After decades of decline, the incidence of cervical cancer is again on the rise, especially in women under age 50. According to the American Cancer Society, about 80,000 women are now diagnosed with cervical cancer each year, but the malignancy is invasive in only 16,000 of these cases. (Invasive cancer may cause unusual vaginal bleeding, a watery discharge, and dull pelvic pain.) The remaining 65,000 have carcinoma in situ, an asymptomatic preinvasive condition. Cervical cancer most commonly develops between the ages of 40 and 55. Its precise cause is unknown, but factors linked to an increased risk include beginning sexual intercourse before the age of 18 and having multiple sex partners; contracting genital warts; and tobacco use. Some studies also suggest that use of oral contraceptives increases risk; others implicate a deficiency of folic acid.
Diagnostic Studies And Procedures
The best means of early detection is a pap smear, which all women should have at least every three years, and more often if they have any of the high risk factors listed above. In a pap test, a sample of cells is collected from the cervix and sent to a laboratory for evaluation. If abnormal cells are detected, colposcopy will usually be done to locate the site of the abnormal cells and biopsy them. This is achieved with the aid of a colposcope, a slender optical instrument with a light at the end to magnify the surface of the cervix and vagina. Fragments of cervix will be removed and studied by a pathologist (punch biopsy) to determine whether the cells show dysplasia, a change in tissue that may develop into carcinoma in situ or more invasive cancer.
In some cases of mild dysplasia, no treatment is given, but frequent pap smears and physical examinations are performed. More often, the abnormal tissue is destroyed using one of three methods: a freezing technique called cryosurgery; hot cauterization with an electrical probe; or laser surgery. Treatment of cancer depends upon its stage . Carcinoma in situ is sometimes treated with conization , which usually preserves a woman’s ability to have a baby. In other cases, radiation therapy or a hysterectomy may be advised, especially if a woman has completed her family or is past menopause. More extensive cervical cancer almost always requires surgery, often a radical hysterectomy. This operation may be followed up with radiation therapy. Occasionally, radiation precedes or substitutes for surgery. Radiation can be administered externally in the form of low dose X-rays, or internally as radioactive rods inserted into the vagina and uterus.
While there is no substitute for medical care of cervical cancer, acupuncture, meditation, and other relaxation therapies may be employed to control pain. More controversial is the use of garlic inserted into the vagina. Though it is said to have anticancer properties, it is highly irritating to mucous membranes.
After cryosurgery, use sanitary napkins, not tampons, to absorb discharge. Plan on at least six weeks to recover fully from a hysterectomy. In the mean time, avoid lifting heavy objects and any other activity that will put a strain on the incision. If constipation is a problem, use a stool softener. Following treatment for cervical cancer, check with your doctor before resuming sexual intercourse, although it is usually safe when healing is complete.
Other Causes of Cervical Symptoms
Polyps, infections, and chronic pelvic inflammatory disease can produce bleeding, pain, and other symptoms similar to those of cervical cancer.