The cervix is the lower, narrow part of the uterus (womb) located between the bladder and the rectum. It forms a canal that opens into the vagina, which leads to the outside of the body.
Precancerous conditions of the cervix are identified as cells that appear to be abnormal, but are not cancerous at the present time. However, the appearance of these abnormal cells may be the first evidence of cancer that develops years later.
Precancerous changes of the cervix usually do not cause pain and, in general, do not cause any symptoms. They are detected with a pelvic exam or a Pap test.
Squamous intraepithelial lesions (SIL) is a term that refers to abnormal changes in the cells on the surface of the cervix.
According to the National Cancer Institute (NCI), changes in these cells can be divided into two categories:
If abnormal cells on the surface of the cervix spread deeper into the cervix, or to other tissues or organs, the disease is then called cervical cancer, or invasive cervical cancer. Cervical cancer occurs most often in women over the age of 40. It is different from cancer that begins in other parts of the uterus and requires different treatment. Most cervical cancers are squamous cell carcinomas and adenocarcinomas.
The mortality rates for cervical cancer have declined sharply as Pap screenings have become more prevalent. According to the American Cancer Society (ACS) about 11,150 cases of invasive cervical cancer will be diagnosed in the US during 2007. Some researchers estimate that noninvasive cervical cancer (also referred to as "carcinoma in situ") is nearly four times more common than invasive cervical cancer.
The following have been suggested as risk factors for cervical cancer:
Early detection of cervical problems is the best way to prevent cervical cancer. Routine, annual pelvic examinations and Pap tests can detect precancerous conditions that often can be treated before cancer develops. Invasive cancer that does occur would likely be found at an earlier stage. Pelvic examinations and Pap tests are the methods used to determine if there are cervical problems. Women who are or have been sexually active, or are age 18 or older, should have regular checkups, including a pelvic exam and Pap test.
According to the National Institutes of Health (NIH):
A pelvic exam and Pap test allow the physician to detect abnormal changes in the cervix. If an infection is present, it is treated and the Pap test is repeated at a later time. If the exam or Pap test suggests something other than an infection, a repeated Pap test and other tests are performed to determine the problem.
Women who have had a hysterectomy (surgery to remove the uterus, including the cervix) should ask their physician's advice about having pelvic exams and Pap tests.
Because certain strains of HPV have been found to cause most cases of cervical cancer, research efforts have focused on developing a vaccine against HPV. Two HPV vaccines have been developed, and clinical trials of these vaccines have been successful.
One of the vaccines, Gardasil®, was approved by the US Food and Drug Administration in 2006 and can protect women from HPV infections. It protects against four types of the HPV virus, including the two viruses that cause 90 percent of genital warts. Gardasil can only be used to prevent HPV infection before an abnormal pap test develops.
There is new evidence that Gardasil may also help protect against changes that can lead to vaginal, vulvar, and anal cancers.
Gardasil is administered as a series of three injections over a six month period. Recommendations for giving this vaccine are still being discussed but many professionals feel the vaccine should be given to girls before they become sexually active.
Symptoms of cervical cancer usually do not appear until abnormal cervical cells become cancerous and invade nearby tissue.
The symptoms of cervical cancer may resemble other conditions or medical problems. Consult a physician for diagnosis.
When cervical problems are found during a pelvic examination, or abnormal cells are found through a Pap test, a cervical biopsy may be performed.
There are several types of cervical biopsies that may be used to diagnose cervical cancer, and some of these procedures that can completely remove areas of abnormal tissue may also be used for treatment of precancerous lesions. Some biopsy procedures only require local anesthesia, while others require a general anesthesia. Several types of cervical biopsies include:
Specific treatment for cervical cancer will be determined by your physician based on:
Treatment may include:
LEEP or conization may also be used to remove abnormal tissue.
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