Woman And Cervical Cancer

Human papillomavirus (HPV) infection of the cervix can lead to cervical cancer. A vaccine designed to prevent cervical cancer and other diseases caused by infection with HPVs was approved for use in the U.S. in June 2006. This is the first vaccine to be developed against a known risk factor for the development of a cancer.

While some HPV types infect the skin and cause benign warts and other lesions, about 40 types of HPVs can infect the genital tract. Genital HPV infection is very common in the general population; estimates suggest that up to 50% of all sexually active people will be infected at some point in their lives. In the majority of cases, the infection does not cause any symptoms, but in some women, HPV infection can progress to cause precancerous and cancerous lesions of the uterine cervix. HPVs that infect the genital area are also associated with other less common genital cancers in men and women such as cancers of the anus, vagina, penis, and vulva. HPV infection also causes genital warts in men and women.

The most common HPV types that infect the genital area are HPV types 6, 11, 16, and 18. Among these, HPV types 6 and 11 are most commonly associated with benign lesions, such as genital warts and mild precancerous changes of the cervix. In contrast, HPV types 16 and 18 are the types found in the majority of cancers as well as in severe precancerous changes of the cervix. The vaccine, called Gardasil, targets these four common HPV types.

Symptoms

Early cervical cancers usually don't cause symptoms. When the cancer grows larger, women may notice one or more of these symptoms:

• Abnormal vaginal bleeding

• Bleeding that occurs between regular menstrual periods

• Bleeding after sexual intercourse, douching, or a pelvic exam

• Menstrual periods that last longer and are heavier than before

• Bleeding after going through menopause

• Increased vaginal discharge

• Pelvic pain

• Pain during sex

Infections or other health problems may also cause these symptoms. Only a doctor can tell for sure. A woman with any of these symptoms should tell her doctor so that problems can be diagnosed and treated as early as possible.

Detection and diagnosis

Doctors recommend that women help reduce their risk of cervical cancer by having regular Pap tests. A Pap test (sometimes called Pap smear or cervical smear) is a simple test used to look at cervical cells. Pap tests can find cervical cancer or abnormal cells that can lead to cervical cancer.

Finding and treating abnormal cells can prevent most cervical cancer. Also, the Pap test can help find cancer early, when treatment is more likely to be effective.

For most women, the Pap test is not painful. It's done in a doctor's office or clinic during a pelvic exam. The doctor or nurse scrapes a sample of cells from the cervix. A lab checks the cells under a microscope for cell changes. Most often, abnormal cells found by a Pap test are not cancerous. The same sample of cells may be tested for HPV infection.

If you have abnormal Pap or HPV test results, your doctor will suggest other tests to make a diagnosis:

Colposcopy: The doctor uses a colposcope to look at the cervix. The colposcope combines a bright light with a magnifying lens to make tissue easier to see. It is not inserted into the vagina. A colposcopy is usually done in the doctor's office or clinic.

Biopsy: Most women have tissue removed in the doctor's office with local anesthesia. A pathologist checks the tissue under a microscope for abnormal cells.

Punch biopsy: The doctor uses a sharp tool to pinch off small samples of cervical tissue.

LEEP: The doctor uses an electric wire loop to slice off a thin, round piece of cervical tissue.

Endocervical curettage: The doctor uses a curette (a small, spoon-shaped instrument) to scrape a small sample of tissue from the cervix. Some doctors may use a thin, soft brush instead of a curette.

Conization: The doctor removes a cone-shaped sample of tissue. A conization, or cone biopsy, lets the pathologist see if abnormal cells are in the tissue beneath the surface of the cervix. The doctor may do this test in the hospital under general anesthesia.

Removing tissue from the cervix may cause some bleeding or other discharge. The area usually heals quickly. Some women also feel some pain similar to menstrual cramps. Your doctor can suggest medicine that will help relieve your pain.

Medical Author: Melissa Conrad Stöppler, MD

Medical Editor: William C. Shiel Jr., MD, FACP, FACR