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Types of Cancer > Gynecologic Cancers > Cervical Cancer > Overview Cervical Cancer: The Basics Christopher Dolinsky, MD and Christine Hill-Kayser, MD Affiliation: Abramson Cancer Center of the University of Pennsylvania Last Modified: April 17, 2009

What is the cervix?

The cervix is the name for the lowest part of the uterus. The uterus is an organ that only women have, and it is where a baby grows and develops when a woman is pregnant. During pregnancy, the uterus has an enormous increase in size. When a woman is not pregnant, the uterus is a small, pear-shaped organ that sits between a woman's rectum and her bladder. The cervix connects the uterus with the birth canal (the vagina). The cervix can both be visualized and sampled by your doctor during a routine pelvic examination in his or her office.

What is cervical cancer?

Cervical cancer develops when cells in the cervix begin to grow out of control and can then invade nearby tissues or spread throughout the body. Large collections of cells that grow abnormally are called tumors. Some tumors are not cancer, because they cannot spread or threaten someone's life. These are called benign tumors. The tumors that can spread throughout the body or invade nearby tissues are considered cancer and are called malignant tumors. Usually, cervix cancer is very slow growing, although in certain circumstances it can grow and spread quickly. Cancers are characterized by the cells that they originally form from. The most common type of cervical cancer is called squamous cell carcinoma; it comes from cells that lie on the surface of the cervix known as squamous cells. Squamous cell cervical cancer compromises about 80% of all cervical cancers. The second most common form is adenocarcinoma; it comes from cells that make up glands in the cervix. The percentage of cervical cancers that are adenocarcinomas has risen since the 1970s, although no one knows exactly why. About 3% to 5% of cervical cancers have characteristics of both squamous and adenocarcinomas and are called adenosquamous carcinomas. There are a few other very rare types like small cell and neuroendocrine carcinoma that are so infrequent that they will not be discussed further here.

Am I at risk for cervical cancer?

Cervical cancer is vastly more common in developing nations than it is in developed nations, and it is fairly rare inthe United States. In the U.S., it is expected that 13,000 women will develop cervical cancer in 2002; and 4100 women will die of cervical cancer in 2002. This puts cervical cancer as the 12th most common cancer that women develop, and the 14th most common cause of cancer death for women in the U.S. However, cervical cancer is the 2nd most common cause of cancer death in developing nations, with about 370,000 new cases annually having a 50% mortality rate. There has been a 75% decrease in incidence and mortality from cervical cancer in developed nations over the past 50 years. Most of this decrease is attributed to the effective institution of cervical cancer screening programs in the wealthier nations. Although there are several known risk factors for getting cervical cancer, no one knows exactly why one woman gets it and another doesn't. One of the most important risk factors for cervical cancer is infection with a virus called HPV (human papillomavirus). HPV is a sexually transmitted disease that is incredibly common in the population; most college-aged men and women have been exposed to HPV. HPV is the virus that causes genital warts, but having genital warts doesn't necessarily mean you are going to get cervical cancer. There are different subtypes, or strains, of HPV. Only certain subtypes are likely to cause cervical cancer, and the subtypes that cause warts are unlikely to cause a cancer. Often, infection with HPV causes no symptoms at all, until a woman develops a pre-cancerous lesion of the cervix. It should be stressed that only a very small percentage of women who have HPV will develop cervical cancer; so simply having HPV doesn't mean that you will get sick. However, almost all cervical cancers have evidence of HPV virus in them, so infection is a major risk factor for developing it. Because infection with a sexually transmitted disease is a risk factor for cervical cancer, any risk factors for developing sexually transmitted diseases are also risk factors for developing cervical cancer. Women who have had multiple male sexual partners, began having sexual intercourse at an early age, or have had male sexual partners who are considered high risk (meaning that they have had many sexual partners and/or began having sexual intercourse at an early age) are at a higher risk for developing cervical cancer. Also, contracting any other sexually transmitted diseases (like herpes, gonorrhea, syphilis, or Chlamydia) increases a woman's risk. HIV infection is another risk factor for cervical cancer, but it may be so for a slightly different reason. It seems that any condition that weakens your immune system also increases your risk for developing cervical cancer. Conditions that weaken your immune system include HIV, having had an organ transplantation, and Hodgkin's disease. Another important risk factor for developing cervical cancer is smoking. Smokers are at least twice as likely as non-smokers to develop cervix tumors. Smoking may also increase the importance of the other risk factors for cancer. Finally, being in a low socioeconomic group seems to increase the likelihood for developing and dying from cervical cancer. This may be because of increased smoking rates, or perhaps because there are more barriers to getting annual screening exams. Cervical cancer is one of the few cancers that affects young women (in their twenties and even their teens), so no one who is sexually active is really too young to begin screening. Additionally, the risk for cervical cancer doesn't ever decline, so no one is too old to continue screening. Remember that all risk factors are based on probabilities, and even someone without any risk factors can still get cervical cancer. Proper

screening and early detection are our best weapons in reducing the mortality associated with this disease.