is a premalignant condition of the cervix. The dysplasia can then progress to preinvasive cancer which invades only the outer layer of the cervix. Eventually the cancer spreads to the deeper layers, and ultimately, if untreated, to the other pelvic organs.

Routine Pap smears are very effective at detecting abnormal cells, but it is very easy to put off going to the doctor, especially when you aren't ill. There are no symptoms in the early stages of cervical cancer and frequently symptoms don't appear until after the invasive cancer begins to erode tiny blood vessels within the cervix. The absence of symptoms allows the unsuspecting person to postpone a much needed visit to the doctor. Proper treatment of cervical cancer that has progressed to this early stage (see stages listed in the signs and tests section) can save 80% of women. If, however, the cancer spreads to other organs before treatment is initiated, the survival rate drops significantly.