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Article title: Cervical Cancer: NWHIC
Conditions: Cervical Cancer
What is cervical
What are the risk factors for developing cervical cancer?
What are the symptoms of cervical cancer?
What if abnormal cells are seen on my Pap smear?
What kind of attention do each type of cell abnormalities require?
What are the treatments for cervical cancer?
Cancer of the cervix, a very common kind of cancer in women, is a disease in which cancer (malignant) cells are found in the tissues of the cervix. The cervix is the opening of the uterus (womb). It connects the uterus to the vagina (the birth canal). Cancer of the cervix usually grows slowly over a period of time. Before cancer cells are found on the cervix, the tissues of the cervix go through changes in which abnormal cells begin to appear (a condition called dysplasia). Later, cancer starts to grow and spread more deeply into the cervix and to surrounding areas.
According to the National Cancer Institute, strong risk factors include early age at first intercourse, a history of multiple sexual partners, genital human papillomavirus infection (HPV) or other sexually transmitted disease (STD), and the presence or history of other genital tract abnormalities. Women age 60 and above are at greater risk for cervical cancer than are women in other age groups because these older women are less willing or able to seek medical care for early screening. One reason that many of these women do not get screened for cervical cancer is that they often don't view themselves as being at risk. Other risk factors include active or passive ("second-hand") smoking, poor nutrition, and a current or past sexual partner with risk factors for STDs, or HIV/AIDS.
There are no real symptoms of the early stages of cervical cancer. That is why is it is so important that your doctor does a series of tests regularly to look for it. The first of these is a Pap smear, which is done by using a piece of cotton, a brush, or a small wooden stick to gently scrape the outside of the cervix to pick up some cells that can be examined under a microscope. You may feel some pressure, but you usually do not feel pain. Most cervical cancers can be caught early with regular screening. (Connect to the Internet link for "Pap Smear" listed at the top of this FAQ for more information.)
Results from five to 10% of Pap smears performed each year on women in the United States are reported as abnormal. Abnormal cell types include:
ASCUS-atypical squamous cells of undetermined significance. Squamous cells are the thin flat cells that form the surface of the cervix.
LSIL-low-grade (early changes in the size, shape, and number of cells) squamous intraepithelial lesion. The word lesion refers to an area of abnormal tissue; intraepithelial means that the abnormal cells are present only in the surface layer of cells.
HSIL-high-grade squamous intraepithelial lesion. High-grade means that there are a large number of precancerous cells that look very different from normal cells.
ASCUS and LSIL are considered mild abnormalities. HSIL is more severe and has a higher likelihood of progressing to invasive cancer.
If the Pap test abnormality is unclear or minor, the doctor may repeat the test to ensure accuracy. If the Pap test shows a significant abnormality, the doctor may then perform a test called a colposcopy. For this test, the doctor uses a magnifying instrument to view the tissue surrounding the vagina and cervix to check for any abnormalities. A Schiller test may also be performed. For this test, the doctor coats the cervix with an iodine solution. Healthy cells turn brown and abnormal cells turn white or yellow. Both of these procedures can be done in the doctor's office. Finally, the doctor may also remove a small amount of cervical tissue for examination. This procedure is called a biopsy and is the only sure way to know whether the abnormal cells indicate cancer.
All doctors agree that women who show HSIL cells on their Pap tests should receive a colposcopy and, if necessary, a biopsy. However, there is no agreement among doctors about how to manage women who show ASCUS or LSIL cells. Most doctors either perform immediate colposcopy and, if necessary, biopsy, as for women with high grade lesions. Since low-grade cell changes in many women tend to go back to normal on their own, other doctors choose to wait and repeat the Pap smear every four to six months, then perform colposcopy if the abnormality is still present.
The National Cancer Institute is conducting a study called the ASCUS/LSIL Triage Study to help doctors determine how to best manage these two abnormal cell types in women. So far, results show that it is helpful for women with ASCUS cells to also be tested for HPV to see if their abnormalities need immediate attention. The study found that many women with ASCUS cells who tested positive for HPV had precancer, or rarely, cancer. A negative HPV test provided strong reassurance that precancer or cancer was not present.
Treatments for cancer of the cervix depend on the stage of disease, the size of the tumor, and a woman's age, overall physical condition, and desire to have children. Treatment for cervical cancer during pregnancy may be delayed, depending on the stage of the cancer and how many months of pregnancy remain. There are three kinds of treatment for women with cancer of the cervix:
surgery---removing the cancer in an operation;
radiation therapy---using high-dose x-rays or other high-energy rays to kill cancer cells;
chemotherapy---using drugs to kill cancer cells.
The National Cancer Institute recommends that doctors should strongly consider giving chemotherapy at the same time as radiation therapy for women with invasive cervical cancer. Five major studies showed that chemotherapy that includes the drug cisplatin, when given at the same time as radiation therapy, prolongs survival in women with this disease. Up to now, surgery or radiation alone has been considered standard treatment for this form of cancer.
You can find out more about cancer in women by contacting the National Women's Health Information Center (800-994-9662) or the following organizations:
National Cancer Institute's Cancer Information Service
Phone: (800) 422-6237
Internet Address: http://www.nci.nih.gov/
American Cancer Society
Phone: (800) 4-CANCER
Internet Address: http://www.cancer.org/
National Cervical Cancer Coalition
Phone: (800) 685-5531
Internet Address: http://www.nccc-online.org/
Publication Date: June 2001
This information was abstracted from the following fact sheets from the National Cancer Institute: Concurrent Chemotherapy and Radiation for Cervical Cancer - Questions and Answers; HPV Testing Shows Which Pap Abnormalities Need Attention; NCI ASCUS/LSIL Triage Study (ALTS); Questions and Answers About the Pap Test.
All material contained in the FAQs is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office on Women's Health in the Department of Health and Human Services; citation of the sources is appreciated.
Publication date: June 2001
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