Cervical cancer is malignancy found on the cervix of the female reproductive system. The Human Papillomavirus is highly believed to be cause of approximately 50-80% of cervical cancers. HPV is contracted sexually and it is estimated that there is 75-90% risk to women in the United States of contracting this virus. More than 100 types of HPV exist and can be classified high, intermediate, or low based on risk for causing cervical cancer(1). Because of these statistics, this type of cancer is the third most common gynecological malignancy in American women(2). Risk factors include a higher number of sexual partners, early age of first sexual intercourse, pre-existing STD and HIV, and long term use of oral contraceptives(1). Other risks include smoking or exposure to smoke, history of sexual abuse, lower socioeconomic status, intimate partner abuse, and females whose mothers used the drug DES (diethylstilbestrol) during pregnancy(2). The American College of Obstetricians and Gynecologists’s recent recommendation for cervical cancer screening is to start screening at age 21 and to continue to do so every two years for women under the age of 30(3). The American Cancer Society recommends stopping screening at age 65 if women are not sexually active with multiple partners. It is also recommended that young women under the age of 26 should receive the HPV vaccination; however there are some risks involved. Also, this does not mean that there is no further need for HPV and cervical cancer screening as these vaccines only fight against 4 of the many strains of HPV(4).
Signs and symptoms of cervical cancer are often not evident until later in the disease’s progression. Advanced symptoms include painful intercourse, post-coital bleeding or bleeding during intercourse, and a watery, foul-smelling vaginal discharge. Symptoms of advanced cervical cancer can also include hemiparesis or headache. This can signal metastases to the brain(2).
The Pap test used by the gynecologist is the most conventional way to screen for premalignant lesions, however it cannot diagnose HPV. Newer, liquid based methods used, instead of using traditional smears of cells on a microscope slide, allow for detection of premalignant cells and HPV. Pap tests come back as either normal or abnormal. Abnormal tests are indicated by the presence of atypical squamous cells that need to be looked at more carefully. 60% of women who receive an abnormal pap are actually HPV negative and lack any cervical disease(1). Further testing is needed to determine the relevance of abnormal cell production. Often, women must see their gynecologist for a procedure called a colposcopy in which the cervix is looked at under a microscope and samples or biopsies are taken to determine if cancerous changes or HPV are present. If they are present, stages of these changes are assigned. The results of cervical biopsies are categorized into 6 categories: normal, cervical intraepithelial neoplasia grade 1 (CIN1), CIN2 or moderate dysplasia, CIN3 or severe dysplasia, carcinoma in situ, and invasive cervical cancer. All lesions that meet the criteria for category CIN2 and higher are considered to be a “high-grade” lesion(4). If only mild changes such as CIN1 are present, only monitoring may be needed due to spontaneous resolution in 50-70% of cases. A pap test or colposcopy is recommended every 6 months. Cryotherapy may also be used. Higher risk cases are treated with cryotherapy, laser ablasion, LEEP (use of a thin wire with an electrical current(1).