INTRODUCTION: Cervical cancer is malignant cancer of the cervix uteri or cervical area. it is a carcinoma, typically composed of squamous cells, and is similar in some respects to squamous cell cancers of the head, neck and anus. Cervical cancers and cervical pre-cancers are classified by how they look under a microscope.



In developed countries, the widespread use of cervical screening programs has reduced the incidence of invasive cancer of the cervix by 50% or more. Human papillomavirus (HPV) infection is a necessary factor in the development of nearly all cases of cervical cancer.

RISK: The greatest risk factor in the promotion of this malignancy is infection with a high-risk strain of human papillomavirus. Women who have a lot of sexual partners (or who have sex with men or women who have had many partners) have an increased risk. The American Cancer Society provides the following list of risk factors for cervical malignancy: HPV infection, smoking, HIV infection, chlamydia infection, dietary factors, hormonal contraception, multiple pregnancies, exposure to the hormonal drug diethylstilbestrol and a familial history of the condition.

Despite the creation of an HPV vaccine, some researchers argue that routine neonatal male circumcision is an acceptable way to reduce the chance of cervical cancer in their future female sexual partners. However, in men with low-risk sexual behaviour and monogamous female partners, circumcision makes no difference to the risk of developing the malignancy.

But having a risk factor, or even many, does not mean that you will acquire the disease. Several risk factors increase your odds of developing cervical cancer. Although these risk factors increase the chances of developing the disease, many women with these risks do NOT develop this condition. When a woman develops the cancer or pre-cancerous changes, it may not be possible to say with absolute certainty that a particular risk factor was the cause for the malignancy.

when considering risk factors, it helps to focus on those that you can change or avoid (like smoking or HPV infection), rather than those that you cannot (such as your age and family history).

SYMPTOMS: Symptoms of advanced cervical cancer may include: loss of appetite, weight loss, fatigue, pelvic pain, back pain, leg pain, single swollen leg, heavy bleeding from the vagina, leaking of urine from the vagina, and bone fractures. Also, moderate pain during sexual intercourse and vaginal discharge are symptoms of the disease. HPV infection can be present for years without any symptoms.

TYPES: There are 2 main types of cervical cancers: squamous cellcarcinoma and adenocarcinoma. Although almost all cervical cancers are either squamous cellcarcinomas or adenocarcinomas, other types of cancer also can start in the cervix. These other types, such as melanoma, sarcoma, and lymphoma, occur more commonly in other parts of the body.

Certain forms of HPV are called "high-risk" types because they are often the cause of cancer of the cervix. More than 250 forms of human papilloma virus are acknowledged to exist (some sources indicate more than 200 subtypes). Together, HPV types 16 and 18 currently cause about 70% of infections. Human papilloma virus types 6 and 11 cause about 90 percent of genital wart cases. Different forms of HPVs cause warts on different parts of the body. Some forms cause common warts on the hands and feet. Other types tend to cause warts on the lips or tongue. Still other types of HPV may promote warts on or around the female and male genitalia and in the anal area.

TREATMENT: Treatment consists of surgery (including local excision) in early stages and chemotherapy and radiotherapy in the more advanced stages of the disease. On June 15, 2006, the FDA approved the use of a combination of two chemotherapy drugs, hycamtin and cisplatin for females with late-stage (IVB) cervical cancer.

Because of treatment, the five year relative survival rate for the earliest stage of invasive cancer of the cervix is 92%, and the overall (all stages combined) five year survival rate is about 72%. These statistics may be improved when applied to women newly diagnosed, keeping in mind that these outcome may be partially based on the state of treatment five years ago when the women studied were first diagnosed. With treatment, 80 to 90 percent of women with stage I cancer and 50 to 65% of those with stage II cancer are alive 5 years after diagnosis.

As the cancer metastasizes to other areas of the body, prognosis drops considerably because treatment of local lesions is often more effective than total body treatments such as chemotherapy. 35% of patients with invasive cancer of the cervix have persistent or recurrent disease after treatment. In the majority of cases however the body's immune system fights off the virus, and the infection goes away without any form of treatment.

CONCLUSION: The early stages of the disease may be completely asymptomatic. Types 16 and 18 are generally said to cause about 70 percent of cases. Together with type 31, they are the prime risk factors for cancer of the cervix.

The medically approved paradigm, officially endorsed by the American Cancer Society and other organizations, is that a patient must have been infected with human papilloma virus to develop this type of cancer, and is hence viewed as sexually transmitted, but the majority women infected with high risk HPV will not develop the disease. There has not been any definitive proof to support the claim that male circumcision prevents cervical cancer, although some researchers say there is compelling epidemiological evidence that men who have been circumcised are less likely to have a human papilloma virus infection .

Even though the pap smear is an effective screening test, confirmation of the diagnosis of this disease or pre-cancer requires a biopsy of the cervix. According to the US National Cancer Institute's 2005 Health Information National Trends survey, only 40 percent of American women surveyed had heard of human papillomavirus (HPV) infection and only 20% had heard of its link to cancer of the cervix.

In 2008 an estimated 3,870 women in the USA will die of cancer of the cervix, and around 11,000 new cases are expected to be diagnosed. The American Cancer Society recommends that screening should begin approximately three years after the onset of vaginal intercourse and/or no later than 21 years of age.

The HPV test is a newer technique for cervical cancer triage which detects the presence of human papillomavirus infection in the cervix. Since more than 99 percent of invasive cervical cancers worldwide contain HPV, some researchers recommend that HPV testing be done together with routine cervical screening.Human papillomavirus testing can decrease the incidence of grade 2 or 3 cervical intraepithelial neoplasia or cancer of the cervix detected by subsequent screening tests among women 32-38 years old according to a randomized controlled trial.

Figures suggest that cervical screening is saving 5,000 lives each year in the UK alone by preventing this disease. Worldwide, cancer of the cervix is the fifth most deadly cancer in women.