Understanding cervical cancer

• Cervical cancer is a type of cancer that is caused by persistent infection with human papillomavirus or HPV, which is a group of common and contagious viruses that includes more than 100 different types.
  • More than 30 types of HPV are spread through sexual contact, and can be categorized into oncogenic (cancer-causing) or
    non-oncogenic types.
• Cervical cancer begins in the cervix and becomes gradually more invasive.
• Cervical cancer includes:
  • Squamous cell carcinomas (cancer that begins in epithelial cells, like the skin) comprise about 80-90 percent of all cervical cancers.
  • Adenocarcinomas (cancer that begins in glandular tissue) comprise the remaining 10-20 percent.
• According to the American Cancer Society, “Cervical precancers and early cancers usually show no symptoms or signs.”
  • Cervical cancer’s most common symptom is abnormal vaginal bleeding.
  • An unusual discharge from the vagina that occurs separate from menstrual cycles can be a symptom of cervical cancer, as well.
  • Bleeding also may occur after sexual intercourse, douching or a pelvic exam.
  • After menopause, symptoms may include vaginal bleeding or increased vaginal discharge.

Understanding HPV

• At least 80 percent of women will acquire a genital HPV infection by the age of 50.
• Although there are approximately 15 oncogenic HPV types, types 16, 18, 45 and 31 are responsible for 80 percent of all cervical cancers worldwide.
• HPV is typically transmitted by sexual activity, but does not depend on intercourse. It is spread through skin-to-skin contact.
• The majority of HPV infections clear within one-to-two years, although infections caused by oncogenic HPV can persist and lead to cervical cancer.

Prevalence and impact of cervical cancer

• Cervical cancer is the second most common cancer among women worldwide, resulting in an estimated 270,000 deaths each year.
• According to the American Cancer Society, approximately 11,150 women will develop cervical cancer in the United States in 2007, and nearly 3,700 will die from it.
• Cervical cancer deaths disproportionately occur in women of certain populations and geographic regions (e.g., African-American women in the South, Hispanic women along the Texas-Mexico border, white women in Appalachia, American Indians of the Northern Plains, Vietnamese-American women and Alaska Natives) in the United States.
  • Of the women in the United States who develop cervical cancer, about half have never had a Pap test and an additional 10 percent have not had a Pap test in the last five years.

Cervical cancer progression

• For every one million women who are infected with oncogenic HPV:
  • ≈ 100,000 will develop precancerous cervical cell changes
  • ≈ 8,000 will develop early cancer confined to the outer layers of the cervical cells
  • ≈ 1,600 will develop invasive cervical cancer
• Cervical cancer develops largely without a woman knowing, as there are typically no symptoms of pre-cancers and early cancers.
• It often takes many years for an oncogenic HPV infection to progress into cervical cancer, although some cancers, such as an adenocarcinoma, may develop more rapidly and are more difficult to detect.
• Oncogenic HPV infection is a necessary cause of cervical cancer, although the following risk factors also may contribute to cervical cancer progression:
  • Sexual activity at a young age
  • High number of pregnancies
  • Cigarette smoking
  • Long-term use of oral contraceptives
  • Other sexually transmitted infections (e.g., HIV and chlamydia)

Cervical cancer prevention and treatment

• The Pap test, also called a Pap smear, checks for abnormalities in the cells that line the cervix and is one of the best ways to detect cervical cancer in its early stages.
• The American Cancer Society recommends the following guidelines for the early detection of cervical cancer.
• If Pap test abnormalities are found, a colposcopy may be performed by a healthcare provider to determine the cause of the abnormalty. This procedure uses a colposcope which provides an illuminated, magnified view of the cervix and vagina.
• If Pap test results are slightly abnormal, an HPV test can help determine whether or not a woman needs to be further examined for abnormal cell changes through colposcopy.
• Pap tests can identify the presence of abnormal and precancerous cells on the cervix, which, if treated, may prevent possible progression to cervical cancer.
• HPV tests can identify the presence of the virus that causes these abnormal or precancerous cells.
• In the United States alone, the costs of an established screening program and the follow-up procedures after abnormal Pap tests are estimated to be $6 billion annually.

• There is now a vaccine available to protect women against cervical cancer.
• One vaccine was approved by the U.S. Food and Drug Administration in June 2006 for females aged nine to 26. This vaccine prevents infection from HPV types 16 and 18, which are responsible for approximately 70 percent of cervical cancer, and HPV types 6 and 11, which are responsible for approximately 90 percent of genital warts.
• A second vaccine was submitted for FDA review in March 2007. The FDA submission includes data for HPV types 16 and 18, as well as data for other HPV types that can cause cervical cancer.
• These vaccines are only used to prevent, not treat, cervical cancer.

• Types of surgery for cervical precancer may include the loop electrosurgical excision procedure (LEEP), laser surgery and cryotherapy (freezing abnormal cells).
  • During LEEP, which can be conducted in an office setting, a physician uses a thin electric wire loop to remove abnormal cells from the cervix.
• There are several different treatment options for patients with cervical cancer. The most common are surgery, chemotherapy and radiation, and in some cases the use of two or more methods works best.
  • Surgery: There are several different types of surgery used to remove abnormal cells, depending upon whether the cells are precancerous or invasive. In some instances, a hysterectomy may be performed. This is a procedure in which the uterus is removed and if the cancer has spread beyond the uterus, other organs such as the cervix, colon or rectum may have to be removed as well.
  • Chemotherapy: Treatment consists of a single drug or combination of drugs, given orally or by injection, to kill cancer cells. Once the drug or drugs enter the bloodstream they spread throughout the body. Side effects include upset stomach/vomiting, loss of appetite, temporary loss of hair, mouth or vaginal sores, anemia, fatigue, changes in menstrual cycle, onset of menopause and infertility. Most of the side effects will subside after treatment, except for menopause and infertility.
  • Radiation: This treatment involves the use of high-energy radiation from an external or internal source to kill or shrink cancer cells. Side effects include skin changes, fatigue, narrowing of the vagina, problems urinating and early onset of menopause.

Frequently asked questions

Translating medical “jargon”