Biology 103
2003 First Paper
On Serendip

Cervical cancer is the second most common cancer among women and the leading cause of death among women in underdeveloped countries. In fact, 500,000 cases are diagnosed each year worldwide. This particular cancer is found mainly in middle-aged to older women; it is very rare to find it in women age fifteen and younger. The average age of women with cervical cancer is age 50-55; however, the cancer begins to appear in women in their twenties (2). It is also found in women of lower-class areas, as they are not able to see a gynecologist to be screened. African American, Hispanic, and Native American women are more prone to developing cervical cancer as well (1).

The cervix is an organ in the female reproductive system; it is the entrance to the uterus. Cancer of the cervix develops in the lining of the cervix. The normal cells go through abnormal changes and become precancerous cells. These changes are called Cervical Intraepithelial Neoplasia (CIN). CIN is categorized as low grade and high grade. It progresses to one of two conditions: (a) Squamos Intraepithelial Lesion (SIL) which leads to invasive cervical cancer, or (b) Carcinoma in Situ which is non-invasive, or localized, cervical cancer (1).

The causes of cervical cancer are unknown. However, scientists believe that there is a link between two kinds of Human Papallomavirus (HPV) and the cancer. HPV is a group of 100 different viruses. Some types of HPV cause warts and are considered "low-risk" when discussing causes of cervical cancer. However, other types of HPV cause precancerous conditions, resulting in different types of genital cancers, and is therefore considered "high-risk" (1). HPV is a sexually transmitted disease and it is extremely contagious. Recent research has shown that condoms do not completely prevent HPV from being transmitted. Women with HPV usually do not have symptoms, and at times will never develop the cancer; and in the same manner, some women have developed the cancer without ever having had HPV (2).

Also, Human Immunodeficiency Virus (HIV) increases the likelihood of the precancerous cells developing into cancer. This occurs because HIV weakens the immune system, and a woman with HIV is unable to fight off HPV and precancerous abnormalities (2). Scientists have also found that smokers are possibly twice as likely to develop cervical cancer. Cigarettes release many chemicals that cause cancer (1). When a woman smokes a cigarette, these chemicals enter her bloodstream, and they are carried to all parts of the body. These chemicals are also believed to damage the DNA in cervical cells (2). Scientists are also examining the effects of Oral Contraceptives. No direct links have been found, but there is some statistical evidence showing that women that have taken Oral Contraceptives for over five years have a low risk of developing the cancer (2).

Often there are no symptoms while developing the cancer. For this reason, it is extremely important for a woman to have an annual Pap smear test, as this is the only way to detect any kind of abnormalities. The Pap smear evaluates the cells of the cervix under a microscope. It looks for three signs: (a) inflammation of the cells, (b) the amount of estrogen in the cells and (c) the presence of precancerous cells. The test is 90-95% accurate in finding an abnormality (3). Some possible symptoms of the cancer, however, are abnormal vaginal bleeding, abnormal vaginal discharge, low back pain, painful sexual intercourse, and painful urination (1).

To be diagnosed with Cervical Cancer, a woman would need to have a Pap smear test with abnormal results. The most common abnormality is called dysplasia, precancerous cells. Dysplasia is caused by CIN or by low or high-grade intraepithelial lesions. In simpler terms, dysplasia is an abnormal cell growth (4).

The best form of prevention of cervical cancer is to be informed and aware. If you are a woman age 18 or older, whether you are sexually active or not, go see a gynecologist. Why is this so important for women our age? Because at the age of 19, I was diagnosed with cancerous abnormalities of the cervix. Here is what happened.

My mother never thought it necessary for me to see a gynecologist. But when I came to Bryn Mawr, I took it upon myself to see one. My freshman year, everything in that department was perfectly normal. At the beginning of my sophomore year, I saw the gynecologist again for my annual Pap smear. Two weeks later, I received a message from the doctor asking me to make an appointment to see her immediately. It turned out that the results of my Pap were extremely abnormal. I had high-grade dysplasia and lesions on my cervix. So what do I do next? I thought. I asked if I could retake the Pap, as there are many false negatives and false positives; maybe this was just a false positive. But the gynecologist here in Bryn Mawr, as well as the other two doctors that I got second and third opinions from, all felt that I was at too much of a risk to waste time with another Pap. They told me that on a scale from zero to four, zero being perfectly normal and four being invasive cervical cancer, I was at a three.

We went ahead with a test called a Colposcopy. (These next procedures cannot be done in the Bryn Mawr College Health Center, so I went back to my hometown for the rest of my treatments.) The Colposcopy was done in my gynecologist's office, and, in retrospect, it was not terrible at all. My doctor applied a vinegar solution to the surface of my cervix, which highlighted the infected areas. She then put a microscope into my birth canal to have a closer look. The image of the infected area was transmitted to a monitor that we were both able to look at. During the same office visit, I also had a biopsy. For this procedure, my doctor removed a small piece of the surface of my cervix to have sent to a lab. Thankfully, the biopsy did not hurt at all, as there are very few nerve endings in the cervix.

At this point, I thought to myself that these tests would come up negative, because after all, I felt fine. I felt completely healthy. I had absolutely no indications or symptoms of anything whatsoever. But I was wrong. My gynecologist called me about two weeks later to tell me that my cervix was, in fact, infected with cancerous cells. The next step was surgery. The surgery I underwent is called a cone-biopsy. The surgery was done under general anesthesia, so I was not awake for any of it. While I was sleeping, my doctor removed a large piece of my cervix, starting with the entire surface and cutting into the back of the cervix in a cone-shape. The point of this surgery was to have a large enough sample of the infected area to see how deep the cancer is.

Another two weeks went by and I received a call from my gynecologist. It turned out that I had non-invasive cervical cancer, and they had successfully removed the entire affected area during the surgery. Where did we go from there? Every three months I had to have another Pap smear. This passed summer I had my third Pap since the surgery, and all of them have had normal results. My next Pap will be in six months, and if that test also has normal results, I will be back to my annual Pap, just like everyone else.

Here is the unsettling part: Had I skipped that Pap smear during my sophomore year, I would have had invasive cervical cancer within a year and would have had to undergo chemotherapy. So once again, and I cannot stress this enough, the best form of prevention of cervical cancer is to be informed and aware. If you are a woman age 18 or older, whether you are sexually active or not, go see a gynecologist.

References

1)Oncology Channel
2)American Cancer Society: Do We Know What Causes Cervical Cancer?
3)BestDoctor.com: Pap Smears
4)Cervical Dysplasia Causes


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