Human papilloma virus (HPV virus)
Most women who develop cervical cancer have been infected with a strain (sub-type) of the HPV virus. There are many strains of HPV virus. Some strains are associated with cervical dysplasia and cervical cancer. (Note: some other strains of HPV cause genital warts, common warts and verrucas. The strains of HPV which cause these common conditions are not associated with cervical cancer.)
The strains of HPV which are associated with cervical cancer seem to damage the cells which cover the cervix. This makes them more likely to become abnormal and turn into dysplastic cells which may later turn into cancerous cells. But note: most women who are infected with these strains of HPV do not develop cancer. This infection just increases the risk of developing cancer.
The strains of HPV virus associated with cervical cancer are nearly always passed on by having sex with an infected person. An infection with one of these strains of HPV does not usually cause symptoms. So, you cannot tell if you or the person you have sex with are infected with one of these strains of HPV.
Smoking
Chemicals from cigarettes get into the bloodstream and can affect cells throughout the body. Smokers are more likely than non-smokers to develop certain cancers, including cervical cancer. In particular, if you smoke and have HPV infection, the risk is compounded. (Chemicals from smoking may affect the immune system in some way to make you less resistant to the damaging effects of HPV.)
A poor immune system
For example, people with AIDS or people taking immunosuppressant medication have an increased risk. (The immune system helps to protect against HPV, and helps to destroy cells which become abnormal. If your immune system is not working fully, you are less able to deal with HPV infection and abnormal cells, and you are more at risk of developing cervical cancer.)
Users of the contraceptive pill
Possibly have a small increased risk.
What are the symptoms of cervical cancer?
You may have no symptoms at first when the tumour is small. As the tumour becomes larger, in most cases the first symptom to develop is abnormal vaginal bleeding such as:
An early symptom in some cases is a vaginal discharge, or pain when having sex.
All of the above symptoms can be caused by various other common conditions. But if you develop any of these symptoms, you should have it checked out by a doctor.医学全在线www.med126.com
In time, if the cancer spreads to other parts of the body, various other symptoms can develop.
How is cervical cancer diagnosed and assessed?
To confirm the diagnosis
A doctor will usually do a vaginal examination if you have symptoms which may possibly be cervical cancer. He or she may feel an abnormal cervix. If cervical cancer is suspected, you will usually be referred for colposcopy.
Colposcopy is a more detailed examination of the cervix. In this test, like a smear test, a speculum is gently put into the vagina so the cervix can be seen. The doctor uses a magnifier (colposcope) to look at the cervix in more detail. It takes longer than a normal smear test (about 15 minutes). During colposcopy it is usual to take a small piece of tissue from the cervix (biopsy). The biopsy sample is then examined under the microscope to look for cancer cells.
Assessing the extent and spread
If you are found to have cervical cancer then further tests may be advised to assess if the cancer has spread. For example, a CT scan, an MRI scan, a chest x-ray, an ultrasound scan, blood tests, an examination under anaesthetic of the uterus, bladder or rectum, or other tests. (There are separate leaflets which describe most of these tests in more detail.) This assessment is called 'staging' of the cancer. The aim of staging is to find out:
Exactly what tests are needed depends on the initial assessment, and the results of the biopsy. For example, the biopsy may show that the cancer is at a very early stage and remains just in the surface cells of the cervix (a 'carcinoma in situ'). This is unlikely to have spread (metastasised) and you may not need many other tests. However, if the cancer appears to be more advanced and likely to have spread then a range of tests may be needed.
Finding out the stage of the cancer helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis). See separate leaflet called 'Cancer Staging and Grading' for details.
What are the treatment options for cervical cancer?
Treatment options which may be considered include surgery, radiotherapy, chemotherapy, or a combination of these treatments. The treatment advised for each case depends on various factors such as the stage of the cancer (how large the cancer is and whether it has spread), and your general health.
You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side-effects, and other details about the various possible treatment options for your type of cancer.
You should also discuss with your specialist the aims of treatment. For example:
Surgery
An operation to remove the cervix and uterus (hysterectomy) is a common treatment. If the cancer is at an early stage and has not spread then surgery alone can be curative. In some cases where the cancer is at a very early stage, it may be possible to just remove the part of the cervix affected by the cancer without removing the entire uterus.
If the cancer has spread to other parts of the body, surgery may still be advised, often in addition to other treatments. For example, in some cases where the cancer has spread to other nearby structures, extensive surgery may be an option. This may be to remove not only the cervix and uterus but also nearby structures which may have become affected such as the bladder and/or rectum.
Even if the cancer is advanced and a cure is not possible, some surgical techniques may still have a place to ease symptoms. For example, to relieve a blockage of the bowel or urinary tract which has been caused by the spread of the cancer.
Radiotherapy
Radiotherapy is a treatment which uses high energy beams of radiation which are focussed on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. (There is a separate leaflet which gives more details about radiotherapy.)
Radiotherapy alone can be curative for early stage cervical cancer and may be an alternative to surgery. For more advanced cancers radiotherapy may be advised in addition to other treatments.
Two types of radiotherapy are used for cervical cancer, external and internal. In many cases both types are used.
Even if the cancer is advanced and a cure is not possible, radiotherapy may still have a place to ease symptoms. For example, radiotherapy may be used to shrink secondary tumours which have developed in other parts of the body and are causing pain.
Chemotherapy
Chemotherapy is a treatment of cancer by using anti-cancer drugs which kill cancer cells, or stop them from multiplying. See separate leaflet called chemotherapy for more details. Chemotherapy may be given in addition to radiotherapy or surgery in certain situations.
What is the prognosis (outlook)?
The outlook is best in those who are diagnosed when the cancer is confined to the cervix and has not spread. Surgery or radiotherapy in this situation gives a good chance of cure. For women who are diagnosed when the cancer has already spread, a cure is less likely but still possible. Even if a cure is not possible, treatment can often slow down the progression of the cancer.
The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer is likely to respond to treatment.
