Health News and Information

The cervix is the neck of the uterus that juts into the upper vagina. It is usually about 3-4 cm long and 2-3 cm in diameter. The cervix often gets bigger following pregnancy. The outside of the cervix is usually covered by the same tissue as that which lines the vagina (‘squamous’). The inside of the cervix consists of glandular tissue responsible for producing mucus which in turn ensures that sperm is able to swim up into the uterus and subsequently along the tubes to meet the egg so that fertilization can take place and pregnancy occur.The junction where the outside skin and inner glandular material meet is called the ‘transformation zone’ and it is at this site where precancerous change develops. In younger women this site is on the outside of the cervix. In postmenopausal women it is usually within the canal of the cervix, which is why a brush sample is routinely taken during a Pap smear.The principal reason why cancer of the cervix develops is due to an infection with a virus – the ‘human papilloma virus’ (HPV). It is estimated that at least 80% of the sexually active adult population at some point are both exposed to and infected with human papilloma viruses of which there are over 100 different types. Approximately 15-20% of these can affect the female genital tract and can be responsible not only for the development of cancer of the cervix, but in some cases can also cause vaginal cancer and vulval cancer.Since these viruses are transmitted sexually, infections are usually quickly resolved through a woman’s immunity and therefore do not result in cancer. It is still unclear as to why in some women these infections persist and eventually lead to precancerous and ultimately cancerous changes. Certainly smoking cigarettes increases the risk by about 4 times. It is obvious that the more times a woman can be exposed to such viruses, then the higher the chances of her getting cancer of the cervix.The incidence of this cancer is increased in women with multiple sexual partners, particularly when barrier contraception, such as condoms, is not used. Lesbian women also have a risk of developing cancer of the cervix and need to have regular Pap tests.There are two common cancers affecting the cervix. In about 80% of cases, the cancer arises from the outside skin of the cervix – the ‘squamous epithelium’, thus these are called squamous cancers.In about 20% of cases, however, the cancers can arise either from the glandular tissue in the canal of the cervix (‘adenocarcinoma’), or can be mixed cancers called ‘adenosquamous cancers. These cancers grow locally into the upper vagina and into the ligaments supporting the cervix – the so-called ‘cardinal’ ligaments or ‘parametrium’. Because the tube running from the kidney to the bladder runs in the parametrium, if local spread of cancer does occur, these tubes can get blocked and the kidneys become swollen causing pain in the back, below the ribs on either side of the midline.These particular cancers are prone to infection, so foul smelling discharge and heavy bleeding can be a problem if left untreated. In advanced cases the bleeding can be life threatening. As in uterine cancers, advanced cancers of the cervix can invade into the bladder and into the rectum with leakage of bladder and/or rectal contents into the vagina. Because the nerves supplying the pelvis run along the ligaments supporting the cervix, then pain can be a feature, particularly in advanced cases.Cancers of the cervix take a while to spread outside of the pelvic area. The cancer spreads most often to the lungs and occasionally to the bones so that a cough or chest pain and/or bone pain becomes prominent.*4/144/5*

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