Cervical Cancer

What Is Cervical Cancer?

Cervical cancer occurs when abnormal cells on the cervix grow out of control. The cervix is the lower part of the uterus that opens into the vagina. Cervical cancer can often be cured when it’s found early. It is usually found at a very early stage through a Pap test.

What Are The Symptoms of Cervical Cancer ?

Symptoms of acne include whiteheads, blackheads, and pimples. These can occur on the face, neck, shoulders, back, or chest.

Pimples that are large and deep are called cystic lesions. These can be painful if they get infected. They also can scar the skin.

What Causes Cervical Cancer?

Cervical cancer is caused by severe abnormal changes in the cells of the cervix. Most precancerous or cancerous cell changes occur in the cervix at the transformation zone because these cells normally undergo constant change. During this natural process of change, some cervical cells can become abnormal if you are infected with high-risk types of HPV.

Other factors that may play a role in causing cervical cancer include:

1 One study shows that your risk of cervical cell changes may also increase if you are around someone else while they smoke (secondhand smoke).2 Cervical cell changes are more likely to go away on their own in women who don’t smoke.

Having an impaired immune system, such as from having human immunodeficiency virus (HIV).

Using birth control pills for more than 5 years. This may be related to infection with HPV,

Regular Pap test screening is the single most important tool to identify cervical cell changes early before they progress to cancer.

What Increases Your Risk ?

The most common cause of cervical cancer is a persistent infection with a high-risk type of human papillomavirus (HPV). HPV infection of the cervix is a sexually transmitted disease (STD). A past HPV infection in you or your partner can cause abnormal cervical cell changes years later since the virus may remain in the body for life. HPV infection usually does not cause symptoms and often goes away without causing any problems, so you or your partner may not be aware of a current or past HPV infection.

Other risk factors that may increase your risk for cervical cancer include:
Having an impaired immune system.

For example, women with human immunodeficiency virus (HIV) seem to:

Have higher rates of HPV infection.
Be more likely to develop cervical cell changes from HPV.
Be more likely to quickly develop cervical cancer from those cell changes.
Using birth control pills for more than 5 years. This may be related to infection with HPV.
Exposure to diethylstilbestrol (DES) before birth (prenatal exposure), though this is rare.
Smoking or a history of smoking, and possibly exposure to secondhand smoke.
Pregnant women have the same risk of developing cervical cancer as nonpregnant women.

What To Think About Cervical Cancer?

Most chemotherapy will cause some side effects.

Chemotherapy may be given after surgery to try to kill any cancer cells that may remain, which is called adjuvant therapy.

Studies show that chemotherapy given at the same time as radiation treatment (chemoradiation) improves survival rates in stages IIB, IIIA, IIIB and IVA cervical cancer without significantly increasing the side effects of either treatment. Chemoradiation may also improve survival rates in stages IB and IIA for women with large tumors.6, 1 Compared with radiation alone, chemoradiation improves survival.7 It is usually used as the primary therapy or after a hysterectomy.

Cisplatin is the medicine most often used in chemoradiation for cervical cancer.

Can Cervical Cancer Be Prevented?

The Pap test is the best way to find cervical cell changes that can lead to cervical cancer. Regular Pap tests almost always show these cell changes before they turn into cancer. It is important to follow up with your doctor after any abnormal Pap test result to treat abnormal cell changes. This may help prevent cervical cancer.

A new vaccine called Gardasil protects against four types of HPV, which together cause most cases of cervical cancer and genital warts.

You get three shots over 6 months. The vaccine is recommended for girls 11 to 12 years old. It is also recommended for females 13 to 26 years old who did not get the vaccine when they were younger.

The virus that causes cervical cancer is spread through sexual contact. The best way to avoid getting a sexually transmitted disease is to not have sex. If you do have sex, practice safer sex, such as using condoms and limiting the number of sex partners you have.

Early Detection Of Cervical Cancer

As part of your routine gynecological exam, you should have a Pap test. A Pap test is used to identify abnormal cell changes of your cervix and to screen for cervical cancer. The Pap test is the most effective screening test to prevent the development of cervical cancer.

Abnormal cervical cells on a Pap test are classified according to their degree of abnormality. Treatment decisions are guided by the kind of changes seen in the cells. In North America, abnormal cells are classified using the Bethesda system (TBS). The Bethesda system or other classification systems are used in other parts of the world.

Exams And Tests Of Cervical Cancer

The Pap test is a routine screening test used to identify abnormal cell changes of the cervix and to screen for cervical cancer. Regular Pap test screening is the single most important tool in identifying and treating cervical cell changes before they progress to cervical cancer. If cervical cancer is suspected, your health professional will take a medical history and perform a physical exam, including a pelvic exam and a Pap test. Several follow-up tests may be needed for evaluation and treatment.

Tests to confirm a diagnosis of cervical cancer include:

A colposcopy and cervical biopsy, to find out whether and where cancer cells are on the surface of the cervix.
An endocervical biopsy (or curettage), to find out whether cancer cells are in the cervical canal.
A cone biopsy or loop electrosurgical excision procedure (LEEP). These tests are sometimes recommended to remove cervical tissue for examination under a microscope.
If you are pregnant, a colposcopy and cervical biopsy can be done to confirm cervical cancer.

Tests to determine the extent (stage) of cervical cancer include:
A cone biopsy or loop electrosurgical excision procedure (LEEP).

These tests are sometimes recommended to determine the spread of cancer in cervical tissue.
A cystoscopy, to look at the interior lining of the bladder and the urethra to determine whether the cancer has spread to the urinary system.
A proctoscopy, to look at the lower part of the large intestine (colon) to determine whether the cancer has metastasized.
An intravenous pyelogram, to see whether there is any blockage of a kidney.
A chest X-ray, to check for cancer cells that have spread from the cervix.

Tests to guide treatment decisions include:

A complete blood count (CBC), to check for anemia and other abnormal blood values.
A chemistry screen, to find out how the liver and kidney are working.
A computed tomography (CT) scan of the abdomen and pelvis, to determine which treatment choice is needed depending on the spread of cancer in the abdomen and pelvis.

A magnetic resonance imaging (MRI) of the abdomen and pelvis. This test can also help determine which treatment will be recommended depending on the spread of cancer in the abdomen and pelvis.
A positron emission tomography (PET). This test is sometimes used to evaluate which organs the cancer has spread to.

How Is Cervical Cancer Diagnosed?

As part of your regular pelvic exam, you should have a Pap test. During a Pap test the doctor scrapes a small sample of cells from the surface of the cervix to look for cell changes.

If a Pap test shows abnormal cell changes, your doctor may do other tests to look for precancerous or cancer cells on your cervix.

Your doctor may also do a Pap test and take a sample of tissue (biopsy) if you have symptoms of cervical cancer, such as bleeding after sex.

Home Treatment Of Cervical Cancer

During medical treatment for any stage of cervical cancer, you can use home treatment to help manage the side effects of cervical cancer or cancer treatment. Home treatment may be all that is needed to manage the following common problems. If your doctor has given you instructions or medicines to treat these symptoms, be sure to follow them. In general, healthy habits such as eating a balanced diet and getting enough sleep and exercise can help control your symptoms.

Home treatment for:

Nausea or vomiting includes watching for and treating early signs of dehydration, such as a dry mouth, sticky saliva, and reduced urine output with dark yellow urine. Older adults can quickly become dehydrated from vomiting. Nausea and vomiting caused by chemotherapy usually require medical treatment. Your doctor may also prescribe medicines to control nausea and vomiting.
Diarrhea includes resting your stomach and being alert for signs of dehydration. Check with your doctor before using any nonprescription medicines for your diarrhea.

Constipation includes making sure that you drink enough fluids and include fruits, vegetables, and fiber in your diet each day. Do not use a laxative without consulting your doctor.
Other issues that may arise include:

Sleep problems. If you find you have trouble sleeping, some tips for managing sleep problems may be helpful, such as having a regular bedtime, getting some exercise during the day, and avoiding naps.
Fatigue. If you feel as though you do not have any energy and tire easily, try some measures to manage fatigue, such as getting extra rest, eating a balanced diet, and reducing your stress.

Urinary problems, which can be caused by both cervical cancer and its treatment. It may help to eliminate caffeinated drinks from your diet and to establish a schedule of urinating every 3 to 4 hours, regardless of whether you feel the need.
Hair loss. Hair loss may be unavoidable, but using mild shampoos and avoiding damaging hair products will reduce irritation of your scalp.
Many women with cervical cancer face emotional issues as a result of their disease or its treatment.

Finding out that you have cancer and undergoing treatment is stressful. Managing stress may include expressing your feelings to others. Learning relaxation techniques may also be helpful. Relaxation techniques, such as meditation, and support groups may be helpful.

Your feelings about your body and your sexuality may change following treatment for cancer. It may help to talk openly about your feelings with your partner and to discuss your concerns with your doctor. Your doctor may be able to refer you to organizations that can offer additional support and information.

Not all forms of cancer or cancer treatment cause pain. If pain occurs, many options are available to relieve it. If your doctor has given you instructions or medicines to treat pain, be sure to follow them. Home treatment for pain such as a nonsteroidal anti-inflammatory drug (NSAID) or an alternative therapy like biofeedback may improve your physical and mental well-being. Be sure to discuss any home treatment you use for pain with your doctor.

Some women with advanced-stage disease may choose not to have treatment because the time, costs, and side effects of treatment may be greater than the benefits. Making the decision about when to stop medical treatment aimed at prolonging life and shift the focus to end-of-life care can be difficult.

Medication Choices

The most common chemotherapy medicines used for initial treatment or with radiation treatment in stage IIA, IIB, IIIA, IIIB, and IVA include:
Cisplatin.
Fluorouracil (5-FU).

For advanced stage (stage IVB) cervical cancer or recurrent cervical cancer, the most common chemotherapy medicines used are:
Mitomycin.
Paclitaxel.
Ifosfamide.
Topotecan has been approved to use with cisplatin for advanced cervical cancer. These drugs may be used when surgery or radiation cannot be done or are not likely to work. They can also be used for cervical cancer that has returned or spread to other organs.

What To Think About Surgery Of Cervical Cancer?

If surgery is part of your treatment, you also may be given radiation therapy, chemotherapy, or combination chemoradiation. These treatments may be given before or after surgery to try to destroy any cancer cells that may remain. Radiation, chemotherapy, or chemoradiation given before a surgery to help control or reduce the size of the tumor is called neoadjuvant therapy.

Using these therapies after a surgery when only microscopic areas of cancer may still be present is called adjuvant therapy.

Compared with radiation alone, chemoradiation improves survival if it is used either before or after a hysterectomy.
Side effects from surgery can include difficulty with urination or problems with bowel habits, such as constipation or diarrhea. Your ability to have or enjoy sexual intercourse may also be affected.

Surgery Choices Of Cervical Cancer

Surgery for very early stages of cervical cancer that preserves your ability to have children includes:
A cone biopsy or loop electrosurgical excision procedure (LEEP), which removes a wedge of cervical tissue that contains the cancer.
Radical trachelectomy and laparoscopy for pelvic lymph node dissection, which removes the cervix and area lymph nodes, but not the uterus. Radical trachelectomy is not commonly used.

Surgery for most stages of cervical cancer does not preserve your ability to have children. Surgeries include:
Hysterectomy with or without removal of the ovaries, to remove the cervix and related organs where recurrence would be most likely to occur.

Modified radical hysterectomy with pelvic lymph node dissection. A radical hysterectomy usually includes removal of part of the vagina, the uterus, the ovaries, and the fallopian tubes. This removes the most likely sites of cancer and may reduce the risk of recurrence.

Other Treatment Choices

In addition to conventional medical treatment for cervical cancer, you may wish to try complementary therapies, such as:
Acupuncture.
Herbs.
Biofeedback.
Meditation.
Yoga.
Guided imagery.
Vitamins and nutritional supplements.

Complementary therapies are not a substitute for the standard treatment recommended for cervical cancer. Before you try any of these therapies, discuss their possible benefits and side effects with your doctor. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.

Treatment Overview

Cervical cancer detected in its early stages can be cured with treatment and close follow-up. Treatment choices for cervical cancer may include one or more of the following therapies:

Surgery to remove the cancer
Radiation therapy to treat the cancer itself or other organs affected by the cancer
Chemotherapy to help make the cancer more sensitive to radiation therapy and to treat cancer that has spread (metastasized)
Your quality of life becomes a critical issue when considering treatment options. Be sure to discuss your personal preferences with your oncologist when he or she recommends treatment.
Initial treatment
The choice of treatment and the long-term outcome (prognosis) of cervical cancer depends on the type and stage of cancer. Your age, overall health, quality of life, and desire to be able to have children must also be considered. Treatment choices for cervical cancer may be a single therapy or a combination of therapies, such as:
Cone biopsy to remove the cancer.
Simple hysterectomy to remove the uterus and cervix.
Modified radical hysterectomy and lymph node dissection to remove the cancer.
Radiation therapy, which uses high-dose X-rays or implants in the vaginal cavity to kill cancer cells.
Chemotherapy, which uses medicines to kill cancer cells.
Radical trachelectomy to remove the cervix and the pelvic lymph nodes (lymph node dissection). But the uterus is left in place. This treatment is done less often.

Chemotherapy may be given at the same time as radiation therapy (chemo radiation). Studies show that chemotherapy given at the same time as radiation treatment (chemo radiation) improves survival rates in stages IIB, IIIA, IIIB and IVA cervical cancer without significantly increasing the side effects of either treatment. Chemo radiation may also improve survival rates in stages IB and IIA for women with large tumors. Compared with radiation alone, chemo radiation improves survival.7 It is usually used as the primary therapy or after a hysterectomy.

Microinvasive squamous cell carcinoma (stage IA1) with minimal invasion into deeper cell layers is the most treatable stage with the highest survival rates. This stage is treated with a cone biopsy or loop electrosurgical excision procedure (LEEP) or simple hysterectomy; 5-year survival rates are close to 100%.

Most treatments for cervical cancer cause side effects. Side effects may differ, depending on the type of treatment used and your age and overall health. Your doctor can talk to you about your treatment choices and the side effects associated with each treatment.
Side effects of chemotherapy may include loss of appetite, nausea, vomiting, diarrhea, mouth sores, or hair loss.
Side effects of radiation therapy may include fatigue, skin irritation, or changes in your bowel or urinary habits.
Side effects of surgery depend on the surgery used to treat the stage of your cancer.
Home treatment measures may help relieve some common side effects of cancer treatment. For more information, see the Home Treatment section of this topic.

If you have recently been diagnosed with cervical cancer, you may experience a wide variety of emotions in reaction to your diagnosis. Most women will feel some denial, anger, and grief. There is no “normal” or “right” way to react to a diagnosis of cancer. You can take steps, though, to manage your emotional reactions to learning that you have cervical cancer. Some women find that talking with family and friends is comforting, while others may need to spend time alone to understand their feelings about their disease.

If your emotions are interfering with your ability to make decisions about your health and to move forward with your life, it is important to talk with your doctor. Your cancer treatment center may offer counseling services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other women who have had similar feelings after a diagnosis such as yours can help you accept and deal with your disease.
Treatment for pregnant women
Recommended treatments are the same for pregnant women as for nonpregnant women. Treatment for early stage IA cervical cancer may be delayed until after delivery if the pregnancy is in the third trimester. A vaginal delivery may be possible.

For all stages of cervical cancer, treatment will be managed by a team of doctors specializing in cancer and high-risk pregnancies. The baby does not appear to be affected by cervical cancer, but treatment for the cancer may cause problems such as an early delivery or even the loss of the baby.

10 Treatment will consider the recommendations for the specific stage of cancer, the development of the baby, and the mother’s preferences.

What to think about during initial treatment

Depending on the extent (stage) of your cancer, surgery may be combined with radiation therapy and chemotherapy. Radiation or chemotherapy given after a surgery is called adjuvant therapy.

Some women with cervical cancer may be interested in participating in research studies called clinical trials. Clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Women who do not want standard treatments or are not cured using standard treatments may want to participate in clinical trials. These are ongoing in most parts of the United States and in some other countries for all stages of cervical cancer.

Cervical cancer progresses more rapidly, has higher recurrence rates, and has a poorer prognosis in women with human immunodeficiency virus (HIV).
For more information about specific cervical cancer treatments, see the topics:
Cervical Cancer—Health Professional Information [NCI PDQ].
Cervical Cancer—Patient Information [NCI PDQ].

Ongoing treatment
After initial treatment for cervical cancer, it is important to receive follow-up care. Your emotional reactions may continue throughout the course of your treatment depending on your prognosis, the treatment methods used, and your quality-of-life decisions.

Your oncologist or gynecological oncologist will schedule regular checkups that will include:
A pelvic exam and Pap test every 3 months for the first 2 or 3 years.
After the first 2 or 3 years, a pelvic exam and Pap test every 6 months until 5 years after treatment.
Follow-up tests that may be recommended by your oncologist include an abdominal and pelvic computed tomography (CT) scan to monitor whether cancer has spread to other organs in the abdomen or pelvis.
If respiratory symptoms are present, a chest X-ray may be done to determine whether cancer has spread to the lungs.

Treatment if the condition gets worse
Cervical cancer can return after treatment. About 35% of women with cervical cancer will have persistent or recurrent disease.11 The chance that your cancer will return depends on the stage of the initial cancer: cancer found early is less likely to come back than cancer found at a later stage. If cancer returns after treatment, it is usually within 2 years of the first diagnosis.8 Your long-term outcome (prognosis) for recurrent cervical cancer depends greatly on how much the cancer has spread when the recurrence is diagnosed.

Overall, fewer than 5% of women with recurrent cancer survive 5 more years even with additional treatment.
Women who have had a radical hysterectomy and develop a recurrence that has not spread outside the pelvis have a 5-year survival rate of 30% to 40% when treated with radiation therapy. Chemotherapy may also be recommended.
Women who develop a local recurrence that has not spread outside the pelvis may be treated with an extensive surgery called pelvic exenteration, which removes all the pelvic organs and surrounding tissue to eliminate the risk of additional recurrences.
The goal of treatment of advanced-stage cervical cancer that has spread outside the pelvis is to control symptoms, reduce complications, and increase comfort (palliative care). It is not intended to cure the disease. Palliative care may include:
Radiation therapy.
Chemotherapy medicines.
Medicines for symptoms such as nausea or pain.
Complementary therapies
In addition to conventional medical treatment, you may wish to try complementary therapies, such as:
Acupuncture.
Herbs.
Biofeedback.
Meditation.
Yoga.
Visualization.
Vitamins and nutritional supplements.
Complementary therapies are not a substitute for the standard treatment recommended for cervical cancer. Before you try any of these therapies, discuss their possible benefits and side effects with your doctor. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.

End-of-life issues
Some women with advanced-stage disease that is not curable may choose not to have cancer treatment because the time, costs, and side effects of treatment may be greater than the benefits. Making the decision about when to stop cancer treatment aimed at prolonging life and shift the focus to best supportive care can be difficult.

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