Understanding cervical cancer

Cervical cancer begins in the cervix, the lower portion of the uterus that connects to the vagina, or birth canal. The American Cancer Society estimates that approximately 12,170 new cases will be diagnosed, and 4,220 women will die from cervical cancer in 2012. These numbers demonstrate a declining death rate, due largely to screening.

Causes
Cells replicate themselves so new, healthy cells can replace old ones. However, if cancerous cells develop, they will multiply at an unbridled rate.

Almost all instances of cervical cancer are caused by the human papillomavirus (HPV), which is a sexually transmitted infection. However, the Mayo Clinic noted that the majority of women with HPV never develop cervical cancer. This implies that other factors -- genetics, environment and lifestyle -- also play a role. Smoking, immunosuppression, chlamydia, poor diet and extensive oral contraceptive use were noted as risk factors by the American Cancer Society.

Symptoms
Early cervical cancer does not produce any detectable symptoms. David Rosi, oncologist at the Marjorie G. Weinberg Cancer Center, said, "Unlike breast cancer where a small lump is first detected, cervical cancer is dangerously deceptive in that it usually presents no signs in the earlier stages."

After progressing, however, symptoms begin to appear. The classic symptom taught in medical school is post-coital bleeding, but gynecologic oncologist Hyung Ryu of Mercy Medical Center, explained bloody or watery malodorous vaginal discharge is the most common sign. Ryu also said that the advanced disease "can present [itself] with pelvic or lower back pain which can radiate to the legs."

These signs could be caused by other conditions such as a vaginal infection, but you should visit a health care provider immediately to isolate the underlying cause.

Diagnosis
A primary doctor can usually diagnose (and even treat) pre- or early cancers. The first step is a screening test called a pap test, which detects abnormal lesions. Surgeon Daniel Tobias of Atlantic Health, said, "Pap tests allow us to detect cancers of the cervix that are asymptomatic and not visible to the naked eye."

This result prompts further tests: colposcopy, biopsy and endocervical scraping. During a colposcopy, the doctor opens the vagina with a device called a speculum and examines the cervix with a colposcope, an instrument with magnifying lenses. The doctor will apply an acetic acid to the cervix, making its details clearer.

If an abnormal area is detected, the doctor will perform a biopsy: the removal of a small piece of tissue for microscopic examination by a pathologist.

If the HPV infection cannot be seen with the colposcope at all, endocervical scraping will be administered. The doctor will inset a curette into the endocervical canal to scrape off a small amount of questionable tissue. Similarly to a biopsy, this tissue is sent to a laboratory for further analysis.

If she or he diagnoses an invasive cancer, you will need to see a gynecologic oncologist, a female reproductive system cancers doctor.

Treatment
One's treatment method will be largely determined by the stage of the disease. The basic treatments for cervical cancer are surgery, radiation therapy and chemotherapy. "Many patients with early stage cancer," said Tobias, "are curable with surgery alone."

The American Cancer Society has outlined the variety of surgeries for cervical cancer: cryosurgery, laser surgery, conization, hysterectomy, trachelectomy, pelvic exenteration and pelvic lymph node dissection.

If curing the cancer is not possible, your doctors will deliver palliative treatment, which aims to relieve your symptoms to extend your life and improve how you feel.