Cervical Cancer

What is cervical cancer?

Cervical cancer is the growth of abnormal cells in the cervix. The abnormal cells are called a tumor.

The cervix is the lower part of the uterus that opens into the vagina. The uterus is the muscular organ at the top of the vagina. Babies grow in the uterus, and menstrual blood comes from the uterus, through the cervix.

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

What is the cause?

The exact cause of cervical cancer is not clear. However, we do know that women with certain risk factors may be more likely than others to have cervical cancer.

The main risk factor for cervical cancer is infection with human papillomavirus (HPV). There are many types of HPV and they can infect different parts of the body. Some types infect the genital area and can develop into cancer.

Other possible or related risk factors are:

• having sex when you were a teen
• having abnormal Pap test results
• not having regular Pap tests to look for HPV or abnormal, precancerous cells in the cervix
• having more than 1 sex partner
• having a partner who has had many other partners (because this increases your risk of HPV infection)
• having sexually transmitted diseases (STDs)
• smoking
• having a weakened immune system; for example, because you are taking immunosuppressive drugs or because 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 the cells from becoming cancer.

What are the symptoms?

Abnormal cells in the cervix and the early stages of cervical cancer do not always cause symptoms.

In its later stages, cervical cancer causes abnormal vaginal bleeding or a blood-stained vaginal discharge at unexpected times. For example, you may have bleeding between menstrual periods, after sex, 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 sex.

Infections or other health problems may also cause these symptoms. If you have any of these symptoms, tell your healthcare provider.

How is it diagnosed?

Precancerous or cancerous cells are usually found when you have a pelvic exam and Pap test. This is why a Pap test is suggested for all women 21 or older.

Some women may get an HPV test along with the Pap test. Talk with your healthcare provider to see if you need an HPV test.

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. Your provider may remove a sample of tissue (biopsy). The sample may be removed by cutting off a tiny piece of the cervix. Or it may be removed by taking scrapings from the lining of the cervical canal. The tissue samples are tested in the lab.

Sometimes abnormal cells may not be picked up with a Pap test. If an area of your cervix does not look normal in a pelvic exam, your healthcare provider may suggest a biopsy of the area even if your Pap test was normal.

How is it treated?

There are 2 types of cervical cancer:

• squamous cell cancer (the more common type)
• adenocarcinoma

They are treated in similar ways. They may be treated with surgery, radiation therapy, chemotherapy, or a combination of these treatments.

Surgery
Surgery to remove the cervix and uterus is called a hysterectomy. Tissue on the sides of the cervix may also be removed. In some cases the fallopian tubes and ovaries are removed as well.

The surgeon may remove lymph nodes in the pelvic area to check for cancer. If cancer cells have reached the lymph nodes, it means the disease may have spread to other parts of the body.

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 try to remove cancerous tissue but keep your ability to have children. For example, a surgical procedure called a cone biopsy may be done. This procedure removes a cone-shaped piece of tissue from the cervix and cervical canal. A scalpel, a laser, or an electrical current may be used to do the cone biopsy.

Radiation Therapy
If surgery is not a possible treatment for you, your healthcare provider may suggest radiation therapy instead. Radiation therapy uses high-energy rays to kill cancer cells.

Two types of radiation therapy may be used to treat cervical cancer: internal or 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, 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 while the tubes are in place, you may not be able to have visitors, or you may be able to have visitors for just very short times. Once the tubes are removed, no radioactivity is left in your body. The treatment may be repeated 2 or more times over several weeks.

Chemotherapy
Chemotherapy uses anticancer drugs to kill cancer cells. Anticancer drugs for cervical cancer are usually given through a vein. Chemotherapy is used more often when the cancer has spread to other parts of the body.

How long will the effects last?

When it is found early and treated, cervical cancer is very curable. If it is not treated, the cancer may spread. 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 chance of survival.

The earlier cervical cancer is found and treated, the greater the chances are that you will keep your ability to have children. If you are diagnosed with cervical cancer during pregnancy, your provider will discuss with you the risks of being treated and the risks of not being treated.

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 about sex, douching, and 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 healthcare provider about getting the vaccine that helps prevent certain types of HPV infection that increase your risk for cervical cancer. The vaccine is approved for females and males between the ages of 9 and 26 years.
• If you are or have ever been sexually active, you should have regular pelvic exams, including a Pap test. The Pap test can find precancerous cell changes in the cervix. Treatment of these cell changes can help avoid cervical cancer. Ask your healthcare provider how often you should have a Pap test.
• If you have a Pap test with abnormal results, follow your healthcare provider's recommendations for treatment.
• Don’t smoke.