Cervical Cancer
Cervical cancer is a disease in which cancer cells form in the tissues of the cervix. In the last 50 years, there has been a decrease in the number of new cases and the number of deaths due to cervical cancer.
The cervix is part of a woman's reproductive system. It is located in the lower, narrow part of the uterus (womb). The uterus is a hollow, pear-shaped organ located in the lower abdomen. The cervix connects the uterus to the vagina and the vagina leads to the outside of the body.
The cervical canal is a passageway. Blood flows from the uterus through the canal into the vagina during a woman's menstrual period. The cervix also produces mucus, which helps sperm move from the vagina into the uterus. During pregnancy, the cervix is tightly closed to help keep the baby inside the uterus. During childbirth, the cervix dilates (opens) to allow the baby to pass through the vagina.
Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia, in which cells that are not normal begin to appear in the cervical tissue. Later, cancer cells start to grow and spread more deeply into the cervix and to surrounding areas.
Studies have found a number of factors that may increase the risk of cervical cancer, which include:
- Human papillomavirus (HPV) infection
- Lack of regular Pap tests
- Weakened immune system
- Age
- Sexual history
- Smoking cigarettes
- Birth control pills taken for a long period of time
- Having many children
- Diethylstilbestrol (DES).
Human Papillomavirus (HPV)
HPV is a group of viruses that can infect the cervix and can be passed from person to person through sexual contact. HPV infections are very common and are considered to be the main risk factor for cervical cancer. Most adults have been infected with HPV at some time in their lives.
Lack of Regular Pap Tests
Cervical cancer is more common among women who do not have regular Pap tests. Pap tests help doctors find precancerous cells (cells that are not cancerous but will likely become cancerous if left untreated) and treat precancerous cervical changes, thus helping to prevent cancer.
Weakened Immune System
Women who have a weakened immune system may have a higher-than-average risk of developing cervical cancer. A weakened immune system can develop from:
- Human Immunodeficiency Virus (HIV)
- Infection
- Drugs that suppress the immune system.
For women who have a weakened immune system, doctors suggest regular screening for cervical cancer.
Age
Cancer of the cervix occurs most often in women over the age of 40.
Sexual History
Women who have had many sexual partners and women who have had sexual intercourse with a partner who has had many sexual partners may be at a higher risk of developing cervical cancer. These women are at a greater risk because they have a higher-than-average risk of HPV infection.
Smoking Cigarettes
Women with an HPV infection who smoke cigarettes have a higher risk of cervical cancer than women with an HPV infection who do not smoke.
Using Birth Control Pills for a Long Time
Using birth control pills for a long time (5 or more years) may increase the risk of cervical cancer among women with an HPV infection.
Having Many Children
Studies suggest that giving birth to many children may increase the risk of cervical cancer among women with an HPV infection.
Diethylstilbestrol
Diethylstilbestrol (DES) may increase the risk of a rare form of cervical cancer in daughters exposed to this drug before birth. DES is a drug that was once prescribed during pregnancy to prevent miscarriages or premature deliveries. It was given to some pregnant women in the United States between 1938 and 1971. However, it is no longer given to pregnant women.
Why Early Cervical Cancer Screenings Are So Important
Cervical cancer screenings are extremely important because they can help doctors find abnormal cells before cancer develops. Finding and treating abnormal cells can prevent most cervical cancer, and treatment is more likely to be effective if cancer is found early.
The number of women who are diagnosed each year has been decreasing for the past several decades. Doctors believe that this decrease is directly related to the success of cervical cancer screening.
In order to reduce the risk of developing cervical cancer, healthcare providers recommend that women have regular Pap tests. A Pap test, also known as a Pap smear or cervical smear, is a simple test that is used to look at cervical cells.
Pap tests are important because they can find cervical cancer or abnormal cells that can lead to cervical cancer. Doctors generally recommend that:
- Women should begin having Pap tests three years after they begin having sexual intercourse or when they reach age 21 (whichever comes first).
- Most women should have a Pap test at least once every three years. Talk to your healthcare provider about what schedule is best for you.
- Women age 65 to 70 who have had at least three normal Pap tests and no abnormal Pap tests in the past 10 years may decide, after speaking with their doctor, to stop cervical cancer screening.
- Women who have had a hysterectomy to remove the uterus and cervix, also called a total hysterectomy, do not need to have cervical cancer screening. However, if the surgery was used as a treatment for precancerous cells or cancer, the woman should continue with these screenings.
Women should talk with their healthcare provider about when they should begin having Pap tests, how often they should have them, and when they can stop having them. This is especially important for women who have a higher-than-average risk of cervical cancer.
Serious Symptoms
When cervical cancer becomes worse, women may notice one or more of these symptoms:
Cervical Cancer Diagnosis
- See if the patient has possible symptoms of cervical cancer
- Review Pap test results, which may show precancerous cells (cells that are not cancerous but will likely become cancerous if left untreated) or cervical cancer
- Perform a physical exam
- Ask about the patient's personal and family medical history
- Recommend additional tests and procedures.
The exams and tests that are used to make a cervical cancer diagnosis may include:
- Colposcopy
- Biopsy
- Punch biopsy
- Loop electrosurgical excision procedure (LEEP)
- Endocervical curettage
- Conization.
Staging Tests for Cervical Cancer
In order to identify how far the cancer has spread, doctors use a process called cervical cancer staging. Once the stage is known, doctors will be able to plan the best treatment.The following tests may be used in the staging process of cervical cancer.
Chest X-Ray
An x-ray is a type of energy beam that can go through the body and onto film. It creates a picture of areas inside the body. Doctors will perform a chest x-ray to make sure that the cervical cancer hasn't spread to other areas of the body.
Computed Tomography (CT) Scan
A CT scan is a procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. A computer that is linked to an x-ray machine creates these pictures. Doctors may also use a dye that is injected into a vein or swallowed by the person to help the organs or tissues show up more clearly on these pictures. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography (CAT). This can help determine the extent of the cervical cancer and whether it has spread.
Lymphangiogram
A lymphangiogram is a procedure that is used to x-ray the lymph system. This procedure requires doctors to inject a dye into the lymph vessels in the feet. The dye will travel upward through the lymph nodes and lymph vessels, and an x-ray will be taken to see if there are any blockages. A lymphangiogram will show doctors if the cervical cancer has spread to the lymph nodes.
Ultrasound Exam
An ultrasound is a procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs, resulting in echoes. These echoes will form a picture (called a sonogram) of body tissues.
MRI (Magnetic Resonance Imaging)
An MRI is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
Specific Stages of Cervical Cancer
Stages of cervical cancer include:
- Stage 0
- Stage I
- Stage II
- Stage III
- Stage IV
- Recurrent.
Stage 0 (Carcinoma in Situ)
In stage 0, cancer is only found in the first layer of cells lining the cervix, which means that it has not invaded the deeper tissues of the cervix. Stage 0 is also called carcinoma in situ.
Stage I
In stage I, cancer is only found in the cervix. This stage of cervical cancer is divided into stages IA and IB, based on the amount of cancer that is found.
Stage IA
In stage IA:
- A very small amount of cancer that can only be seen with a microscope is found in the tissues of the cervix
- The cancer is not deeper than 5 millimeters
- The cancer is not wider than 7 millimeters.
Stage IB
In stage IB, one of the following conditions is present:
- Cancer is still within the cervix
- Cancer can be seen with a microscope and is deeper than 5 millimeters or wider than 7 millimeters
- Cancer can be seen without a microscope and may be larger than 4 centimeters.
Stage II
In stage II, cancer has spread beyond the cervix but not to the pelvic wall (the tissues that line the part of the body between the hips). This cervical cancer stage is divided into stages IIA and IIB, based on how far the cancer has spread.
Stage IIA
In stage IIA, cancer has spread beyond the cervix to the upper two-thirds of the vagina but not to the tissues around the uterus.
Stage IIB
In stage IIB, cancer has spread beyond the cervix to the upper two-thirds of the vagina and to the tissues around the uterus.
Stage III
In stage III, cancer has spread to the lower third of the vagina and may have spread to the pelvic wall and nearby lymph nodes. This stage of cervical cancer is divided into stages IIIA and IIIB, based on how far the cancer has spread.
Stage IIIA
In stage IIIA, cancer has spread to the lower third of the vagina but not to the pelvic wall.
Stage IIIB
In stage IIIB, cancer has spread to the pelvic wall and/or the tumor has become large enough to block the ureters (the tubes that connect the kidneys to the bladder). This blockage can cause the kidneys to enlarge or stop working. In stage IIIB, cancer cells may also have spread to the lymph nodes in the pelvis.
Stage IV
In stage IV, cancer has spread to the bladder, rectum, or other parts of the body. This cervical cancer stage is divided into stages IVA and IVB, based on where the cancer is found.
Stage IVA
In stage IVA, cancer has spread to the bladder or rectal wall and may have spread to lymph nodes in the pelvis.
Stage IVB
In stage IVB, cancer has spread beyond the pelvis and pelvic lymph nodes to other places in the body, such as the abdomen (stomach), liver, intestinal tract, or lungs.
Recurrent Cervical Cancer
Recurrent cervical cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the cervix or in other parts of the body.
Cervical Cancer Treatment
Factors that may influence treatment options include:
- The stage of the cancer
- The size of the tumor
- The patient's desire to have children
- The patient's age.
In general, treatment options include:
- Surgery
- Chemotherapy
- Radiation therapy.
Choosing the most appropriate treatment is a decision that ideally involves the patient, her family, and the healthcare team.
Although many women with cervical cancer want to take an active part in making decisions about their medical care, the shock and stress of a cervical cancer diagnosis can make it hard to think of everything to ask the doctor. Therefore, patients may want to make a list of questions before their appointment with the doctor.
There are usually several healthcare providers involved in a person's cervical cancer treatment. Doctors may refer patients to a cervical cancer specialist, or patients may ask for a referral. Specialists who treat cervical cancer include:
- Gynecologists
- Gynecologic oncologists
- Medical oncologists
- Radiation oncologists.
Cervical cancer treatment can lead to other health problems. In order to control these problems, patients receive supportive care (also called symptom management, supportive care, or palliative care), which will improve their comfort and quality of life during treatment.
- Prescribe antibiotics and other drugs to help protect patients from infections
- Advise patients to stay away from crowds
- Advise patients to stay away from people with colds and other contagious diseases.
If an infection develops, it can be serious and should be treated promptly.
Treatment for cervical cancer can lead to anemia and bleeding, which often require supportive care such as transfusions of red blood cells or platelet transfusions.
Cervical cancer and chemotherapy can make the mouth sensitive, easily infected, and likely to bleed, which is why dental care is very important. Doctors often advise cervical cancer patients to have a complete dental exam and, if possible, undergo needed dental procedures before chemotherapy begins.
Patients need to eat well during treatment, which will include a diet that has enough calories to maintain a good weight and enough protein to keep up strength. Good nutrition often helps people with cancer feel better and have more energy.
However, eating well can be difficult because patients may not feel like eating if they are uncomfortable or tired. Side effects of treatment can also cause: poor appetite, nausea, vomiting, and food to taste different. A patient's doctor, dietitian, or other healthcare provider can suggest ways to maintain a healthy diet during treatment.
Clinical Trials
Before starting treatment for cervical cancer, patients may want to consider taking part in a clinical trial. A clinical trial is a cervical cancer research study that is meant to help improve current treatments or obtain information on new treatments. When clinical trials prove that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
It is important to have follow-up care after you have been treated for cervical cancer. Cancer can return after treatment even when the cancer appears to have been completely removed or destroyed. If undetected cancer cells remain somewhere in the body after treatment, the cancer can recur.
Throughout your follow-up care, your doctor will monitor your recovery and check for recurrence of the cancer. Checkups help ensure that any changes in your health are noted and treated as needed. Checkups may include a physical exam, Pap tests, and chest x-rays. However, between scheduled visits, you should contact your doctor right away if you experience any health problems.
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