Cervical Cancer

The cervix is the mouth of the uterus, located inside the vagina. Cervical cancer causes cells to grow out of control on the cervix. Women who are infected with HIV are more likely to develop cell abnormalities that lead to cervical cancer. When a woman with HIV gets cervical cancer, her HIV infection has become AIDS. 

Symptoms

Cervical cancer often has no signs until it is advanced. Sometimes, there is vaginal bleeding. In rare cases, there may be a lump or tumor. There may be some pain during sex and a vaginal discharge. In advanced cervical cancer, the cancer spreads to the lungs or other organs. 

Causes

More than 90% of all cervical cancer is linked to the human papillomavirus (HPV). HPV is a common virus that is transmitted through sexual contact with infected partners. It causes genital and oral warts. Of the more than 100 types of HPV, five are linked to cervical cancer in women and anal cancer in men and women. People with HIV infection are more likely to also have HPV. It may be that when HIV weakens a woman’s immune system, her body can’t fight HPV as well. 

Risk Factors

The chance of getting cervical cancer goes up in women who:

• Come from a family where other women have had cervical cancer
• Have been pregnant more than once
• Have chlamydia (a sexually transmitted disease)
• Have used of the drug diethylstilbestrol (DES) 
• Smoke
• Take birth control pills

Prevention

Regular Pap smears help check for abnormal cells that may be cervical cancer. HIV+ women should have Pap smears every six months, or once a year if the test results are normal.   Some healthcare providers recommend that HPV testing should also be done at the same time.

Having highly active antiretroviral therapy (HAART) helps the body’s immune system to fight HPV.

Diagnosis

Cervical cancer is diagnosed by taking a sample of tissue (a biopsy) to look at under a microscope. This often involves a colposcopy. This uses a scope that lets the doctor look at the cervix with magnification. Sometimes acid is used to highlight abnormal cells on the cervix.

If cervical cancer is found, the doctor will decide what stage it is:

• Stage 0. The cancer is only in the top layer of the cervical tissue.
• Stage I. The cancer has spread to the uterus, but not beyond.
• Stage II. The cancer has spread beyond the uterus.
• Stage III. The cancer has spread to the pelvic wall or the lower third of the vagina.
• Stage IV. Cancer has spread to the bladder, rectum or other organs.

Treatment

The earlier cervical cancer is found and treated, the better. When precancerous cells are found, creams such as imiquimod can be applied to the area. The cells can be frozen with liquid nitrogen or removed with a laser or simple surgery.

If the cancer is advanced, the uterus is removed with surgery. Radiation is usually done after surgery. This is especially so in cases where a woman has many risk factors.

Radiation therapy uses high-energy rays such as X-rays to kill cancer cells and shrink tumors. It can either be beamed through the body from the outside or done by putting radioactive materials (radioisotopes) where the cancer cells were found (brachytherapy).

Chemotherapy uses drugs to kill cancer cells. The drugs are given as pills or through a needle into a vein or muscle. The chemicals enter the blood stream to kill cancer cells throughout the body. Some chemotherapy drugs make cancer cells more sensitive to radiation.

Women who have cervical cancer who also have CD4 counts of 500 or more do better than women whose CD4 counts are lower. Women with CD4+ counts of less than 50 are at high risk for the cancer coming back after treatment.