From Encyclopedia of Sex and Sexuality
After uterine cancer and ovarian cancer, cancer of the cervix is the most common type of cancer of the reproductive tract. It commonly appears in women after age forty-five, but it also appears in women of reproductive age: in 1 percent of cases it is detected during pregnancy. The incidence of cervical cancer has declined during the last decade. Nevertheless, the incidence of precancerous lesions (called carcinoma in situ) of the cervix is rising abruptly. Some precancerous change of the cervix usually precedes the development of invasive cancer by ten to fifteen years.
Factors contributing to the development of cervical cancer include sexual activity and multiple sexual partners; race—the disease is rare among Jewish women, but twice as prevalent among African-American than among white women; low socioeconomic situation; and previous sexually transmitted diseases.
Carcinoma in situ is usually asymptomatic. Symptoms of the invasive cancer include postcoital bleeding (bleeding that occurs after intercourse); vaginal discharge; and, in some instances, pelvic pain. Only during the invasive stage are there symptoms of malignancy such as weight loss, weakness, and anemia, and clinical features related to the spread of the tumor, such as a pelvic mass and obstruction of the urinary tract.
When there is only carcinoma in situ, diagnosis can be made through a Pap test, colposcopy (observing the cervix with a magnifying glass), and cervical biopsy. In the invasive stages there are physical findings in the cervix that can be observed using a speculum. During the clinical stage, diagnosis is based on a pelvic examination. It is important to determine if the lesion is localized only in the cervix or if it has spread. In progressive stages of the disease the cancer spreads mainly through the lymphatic tracts and may appear later in the lungs, brain, bones, and other organs. CT scans and MRA (magnetic resonance imaging) are used to diagnose the spread of the disease to the lymph nodes and other organs.
In its earliest stages cervical cancer can be completely cured by destroying the growth with heat coagulation or laser. In premenopausal and menopausal women hysterectomy is recommended. In later stages of the disease radical hysterectomy is the best treatment: this includes removal of the uterus, ovaries, fallopian tubes, and the upper part of the vagina. Dissection of the pelvic and sometimes of the abdominal lymph nodes is performed. In the more advanced stages the primary treatment should be by radiation. Chemotherapy is sometimes applied in advanced cases. At present, experiments are being made with different combined treatments.
The outlook for patients with cervical cancer is favorable if it is caught at the early, in situ stage. The prognosis is less hopeful for more advanced lesions and depends mainly on the clinical stage of the disease. The earlier the lesion is diagnosed and treated, the better prospects are for cure. In the early stage of the invasive disease the cure rate is 85 percent, while in the more progressive stage of the disease, only 4 to10 percent of patients are cured.