Servical cancer

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This topic talks about the testing, diagnosis, and treatment of cervical cancer. For general information about abnormal Pap test results, see the topic Abnormal Pap Test.

What is cervical cancer?

Cervical cancer occurs when abnormal cells on the cervix grow out of control. The cervix is the lower part of the uterus that opens into the vagina. Cervical cancer can often be cured when it’s found early. It is usually found at a very early stage through a Pap test.

What causes cervical cancer?

Most cervical cancer is caused by a virus called human papillomavirus, or HPV. You can get HPV by having sexual contact with someone who has it. There are many types of the HPV virus. Not all types of HPV cause cervical cancer. Some of them cause genital warts, but other types may not cause any symptoms.

You can have HPV for years and not know it. It stays in your body and can lead to cervical cancer years after you were infected. This is why it is important for you to have regular Pap tests. A Pap test can find changes in cervical cells before they turn into cancer. If you treat these cell changes, you may prevent cervical cancer.

What are the symptoms?

Abnormal cervical cell changes rarely cause symptoms. But you may have symptoms if those cell changes grow into cervical cancer. Symptoms of cervical cancer may include:

• Bleeding from the vagina that is not normal, or a change in your menstrual cycle that you can't explain.
• Bleeding when something comes in contact with your cervix, such as during sex or when you put in a diaphragm.
• Pain during sex.
• Vaginal discharge that is tinged with blood.

How is cervical cancer diagnosed?

As part of your regular pelvic exam, you should have a Pap test. During a Pap test the doctor scrapes a small sample of cells from the surface of the cervix to look for cell changes. If a Pap test shows abnormal cell changes, your doctor may do other tests to look for precancerous or cancer cells on your cervix.

Your doctor may also do a Pap test and take a sample of tissue (biopsy) if you have symptoms of cervical cancer, such as bleeding after sex.

How is it treated?

Cervical cancer that is caught early can usually be cured. If the cancer is caught very early, you still may be able to have children after treatment.

The treatment for most stages of cervical cancer removes the cancer and makes you unable to have children. These treatments include:

• A hysterectomy and removal of pelvic lymph nodes with or without removal of both ovaries and fallopian tubes.
• Radiation therapy.
• Chemotherapy.

Depending on how much the cancer has grown, you may have one or more treatments. And you may have a combination of treatments.

It’s common to feel scared, sad, or angry after finding out that you have cervical cancer. Talking to others who have had the disease may help you feel better. Ask your doctor about support groups in your area. You can also find people online who will share their experiences with you.

How to Weigh Your Breast Cancer Risk Factors

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Not all breast cancer risks factors have the same influence.

• "A family history will still drive [risk] much more powerfully than other reproductive risk factors—like having no children, having few children, or having children late," says Angela R. Bradbury, MD, director of the Margaret Dyson Family Risk Assessment Program at Fox Chase Cancer Center in Philadelphia.

• Having a first-degree relative such as a mother, sister, or daughter with a breast cancer history boosts your risk much more than if a cousin or more distant relative has had it—particularly if the diagnosis came before the age of 50 or your family’s background is Ashkenazi Jewish.

• Then there are the so-called breast cancer genes, BRCA-1 and BRCA-2. Mutations in these genes raise your risk even higher than the family connection alone. If you have relatives with breast cancer, you might be a candidate for BRCA testing or for other modifications to your screening for the disease. Make an appointment to talk through your options with your doctor or a genetic counselor.

What Causes Breast Cancer?

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No one knows very much about why breast cancer happens, except that it likely starts in our genes. "Cancer in general is a disease of aging, and breast cancer is probably caused by an error in gene replication—the older we get, the more error prone we get," says Ramona F. Swaby, MD, a medical oncologist specializing in breast cancer at Fox Chase Cancer Center in Philadelphia. Indeed, a woman’s chance of getting breast cancer doesn’t rise to the terrifying one in eight until she’s reached 85 years of age. If you’re a woman under 40, for instance, your risk is much lower: one in 233.

Approximatly 5% to 10% of the roughly 200,000 American women diagnosed with breast cancer each year have an inherited gene mutation that puts them at higher risk for developing the disease. Most of these genes remain unidentified, but scientists know that mutations to the BRCA-1 and BRCA-2 (Breast Cancer 1 and 2) genes, which normally help prevent cancer by regulating cell growth, are linked to an increased risk for breast and ovarian cancer.

If you’re wondering whether you carry the BRCA-1 or BRCA-2 mutations, you may have considered getting a genetic test to find out. That’s a tough decision, because it’s not always clear what to do with your test results. Some women who know they are at higher risk without taking the test simply commit to more frequent mammograms; others feel the need to know as much as possible and may consider prophylactic surgery if they test positive.

What African American woman need to know about breast cancer

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Even though breast cancer incidence rates are slightly lower overall among African-American women than white women (the incidence is lower still among Hispanic, Asian, and Native American women), a combination of socioeconomic factors and unexplained biological differences make the disease more deadly—and in some cases, harder to treat—in the black community. Also, African-American women under 45 have a greater incidence of breast cancer than white women in the same age range.

Many women are "triple negative"

No one yet knows precisely why, but African-American women are roughly twice as likely as white women to have triple-negative breast cancer—so called because tumor cells in this particularly aggressive form of the disease test negative for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2). This puts Herceptin and hormone therapies, such as tamoxifen and aromatase inhibitors, entirely out of reach as treatment options. It's suspected that some combination of genetics and environmental factors are at play in triple-negative disease.

Socioeconomic factors

The five-year survival rate for white women is approximately 90%; for African-American women it's roughly 77%. Differences in medical coverage and health-care access likely explain this. Overall, African Americans tend to have more trouble finding consistent, good-quality health care—which amounts to fewer breast cancer screenings and inferior treatment when they are diagnosed.

"Black women have been noted to present [at a doctor's office] with later stage cancer, which has a worse outcome—and they don't always get adequate care," says Ruth O’Regan, MD, associate professor of hematology and oncology and director of the translational breast cancer research program at Emory University's Winship Cancer Institute in Atlanta. Seeking medical help when a tumor is larger, higher grade, and/or with more lymph nodes involved can dramatically lower a woman's odds for survival.

Another potential problem for African-American women seeking treatment for breast cancer is that they have been underrepresented in chemotherapy breast cancer research, so it has been difficult to determine whether they might metabolize chemotherapy drugs differently from the primarily white research subjects. The issue is being actively researched now.

Breast cancer

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Breast cancer (malignant breast neoplasm) is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas.

Prognosis and survival rate varies greatly depending on cancer type and staging. Computerized models are available to predict survival. With best treatment and dependent on staging, 10-year disease-free survival varies from 98% to 10%. Treatment includes surgery, drugs (hormonal therapy and chemotherapy), and radiation.

Worldwide, breast cancer comprises 10.4% of all cancer incidence among women, making it the most common type of non-skin cancer in women and the fifth most common cause of cancer death. In 2004, breast cancer caused 519,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths). Breast cancer is about 100 times more common in women than in men, although males tend to have poorer outcomes due to delays in diagnosis.

Some breast cancers are sensitive to hormones such as estrogen and/or progesterone, which makes it possible to treat them by blocking the effects of these hormones in the target tissues. Estrogen and progesterone receptor positive tumors have better prognosis and require less aggressive treatment than hormone negative cancers.

Breast cancers without hormone receptors, or which have spread to the lymph nodes in the armpits, or which express certain genetic characteristics, are higher-risk, and are treated more aggressively. One standard regimen, popular in the U.S., is cyclophosphamide plus doxorubicin (Adriamycin), known as CA; these drugs damage DNA in the cancer, but also in fast-growing normal cells where they cause serious side effects. Sometimes a taxane drug, such as docetaxel, is added, and the regime is then known as CAT; taxane attacks the microtubules in cancer cells. An equivalent treatment, popular in Europe, is cyclophosphamide, 

methotrexate, and fluorouracil (CMF). Monoclonal antibodies, such as trastuzumab (Herceptin), are used for cancer cells that have HER2/neu overexpressed. Radiation is usually added to the surgical bed to control cancer cells that were missed by the surgery, which usually extends survival, although radiation exposure to the heart may cause damage and heart failure in the following years.