Cervical Cancer Diagnosis
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Cervical Cancer Diagnosis
You're probably reading this because your health care provider told you that your recent Pap test (sometimes called a Pap smear) showed cell changes in your cervix. Although it is quite common to feel uneasy about your Pap test results, it may comfort you to know that each year more than 3 million women receive similar results.
The good news is that almost always, women with cell changes do not have cancer of the cervix (also called cervical cancer). But it is important that you protect your health by getting the follow-up tests and care that your health care provider suggests.
Cell changes do not mean that you will get cancer of the cervix. And because your cell changes were found, simple tests or treatments can help you. When cell changes are found through cervical cancer diagnosis and treated early, almost all women can avoid getting cervical cancer.
Getting Your Questions Answered
So what is the next step? What do your results mean? Does this mean you need treatment and, if so, what kind? Here we help answer these questions and discuss:
Types of changes in your cervix
Cervical cancer diagnosis - Common tests and treatments
How to find the support and resources you need
You will probably have other questions, or you might be concerned about the choices you may need to make. These reactions are normal. But understanding your Pap test results--and what to expect when the results are not normal--can help you make informed decisions and plan your next steps.
The cervix is the narrow, lower part of the uterus (where the baby grows when a woman is pregnant). During a pelvic exam, the doctor or nurse practitioner can see the cervix at the upper end of the vagina.
The cervix has an opening to the endocervical canal. This opening lets blood flow from the uterus into the vagina during a woman's menstrual period. During childbirth, the cervix opens much wider to let the baby pass through.
The surface lining of the cervix is made up of two different types of cells:
Tall cells, called glandular cells (or columnar cells) toward the top of the endocervical canal (above the cervix). They make mucus, which helps guard the entrance to the uterus.
Thin, flat cells, called squamous epithelial cells (or squamous cells). Arranged in layers, they protect the tissues underneath them.
Pap tests can help health care providers find changes in these cells.
Common Changes in Cervical Cells
Cervical cells can go through many types of changes that are not cancer. Many times these changes will go away on their own. These changes can be caused by:
Inflammation (redness and swelling)
An infection (bacterial, viral, or yeast)
Growths such as benign polyps or cysts
Changes in hormones from pregnancy or menopause
These cell changes are very common and are not related to cancer. But they sometimes make these cells look like abnormal cells. So your health care provider may suggest that you repeat your Pap test or have other follow-up tests to be certain you don't have any cell changes. (See the tables beginning at Table 1 for more information.)
Although most cell changes in the cervix are not cancer, it is still important to get a Pap test at least once every 3 years to be sure.
Cell Changes Caused by HPV Are a Special Concern
Some cell changes are a sign of a certain viral infection called HPV (human papillomavirus). In most women, HPV infections go away on their own. Sometimes, the cells infected with HPV will become precancerous. These precancerous cells can become cervical cancer (called invasive cancer of the cervix). They can grow and spread, invading nearby tissues and possibly spreading throughout the body. An HPV test, which is done much like a Pap test, can detect the virus in cervical cells.
What is HPV?
It is a very common virus.
There are more than 100 types.
About 15 types can cause cervical cancer.
Some types cause warts on the fingers or feet but do not cause cancer.
Other types cause warts in the genital area that are not cancerous.
Other Risk Factors for Cervical Cancer
HPV is the most important cause of and risk factor for cervical cancer. But studies have shown that other factors may act together with HPV to increase your risk of developing cervical cancer. These factors include cigarette smoking and having given birth to many children. Also, if you have a weak immune system, you may be at higher risk because your body may not be able to clear up HPV on its own. For example, if you take medicine to block your body's immune response or if you have HIV, you may be at higher risk.
How Women Get HPV
Almost all HPV that affects the cervix is spread by sex (through intimate genital to genital contact including vaginal or anal intercourse, finger to genital contact, and finger to anal contact). It is rarely spread through oral sex. You are at higher risk of getting HPV if:
You have had more than one sex partner, or
Your sex partner(s) has had other partners.
If your health care provider finds you have HPV, your sex partner(s) should also get checked. They usually will have no symptoms. For more information about HPV and how to protect yourself, see the Resources section.
How Can I Tell if I Have HPV? And What Can Happen to Me if I Have It?
Most women with HPV of the cervix do not know they have it. Most of the time, it does not cause any symptoms. Certain types of HPV can cause warts on the outside of the genitals, but the only way to know for sure whether you have HPV is by seeing your health care provider.
Almost all HPV infections clear up on their own. Many women with HPV will have cell changes at least briefly within a few months to a year after getting the virus. Most types of HPV do not lead to cancer. But if HPV does not go away, you are more at risk of developing a precancerous change that needs to be treated. It is best to see your health care provider on a regular basis.
How Is an HPV Infection Treated?
Although HPV itself cannot be treated, the cell changes that it causes can be treated. Simple treatments that remove or destroy the cells may prevent cancer. This is why regular pelvic exams and Pap tests are important, along with care for cell changes.
If I Have HPV and It Goes Away, Can I Get It Again?
If you or your partner has HPV, you will share it until your bodies' immune systems get rid of the infection. If you have sex only with each other, you will not pass the HPV virus back and forth. This is because when the HPV goes away, the immune system will remember that HPV type and keep you from getting it again. Even though you are protected from one type of HPV, you are not protected from getting the many other types of HPV.
The Pap Test
The Pap test finds certain cell changes before they lead to cancer or cause you to have symptoms.
These cell changes can almost always be treated so that you don't get cancer of the cervix. Most changes in the cervix happen very slowly.
If the lab finds cell changes, the Pap test result is called "positive" or abnormal. If cells look healthy, the result is called "negative" or normal.
The Pap test is not always 100-percent accurate. If the test misses cell changes once, they can often be found the next time you have one. This is why it is very important that you have regular Pap tests. You should also go back to your health care provider for care if you get an abnormal result.
The Pap Test and DES
If you were born between 1940 and 1971, and your mother was given a synthetic form of the hormone estrogen called diethylstilbestrol (DES) when she was pregnant with you, be sure to tell your doctor. Your doctor will want to take additional cells to check for a rare type of cancer.
The HPV Test
Almost all cervical cancer begins as an infection with the virus called HPV. An HPV test, which is done much like a Pap test, can detect the virus in cervical cells.
Because health care providers know what causes most cervical cancers, it is important to get an HPV test if your health care provider recommends one.
How Is the HPV Test Done?
In an HPV test, a small number of cells is collected from the cervix, much like a Pap test. Sometimes this can be done at the same time as a Pap test. A lab then checks to see if HPV is present.
When Is an HPV Test Useful?
An HPV test can be useful in cervical cancer screening in two ways:
For women of all ages, an HPV test can be useful as follow-up to a Pap test with an unclear result of ASC-US (see Table 1).
If you are age 30 or older, an HPV test can be very useful if it is done together with a Pap test as a routine screening for cancer once every 3 years.
But if you are under age 30, getting an HPV and a Pap test together on a regular basis is not helpful. HPV tests can lead to unnecessary treatment, because HPV infection is very common in women under 30 and usually goes away on its own. This is why cervical cancer is very rare for women in this age group.
Here are some questions you may want to ask re cervical cancer diagnosis:
What do my test results mean?
What care is best for me?
Is this a test designed to help you learn more about the changes in my cervix? Or is it a treatment to cure the changes?
What are the possible results? Will I need more care afterward?
Are there any risks or side effects? How can I manage them?
Do I need to do anything special to prepare for this test or treatment?
Do I need to do anything special to care for myself afterward?
Will this affect my ability to get or stay pregnant?
Will my health insurance pay for the treatment you suggested?
If a woman has a symptom or Pap test results that suggest precancerous cells or cancer of the cervix, her doctor will suggest other procedures to make a cervical cancer diagnosis.
These may include:
Colposcopy: The doctor uses a colposcope to look at the cervix. The colposcope combines a bright light with a magnifying lens to make tissue easier to see. It is not inserted into the vagina. A colposcopy is usually done in the doctor's office or clinic.
Biopsy : The doctor removes tissue to look for precancerous cells or cancer cells. Most women have their biopsy in the doctor's office with local anesthesia. A pathologist checks the tissue with a microscope.
Punch biopsy: The doctor uses a sharp, hollow device to pinch off small samples of cervical tissue.
LEEP: The doctor uses an electric wire loop to slice off a thin, round piece of tissue.
Endocervical curettage: The doctor uses a curette (a small, spoon-shaped instrument) to scrape a small sample of tissue from the cervical canal. Some doctors may use a thin, soft brush instead of a curette.
Conization: The doctor removes a cone-shaped sample of tissue. A conization, or cone biopsy, lets the pathologist see if abnormal cells are in the tissue beneath the surface of the cervix. The doctor may do this test in the hospital under general anesthesia. Conization also may be used to remove a precancerous area.
Removing tissue from the cervix may cause some bleeding or other discharge. The area usually heals quickly. Women may also feel some pain similar to menstrual cramps. Medicine can relieve this discomfort.
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