What causes it and who gets it?
Listed below are some of the known risk factors for this cancer. Not all of the risk factors below may cause this cancer, but they may be contributing factors.
All women who have ever been sexually active (touching or intercourse) are at risk of cervical cancer.
Almost all cervical cancers are caused by certain types of the Human papillomavirus (HPV).
- There are more than 100 types of HPV and about 40 can infect the genital area. About 15 types of genital HPV can cause cervical cancer.
- HPV is one of the most common sexually transmitted infections (STIs). Most adults have HPV some time in their lives and it usually goes away within 24 months without any problem.
- In some women, the dysplasia (abnormal cells caused by HPV) does not go away. Over time these abnormal cells in the cervix can change into cervical cancer.
- Risk factors for HPV infection:
- Starting sexual activity at a young age
- Multiple sexual partners
- A sexual partner who has had multiple partners
- Not using condoms
Risk factors for HPV progressing to cervical cancer:
- Weakened immunity, for example because of HIV / AIDS, or drugs taken for an organ transplant
- Cervical cancer is probably not affected by heredity (family or genetic history).
- Cervical cancer can start to develop at a younger age than many cancers and affects women over a wide age range. Most women diagnosed with cervical cancer are between the ages of 30 and 60.
Can I help to prevent it?
- Limit the number of sexual partners you have
- Use condoms
- Don't smoke
- Vaccination for girls and women, prior to beginning sexual activity
- A vaccine is available that protects against two types of Human papillomaviruses that cause most cervical cancers.
- HPV vaccines protect against two high risk HPV types that cause most cases of cervical cancer.
The vaccination is given in a series of three doses and works best when given before contact with HPV. The vaccines may also benefit women who are sexually active and have not yet been infected with HPV. The vaccines prevent HPV infection but do not get rid of it once the infection occurs. In women who have never been infected with HPV, the vaccines:
- Protects against 7 out of 10 cases of cervical cancer
- Are safe, effective and have few side effects
- For more information, call your local public health unit or speak to your family physician.
Screening for this cancer
- Pre-cancerous and cancerous cells in the cervix can be found through routine physical exams that include a Pap test, the current method used for cervical cancer screening.
- The Pap test detects pre-cancerous changes in the cervix and cervical cancer before symptoms appear.
- Cervical cancer can be prevented from developing when abnormal cells are found and treated early through regular Pap test screening.
- When abnormal cells are removed before cancer develops, the cure rate is 100 percent.
For cancer limited to the surface tissue of the cervix, the cure rate is 80 to 90 percent.
Signs and symptoms
- Women with abnormal cells in the cervix and early stage cervical cancer often do not experience any symptoms.
As the cancer advances, the more common symptoms are:
- Spotting: spots of blood from the vagina, other than a normal menstrual period
- Bleeding after intercourse
Discharge: from the vagina, more or different than your usual
These are tests that may be used to diagnose this type of cancer.
Colposcopy is used to confirm the diagnosis from the Pap test
- The vagina and cervix are examined with a magnifying instrument called a colposcope
- The magnification allows for more accurate identification of the type and extent of the abnormal cells.
- Colposcopy clinics are located throughout the province
- Biopsy: removing the suspicious area (lesion, or tissue) so the cells can be examined with a microscope or other tests.
Other tests may be recommended by your doctor, possibly including:
- Blood tests at a lab
- Chest X-ray or CT scans
- Cystoscopy: viewing the bladder through a scope.
Sigmoidoscopy: viewing the lower intestine and rectum through a scope.
Types and stages
- Squamous cell cervical cancer account for about 75 percent of all cervical cancers
- Adenocarcinoma cervical cancer
- Other rare types (mixed adenosquamous carcinomas, small cell carcinomas)
Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general, a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.
T describes the site and size of the main tumour (primary);
N describes involvement of lymph nodes;
M relates to whether the cancer has spread (presence or absence of distant metastases).
Stage 0 Pre-cancer, or cancer limited to the surface tissue of the cervix. Sometimes called CIN, Cervical Intraepithelial Neoplasia.
Stage I Cancer limited to the cervix, growing into the underlying tissue, divided into sub-stages by size and / or spread within the cervix area.
Stage II The cancer extends beyond the cervix, into the upper vagina, but not into the pelvic wall.
Stage III The cancer is in the pelvic wall and/or the lower third of the vagina.
Stage IV The cancer extends beyond the pelvis into the bladder and rectum, or has moved into a distant site.
Cancer therapies can be highly individualized – your treatment may differ from what is described below.
Treatment by Stage
Stage 0 – pre-cancerous abnormal cells (dysplasia)
Patients go for colposcopy to assess the degree and extent of any abnormal cells in the cervix.
Loop Electrosurgical Excision (LEEP)
- A fine wire loop electrode is used to remove the abnormal cells.
- Done in a physician's office or clinic, with a local anesthetic.
- Increased but small risk of future pregnancy problems.
- A high-energy beam of light is used to vaporize the abnormal cells.
- Extremely precise and minimal effect on the surrounding normal tissue.
- Done in a clinic, without need for local anesthestics.
- Patients may experience a sensation of heat or warmth, but this passes rapidly as the procedure is completed.
- More rapid healing compared to other treatment methods.
- Unlikely to affect a woman's fertility or ability to carry a pregnancy.
- Not recommended during pregnancy.
- If a biopsy (sample) specimen is required, laser may not be recommended.
Cone biopsy (conization)
- A cone-shaped sample of tissue is removed from the cervix using a scalpel or laser.
- Used for treatment when the precancerous cells are too far up the cervical canal to be reached with other methods.
- Usually requires hospital day surgery, done under local anesthetic.
- Increased but small risk of future pregnancy problems.
- Surgical removal of the cervix, uterus and sometimes the fallopian tubes and ovaries.
- Chosen under certain circumstances, and for women who have other gynecological conditions, for which a hysterectomy is an appropriate treatment option, and who do not want to have future pregnancies.
Cryotherapy / cryosurgery is no longer used in BC as it has a higher long term risk of later cancer than laser or LEEP.
After treatment of pre-cancers (with laser, cone biopsy, LEEP):
- Patients may feel menstrual-like cramps after treatment. Aspirin, Ibuprofen or a similar mild pain medication can be used to relieve discomfort.
- There is usually a bloodstained or yellow-coloured vaginal discharge for several weeks following these procedures.
- To prevent infection while the cervix heals do not put anything into the vagina - no tampons, no douches. You should not have intercourse for several weeks following treatment.
- Contact your doctor if you have heavy bleeding, or bleeding with clots, fever, or persistent, increasing pain.
Stage I - IIa – Treatment will be tailored to individual patients depending on biopsy results
- Cone biopsy may be used for early stage cancer if future pregnancy is desired
- Simple hysterectomy
- Radical hysterectomy and removal of pelvic lymph nodes
- Radiotherapy may be the primary treatment or may be used with surgery.
- Radiation is directed at the cancer with an external beam, or from inside the body (brachytherapy, Selectron treatment).
Stage II, III, IV
Radiotherapy is usually the primary treatment (as above).
Further surgery may be considered if disease persists after radiation.
- Chemotherapy is an option when cancer re-occurs or has spread to other sites.
- Some chemotherapy drugs are used in combination with radiotherapy, as a radiation sensitiser (improves outcomes).