Cervical Cancer

What is cervical cancer?

Cervical cancer is the uncontrolled growth of abnormal cells in the cervix. The cervix is the lower part of the uterus that opens into the vagina. The abnormal growth of cells is called a tumor.

Cervical cancer is one of the most common cancers affecting women. Most often, it develops in women aged 40 or older.

How does it occur?

The exact causes of cervical cancer are unclear. However, we do know that women with certain risk factors may be more likely than others to have cervical cancer. A risk factor is something that may increase the chance of developing a disease.

The main risk factor for cervical cancer is infection with human papillomavirus (HPV). There are many types of HPV, including types that infect the genital area and some that cause genital warts. Some types of HPV infection can develop into cancer if not treated. Some other possible or related risk factors are:

• not having regular Pap tests to look for HPV or abnormal, precancerous cells in the cervix
• having more than 1 sex partner or having a partner who has had many other partners (because this increases your risk of HPV infection)
• smoking
• a weakened immune system; for example, because you are taking immunosuppressive drugs, or you have AIDS.

The cells in the cervix start to change before they become cancerous. These precancerous changes are called cervical intraepithelial neoplasia, or CIN. Early detection and treatment of precancerous cells can prevent them from becoming cancerous. Without treatment the abnormal cells can become cancer and spread to other parts of the body.

What are the symptoms?

Abnormal cells in the cervix and cervical cancer do not always cause symptoms. Precancerous or cancerous cells are usually found with a pelvic exam and Pap test. This is why a Pap test is suggested for all women who are sexually active or age 18 and older.

Later stages of cervical cancer cause abnormal vaginal bleeding or a blood-stained discharge at unexpected times. For example, you may have bleeding between menstrual periods, after intercourse, or after menopause. Menstrual periods may last longer and be heavier than normal. You may have more vaginal discharge. The cancer can cause pelvic pain or pain during intercourse.

Infections or other health problems may also cause these symptoms. If you have any of these symptoms, tell your healthcare provider so that problems can be diagnosed and treated as early as possible.

How is it diagnosed?

Pelvic exams and Pap tests are used to check for changes in cervical cells or cancer. For a Pap test, your healthcare provider gently scrapes cells from the cervix. The cells are sent to a lab for tests.

Some women may get an HPV test along with the Pap test. You should talk with your provider to see if this is right for you.

If your Pap test is not normal, your provider may look at the cervix with a colposcope. A colposcope is a special type of microscope for looking at the vagina and cervix. The test is called a colposcopy. During the test, your provider may take a sample of tissue. For example, this may be done by cutting off a tiny piece of the cervix (a biopsy) or by taking scrapings from the lining of the cervical canal (endocervical curettage). The samples are tested in the lab.

Sometimes there may be abnormal cells that are not picked up with the Pap test. If you have a normal Pap test but an area of the cervix does not look normal in a pelvic exam, your provider may want to do a biopsy of the area.

How is it treated?

There are 2 types of cervical cancer: squamous cell cancer (the more common type) and adenocancer. They are treated the same way. The cancer may be treated with surgery, radiation therapy, chemotherapy, or a combination of these therapies.

Surgery

Surgery to remove the cervix and uterus is called a hysterectomy. In some cases part of the vagina, the fallopian tubes, and ovaries may be removed as well (a procedure called a radical hysterectomy). The surgeon may remove lymph nodes in the pelvic area to see if they contain cancer. If cancer cells have reached the lymph nodes, it means the disease may have spread to other parts of the body. This is called metastases.

If your uterus is removed, you will no longer be able to have children. For very early cervical cancer, other methods may be used to remove cancerous tissue and keep your ability to have children. For example, a surgical procedure called conization may be done to remove a cone-shaped piece of tissue from the cervix and cervical canal. Or freezing, a laser, or an electrical current may be used to remove tissue. The earlier cervical cancer is found and treated, the greater the chances are that you will keep your ability to have children.

Radiation Therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area. If surgery is not a possible treatment for you, your healthcare provider may suggest radiation therapy instead.

Doctors use 2 types of radiation therapy to treat cervical cancer: internal and external radiation.

• External radiation comes from a large machine outside the body. The treatment is usually given in an outpatient clinic 5 days a week for several weeks.
• For internal radiation, also called intracavitary radiation, thin tubes containing a radioactive substance are left in the vagina for a few hours or up to 3 days. You may stay in the hospital during this time. To protect others from the radiation, you may not be able to have visitors or may have visitors for only a short period of time while the tubes are in place. Once the tubes are removed, no radioactivity is left in the body. The treatment may be repeated 2 or more times over several weeks.

Chemotherapy

Chemotherapy uses anticancer drugs to kill cancer cells. It can affect cells all over the body. Anticancer drugs for cervical cancer are usually given through a vein. The treatment is usually given in an outpatient part of the hospital, at your provider's office, or at home. Chemotherapy is used more often when the cancer has spread to other parts of your body.

If you are diagnosed with cervical cancer during pregnancy, your provider will discuss with you the risks of treatment and the risks of not getting treatment.

How long will the effects last?

When it is found early and treated, cervical cancer is highly curable. If it is not treated, the cancer may spread to surrounding areas such as lymph nodes and nearby pelvic tissues. As the tumor gets bigger or spreads beyond the cervix, the chance of cure is less. However, combined treatment with surgery, radiation, and chemotherapy does improve the survival rate.

How can I take care of myself?

If you have been diagnosed with cervical cancer:

• Discuss your cancer and treatment choices with your healthcare provider so that you understand them. You may want to get a second opinion.
• Tell your provider if your treatment causes discomfort. Usually there are ways to relieve the discomfort.
• Ask your provider for instructions regarding intercourse, douching, or using tampons.
• After your treatment, be sure to follow your provider's schedule for checkups. Your provider will monitor your recovery and check for recurrence of the cancer. Checkups may include a physical exam as well as Pap tests and chest X-rays. Between scheduled visits, you should contact your provider right away if you have any health problems.

How can I help prevent cervical cancer?

To help reduce your risk of cervical cancer:

• Try to avoid exposure to HPV. Do not have more than 1 sexual partner. It will also help if your partner has not been sexually active with anyone else. Find out if your partner has had any sexually transmitted diseases. You can get some protection from HPV by using latex or polyurethane condoms every time you have sexual intercourse. However, condoms do not completely protect against this infection, which can be spread from other parts of the body.
• Ask your provider about getting the shot (Gardasil) that prevents types of HPV infection that are a high risk for cervical cancer.
• If you are or have ever been sexually active, you should have regular pelvic exams, including a Pap test. The Pap test can find cell changes in the cervix caused by HPV. Treatment of these cell changes can prevent cervical cancer. Ask your provider how often you should have a Pap test.
• If you have a Pap test with abnormal results, follow your provider's recommendations for treatment.
• Do not smoke.