Cervical Cancer
About the disease
The cervix is part of the reproductive system and is the lower, narrow part of the womb or uterus which forms a canal that opens into the vagina.
Cervical cancer is among the most common cancers affecting women’s reproductive organs but since the cells change so slowly screening through the Pap test has been very effective at improving survival rates. This disease is triggered through viruses, the most common being human papillomavirus, and spread through sexual contact.
About 150 Alberta women are diagnosed with cervical cancer every year with a 70 – 75 per cent survival rate.
Risk factors
Risk factors are determined by analyzing the numbers of patients with cancer in a larger population and trying to find differences in the characteristics or behaviors between those individuals who develop cancer and those who do not.
Other factors that may increase the risk of developing cervical cancer include:
- The most important risk factor is not having regular Pap smears. For information on Pap smear screening, go to Alberta Cervical Cancer Screening Program at www.cancerboard.ab.ca/accsp/
- Sexual history – the greater the number of sexual partners, the greater the risk
- Sexual activity before the age of 18 - immature cells may be more likely to develop precancerous change
- Other STDs – Chlamydia, gonorrhea, syphilis or HIVS/AIDS
- Immune system weakness or deficiencies
- Smoking doubles the risk
- Age – most cases occur in women between 35-55 years old
- Birth Control Pills – long term use of birth control pills – for more than five years – increases the risk
- Giving birth to many children
- Ethnicity – incidents are higher among black, hispanic and aboriginal women
Factors that may decrease the risk of developing cervical cancer include:
- Non-smoking
- Regular Pap tests
- Limited sexual partners
- Always using a condom
Genetic link
Genetics are not believed to be a factor in cervical cancer.
Detection and diagnosis
Cervical cancer produces few signs and symptoms in its early stages ; it is most commonly detected through a Pap test. Doctors take Pap smears as a simple part of an annual physical, removing cells from the cervix and then sending them to lab for examination under a microscope. The Pap test finds abnormal cells in the precancerous stage before they have invaded deeply and before they have converted to cancer cells. At this point the condition is rarely life-threatening and can usually be treated without hospitalization.
All women ages 18 – 69 who have ever had sexual intercourse should have an annual Pap smear. The Alberta Cancer Board is involved in the administration of the Alberta Cervical Cancer Screening Program (ACCSP). Their website at www.cancerboard.ab.ca/accsp/ provides information on Pap smear screening, precancer changes, and cancer.
If the disease has progressed it may produce vaginal bleeding after intercourse, between periods or after menopause and women may notice a watery, bloody vaginal discharge which smells badly. Other signs could be pain during intercourse or in the pelvis and lower back.
If there are indications of changes to the cells, the doctor may recommend a colposcopy, where the doctor uses a colposcope to see the cells of the vagina and cervix in detail. This procedure can be done in a clinic.
Colposcopy involves looking at the cervix under magnification after the application of certain solutions that highlight the abnormal cells.
Treatment
Treatment options for cervical cancer include surgery, chemotherapy and radiation therapy, sometimes in combination depending on the progression of the disease.
If the cancer is caught early or in the precancer state, before it invades the deeper tissue, it can often be treated on an outpatient basis.
Conization is simple surgery which removes a cone-shaped section of the abnormal tissues.
Treatments available for precancer changes on the cervix that have been picked up by Pap smear and confirmed by colposcopy and biopsy include:
Laser surgery uses focused, narrow beams of light to kill precancerous or cancerous cells
LEEP or Loop Electrosurgical Excision Procedure uses electrical current running through a wire loop, which acts like a scalpel to remove the problem cells.
Cryosurgery freezes and kills abnormal cells with liquid nitrogen.
Treatment for cervical cancer:
Hysterectomy is major surgery to remove the cervix and the uterus and is often an option for younger women as it preserves one or both ovaries, maintaining estrogen production which is an important factor in bone strength. A simple hysterectomy is usually an option only when there is a microscopic lesion. A radical hysterectomy which removes the cervix, uterus, parts of the vagina and lymph nodes may be required when the invasion has progressed further.
Radical Trachelectomy may be an option for women with early-stage cancer who wish to have children in the future. The procedure removes the cervix and the lower part of the uterus, potentially leaving enough to the womb to allow carrying a child to term.
Radiation therapy, concentrated beams of high-energy X-rays, is sometimes used to shrink tumours and is the treatment of choice when the cancer can not be completely removed by surgery or when the patient is not fit to undergo major surgery . Usually radiation is used when the cancer has spread to other organs. The treatment will end ovarian production and trigger menopause.
Chemotherapy may be an option in conjunction with radiation. It is sometimes used alone for cancer which has spread to distant organs.
Links:
National Comprehensive Cancer Network (U.S.) guide to treatment decisions with links to other sites:
National Cervical Cancer Coalition (U.S.)
Gynecologic Cancer Foundation (U.S.)
Factors affecting prognosis
As with many cancers, early detection is the key to successful treatment and for that reason women who get a yearly Pap test are more likely to show good long-term results. The number of women diagnosed with cervical cancer has been steadily falling for several decades and researchers attribute the decline to the success of the screening program.
About 70 per cent of cervical cancer patients are alive after five years.
Learn more
Support for cervical cancer patients
- Psychosocial and spiritual support, Edmonton,
Cross Cancer Institute
- Phone: (780) 432-8703 or 8704
- Psychosocial and spiritual support, Calgary,
Holy Cross site of the Tom Baker Cancer Centre
- Compassion House
How you can help
Other Resources
Canadian Cancer Society - cervical cancer information
American Society of Clinical Oncology
Health Canada