INTRODUCTION: Cervical cancer is a malignancy of the cervix uteri or cervical area. it is a carcinoma, typically made up of squamous cells, and is akin in some respects to squamous cell cancers of the head, neck and anus. These malignancies and cervical pre-cancers are classified by how they appear under a microscope.
In industrialized countries, the widespread use of cervical screening programs has reduced the cases of invasive cancer of the cervix by 50% or more. Human papillomavirus (HPV) infection is a necessary factor in the development of almost all cases of cervical cancer.
RISK: The most important risk factor in the development of cervical cancer is infection with a high-risk strain of human papillomavirus. Women who have many sexual partners (or who have sex with men or women who have had many partners) have a greater risk. The American Cancer Society provides the following list of risk factors for cervical cancer: human papillomavirus (HPV) infection, smoking, HIV infection, chlamydia infection, dietary factors, hormonal contraception, multiple pregnancies, exposure to the hormonal drug diethylstilbestrol (DES) and a family history of the disease.
Despite the development of an HPV vaccine, some researchers argue that routine neonatal male circumcision is an acceptable way to lower the risk of cervical cancer in their future female sexual partners. However, in men with low-risk sexual behaviour and monogamous female partners, circumcision makes no difference to the risk of developing the disease.
But having a risk factor, or even several, does not mean that you will get the disease. Several risk factors increase your chance of developing cervical cancer. Although these risk factors increase the odds of developing the disease, many women with these risks do NOT develop this disease. When a woman develops the cancer or pre-cancerous changes, it may not be possible to say with certainty that a particular risk factor was the cause.
when thinking about risk factors, it helps to focus on those that you can change or avoid (like smoking or human papilloma virus infection), rather than those that you cannot (such as how old you are and family history).
SYMPTOMS: Signs of advanced cervical cancer may include: no appetite, weight loss, fatigue, pelvic pain, back pain, leg pain, single swollen leg, heavy vaginal bleeding, leaking of urine from the vagina, and fracture of bones. Also, moderate pain during sexual intercourse and vaginal discharge are symptoms of the disease. HPV infection can be present for years without any symptoms.
TYPES: There are two main types of cervical cancers: squamous cellcarcinoma and adenocarcinoma. Although nearly all cervical cancers are either squamous cellcarcinomas or adenocarcinomas, other kinds of cancer also can begin in the cervix. These other kinds, such as melanoma, sarcoma, and lymphoma, occur more often in other parts of the body.
Certain forms of HPV are called “high-risk” types because they are often the cause of cancer of the cervix. More than 250 forms of human papilloma virus are acknowledged to exist (some sources indicate more than 200 subtypes). Together, HPV types 16 and 18 currently cause about 70% of infections. Human papilloma virus types 6 and 11 cause about 90 percent of genital wart cases. Different forms of HPVs cause warts on different parts of the body. Some forms cause common warts on the hands and feet. Other types tend to cause warts on the lips or tongue. Still other types of HPV may promote warts on or around the female and male genitalia and in the anal area.
TREATMENT: Treatment consists of surgery (including local excision) in the beginning stages and chemotherapy and radiotherapy in advanced stages of the disease. On June 15, 2006, the Food and Drug Administration approved the use of a combination of 2 chemotherapy drugs, hycamtin and cisplatin for women with late-stage (IVB) cervical malignancy.
Because of treatment, the five year relative survival rate for the earliest stage of invasive cancer of the cervix is 92%, and the overall (all stages combined) five year survival rate is about 72%. These statistics may be improved when applied to women newly diagnosed, keeping in mind that these outcome may be partially based on the state of treatment five years ago when the women studied were first diagnosed. With treatment, 80 to 90 percent of women with stage I cancer and 50 to 65% of those with stage II cancer are alive 5 years after diagnosis.
As the cancer metastasizes to other parts of the body, prognosis drops dramatically because treatment of local lesions is generally more effective than whole body treatments such as chemotherapy. Thirty-five percent of patients with invasive cancer of the cervix have persistent or recurrent disease after treatment. In most cases however the body’s immune system fights off the virus, and the infection goes away without any treatment.
CONCLUSION: The beginning stages of the malignancy may be completely asymptomatic. Types 16 and 18 are generally believed to cause about 70% of cases. Along with type 31, they are the prime risk factors for cancer of the cervix.
The medically accepted paradigm, officially recognized by the American Cancer Society and other organizations, is that a patient must have been infected with HPV to develop this form of cancer, and is therefore viewed as a sexually transmitted disease, however most women infected with high risk human papilloma virus will not develop the disease. There has not been any definitive evidence to support the claim that male circumcision prevents the disease, although some researchers say there is compelling epidemiological proof that men who have been circumcised are less likely to be infected with HPV.
Even though the pap smear is an effective screening test, confirmation of the diagnosis of this disease or pre-cancer requires a biopsy of the cervix. According to the US National Cancer Institute’s 2005 Health Information National Trends survey, only 40 percent of American women surveyed had heard of human papillomavirus (HPV) infection and only 20% had heard of its link to cancer of the cervix.
In 2008 an estimated 3,870 women in the USA will die of cancer of the cervix, and around 11,000 new cases are expected to be diagnosed. The American Cancer Society recommends that screening should begin approximately three years after the onset of vaginal intercourse and/or no later than 21 years of age.
The HPV test is a newer technique for cervical cancer triage which detects the presence of human papillomavirus infection in the cervix. Since more than 99% of invasive cervical cancers worldwide contain HPV, some researchers recommend that HPV testing be done together with routine cervical screening. HPV testing can reduce the incidence of grade 2 or 3 cervical intraepithelial neoplasia or cancer of the cervix detected by subsequent screening tests among women 32-38 years old according to a randomized controlled trial.
Figures suggest that cervical screening is saving 5,000 lives per year in the UK alone by preventing this disease. Worldwide, cancer of the cervix is the 5th most deadly cancer in women.