Hesperian Health Guides
Problems of the Cervix (the Opening of the Womb)
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Problems of the cervix that are not cancer
Nabothian cysts are small bumps on the cervix that are filled with fluid. There are no signs, but they can be seen during a pelvic exam (with a speculum). These cysts are harmless, so no treatment is needed.
Polyps are dark red growths, sometimes found at the cervix. They also grow inside the womb. They do not need to be treated. For more about them, see ‘Common Growths of the Womb’.
Inflammation of the cervix. Many infections of the vagina— like trichomonas—and some STIs affect the cervix, and can cause growths, sores, or irritation and bleeding after sex. For more information, including treatment, see the chapter on STIs.
Cancer of the cervix (cervical cancer)
Cancer of the cervix is the most common cause of death from cancer among women in many parts of the world. Most cervical cancer is caused by the Human Papilloma Virus, or HPV. There are many types of HPV and only a very few of them can cause cervical cancer. (A different type of HPV causes genital warts.)
HPV is a common infection that many people will have in their life. Most of these infections go away without treatment. HPV infections that do not go away (persistent) can slowly cause cancer. Because this cancer grows slowly, there is time to find it early and completely cure it. Unfortunately, many women die from cervical cancer because they never knew they had it.
The best time to be screened for cervical cancer is around the age of 30, and every 3 to 5 years after that.
Women with HIV are more likely to get cervical cancer because their immune systems are less able to fight the HPV. They should be screened for cervical cancer even if they are younger than 30. If the results are normal, then they should be tested every 3 years.
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There are usually no outward signs of cancer of the cervix until it has spread and is more difficult to treat. (There may be early signs on the cervix, which can be seen during a pelvic exam. This is why regular exams are so important.)
The later warning signs are abnormal bleeding from the vagina, including bleeding after sex, and persistent abnormal discharge or bad smell from the vagina. If you have any of these signs, try to get a pelvic exam and a screening test.
Finding and treating cancer of the cervix
If you are a health worker, try to get training in testing for cervical cancer. Encourage your community to offer cancer screening and low-cost treatment (cryotherapy).
Because cancer of the cervix can be cured if found early, but does not have early warning signs, it is good to test for it regularly. There are 3 screening tests that look for early signs of cervical cancer. Each test is done during a pelvic exam and requires touching the cervix with a cotton swab or small brush. This is not painful.
Visual inspection with acetic acid
A health worker examines the cervix by looking at it through the speculum. Then she puts vinegar (acetic acid) on a cotton swab and wipes it on the cervix. The acetic acid will make any abnormal tissue turn white. This test gives you the result right away and you can often receive treatment the same day. It is low cost and easy to learn how to do.
The Pap test
For this test, a health worker gently takes some cells from the cervix and sends them to a laboratory to be examined with a microscope. This test looks for abnormal cells that may be cancer or pre-cancer. You will need to return in 2 to 3 weeks to get the results.
Like the Pap test, a health worker takes some cells from the cervix and sends them to a laboratory to be examined for the HPV virus. It does not tell if you have abnormal cells and need treatment. You will need to return in 2 to 3 weeks to get the results. If the test is positive and shows you have HPV, it does not mean that you have cancer. You will still need a Pap test or visual inspection.
These tests are sometimes used to find cancer when a Pap test or visual inspection show abnormal cells.
- Colposcopy. A doctor uses a special lens to magnify the cervix so it is easier to see signs of cancer.
- Biopsy. A small bit of tissue is taken from the cervix and sent to a laboratory to be examined for cancer cells.
More Informationdeciding about treatment
If a screening test shows that you have pre-cancer or cancer, you need treatment. Treatment for pre-cancer is simple, using methods that remove or destroy the abnormal tissue. A method called cryotherapy, which can be done in a small clinic, freezes the cervix and kills the pre-cancer. Other methods remove part of the cervix with surgery (cone biopsy or LEEP – Loop Electrosurgical Excision Procedure).
You may need to go to a large, special hospital for cancer treatment.
When cancer is found and treated before it spreads, it can be cured. If the cancer is only on the cervix, you will need a hysterectomy (removal of the womb, including the cervix).
If the cancer is found late, and has spread beyond the cervix to other parts of the body, you may need surgery to remove the cervix, womb, parts of the vagina, and other parts that the cancer may have reached. Radiation therapy is very effective at curing cervical cancer if it has not spread too far.
Deaths from cancer of the cervix can be prevented
To reduce the risks for cancer of the cervix by finding and treating more cancers early, we can:
- learn what increases a woman’s risk, and work together on finding ways to reduce these risks. It is especially important for girls to be able to wait until they are grown women before having sex. All women also need to be able to protect themselves from STIs, including HIV.
- help women avoid or quit smoking tobacco.
- learn about cancer screening and work to make it more available. Finding cancer of the cervix early can save lives.
Developing screening programs may seem too costly but it is cheaper than treatment. Screening programs can help the most women while costing the least if they:
- target older women. Young women rarely get cancer of the cervix, and women over 35 are most at risk.
- test as many women as possible, even if this means testing them less often. Testing all women at risk every 5 to 10 years will find many more cancers than testing only some women more often.
- train local health workers in how to do visual inspection, use cryotherapy, and give Pap tests.
A new vaccine, called ‘HPV vaccine’, to protect youth against cervical cancer has been developed and is in use in many countries. It must be given to girls before they start having sexual intercourse. See if it is available where you live.