Understanding Cervical Cancer
- Amie Wood, a 39-year-old single-mom of two, was diagnosed with cervical cancer just two years after a “normal” pap smear which confirmed she had the human papillomavirus (HPV), which increases cancer risk. Despite alleging not receiving a correct pap smear result, Wood still encourages women to get screened for cervical cancer as early detection saves lives.
- Cervical cancer begins in the cells lining the cervix, the lower part of the womb (uterus). It usually develops slowly, however, before cancer presents itself. Vaginal bleeding or pelvic pains are common symptoms.
- Pap smears are one way to detect cervical cancer early. During the test, a doctor will collect a sample of cells from your cervix (using a small brush or spatula). The cells are then examined under a microscope for abnormalities, including cancer and changes that could indicate pre-cancer.
- It’s important to note that more than 70% of cases of cervical cancer are caused by the human papillomavirus (HPV). More than 90% of HPV-related cancers, including cervical cancer, are preventable in people who get the HPV vaccine that is recommended for all preteens (both girls and boys) 11 to 12 years old.
- When it comes to your health, be a little pushy. You know your body better than anyone else. When you see a doctor for a problem, don’t hesitate to make sure that your question is fully answered and that you are comfortable with the plan moving forward. From a doctor’s perspective, every problem should have a diagnosis, a treatment, a plan for follow-up, and a plan for what happens next if the treatment doesn’t work.
It’s important to understand that HPV is the biggest risk factor when it comes to cervical cancer, and there’s often no early signs or symptoms of the disease. However, cervical cancer can be detected through regular check-ups, such as pap smears.
Read More“To be diagnosed with cervical cancer and undergo a hysterectomy was heartbreaking enough, but then I found out that my smear results had been misreported and it could have all been avoided.”
Wood has since received an apology from the place she had her pap smear at, but she admitted to BBC: “An apology is an apology but it doesn’t take back what I have had to go through, what I will always have to go through mentally.”
However, she still advises others to get pap smears, adding, “I would still 100% have a smear. Smears do save lives, it’s proven.
“So 100% I would encourage anyone to have smears and to talk about it because for a lot of girls it’s an embarrassing taboo subject.”
A Pap test, also known as a Pap smear or cervical cytology test, is a vital screening tool to detect potentially harmful changes in the cells of a woman’s cervix that could lead to cervical cancer if left untreated.
What You Need to Know About Pap Tests
The simple, quick and relatively non-invasive procedure helps identify cellular abnormalities at an early stage, making it easier to treat and prevent progression to cancer. It can also identify certain infections and inflammation.
After the Pap test is completed, the collected cell samples are sent to a laboratory for analysis. It typically takes a few days to a couple of weeks to receive the results, and your healthcare provider will contact you with the findings. It’s essential to understand how to interpret these outcomes and what they mean for your cervical health.
Generally, your Pap test results will be reported as either normal (also known as negative) or abnormal.
- Normal (Negative) Results: This indicates that no abnormal cells were detected on your cervix. In this case, you can follow your healthcare provider’s recommendations for the timing of your next Pap test. Remember that a normal result doesn’t necessarily mean you won’t develop cervical cancer in the future – it’s still important to maintain regular screening.
- Unclear Results: The laboratory could not determine if the cells are normal or abnormal. You may need repeat testing immediately or in approximately 6 months with another pap smear.
- Abnormal Results: Abnormal findings mean that some cervical cells appeared different from typical healthy cells. It’s important to note that abnormal results do not always indicate cancer or even precancerous changes. There are varying degrees of abnormal results, and your healthcare provider will discuss what they mean in your specific situation.
Abnormal Pap test results can show the following types of cell changes:
- Atypical Squamous Cells of Undetermined Significance (ASC-US): This is the most common type of abnormal result. It means that some cervical cells appear slightly atypical, but the cause may not necessarily be related to human papillomavirus (HPV) or precancerous changes. It is essential to discuss follow-up testing and future screening schedules with your healthcare provider if you have an ASC-US result.
- Low-Grade Squamous Intraepithelial Lesion (LSIL): This finding suggests that there are mild cell abnormalities, which are usually caused by HPV infection. LSIL doesn’t typically indicate precancer but may require further testing to determine the appropriate course of action. Typically this goes away on its own.
- High-Grade Squamous Intraepithelial Lesion (HSIL): When cells appear more severely abnormal, it may be a sign of more significant changes that are more likely associated with cancer or pre-cancer.
- Atypical Glandular Cells (AGC): These findings are less common and involve glandular cells, which produce mucus in the cervical canal and endometrium. These are more likely associated with cancer or pre-cancer.
- Squamous cell carcinoma or adenocarcinoma cells: The cells collected appears significantly abnormal with the pathologist almost certain that cancer is present.
It’s crucial to remember that an abnormal Pap test result is not always a diagnosis of cancer. It is often an indication that further evaluation is needed to determine the necessary follow-up or treatment. Your healthcare provider will discuss the specifics of your results, as well as any recommended additional testing, treatment options, and future screening schedules.
Understanding Cervical Cancer
According to the National Cancer Institute (NCI), cervical cancer forms in the cells of the cervix, the lower, narrow end of the uterus (womb) which connected the uterus to the vagina.
“Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia, in which abnormal cells begin to appear in the cervical tissue,” the NCI explains.
“Over time, if not destroyed or removed, the abnormal cells may become cancer cells and start to grow and spread more deeply into the cervix and to surrounding areas.”
Helping Patients Understand Cervical Cancer and Its Link to HPV
- Can the U.S. Eliminate Cervical Cancer? Australia Says It’s About to Do Just That
- Breaking: HPV Vaccine Not Recommended For Adults Over 26, Per New American Cancer Society Guidelines
- Farewell to the Pap Smear? World Health Organization Recommends HPV DNA Test As Best Screening Option for Cervical Cancer
- New Cervical Cancer Test Detects Disease Significantly Better Than HPV Test and Pap Smear
- Top 5 Excuses Women Give for Not Getting a Pap Smear: Are You Guilty of Using One of These?
- Busting the Myths About the HPV Vaccine
- New Cervical Cancer Screening Guidelines Recommend HPV & Pap Testing Now Start at Age 25
- Why Is Late-Stage Cervical Cancer On The Rise? The Importance of Pap Smears and Testing For HPV
It’s important to know there are two main types of the disease, squamous cell carcinoma (up to 90% of cervical cancers) and adenocarcinoma.
Squamous cell carcinoma forms in the cells of the ectocervix (outer part of the cervix) and adenocarcinoma develops in the glandular cells of the endocervix (inner part of the cervix).
Cervical cancer is often difficult to detect as it doesn’t normally have symptoms until the disease has spread.
The NCI explains that symptoms of early-stage cervical cancer may include:
- vaginal bleeding after sex
- vaginal bleeding after menopause
- vaginal bleeding between periods or periods that are heavier or longer than normal
- vaginal discharge that is watery and has a strong odor or that contains blood
- pelvic pain or pain during sex
Symptoms of a advanced cervical cancer may include:
- difficult or painful bowel movements or bleeding from the rectum during bowel movements
- painful urination or blood in the urine
- dull backache
- swelling of the legs
- abdominal pain
- fatigue
“These symptoms may be caused by many conditions other than cervical cancer. The only way to know is to see a health professional. If it is cervical cancer, ignoring symptoms can delay treatment and make it less effective,” the NCI explains.
Should I Give My Kids the HPV Vaccine? A Leading Doctor On Why She Says “Yes!”
The Importance of Pap Smears
Pap smears are one way to detect cervical cancer early. During the test, a doctor will collect a sample of cells from your cervix (using a small brush or spatula). The cells are then examined under a microscope for abnormalities, including cancer and changes that could indicate pre-cancer.
This is an important procedure because symptoms of cervical cancer might show up until the disease is at stage 3 or 4. By helping doctors catch signs of the disease early, Pap smears can lead to broader and more effective treatment options.
One of the leading causes of cervical cancer is the human papillomavirus (HPV), one of the most common viruses which can be transmitted through sexual contact. HPV is the biggest risk factor for cervical cancer, and there are usually no early signs or symptoms of the disease. However, cervical cancer can be detected through regular check-ups, such as pap smears.
According to the Centers for Disease Control and Prevention, it’s recommended that women start getting Pap tests at age 21. “If your Pap test result is normal, your doctor may tell you that you can wait three years until your next Pap test,” the CDC explains.
Meanwhile, anyone between 20 and 65 years old is urged to speak with their doctor on which testing option is best for them. The CDC explains, “An HPV test only. This is called primary HPV testing. If your result is normal, your doctor may tell you that you can wait five years until your next screening test.
“An HPV test along with the Pap test. This is called co-testing. If both of your results are normal, your doctor may tell you that you can wait five years until your next screening test. A Pap test only. If your result is normal, your doctor may tell you that you can wait three years until your next Pap test.”
For women older than age 65, the CDC says your doctor may suggest you don’t need further screenings if: “You have had at least three Pap tests or two HPV tests in the past 10 years, and the test results were normal or negative, and you have not had a cervical precancer in the past, or you have had your cervix removed as part of a total hysterectomy for non-cancerous conditions, like fibroids.”
What Is HPV & How Is It Related to Cancer?
Nearly every sexually-active person will get HPV at some point in their lives, but most people with the infection do not know they have it and never develop symptoms or health problems from it. The virus is spread via sexual activity and can manifest as warts on your genitals or mouth.
When people talk about HPV and cancer risk, they tend to focus on cervical cancer. And while it’s true that nearly all cases of cervical cancer are caused by HPV, people should also be aware that HPV puts both men and women at risk of developing several other cancers as well including cancers of the vagina, penis, anus and throat.
Oral and throat cancers, for example, are both on the rise in young, non-smoking adults, and Dr. Allen S. Ho, an oncologist at Cedars-Sinai Medical Center, says HPV is the cause.
“The fastest-growing segment of the people developing oral cancers are young non-smokers, ” Dr. Ho told SurvivorNet in a previous interview. “HPV, a very common virus, one responsible for the vast majority of cervical cancers, is now identified as a cause of this rapid rise of oral cancers.”
Overall, HPV is believed to cause 90% of anal and cervical cancers, approximately 70% of vaginal and vulvar cancers, and 60% of penile cancers.
“There are no screening guidelines to screen for throat cancer, unlike cervical cancer with pap smears,” says Dr. Jessica Geiger, a medical oncologist at Cleveland Clinic Cancer Center, previously told SurvivorNet. “There are no standard tests to determine if you harbor the virus.”
On the plus side, HPV-related throat cancers are generally very responsive to a combination of radiation and chemotherapy treatments, according to Dr. Geiger.
“The cure rates for people who have HPV-related disease are a lot higher than those who have tobacco-related throat cancer,” she said.
Avoiding Provider Bias – Is Your Doctor Understanding You?
While your doctor has undergone years of training and practice, they are still human, and may come with their own set of biases that can impact how they treat patients.
To combat these biases and really get the most out of your interactions with your doctor, you should provide her or him with plenty of information about your life and ask plenty of questions when things aren’t clear. To better understand how you should approach conversations with your doctor, we previously spoke with Dr. Dana Chase, gynecologic oncologist at Arizona Oncology.
According to Dr. Chase, physicians, like many of us, can be a bit biased when seeing patients. She made it clear that these biases are rarely sinister, but rather unconscious and more subtle.
She explained, “We have certain beliefs that we don’t know about. We might look, for example, at an older woman, and just by the way she looks we might make certain assumptions, and we might not even know that we’re making these assumptions.”
Let’s Talk About Provider Bias
Clearing up misconceptions is important, but so is understanding what your doctor is telling you, Dr. Chase noted. Overall, she advises women to speak up and ask questions when they don’t understand something.
“It’s never a bad thing to ask for something to be repeated, or to ask the doctors to explain it in different terms.”
So next time you go to your physician, speak up if you need clarity, so your doctor can understand you and you can understand them.
Remember, standing up for yourself is important. If you feel that you’re being dismissed or mistreated by a doctor. Getting a second opinion is crucial if something doesn’t feel right. Experts tell SurvivorNet that no one knows your body better than you, so if you feel like something is wrong, keep pushing for answers.
Dr. Steven Rosenberg is the National Cancer Institute Chief of Surgery, and he previously told SurvivorNet about the advantages of getting input from multiple doctors.
“If I had any advice for you following a cancer diagnosis, it would be, first, to seek out multiple opinions as to the best care. Because finding a doctor who is up to the latest of information is important,” Dr. Rosenberg said.
Contributing: SurvivorNet Staff
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