Thuy D. Le Instructional Media, Health Education Western University of Health Sciences

What is cervical cancer? Cervical cancer is a disease in which cancer cells form in the cervix. The cervix is located in the lower portion of the uterus. It connects the uterus (where a baby grows when a woman is pregnant) to the vagina (birth canal). Typically, cervical cancer develops slowly. The cancerous cells begin to grow in the tissues of the cervix. Gradually, the cells spread throughout the cervix and to surrounding areas.

Female External Genitalia

Cervix

The Cervix Size and shape of the cervix The cervix is the opening of the uterus. It is cylindrical in shape and is normally 3–4 cm long and 2.5–3.5 cm in diameter. The external of the cervix opens into the vagina. The internal is the point at which the cervix and uterus meet, above the vagina.

Composition of the cervix The cervix is composed of dense, fibromuscular connective tissue. It is covered by two types of epithelium: Stratified squamous epithelium (usually covering large areas of the ectocervix). Columnar epithelium (covers the endocervix and may also be visible on the ectocervix).

Who does cervical cancer affect? Each day in the United States, 30 women are diagnosed with cervical cancer (about 11,000 women per year) and 11 women die from it. Southeast Asian women have higher invasive cervical cancer incidence rates and lower Pap testing frequencies than most other ethnic groups in the US. According to some studies, a large number of Vietnamese women cannot correctly explain what a Pap test is used for.

The most commonly occurring cancer in Vietnamese females in the US is cervical cancer. Cervical cancer incidence rates are five times higher among Vietnamese American women than White women. Cervical cancer is the number one incident cancer in Vietnamese women, whereas breast cancer is the number one incident cancer for all racial and ethnic groups.

What causes cervical cancer? We don't know exactly what causes cervical cancer, but certain risk factors are believed to have an effect. Medical history and lifestyle - especially sexual habits - play a role in a woman's chances of developing cervical cancer.

Risking factors of cervical cancer? Human papillomavirus (HPV) Sexual History Poverty Pap test history Tobacco Use Eating Habit Weakened Immune System

Cervical Cancer Symptoms Symptoms of cervical cancer don't usually appear until the abnormal cells invade nearby tissue. Symptoms can include: Abnormal bleeding Heavier, long-lasting periods Unusual vaginal discharge Pelvic pain Abnormal bleeding may occur: Between menstrual periods After menopause After intercourse After a pelvic examination These symptoms are not always a sign of cervical cancer. They can be caused by sexually transmitted diseases (STDs) or other conditions. Your doctor can determine the cause of these symptoms.

Cervical Cancer Detection: Early-stage cervical cancer and precancerous cervical conditions are almost 100% curable. The most common forms of cervical cancer begin with changes in cervical cells. If these changes are detected early enough, treatment can be started immediately to prevent cervical cancer from developing. The best way to detect early cervical cancer and precancerous conditions of the cervix is to have a gynecologic examination and Pap test.

Pap Test The American Cancer Society recommends that a woman have her first annual Pap test when she becomes sexually active or reaches the age of 18. Because cervical cancer usually progresses slowly, some physicians feel that a woman doesn't need to have a Pap test every year if she: Is 65 years of age or older Women who have cervical cancer risk factors and who don't have regular gynecologic examinations are increasingly likely to: Develop cervical carcinoma in situ between the ages of 30 and 40 Develop invasive cervical cancer between the ages of 40 and 50

What is the Pap Test? A Pap smear is typically done in conjunction with a pelvic examination — a procedure that allows your doctor to examine your external genitals, vagina, uterus, ovaries and rectum. Although pelvic examinations can screen for reproductive problems or abnormalities, only a Pap smear will detect early cervical cancer or precancers. A Pap smear is a test your doctor does to check for signs of cancer of the cervix. The cervix is part of your uterus (womb). During a Pap smear, your doctor will put a special instrument called a speculum into your vagina. This helps open your vagina so the doctor can see your cervix and take a sample. Your doctor will gently clean your cervix with a cotton swab and then collect a sample of cells with a small brush, a tiny spatula or a cotton swab. Your doctor will put this sample on a glass slide and send it to a lab to be checked under a microscope.

How to prepare for Pap test? To ensure that your Pap smear is most effective, follow these tips prior to your test: Avoid intercourse, douching or using any vaginal medicines or spermicidal foams, creams or jellies for two days before having a Pap smear, as these may wash away or obscure abnormal cells. Try not to schedule a Pap smear during your menstrual period. Although the test can be done, it's best to avoid this time of your cycle, if possible.

Steps to Pap test Step 1 Schedule your Pap smear for a day when you won't be on your period. Step 2 Refrain from having intercourse, using douche, inserting tampons or using any type of vaginal medications for at least 48 hours prior to your Pap smear, recommends the Centers for Disease Control and Prevention. Step 3 Know that the doctor or nurse will explain everything that is going on. Be sure to ask any questions you have. Step 4 Understand the way the test will be performed. You will be placed on your back with your legs bent; sometimes, your feet will be in stirrups. Your doctor may perform a manual pelvic exam. For the Pap smear, a speculum will be inserted into your vagina. The doctor will then get samples of the cells on your cervix using a special tool. You may feel some pressure, but it won't hurt. Step 5 Expect some light cramping and possibly some spotting after the procedure. However, the bleeding should not be heavy and you should be able to return to regular activities immediately following your Pap smear. Step 6 Wait for the results of the test. Test results are usually available in 1 to 2 weeks following the Pap smear.

Procedure 1. Speculum is inserted and cervix is visualized. 2. A spatula is used to “scrape” cells from the cervix and smear them on a glass slide. The spatula is turned 360 degrees while pressed against the cervix. 3. Cells placed on the glass slide are “fixed” in alcohol to preserve them. 4. Slide is then treated with Pap stains to color the cells.

Benefits Pap smear: benefits Trusted, proven over 50 years. Given adequate resources and a screening program, it can be practical, affordable, and accurate. Slide serves as a permanent record.

References Asian American Network for Cancer Awareness, Research and Training. Available from: URL: edu/aancart/About_AANCART.htm Department of Commerce. Bureau of the Census. We the American Asians. Washington, DC: US Government Printing Office; Ziegler RG, Hoover RN, Pike MC, Hildesheim A, Nomura AM, West DW, et al. Migration patterns and breast cancer risking Asian American women. J Natl Cancer Inst 1993; 85(22): National Center for Health Statistics. Health, United States, 1998 with socioeconomic status and health chartbook. Hyattsville, MD: National Center for Health Statistics; Tang TS, Solomon LJ, Yeh CJ, Worden JK. The role of cultural variables in breast self-examination and cervical cancer screening behavior in young Asian women living in the United States. J Behav Med 1999; 22(5): Schulmeister L, Lifsey DS. Cervical cancer screening knowledge, behaviors, and beliefs of Vietnamese women. Oncol Nurs Forum 1999; 26(5): Parker SL, Tong T, Bolded S, Wingo PA. Cancer Statistics, CA Cancer J Clin 1997; 47(1):