Uterine and Cervical Cancer



Uterine And Cervical Cancer 2339
Photo by: Lisa F. Young

Uterine (YOO-te-rin) and cervical (SER-vi-kal) cancers are two cancers that occur in the reproductive tract of women.

KEYWORDS

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Human papillomavirus

Pap test

What Are Uterine and Cervical Cancer?

The uterus * is the hollow, pear-shaped organ in which a baby develops when a woman is pregnant. The cervix * is the lower part of the uterus, which extends into the vagina (va-JY-na), the canal that connects to the outside of the body. Uterine and cervical cancers occur when cells in a woman's uterus or cervix undergo abnormal changes and start dividing without control or order, forming tumors * .

How are uterine and cervical cancer similar?

Both types of cancer * begin in the uterus, but in different parts. Uterine cancer usually begins in the cells of the endometrium (en-do-MEE-tree-um), the thin layer of tissue that lines the inside of the main part of the uterus. That is why it is sometimes called endometrial (en-do-MEE-tree-al) cancer. Cervical cancer originates in the thin, flat cells on the surface of the cervix, the lower necklike portion of the uterus.

Both kinds of cancer are more common in women aged 50 and older, but they can occur at any age. Also, both types usually develop gradually, with some of the cells first undergoing precancerous changes. These cells are not yet cancerous, but they have undergone some abnormal changes that indicate that they could turn into cancer.

* uterus (YOO-te-rus) is the organ in females for containing and nourishing the young during development in the period before birth. Also called the womb.

* cervix (SER-viks) is the lower, narrow end of the uterus,

* tumors (TOO-morz) are new growths of tissue in which the multiplication of cells is uncontrolled.

* cancer is any tumorous (TOO-morus) condition, the natural (untreated) course of which is often fatal,

If they are not caught early, both types of cancer can grow through the wall of the uterus or cervix and spread to nearby organs. The cancer cells also can enter nearby lymph nodes * and be carried to other parts of the body.

How do uterine and cervical cancer differ?

Uterine and cervical cancer differ in many important ways: how frequently they occur, what causes them, and how likely they are to be detected early.

Uterine cancer is more common, affecting about 35,000 women each year. Cervical cancer affects about 15,000 women each year.

Doctors have been able to identify an important risk factor * for cervical cancer. Cervical cancer usually is caused by infection with a certain type of virus * called the human papillomavirus (pap-i-LO-ma-VY-rus), or HPV. This virus is transmitted during sex. Women who started having sex at an early age (usually in their teens), have had many sex partners, or have sex without using a condom increase their risk for HPV, and for developing cervical cancer. These behaviors also increase the risk of developing HIV, or human immunodeficiency (im-yoo-no-de-FISH-en-see) virus, which has also been identified as a cause of cervical cancer. Poor nutrition and smoking also may contribute to the development of cervical cancer.

Though the causes of uterine cancer are not fully known, cancer of the uterus occurs more frequently in those women who have an imbalance of reproductive hormones * , particularly estrogen (ES-tro-jen). Researchers still are trying to unravel the connection between estrogen and uterine cancer.

Perhaps the most important difference between the two types of cancer is that cervical cancer is much more likely to be caught early. About 50 years ago, a scientist named George Papanicolaou developed a simple method of examining tissue cells shed by an organ in the body. Doctors use this method, now called the Pap test or Pap smear, to examine cells scraped from the surface of the cervix under a microscope. They can tell whether the cells have undergone any of the abnormal changes that could develop into cancer, or whether cancer already is present in its earliest stage. When found early, cervical cancer is highly curable. Therefore, doctors recommend that women start having yearly Pap tests as soon as they start having sex or they reach age 18, whichever comes first. The Pap test is such a powerful tool because cervical cancer does not cause symptoms right away. As cervical cancer progresses, it usually causes abnormal bleeding from the vagina.

Uterine cancer also usually is curable if it is found early, but unfortunately there are no reliable routine tests for this disease (although a Pap test sometimes can detect early forms). Typically, it is found only after a woman experiences symptoms, such as unusual bleeding or other discharge from the vagina, pain or pressure, or weight loss.

* lymph nodes are round masses of tissue that contain immune cells that filter out harmful microorganisms.

* risk factor is something that is associated with the appearance of a disease.

* virus (VY-rus) is a tiny infectious agent that lacks an independent metabolism (me-TAB-o-lizm) and can only reproduce within the cells it infects.

* hormones are chemicals that are produced by different glands in the body. Hormones are like the body's ambassadors: they are created in one place but are sent through the body to have specific regulatory effects in different places,

How Is Cervical Cancer Diagnosed and Treated?

If doctors suspect that cancer is present based on Pap test results, they may wish to do further tests. One test is called colposcopy (kol-POS-ko-pee), which involves applying a vinegar-like solution to the cervix and then using a very thin lighted instrument to examine it closely. Doctors also may decide to remove a small amount of tissue from the cervix and have it examined under a microscope, a procedure called biopsy (BY-op-see).

Treatment depends on how abnormal the cells look. Some lesions * that have a close-to-normal appearance do not require treatment, but they do need to be checked regularly. Other growths, or tumors, that appear likely to develop into cancer may need to be removed. This often is done by using a special instrument to freeze them off, a procedure called cryosurgery (KRY-o-sur-jer-ee), to burn them off by cauterization (kaw-ter-i-ZAY-shun), or to direct high-energy laser beams at them. These procedures can destroy the abnormal areas without affecting nearby healthy tissue.

These procedures also may be used to remove tumors that definitely are cancerous but have remained on the surface of the cervix. If they have grown into the wall, surgeons either need to remove the tumor and the surrounding tissue, or they need to remove the entire uterus and cervix, an operation called a hysterectomy (his-ter-EK-to-mee). Surgery is the most common treatment for cervical cancer, but it also may be used together with radiation therapy and chemotherapy * . These treatments can help prevent the cancer from spreading, or they help destroy cancer cells that already have traveled to other parts of the body. Radiation therapy uses high-energy rays to damage cancer cells and stop them from growing. Chemotherapy involves giving powerful anticancer drugs either by injection into a vein or by mouth.

How Is Uterine Cancer Diagnosed and Treated?

If doctors suspect uterine cancer, based on a woman's symptoms and a physical examination, a biopsy is necessary to confirm the diagnosis. As with cervical cancer, the most common treatments are surgery, radiation therapy, and chemotherapy. Surgery involves removing the uterus and nearby reproductive organs such as the fallopian tubes * and ovaries * . Lymph nodes near the tumor also may be removed during surgery to see if they contain cancer.

After the treatment is finished, most women can lead normal lives. If their uterus was removed, however, they can no longer bear children. This often is not an issue for women in their fifties and sixties, but younger women in their twenties, thirties, and forties may find it hard to adjust to this reality.

How Can Cervical and Uterine Cancer Be Prevented?

Because cervical cancer is so closely connected with the sexually transmitted virus called HPV, not having sexual intercourse is an effective way to prevent HPV infection. Those who do have sex should always use a condom. Smoking should be avoided, and it is essential that women see their doctors yearly for an examination and a Pap test.

* lesion (LEE-zhun) is any sore, irregularity, or damaged tissue caused by illness or a wound.

* chemotherapy (kee-mo-THER-a-pee) is the treatment of cancer with powerful drugs that kill cancer cells.

* fallopian tubes (fa-LO-pee-an tubes) are two long slender tubes in females that connect the ovaries and the uterus. Typically, a fallopian tube is where conception takes place,

* ovaries (O-va-reez) are the organs in females that contain and release eggs (ova).

* menstrual (MEN-stroo-al) refers to menstruation (men-stroo-AY-shun), the discharging through the vagina of blood and tissue from the uterus that recurs each month in women of reproductive age,

The causes of uterine cancer are less clearly defined, and so it is difficult to say how it might be prevented. Women who have irregular menstrual * periods, which may mean that they have a hormonal imbalance, should be evaluated by a doctor. Hormonal treatment may reduce the risk of uterine cancer. As with other forms of cancer, eating a health-ful diet high in fruits and vegetables and low in animal fat, as well as

Anatomy of the female reproduction system showing cervical and uterine cancers.
Anatomy of the female reproduction system showing cervical and uterine cancers.
maintaining a proper body weight, seems to play some role in lowering the risk of developing it.

Ovarian Cancer

Cancer of the ovaries, the organs in women that produce eggs, is the most dangerous of the cancers that can form in the female reproductive system. Although it is generally treatable if caught early, it is not usually caught early. Unlike uterine cancer, it usually causes no symptoms until it is advanced. And unlike cervical cancer, which can be found with the Pap test, there is no screening test reliable enough to be recommended for all women.

Women at high risk, however, can be screened with a blood test and a sonogram, which uses sound waves to "see" inside the body. Such women include those with close relatives who have had ovarian cancer, those who have mutations in the breast cancer genes BRCA-1 and BRCA-2, and those who have had breast cancer.

When symptoms do occur, they can include swelling of the abdomen, gas, bloating, stomach and leg pain, and a feeling of pressure in the pelvis, as though the woman needs to go to the bathroom.

Diagnosis begins with various imaging procedures, but requires a biopsy, a surgical sampling of tissue, since noncancerous tumors also can occur in the ovaries. As treatment, the ovaries are removed and chemotherapy is usually given.

Can ovarian cancer be prevented? If a woman needs to have her uterus removed for another reason (through an operation called a hysterectomy) and she is past childbearing age, removing the ovaries as well is sometimes advised. Taking birth control pills over a period of years appears to decrease ovarian cancer risk, as does having children before age 30 and breastfeeding.

Resources

Book

Runowicz, Carolyn D., M.D., Jeanne A. Petrek, M.D., and Ted S. Gansler, M.D. Women and Cancer: A Thorough and Compassionate Resource for Patients and Their Families. New York: Villard Books, 1999.

Organizations

The National Cancer Institute (NCI), part of the U.S. National Institutes of Health (NIH), publishes What You Need to Know about Cancer of the Cervix and What You Need to Know about Cancer of the Uterus, which are available by phone or at its website.
Telephone 800-422-6237
http://cancernet.nci.nih.gov/wyntk_pubs/index.html

The American Cancer Society (ACS) posts information on cervical and uterine cancer on its website.
Telephone 800-227-2345
http://www.cancer.org

The National Cervical Cancer Coalition (NCCC) posts information about cervical cancer on its website.
http://www.nccc-online.org

See also
Cancer
Genital Warts
Tobacco-Related Diseases



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