KARACHI: Cervical cancer was once one of the most common causes of cancer death for American women. But over the last 30 years, the cervical cancer death rate has gone down by more than 50%. The main reason for this change was the increased use of screening tests. Screening can find changes in the cervix before cancer develops. It can also find cervical cancer early – in its most curable stage. Another way to prevent cervical cancer is to get vaccinated against human papilloma virus (HPV), which causes most cases of cervical cancer, says a report by American Cancer Society.
The American Cancer Society is actively fighting cervical cancer on many fronts. We are helping people get tested for cervical cancer, helping them understand their diagnosis, and helping them get the treatments they need. The American Cancer Society also funds new research to help prevent, find, and treat cervical cancer. Check out the links below to learn more about these activities.
Cervical cancer can often be found early, and sometimes even prevented entirely, by having regular Pap tests. If detected early, cervical cancer is one of the most successfully treatable cancers. Cervical cancer starts in cells lining the cervix. The cervix is the lower part of the uterus (womb). It is sometimes called the uterine cervix. The body of the uterus (the upper part) is where a fetus grows. The cervix connects the body of the uterus to the vagina (birth canal). The part of the cervix closest to the body of the uterus is called the endocervix. The part next to the vagina is the exocervix (or ectocervix). The 2 main types of cells covering the cervix are squamous cells (on the exocervix) and glandular cells (on the endocervix). The place these cell types meet is called the transformation zone. The exact location of the transformation zone changes as you age and with childbirth. Most cervical cancers start in the cells in the transformation zone.
These cells do not suddenly change into cancer. Instead, the normal cells of the cervix gradually develop pre-cancerous changes that turn into cancer. Doctors use several terms to describe these pre-cancerous changes, including cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL), and dysplasia. These changes can be detected by the Pap test and treated to prevent cancer from developing (see the sections, “The Pap (Papanicolaou) test” and “Work-up of abnormal Pap test results.”).
Cervical cancers and cervical pre-cancers are classified by how they look under a microscope. There are 2 main types of cervical cancer: squamous cell carcinoma and adenocarcinoma. About 80% to 90% of cervical cancers are squamous cell carcinomas. These cancers form from cells in the exocervix, and the cancer cells have features of squamous cells under the microscope.
Most of the remaining types of cervical cancers are adenocarcinomas. Adenocarcinomas are cancers that develop from gland cells. Cervical adenocarcinoma develops from the mucus-producing gland cells of the endocervix. Cervical adenocarcinomas seem to have become more common in the last 20 to 30 years.
Women with early cervical cancers and pre-cancers usually have no symptoms. Symptoms often do not begin until a pre-cancer becomes a true invasive cancer and grows into nearby tissue. When this happens, the most common symptoms are: Abnormal vaginal bleeding, such as bleeding after sex (vaginal intercourse), bleeding after menopause, bleeding and spotting between periods, and having longer or heavier (menstrual) periods than usual. Bleeding after douching, or after a pelvic exam is a common symptom of cervical cancer but not pre-cancer. An unusual discharge from the vagina – the discharge may contain some blood and may occur between your periods or after menopause.
These signs and symptoms can also be caused by conditions other than cervical cancer. For example, an infection can cause pain or bleeding. Still, if you have any of these problems, you should see your health care professional right away – even if you have been getting regular Pap tests. If it is an infection, it will need to be treated. If it’s cancer, ignoring symptoms might allow it to progress to a more advanced stage and lower your chance for effective treatment.
The American Cancer Society recommends that women follow these guidelines to help find cervical cancer early. Following these guidelines can also find pre-cancers, which can be treated to keep cervical cancer from forming. All women should begin cervical cancer testing (screening) at age 21. Women aged 21 to 29, should have a Pap test every 3 years. HPV testing should not be used for screening in this age group (it may be used as a part of follow-up for an abnormal Pap test).
Beginning at age 30, the preferred way to screen is with a Pap test combined with an HPV test every 5 years. This is called co-testing and should continue until age 65. Another reasonable option for women 30 to 65 is to get tested every 3 years with just the Pap test.
Women who are at high risk of cervical cancer because of a suppressed immune system (for example from HIV infection, organ transplant, or long term steroid use) or because they were exposed to DES in utero may need to be screened more often. They should follow the recommendations of their health care team. Women over 65 years of age who have had regular screening in the previous 10 years should stop cervical cancer screening as long as they haven’t had any serious pre-cancers (like CIN2 or CIN3) found in the last 20 years (CIN stands for cervical intraepithelial neoplasia and is discussed later in the section “Work-up of an abnormal Pap test result” under the heading “How biopsy results are reported”). Women with a history of CIN2 or CIN3 should continue to have testing for at least 20 years after the abnormality was found.
Women who have had a total hysterectomy (removal of the uterus and cervix) should stop screening (such as Pap tests and HPV tests), unless the hysterectomy was done as a treatment for cervical pre-cancer (or cancer). Women who have had a hysterectomy without removal of the cervix (called a supra-cervical hysterectomy) should continue cervical cancer screening according to the guidelines above. Women of any age should NOT be screened every year by any screening method. Women who have been vaccinated against HPV should still follow these guidelines.
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