The human papillomavirus or HPV is the most common sexually transmitted infection in the US with more than 40 serotypes that can infect the genital areas of both men and women as well as the lining of the mouth and throat. They are categorized as either low-risk, which causes warts, or high-risk, which can lead to cancer. There are 13 particular subtypes that can cause cancer of the cervix, and one of these types can also lead to cancer of the vulva, vagina, penis, anus, and certain head and neck cancers. The HPV types that cause warts do not cause cancer.
HPV often does not have initial symptoms and a healthy functioning immune system can often clear the virus within 1-2 years. In fact, according to the CDC, 4 out of 5 women will have been infected with HPV at some point. When the body’s immune system cannot clear the virus, it can turn normal cells into abnormal or atypical cells and eventually to cancer.
The CDC has developed an awareness campaign. The National Gynecologic Cancer Awareness Campaign aims to inform, educate, and raise awareness of gynecologic cancers, including cervical cancer. For more information, visit www.cdc.gov/cancer/knowledge/.
Early screening and treatment can prevent cervical cancer. Yearly annual exams and pap smears are recommended along with co-testing for the HPV virus. A pap smear takes samples of cells from the cervix and the endocervical canal (opening in the center of the cervix that dilates for childbirth) and checks for any abnormal features. This can be co-tested for the HPV virus by a pathologist at the lab. If both are negative, meaning there are no abnormalities, then the patient may wait up to 5 years for a repeat pap smear. It is always recommended that the patient continue to return for an annual physical exam yearly. If the pap smear shows any abnormality or atypia, then further testing is warranted.
Positive pap smears can range from atypical cells of undetermined significance (ASCUS), to mild, moderate, or severe dysplasia. They can also reveal carcinoma in situ or frank cervical cancer. Typically the progression from a normal pap smears to cancer takes about 10 years. Certain high-risk HPV strains are more aggressive and require earlier more aggressive treatment.
If a patient is over 25 years old and has a positive pap smear, she will require an in-office procedure called a colposcopy with biopsy. This procedure uses a microscope to look closer at the cervix. A series of solutions are applied to the cervix which highlight any abnormal appearing cells. A small biopsy is then taken from any areas of concern and this is sent to pathology. This is generally not a painful procedure, but will cause some uterine cramping. Patients are recommended to pre-medicate, if applicable, with an over the counter anti-inflammatory 45 minutes prior to the procedure to lessen the cramping.
If a pap smear result is moderate to severe dysplasia, then a different procedure is performed. A LEEP or CONE biopsy are the procedures of choice and can be done in the office with local anesthetic or in a surgical setting with sedation. Both require a larger tissue biopsy sample with the attempt to remove all abnormal tissue and have normal tissue margins. Recovery usually take 2-4 weeks for the cervix to heal from these procedures and usually does not cause significant pain, only uterine cramping.
Yearly screening with a pap smear can detect early changes and prevent the occurrence of cervical cancer. There are also vaccinations for both young girls and boys that can prevent genital warts or cervical cancer. Please review the CDC’s webpage for more information.
~ Erinn Fuller, Certified Physician Assistant