Cervical Cancer

By dr. Yudiartono

What is cervical cancer?

Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body. Cervical cancer is the third most common malignancy in women worldwide, and it remains a leading cause of cancer-related death for women in developing countries. Cervical cancer was once one of the most common causes of cancer death for American women. But over the last 40 years, the cervical cancer death rate has gone down by more than 50%. The main reason for this change was the increased use of the Pap test. This screening procedure can find changes in the cervix before cancer develops. It can also find cervical cancer early − in its most curable stage.

What causes cervical cancer?

Cancers can be caused by DNA mutations (gene defects) that turn on oncogenes or turn off tumor suppressor genes. Human papilloma viruses (HPV) cause the production of two proteins known as E6 and E7 which turn off some tumor suppressor genes. This may allow the cervical lining cells to grow too much and to develop changes in additional genes, which in some cases will lead to cancer. But HPV is not the only cause of cervical cancer. Most women with HPV don’t get cervical cancer, and certain other risk factors, like smoking and HIV infection, influence which women exposed to HPV are more likely to develop cervical cancer.

 

What Are the Risk Factors for Cervical Cancer?

Cervical cancer risk factors include:

  • Human papilloma virus (HPV) infection
  • Smoking
  • Having a weakened immune system (such as AIDS)
  • Chlamydia infection
  • A diet low in fruits and vegetables
  • Being overweight
  • Long-term use of oral contraceptives (birth control pills)
  • Having multiple full-term pregnancies
  • Being younger than 17 at your first full-term pregnancy
  • Economic status
  • Diethylstilbestrol (DES)
  • Having a family history of cervical cancer

 

What are the symptoms?

Abnormal cervical cell changes rarely cause symptoms. Physical symptoms of cervical cancer may include the following :

  • Abnormal vaginal bleeding, such as bleeding between menstrual periods, after sex, or after menopause.
  • Vaginal discomfort.
  • Pain during sex.
  • Malodorous discharge.

 

Can Cervical Cancer Be Prevented?

A well-proven way to prevent cervical cancer is to have testing (screening) to find pre-cancers before they can turn into invasive cancer. If a pre-cancer is found it can be treated, stopping cervical cancer before it really starts. Most invasive cervical cancers are found in women who have not had regular Pap tests. The virus that causes cervical cancer is spread through sexual contact. The best way to avoid getting a sexually transmitted infection is to not have sex. If you do have sex, practice safer sex, such as using condoms and limiting the number of sex partners you have.

If you are age 26 or younger, you can get the HPV vaccine, which protects against types of HPV that cause most cases of cervical cancer. Evidence suggests that HPV vaccines prevent HPV infection.  The following 2 HPV vaccines are approved by the FDA:

  • Gardasil : This quadrivalent vaccine is approved for girls and women 9-26 years of age to prevent cervical cancer (and also genital warts and anal cancer) caused by HPV types 6, 11, 16, and 18; it is also approved for males 9-26 years of age.
  • Cervarix : This bivalent vaccine is approved for girls and women 9-25 years of age to prevent cervical cancer caused by HPV types 16 and 18.