JANURARY is Cervical Cancer Awareness Month. Cervical cancer is discussed more frequently in connection with HPV, the HPV Vaccine as well as other risk factors. However, the every day common questions surrounding Cervical Cancer has little to do with HPV, or the HPV vaccine. As a physician, the text book questions are typically expected, but thanks to you, I have realized over the years that the questions we expect, are not typically the questions you may have. Who would expect “reality” questions about same sex partners, number of sexual partners, location of the cervix, etc.,?
Thank you for your questions regarding Cervical Cancer sent to Ask@Q4CD.com. Be sure to visit our upcoming Events for information on future blogs HERE and submit your questions in advance, based on upcoming blogs.
Keeping the main question in focus, here a few of the top questions we received at Q4CD.com;
By answering these questions, the basic information about cervical cancer will be understood. But first, Bottom Line Up Front (cannot get away from my days of living military acronyms;)
Cervical cancer is a dangerous disease. Although cervical cancer is not an aggressive type of cancer in its initial stage, it is best treated when caught in its early, or pre-cancerous stages. Diagnosing cervical cancer early, offers a better chance of recovery and it also means that you are less likely to have to undergo complex and uncomfortable treatment such as chemotherapy, radiation therapy, or radical hysterectomy (surgical removal of the uterus, fallopian tube, 1 or both ovaries, etc.,). The treatment can be very harsh and if not treated, cervical cancer can ultimately lead to a painful death. We do not want that to happen, so let’s learn what should be done. Now, before I dig into answering the 10 common questions, let’s start with understanding the basics. Knowledge is power…
My Easy Mental Visual: When engaged in intercourse, the penis enters the vagina (simple, I know, but stay with me). The vagina is ~7 inches long (usually between 4 -8 in). The Cervix is at the top, or end of the vagina. The cervix is between 2 organs; it is at the end/top of the vagina and the beginning (gateway) into the Uterus/womb (where babies develop). See illustration below. The cervix is where cervical cancer develops. (Note: Cervical is also used to describe the top part of the spine. The spine is divided into cervical (bones of the neck/vertebral body), thoracic (mid-back), lumbar (low-back), sacral spine (at the bottom) and coccyx (tail-bone). So why not just call it “Cervix Cancer” instead of “Cervical Cancer” and avoid the confusion?? Agreed, someone should change it…
Medical Description/Visual: Cervical Cancer begins on the lower part of the Uterus, called the cervix, the area that opens into the vagina. It is difficult for you to see on your own. It sits at the top of the vagina at a depth of about 3-7 inches. That is why your doctor uses a speculum to best visualize the cervix, because of the length of the vagina. Like other Cancers, cervical cancer occurs when abnormal cells on the cervix grows out of control. This video will help you understand the anatomy and how dysplasia can progress to cancer – Your pap smear is VERY important. Click HERE to watch this video illustration
Human PapillomaVirus (HPV) is a main cause of cervical cancer, but it is not the only thing that can cause cervical cancer. In fact, only certain strains/kinds of HPV, when combined with other risk factors (such as smoking, HIV infection, exposure to DES, chlamydia infection, etc.,) is more likely to cause cancer. You may read more about risk factors HERE
CDC noted that Human papillomavirus (HPV) is a known cause of cervical cancer, as well as some oropharyngeal, vulvar, vaginal, penile, and anal cancers. HPV DNA can be found in these specific tissue types. The natural history from HPV infection to pre-cancerous lesion to invasive cervical cancer is well established.
In the United States, HPV DNA has been determined through special studies and found in:
Read the entire study at this CDC link: Trends in Human Papillomavirus – Associated Cancers – United States 1999-2015
Pap Smear is a very important screening exam, as it used for detecting cervical cancer, but also used to diagnosed endometrial cancer (cancer of the uterus). The U.S. Preventative Services Task Force (USPSTF) recommends Pap smears between the ages of 21 to 65. Make sure you have a full understanding of what the pelvic exam entails, so that you are not surprised/caught off guard. A complete pelvic exam includes 4 parts (some women are surprised by #4, but it is sometimes a very vital part of the exam):
For an in-depth review of the pelvic exam visit the American College of Obstetricians and Gynecologists (ACOG) by clicking HERE. The frequency of the Pap smear exam also depends on whether the HPV test is done. See the USPTF recommendation summary below and read the full Cervical Cancer Screening document by clicking HERE
Reviews show that some types of HPV can be prevented in female ages 11-26 and in male ages 11- 21 with the vaccine. The timing and validity remains a hot topic for some parents. The synopsis of the recommendations are given below, but you may visit the CDC website for full review on the HPV vaccine, reasons to get vaccinated, possible side effects, safety and more by visiting HERE.
Yes. HPV is the most commonly sexually transmitted infection (STI/STD) in the United States and is often acquired soon after initiating sexual activity. Studies indicate that approximately 90% of new cervical HPV infections, including types that cause cancer, clear or become undetectable within 2 years, and those that do not clear take decades to progress to invasive cervical cancer. Less is known about carcinogenic progression of HPV-associated infection at other anatomic sites (mouth, anus, etc.,)
Yes and No. If you have never had any sexual contact – oral or otherwise – THEN NO (~90% certainty). There is no way for the HPV to travel from mouth, anus, cervix, vagina … to develop into cancer. However, remember that in the review above by CDC, only about 90% of cervical cancer was linked to HPC. Meaning, there is an ~10% chance that you may get Cervical Cancer that is not caused by HPV (nothing is absolute, or 100% in medicine. It is about reducing the common known risk). HPV can be in the mouth, so oral sex can lead to Cervical Cancer… and Oral Cancers too. SO YES, depending on your definition of sex, cervical cancer is still possible.
The simple answer is yes. Most Cervical Cancer is caused by HPV that is transmitted by sexual contact. However, there are many types of HPV and not all of them causes Cancer, some causes genital warts, while others causes no symptoms at all. Your body has the power to clear most infection, if no other risk factors are present. You can have HPV for many years and not know it. However, the dangerous form of HPV can also cause oropharyngeal (back of mouth), vulvar, vaginal, penile, and anal cancers. Which means, HPV can live on any of these organs. If your sexual interactions involve any of these organs, then you are at risk, not only for cervical cancer, but all the others listed on the CDC website.
Actually, you should not be expecting any symptoms at all. Routine evaluation is the key, when it comes to cervical cancer. If you are having symptoms, chances are the symptoms may be related to non-cancerous/benign entity. If symptoms are related to cervical cancer, then it is likely in an advance stage. However, the only way to find out is to visit your Primary Care Provider (PCP), or referral to a Gynecologist to learn more about what is going on with your body.
Use this 2 – week tracker of your symptoms and take with you to your appointment. This will help your Primary Care Provider (PCP) or Gynecologist understand your symptoms better. Be prepared for your appointment with this History and Physical preparation guide (click first red box to download guide). Print both these forms, fill out and take with you to your appointment – your triage Nurse will appreciate it, as less time with the nurse and likely more time with the Doctor as well!
There are some gynecological issues that produces symptoms not related to cancer. Again, remember self diagnosis is not the path to choose if there are questions, or doubts. Visit your PCP to be further evaluated. You can still use the 2- week tracker and the History and Physical downloads to record your symptoms. Some common diagnosis associated issues may include, but is not limited to:
If you are experiencing extremely painful periods, you might have endometriosis. This is not the normal period pain most women experience – it is debilitating and has been compared to the pain of childbirth and related pains. Endometriosis occurs when endometrial tissue that is shed during a normal menstrual cycle becomes inflamed and leads to growths or lesions. These are very painful and can cause infertility, among other issues. The main symptoms for endometriosis are extremely painful menstrual cramps, back pain during sexual activity, and often a difficulty conceiving a child naturally
It is possible that you have bad menstrual cramps without having endometriosis. This is a condition known as dysmenorrhea. Most women do have some sort of pain during menstruation, but it can have a wide range on the pain scale. The pain might also lead to symptoms you thought were PMS-related, but are from the pain, such as fatigue, nausea, and vomiting. Dysmenorrhea might be caused by other conditions, such as uterine fibroids, endometriosis, or infections, making it a secondary type of pain.
These are growths that appear on the uterus, but are not cancerous. They are not associated with uterine cancer, or even a risk of developing this type of cancer, but can cause issues like pain and bleeding. Typically, someone with uterine fibroids might have difficulty with long menstrual periods and heavy bleeding, leg pain, back pain, constipation, and frequent urination.
Known as PCOS, polycystic ovarian syndrome can also cause issues with your menstrual cycle and ability to get pregnant. When you have PCOS, it leads to a major imbalance of your hormones. You might have long or short periods, problems with getting pregnant, and physical changes like hair on your face and neck, or weight that you can’t seen to get rid of on your own, acne, etc.,
Low Sex Drive – If you are in pain from any the above, before or after your menstrual cycle, this could lead to low sex drive. Low sex drive may also be hormone related
It is VERY important to have annual Pap Tests, as this can find early changes in the cells lining the cervix before they turn into Cancer. Ask your daughter, your mother, your wife, your girlfriend … any young women in your life, “Did you get your pap test this year?” The guidelines have changed and annual exam is no longer required, IF your pap test is consistently negative for a number of years. Early cervical cell changes usually does not cause any symptoms. However, if it has progress to Cancer you may experience pain, or bleeding during sex, vaginal discharge tinged with blood (not associated with menstrual cycle), or bleeding and pain when applying a diaphragm to the cervix.
Yes (90% of the time) cervical cancer can be prevented, but the debate rages on… abstinence is one way. But even after marriage, if your spouse had HPV prior, what are your risk? This is a conversation beyond the scope of this article. However, decreasing your exposure risk to HPV is very important, can mostly be prevented as any other STD/STI – except for the oral part. Smoking cessation is vital as that can lead to cervical cancer as well as many other cancers and, of course, routine pap-smear. As always, I do encourage you to speak with your PCP. It is a conversation definitely worthwhile having, discussing ways you can personally decrease your risk
As it is with most cancers, the treatment for cervical cancer will depend on how far the cancer has spread. Treatments may include surgery, chemotherapy and radiation therapy. A multi-disciplinary (Multi-D) team consisting of Gynecologic oncologist (surgeon), medical oncologist, radiation oncologist, navigator, psycho-social support staff, etc., would provide information on the treatment process. Since you are reading this blog, it is my hope that you will never need a Multi-D team. But first, you will have to do your part … and if you do and cancer is in your cards, we are here for you.
This only a quick synopsis. As always, the best way to find out about any health issue, is to engage/talk with your PCP/PCM. Continue to do your annual physical and visit sooner if there are any concerning changes or abnormalities.
Until next time know that,
Life is beautiful and God is awesome. And know, you are pure awesomeness!
Ipsa Scientia Potestas est ——— Knowledge itself is power!
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Queen, Your Family Friendly Cancer Doc!