Cervical cancer often has no symptoms. This is especially true in the early stages of disease, when the cancer is most treatable. Therefore, it is extremely important for women to have routine Pap tests to detect early, precancerous cellular changes.
The American Cancer Society recommends that all women have a yearly Pap test starting at age 18 or at the age they become sexually active. Some clinicians think that if the results are normal for 3 years in a row, Pap tests need to be performed only every 2 to 3 years. Older women should continue to have Pap tests because a large percentage of deaths from cervical cancer occur in women aged 65 and older. Pap smears are not needed in women who have had a hysterectomy that involved removal of the cervix. Women who have had a total hysterectomy should still receive routine gynelogical care to detect other problems, however.
When symptoms do occur with cervical cancer, they include abnormal vaginal bleeding and pelvic pain Table 01.
Spotting between periods or bleeding after sex may occur with cervical cancer, but these symptoms may also be signs of other diseases or infections. Abnormally heavy bleeding during menstrual periods or bleeding after menopause could suggest cervical cancer. Unusual vaginal discharge is another possible symptom. In advanced-stage cervical cancer, pelvic pain, problems urinating, and swelling in the legs may occur as the tumor grows and presses on the blood and lymph vessels of the pelvis.
Because diseases other than cervical cancer can cause any of these symptoms, women experiencing them should consult a physician Table 01.
Table 1. Early Signs and Symptoms of Cervical Cancer
Bleeding or spotting between periods Bleeding after sexual intercourse Abnormal vaginal bleeding, especially irregular heavy bleeding Bleeding after menopause Unexplained vaginal discharge, particularly when it is thick or foul-smelling Pelvic (lower abdominal) pain Pressure on bladder or rectum Unexplained bladder irritation
Human papillomavirus (HPV) is the biggest risk factor for cervical cancer. HPV is a sexually transmitted disease (STD). Women often do not realize they are infected with HPV.
Infection with certain types of HPV, the virus that causes genital warts, greatly increases the likelihood of cervical cancer. Not all types of HPV lead to cervical cancer, and not every woman who has cervical cancer is infected with HPV. Studies performed by the United States government indicate that 6 million American women are infected with HPV but that only 15,000 women in the country are diagnosed with cervical cancer yearly.
Women who started having sex at a young age (before age 18) or who have had multiple sexual partners are at increased risk for contracting HPV, a risk factor for cervical cancer.
Having sex at an early age and having multiple sex partners are risk factors for any STD, including HPV. The sexual history of a woman's partner is also important. A woman is at increased risk if her sexual partner has had multiple partners, is infected with HPV, or has had a partner with cervical cancer.
Women who smoke are at increased risk for cervical cancer.
Women who smoke are at least twice as likely as women who don't smoke to get cervical cancer. Tobacco smoke contains chemicals that harm many tissues in the body. Even nonsmokers who are around cigarette smoke on a regular basis can have a higher risk of developing cervical cancer.
Women with weakened immune systems are at increased risk for cervical cancer. They also have a worse prognosis than other cancer patients if they develop the disease.
When the immune system is weakened, it becomes less able to find and destroy abnormal cells in the body, including cancer cells. Women who are taking drugs that suppress the immune system, such as women who have received an organ transplant, are at increased risk for cervical cancer. Women who are infected with HIV, the virus that causes AIDS, are also more likely to develop cervical cancer.
Women whose mothers took the drug diethylstilbestrol (DES) during pregnancy are at increased risk for a rare form of cervical cancer.
DES was prescribed to pregnant women between 1940 and 1971 to prevent miscarriage. A small number of women whose mothers were given this drug have developed a rare type of vaginal and cervical cancer called adenocarcinoma. Fortunately, the incidence of DES-related cancers is decreasing. This is because most of the DES-related cancers have arisen in women younger than 25 years of age, and virtually all before the age of 30 years.
Women who think they have been exposed to DES should inform their clinician and have a special type of Pap test performed yearly. Further information can be obtained from DES Action USA (
www.desaction.org) and DES Cancer Network ( www.descancer.org).
Other behaviors, such as diet, may play a role in cervical cancer.
Those whose diets are lacking in fruits and vegetables may be more likely to get many types of cancer.
The risk for cervical cancer increases with age.
Because full-blown cervical cancer typically takes years to develop, women between the ages of 35 and 50 are the ones who are most frequently diagnosed with the disease. However, women older than 50 and postmenopausal women are not protected from cervical cancer. Twenty-five percent of cervical cancer cases and 41% of deaths occur in women aged 65 and older.
At one point, researchers thought that celibate women such as nuns did not develop cervical cancer, but this is no longer considered true. Therefore, it is important for all women to get routine Pap smears throughout adulthood.
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