Cervical Cancer

Cervical Cancer

What is cervical cancer?

Cervical cancer is a malignancy of the cells lining the sur- face of the cervix. Cervical cancer usually develops slowly over many years. It is most common in women in their 40s but affects women in a wide age range. If left undetected or untreated, it can spread to other organs and cause death. However, if caught early, especially in the pre-cancerous stage, complete cure is the rule.

What is a Pap test?

Pap test

The Pap test (also called the Pap smear) is a quick and sim- ple test used to check for changes to the cells of the cervix that may lead to cervical cancer. It is named after George Papanicolaou, a physician who pioneered this technique. No cancer screening test in medical history is as effective for early detection of cancer as the Pap test. Since its introduc- tion, death rates from cervical cancer have decreased by more than 70%. Unfortunately, thousands of women still fail to have annual Pap tests. And sadly, of those women who do die of cervical cancer, 80% have not had a Pap test in five years or more.

Who should have a Pap test?

Pap test

Every woman should have an annual Pap test as part of a complete pelvic examination beginning when she becomes sexually active or reaches 18 years of age, whichever is earlier, and continuing for the rest of her life. This includes women who are divorced or widowed, those who have had a hysterectomy (if they still have a cervix), and those who have gone through menopause (who have stopped their periods). Menopause does not protect women from cervical cancer. In fact most cases of cervical cancer occur in women older than 40 years.

How is a Pap test performed?

Pap smears consist of cells removed from the cervix which are specially prepared for microscopic examination. The cells are removed by scraping or brushing the cervix during a pelvic examination. The removed cells are evenly spread on one or more glass slides. The slides are then sent to the laboratory to be stained, examined under a microscope, and interpreted.

What preparations are required?

To ensure that the cells your doctor obtains during the ex- amination are adequate for evaluation, you should:

  • Scheduleyour test at the optimum time - two weeks af- ter the first day of your last menstrual period (LMP), not during the time of active bleeding. If you have reached menopause, you can schedule your Pap test 
  • Do not use vaginal medications, creams,contraceptive foams, or douches for 72 hours prior to the 
  • Abstain from intercourse for 24 hours before the exam.
  • Provide your doctor pertinent information such as the dates of your last menstrual period, any medication in- cluding hormones, prior surgical procedures, history of a prior abnormal Pap test and symptoms such as bleed- ing after intercourse or post menopausal bleeding, dis- charge, itching, or pain.

What causes cervical cancer?

Although the exact cause is uncertain, research has shown that there are several risk factors that predispose to cervical cancer. Among others, these include:

  • Infectionwith the Human Papilloma Virus (HPV)
  • Smoking
  • Compromised immunestatus
  • Women who become sexually active or have their first pregnancy at anearly age

What do the results mean?

Pap test

Most Pap test results are normal. A small number show changes in the cells of the cervix but most of these changes are minor infections which can be easily treated or clear up naturally. In a very small number of cases the changes may develop into cervical cancer if left untreated. The medical name for these changes is CIN, which stands for Cervical Intra-epithelial Neoplasia. They are also sometimes known as cervical dysplasia. All this means is that the cells are irregularly shaped or abnormal.

When the abnormal cells are looked at under a microscope, they are divided into three categories. This makes it easier for the doctor to decide on the best form of treatment for you.

CIN 1 or Mild Dysplasia - only one third of the thickness of the covering layer of cervix is affected.

CIN 2 or Moderated Dysplasia - two thirds of the thickness of the covering layer of the cervix is affected.

CIN 3 or Severe Dysplasia - the full thickness of the covering layer of the cervix is affected. CIN 3 is also known as carci- noma-in-situ. Although this sounds like cancer, CIN 3 is not cancer of the cervix. However, it is important that it is treated as soon as possible.

With all three grades of CIN, often only a small part of the cervix is affected by abnormal changes. It is only when the cells below the surface layer of the cervix are penetrated that cancer of the cervix is considered to have developed.

Further tests

Many smears showing CIN 1 return to normal on their own, so you may just require a further smear test in a few months. If your second smear still shows abnormal cells, and in cases

of CIN 2 or 3, the next step in the line of investigations is colposcopy. For this, the doctor uses an instrument (like a

pair of binoculars on a stand) which provides a magnified view of the cervix. During colposcopy, a small sample of

tissue (a biopsy) may be taken and sent to the laboratory for testing.

Depending on the extent and nature of any abnormality, various methods are used to remove abnormal cells from the cervix. All these are very successful and, if any is required, your doctor will discuss them with you.

Your responsibility

The good news is that cervical cancer is preventable and curable if detected early. Regular screening and early detection are the keys to preventing the development of invasive cervical cancer. Do your part and make an annual Pap and pelvic examination an essential part of your health care. It could save your life.

What are the symptoms of cervical cancer?

During the early stages where changes in the cells might lead to cancer, there are no obvious signs or symptoms. The only way in which they can be detected is by having a Pap test.

In later stages, the most common symptom is abnormal bleeding, such as between periods or after intercourse. Often there is also a smelly vaginal discharge, and discomfort during intercourse. In women who have had their menopause, there may be some new bleeding. Of course, there are many other conditions that can produce these symptoms, but it is important that you see your doctor about them. The sooner you see your doctor and the diagnosis is made, the better the chance of treatment being successful.

What can I do to prevent cervical cancer?

Most importantly, have a yearly gynaecologic exam with a Pap test so that any pre-cancerous conditions and HPV infections will be detected. In pre-cancerous conditions, changes that occur in the cervical cells indicate that a cancer may develop. Treatment of these conditions can prevent cervical cancer.

What do the results mean?

Most Pap test results are normal. A small number show changes in the cells of the cervix but most of these changes are minor infections which can be easily treated or clear up

Normal (left) and abnormal (right) cervical smears

naturally. In a very small number of cases the changes may develop into cervical cancer if left untreated. The medical name for these changes is CIN, which stands for Cervical Intra-epithelial Neoplasia. They are also sometimes known as cervical dysplasia. All this means is that the cells are irregularly shaped or abnormal.

When the abnormal cells are looked at under a microscope, they are divided into three categories. This makes it easier for the doctor to decide on the best form of treatment for you.

CIN 1 or Mild Dysplasia - only one third of the thickness of the covering layer of cervix is affected.

CIN 2 or Moderated Dysplasia - two thirds of the thickness of the covering layer of the cervix is affected.

CIN 3 or Severe Dysplasia - the full thickness of the covering layer of the cervix is affected. CIN 3 is also known as carci- noma-in-situ. Although this sounds like cancer, CIN 3 is not cancer of the cervix. However, it is important that it is treated as soon as possible.

With all three grades of CIN, often only a small part of the cervix is affected by abnormal changes. It is only when the cells below the surface layer of the cervix are penetrated that cancer of the cervix is considered to have developed.

Further tests

Many smears showing CIN 1 return to normal on their own, so you may just require a further smear test in a few months. If your second smear still shows abnormal cells, and in cases

of CIN 2 or 3, the next step in the line of investigations is colposcopy. For this, the doctor uses an instrument (like a

pair of binoculars on a stand) which provides a magnified view of the cervix. During colposcopy, a small sample of

tissue (a biopsy) may be taken and sent to the laboratory for testing.

Depending on the extent and nature of any abnormality, various methods are used to remove abnormal cells from the cervix. All these are very successful and, if any is required, your doctor will discuss them with you.

Your responsibility

The good news is that cervical cancer is preventable and curable if detected early. Regular screening and early detection are the keys to preventing the development of invasive cervical cancer. Do your part and make an annual Pap and pelvic examination an essential part of your health care. It could save your life.