Cervical cancer is diagnosed in more than 12,000 women per year in the United States. Until the 1950s, when the Papanicolou test, or Pap smear, was introduced, it was the leading cause of cancer death among women.
An estimated 99% of cervical cancers develop following exposure to certain strains of the sexually transmitted disease human papilloma virus (HPV), which often goes undetected in women and men. In 2006, an HPV vaccine was introduced that could be administered to young adults before they become sexually active, potentially preventing cervical cancer. Continuing research suggests the vaccine may also prevent other types of cancer.
Early cervical cancer often begins asymptomatically. However, symptoms may include abnormal vaginal bleeding, continuous vaginal discharge, or heavy periods of long duration. Advanced cervical cancer symptoms may include vague symptoms such as fatigue, weight loss, poor appetite, leg swelling, or back pain, or more specific discomfort such as bone pain, pelvic pain, or leaking urine or feces from the vagina.
Cervical cancer usually starts in squamous cells found on the surface of the cervix, the lower part of the uterus that connects to the vagina. Cervical cancer typically grows slowly and may begin as a precancerous condition called dysplasia or cervical intraepithelial neoplasia (CIN), meaning abnormal cell growth on the cervix surface lining. Left untreated, abnormal cells sometimes develop into cervical cancer. These changes cannot be seen with the naked eye, but a painless Pap smear can identify precancerous and cancerous cells.
A directed biopsy of the cervix called a colposcopy or a cone biopsy may sample tissue to confirm suspected cervical cancer. If cancer is found, a CT, MRI, or cystoscopy (where a special tube fitted with a small camera travels through the urethra into the bladder) may help determine if and where cancer has spread.
Treatment options for early cervical cancer include destroying cancerous cells through cryotherapy (freezing), laser therapy (burning with high-intensity light pulse instruments), and loop electrosurgical excision procedure (LEEP). For more advanced cases, hysterectomy, removal of pelvic organs, radiation, chemotherapy, or a combination of therapies may be suggested. As with all surgeries, there may be a risk of bleeding or infection.
Cervical cancer deaths remain high in the developing world, but are plummeting in the United States due to annual screening, preventive vaccines, early detection, and aggressive treatment of precancerous cells. The American Congress of Obstetricians and Gynecologists does not recommend screening for the disease in healthy women younger than 21 years, and states women 65 years or older with a history of normal Pap smears may discontinue cervical cancer screening.