January is Cervical Cancer Awareness Month

by Jane Ashley

January is Cervical Cancer Awareness Month. Approximately 13, 240 cases of cervical cancer are diagnosed annually in the United States. Before the Pap smear, cervical cancer was a common cause of death in women. Pap smears have dramatically decreased the death rate from cervical cancer. 

Cervical Cancer Preventable

What is cervical cancer?

The cervix is the lower long, narrow part of a woman’s uterus. Cervical cancer begins slowly with abnormal cells appearing gradually. These abnormal cells are called dysplasia and are pre-cancerous. This is why regular Pap smears catch these abnormal cells before they become malignant. These abnormal cells can be treated at the earliest stage eliminating the risk of cancer.

There are two types of cervical cancer: 1) squamous cell carcinoma, about 80-90 percent of cervical cancer is this type, developing on the outside of the cervix, and 2) adenocarcinoma, which arises from the glandular cells lining the inside of the cervix.

Risk Factors

• Human papillomavirus (HPV) infection. Exposure to the HPV virus is the biggest risk factor for cervical cancer. There are more than 100 types of HPV, but HPV 16 and HPV 18 are considered high-risk HPV viruses and are responsible for about 5 percent of cancers worldwide, including cervical, anal, oropharyngeal along with rarer cancers like vaginal, vulvar and penile.
• Immune system deficiency. Women with weakened immune systems are more likely to develop cervical cancer. Our immune systems may be weakened by corticosteroids, receiving an organ transplant, treatments for other types of cancer or HIV.
• Herpes. Genital herpes are a risk factor.
• Smoking. If we smoke, we are twice are likely to develop cervical cancer.
• Age. This is usually a midlife cancer, most commonly diagnosed between the ages of 35 and 44. Women should begin having Pap smears every three years at age 20 and continue until they are 65.
• Socioeconomic factors. Women who have less access to healthcare are more likely to develop cervical cancer. African-American, Hispanic and American Indian women are at increased risk because of lack of screening by Pap smears.
• Oral contraceptives. Some research suggests that use of oral contraceptives may put women at increased risk.
• Exposure to diethylstilbestrol (DES). This drug was used to prevent miscarriages and was used between 1940 and 1970. Women who received DES need to have an annual pelvic examination and a 4-quadrant Pap smear where all four sides of the cervix are sampled.

Symptoms, Diagnosis and Staging

Precancerous cells seldom produce symptoms. Once women develop cervical cancer, they may experience one or more of the following symptoms.
• Bleeding or spotting between their period
• Heavier and/or longer periods.
• Bleeding after intercourse or douching.
• Vaginal discharge.
• Pain during sex.
• Post-menopausal bleeding.
• Back or pelvic pain that does not go away.

Tests to diagnose cervical cancer include:

• Pap smear.
• Pelvic exam.
• HPV typing.
• Biopsy.
• Imaging tests such as CT scan, MRI or PET scan.

The stages of cervical cancer dictate how aggressive treatment will be. Stages range from an uncomplicated Stage I (confined to the uterus), Stage II (confined within the pelvic area), Stage III (spread to the pelvic wall and may cause swelling of the kidneys), and Stage IV (spread to lymph nodes and distant organs).

Stay Strong And Beat Cervical Cancer

How is cervical cancer treated?

Treatment depends on the stage of our cervical cancer.

• Surgery. From simple procedures for cancer that is detected early to hysterectomy that may or may not require removal of the ovaries, there are many options. Younger women who want to preserve their fertility may want to consider a second opinion to help ensure that their fertility can be spared.
• Radiation. Radiation may either be from an external beam or internal through the use of radioactive implants. Sometimes, a combination is used. External radiation will induce menopause in pre-menopausal women.
• Chemotherapy. Chemotherapy is used most often for cervical cancer that has spread beyond the pelvis or for a recurrence. Sometimes, a low dose of chemotherapy is given while a patient is receiving radiation to increase the effectiveness of the radiation.

Can Cervical Cancer Be Prevented?

Regular Pap smears and/or HPV tests can detect precancerous cells before they turn into cancer. There should never be stigma associated with the connection between HPV and cervical cancer. Approximately 80 percent of all sexually-active men and women will contract the HPV virus sometime in their lifetime. About 79 million people in the U.S. are infected with the HPV virus at any given time – in many cases, there are no symptoms so many people are unaware that they have HPV. Symptoms can occur weeks, months or years after exposure.

Today, there is a HPV vaccine that will help prevent cervical cancer. Gardasil 9 is available in the U.S. and protects against HPV-16, HPV-18, and 5 other types of HPV linked with cancer. This vaccine is recommended for both boys and girls, ages 11 and 12, before they become sexually active.

Gadisil 9 Logo

Uncomfortable about having this conversation with your children or grandchildren? M.D. Anderson provides these tips about talking to your children about the HPV vaccine. The vaccine protects against cervical cancer as well as vulvar, vaginal, penile, anal and oropharyngeal (throat) cancers.

The Bottom Line …

Cervical cancer is one of the most preventable cancers. Every woman is encouraged to have a Pap smear every three years to detect early precancerous changes in their cervix. Parents should vaccinate their daughters and sons between the ages of 11 and 12 to help prevent HPV caused cancers.

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