·
Causes and risk
factors for cervical cancer have been identified and include human
papillomavirus (HPV) infection, having many sexual partners, smoking, taking birth control pills, and engaging in early sexual contact.
·
Regular pelvic exams
and Pap testing can detect precancerous changes in the cervix.
·
Precancerous changes
in the cervix may be treated with cryosurgery, cauterization, or laser surgery.
·
The most common
symptoms and signs of cervical cancer are abnormal bleeding and pelvic pain.
·
Cervical cancer can be
diagnosed using a Pap smear or other procedures that sample the cervix
tissue.
·
Cancer of the cervix
requires different treatment than cancer that begins in other parts of the
uterus.
·
The prognosis of
cervical cancer depends upon the stage and type of cervical cancer and the tumor size.
What is the cervix?
The cervix is part of a woman's reproductive
system. It's in the pelvis. The cervix is the lower, narrow part of the uterus
(womb).
The cervix is a passageway:
·
The cervix connects
the uterus to the vagina. During a menstrual period, blood flows from the
uterus through the cervix into the vagina. The vagina leads to the outside of
the body.
·
The cervix makes
mucus. During sex, mucus helps sperm move from the vagina through the cervix
into the uterus.
·
During pregnancy, the cervix is tightly closed to help keep
the baby inside the uterus. During childbirth, the cervix opens to allow the
baby to pass through the vagina.
Cancer begins in cells, the building blocks that
make up tissues. Tissues make up the cervix and other organs of the body.
Normal cervical cells grow and divide to form
new cells as the body needs them. When normal cells grow old or get damaged,
they die, and new cells take their place.
Sometimes, this process goes wrong. New cells
form when the body does not need them, and old or damaged cells do not die as
they should. The buildup of extra cells often forms a mass of tissue called a
growth or tumor.
Growths on the cervix can be benign (not
cancer) or malignant (cancer):
o are rarely a threat to life
o don't invade the tissues around them
·
Malignant growths
(cervical cancer):
o may sometimes be a threat to life
o can invade nearby tissues and organs
o can spread to other parts of the body
Cervical cancer begins in cells on the surface
of the cervix. Over time, the cervical cancer can invade more deeply into the
cervix and nearby tissues.
Cervical cancer cells can spread by breaking
away from the cervical tumor. They can travel through lymph vessels to nearby
lymph nodes. Also, cancer cells can spread through the blood vessels to the
lungs, liver, or bones.
After spreading, cancer cells may attach to
other tissues and grow to form new tumors that may damage those tissues. See
the Staging section for information about cervical cancer that has spread.
Risk factors
When you get a diagnosis of cervical cancer,
it's natural to wonder what may have caused the disease. Doctors usually can't
explain why one woman develops cervical cancer and another doesn't.
However, we do know that a woman with certain
risk factors may be more likely than other women to develop cervical cancer. A
risk factor is something that may increase the chance of developing a disease.
Studies have found that infection with the
virus called HPV is the cause of almost all cervical cancers. Most adults have
been infected with HPV at some time in their lives, but most infections clear
up on their own. An HPV infection that doesn't go away can cause cervical
cancer in some women.
Other risk factors, such as smoking, can act
to increase the risk of cervical cancer among women infected with HPV even
more.
A woman's risk of cervical cancer can be
reduced by getting regular cervical cancer screening tests. If abnormal
cervical cell changes are found early, cancer can be prevented by removing or
killing the changed cells before they become cancer cells.
Another way a woman can reduce her risk of
cervical cancer is by getting an HPV vaccine before becoming sexually active
(between the ages of 9 and 26). Even women who get an HPV vaccine need regular
cervical cancer screening tests.
Early cervical cancers usually don't cause
symptoms. When the cancer grows larger, women may notice abnormal vaginal bleeding:
·
Menstrual periods that
last longer and are heavier than before
Women may also notice...
·
Pelvic pain
·
Pain during sex
Cervical cancer, infections, or other health
problems may cause these symptoms. A woman with any of these symptoms should
tell her doctor so that problems can be diagnosed and treated as early as
possible.
Diagnosis
If you have symptoms of cervical cancer, your
doctor will try to find out what's causing the problems. You may have the
following tests:
·
Lab
tests: The doctor or nurse
scrapes a sample of cells from the cervix. For a Pap test, the lab checks the
sample for cervical cancer cells or abnormal cells that could become cancer
later if not treated. For an HPV test, the same sample is tested for HPV infection.
HPV can cause cell changes and cervical cancer.
·
Cervical
exam: The doctor uses a
colposcope to look at the cervix. The colposcope combines a bright light with a
magnifying lens to make tissue easier to see. This exam is usually done in the
doctor's office or clinic.
·
Tissue
sample: The removal of
tissue to look for cancer cells is a biopsy. Most women have cervical tissue
removed in the doctor's office, and usually only local anesthesia is needed.
The doctor will remove tissue in one of the
following ways:
o Punch biopsy: The doctor uses a sharp tool to
pinch off small samples of cervical tissue.
o Endocervical curettage: The doctor uses a
curette (a small, spoon-shaped instrument) to scrape a small sample of tissue
from the cervical canal. Some doctors may use a thin, soft brush instead of a
curette.
o Cone biopsy: The doctor removes a cone-shaped
sample of tissue. A cone biopsy lets the pathologist look at the tissue beneath
the surface of the cervix to learn whether it has abnormal cells. The doctor
may do this test in the hospital under general anesthesia.
A pathologist checks the tissue under a
microscope for cancer cells. In most cases, a biopsy is the only sure way to
tell whether cancer is present.
Removing tissue from the cervix may cause some
bleeding or other discharge. The area usually heals quickly. Some women also
feel some pain similar to menstrual cramps. Your doctor can suggest medicine that will
help relieve any pain.
You may want to ask the doctor these questions
before having a biopsy:
·
Which biopsy method do
you recommend?
·
How will tissue be
removed?
·
Will I have to go to
the hospital?
·
How long will it take?
Will I be awake? Will it hurt?
·
Are there any risks?
What are the chances of infection or bleeding after the test?
·
For how many days
afterward should I avoid using tampons, douching, or having sex?
·
Can the test affect my
ability to get pregnant and have children?
·
How soon will I know
the results? Who will explain them to me?
·
If I do have cancer,
who will talk to me about the next steps? When?
Staging
If the biopsy shows that you have cancer, your
doctor will need to learn the extent (stage) of the disease to help you choose
the best treatment. The stage is based on whether the cancer has invaded nearby
tissues or spread to other parts of the body. Cervical cancer spreads most
often to nearby tissues in the pelvis or to lymph nodes. It may also spread to
the lungs, liver, or bones.
When cancer spreads from its original place to
another part of the body, the new tumor has the same kind of cancer cells and
the same name as the original tumor. For example, if cervical cancer spreads to
the lungs, the cancer cells in the lungs are actually cervical cancer cells.
The disease is metastatic cervical cancer, not lung cancer. It's treated as cervical cancer, not as lung
cancer. Doctors sometimes call the new tumor in the lung "distant"
disease.
Your doctor will do a pelvic exam, will feel
for swollen lymph nodes, and may remove additional tissue. To learn
the extent of disease, your doctor may order one or more tests:
·
CT scan: An x-ray machine linked to a computer takes
a series of detailed pictures of your pelvis, abdomen, or chest. Before a CT
scan, you may receive contrast material by injection in your arm or hand, by
mouth, or by enema. The contrast material makes abnormal areas easier to see. A
tumor in the liver, lungs, or elsewhere in the body can show up on the CT scan.
·
MRI: A powerful magnet linked to a computer makes
detailed pictures of your pelvis and abdomen. Before MRI, you may receive an
injection of contrast material. MRI can show whether cancer has invaded tissues
near the cervix or has spread from the cervix to tissues in the pelvis or
abdomen.
The stage is based on where cancer is found.
These are the stages of invasive cervical cancer:
·
Stage
I: Cancer cells are
found only in the cervix.
·
Stage
II: The tumor has grown
through the cervix and invaded the upper part of the vagina. It may have
invaded other nearby tissues but not the pelvic wall (the lining of the part of
the body between the hips) or the lower part of the vagina.
·
Stage
III: The tumor has
invaded the pelvic wall or the lower part of the vagina. If the tumor is large
enough to block one or both of the tubes through which urine passes from the
kidneys, lab tests may show that the kidneys aren't working well.
·
Stage
IV: The tumor has
invaded the bladder or rectum. Or, the cancer has spread to other parts of the
body, such as the lungs.
Treatment
Treatment options for women with cervical
cancer are...
·
Surgery
·
Radiation therapy
·
Chemotherapy
·
A combination of these
methods
The choice of treatment depends mainly on the
size of the tumor and whether the cancer has spread. The treatment choice may
also depend on whether you would like to become pregnant someday.
Your doctor may refer you to a specialist, or
you may ask for a referral. You may want to see a gynecologic oncologist, a
doctor who specializes in treating female cancers. Other specialists who treat
cervical cancer include gynecologists, medical oncologists, and radiation
oncologists.
Your health care team may also include an
oncology nurse and a registered dietitian. Your health care team can describe
your treatment choices, the expected results of each, and the possible side
effects. Because cancer treatments often damage healthy cells and tissues, side
effects are common. These side effects depend on many factors, including the
type of treatment. Side effects may not be the same for each person, and they
may even change from one treatment session to the next. Before treatment
starts, ask your health care team about possible side effects and how treatment
may change your normal activities. You and your health care team can work
together to develop a treatment plan that meets your medical and personal
needs.
At any stage of the disease, supportive care
is available to control pain and other symptoms, to relieve the side effects of
treatment, and to ease emotional concerns. You can get information about coping
on NCI's website at http://www.cancer.gov/cancertopics/coping.
Also, you can get information about supportive
care from NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).
Or, chat using LiveHelp, NCI's instant messaging service, at
http://www.cancer.gov/livehelp.
You may want to talk with your doctor about
taking part in a clinical trial. Clinical trials are research studies testing new treatments.
They are an important option for women with all stages of cervical cancer. See
the section on Taking Part in Cancer Research 4.
You may want to ask the doctor these questions
before treatment begins:
·
What is the stage of
my disease? Has the cancer spread? If so, where?
·
May I have a copy of
the report from the pathologist?
·
What are my treatment
choices? Which do you recommend for me? Will I have more than one kind of
treatment?
·
What are the expected
benefits of each kind of treatment?
·
What are the risks and
possible side effects of each treatment? What can we do to control the side
effects?
·
What can I do to
prepare for treatment?
·
Will I have to stay in
the hospital? If so, for how long?
·
What is the treatment
likely to cost? Will my insurance cover the cost?
·
How will treatment
affect my normal activities?
·
How may treatment
affect my sex life?
·
Will I be able to get
pregnant and have children after treatment? Should I preserve eggs before
treatment starts?
·
What can I do to take
care of myself during treatment?
·
What is my chance of a
full recovery?
·
How often will I need
checkups after treatment?
·
Would a research study
(clinical trial) be right for me?
Surgery
Surgery is an option for women with Stage I or
II cervical cancer. You and your surgeon can talk about the types of surgery
and which may be right for you.
If you have a small tumor, the type of surgery
may depend on whether you want to get pregnant and have children later on. Some
women with very early cervical cancer may decide with their surgeon to have
only the cervix, part of the vagina, and the lymph nodes in the pelvis removed
(radical trachelectomy).
Other women may choose to have the cervix and
uterus removed (complete hysterectomy). The surgeon may also remove some tissue
around the cervix, part of the vagina, the fallopian tubes, or the ovaries. In
addition, the surgeon may remove lymph nodes near the tumor.
It's common to feel tired or weak for a while
after surgery for cervical cancer. The time it takes to heal is different for
each woman. You'll probably be able to leave the hospital within a couple of
days. Most women return to their normal activities within 4 to 8 weeks after
surgery.
You may have pain or discomfort for the first
few days after surgery. Medicine can help control your pain. Before surgery,
you should discuss the plan for pain relief with your health care team. After
surgery, they can adjust the plan if you need more pain control.
After a trachelectomy, some women need to have
a tube put into the bladder to drain urine. It usually can be removed a few
days after surgery.
After a hysterectomy, some women become
constipated or have nausea and vomiting. In addition, some women lose control of
their bladder or have trouble emptying their bladder. These effects are usually
temporary. After a hysterectomy, you'll stop having menstrual periods, and you
won't be able to become pregnant.
After the ovaries are removed, menopause
occurs at once. You may have hot flashes, vaginal dryness, and night sweats. These symptoms are caused by the sudden loss
of female hormones. Talk with your health care team about your symptoms so that
you can develop a treatment plan together. There are drugs and lifestyle changes
that can help, and most symptoms go away or lessen with time.
Surgery to remove lymph nodes may cause
swelling (lymphedema) in one or both legs. Ask your health care
team about how you may prevent or control the swelling. Information about
lymphedema is available on NCI's website at http://www.cancer.gov/cancertopics/coping.
For some women, surgery to remove the cervix
and nearby tissues can affect sexual intimacy. You may have feelings of loss
that make intimacy difficult. Sharing these feelings with your partner may be
helpful. Sometimes couples talk with a counselor to help them express their
concerns.
You may want to ask the doctor these questions
before having surgery:
·
Do you recommend
surgery for me? If so, which kind? Will my ovaries be removed? Do I need to
have lymph nodes removed?
·
What is the goal of
surgery?
·
What are the risks of
surgery?
·
How will I feel after
surgery? If I have pain, how will it be controlled?
·
How long will I have
to be in the hospital?
·
Will I have any
lasting side effects?
·
When will I be able to
resume normal activities?
Radiation therapy
Radiation therapy uses high-energy rays to
kill cancer cells. It's an option for women with any stage of cervical cancer.
Women with early cervical cancer may choose radiation therapy instead of
surgery. It also may be used after surgery to destroy any cancer cells that
remain in the area. Women with cancer that extends beyond the cervix may have
radiation therapy and chemotherapy.
Doctors use two types of radiation therapy to
treat cervical cancer. Some women receive both types:
·
External radiation
therapy: A large machine directs radiation at your pelvis or other areas with
cancer. The treatment usually is given in a hospital or clinic. You may receive
external radiation therapy 5 days a week for several weeks. Each treatment
takes only a few minutes.
·
Internal radiation
therapy (also called brachytherapy): A narrow cylinder is placed inside your
vagina, and a radioactive substance is loaded into the cylinder. Usually, a
session of internal radiation therapy lasts only a few minutes. The cylinder
and substance are removed, and you can go home. The short session may be
repeated two or more times over several weeks. When the radioactive substance
is removed, no radioactivity is left in your body. With a less common method of
internal radiation therapy, you may stay in the hospital for several days
during treatment.
Although radiation therapy is painless, it may
cause side effects. The side effects depend mainly on how much radiation is
given and which part of your body is treated. Radiation to the abdomen and
pelvis may cause nausea, vomiting, diarrhea, or urinary problems. You may lose hair in
your genital area. Also, skin on the abdomen and pelvis may become red, dry,
and tender.
You may have dryness, itching, or burning in your vagina. Your doctor may
advise you to wait until a few weeks after radiation treatment ends to have
sex.
You are likely to become tired during
radiation therapy, especially in the later weeks of treatment. Resting is
important, but doctors usually advise patients to try to stay as active as they
can.
Although the side effects of radiation therapy
can be upsetting, they can usually be treated or controlled. Talk with your
doctor or nurse about ways to relieve discomfort.
It may also help to know that most side
effects go away when treatment ends. However, you may want to discuss with your
doctor the possible long-term effects of radiation therapy. For example,
radiation therapy may make the vagina narrower. A narrow vagina can make sex or
follow-up exams difficult. There are ways to prevent this problem. If it does
occur, however, your health care team can tell you about ways to expand the
vagina.
Another possible long-term effect is damage to
the ovaries. Menstrual periods usually stop, and women may have hot flashes and
vaginal dryness. Menstrual periods may return for some women, especially
younger women. Women who may want to get pregnant after radiation therapy
should ask their health care team about ways to preserve their eggs before
treatment starts.
You may want to ask the doctor these questions
before having radiation therapy:
·
What is the goal of
this treatment?
·
How will the radiation
be given?
·
Will I need to stay in
the hospital? If so, for how long?
·
When will the
treatments begin?
·
How often will I have
them? When will they end?
·
How will I feel during
treatment? Are there side effects?
·
How will we know if
the radiation therapy is working?
·
Will I be able to
continue my normal activities during treatment?
·
How will radiation
therapy affect my sex life?
·
Are there lasting side
effects?
Chemotherapy
Chemotherapy uses drugs to kill cancer cells.
For the treatment of cervical cancer, chemotherapy is usually combined with
radiation therapy. For cancer that has spread to distant organs, chemotherapy
may be used alone.
Most drugs for cervical cancer are given
directly into a vein (intravenously) through a thin needle. Some drugs can be
taken by mouth. Most women receive chemotherapy in a clinic or at the doctor's
office. Drugs that are swallowed may be taken at home instead. Some women need
to stay in the hospital during treatment.
The side effects depend mainly on which drugs
are given and how much. Chemotherapy kills fast-growing cancer cells, but the
drugs can also harm normal cells that divide rapidly:
·
Blood
cells: When chemotherapy
lowers the levels of healthy blood cells, you're more likely to get infections,
bruise or bleed easily, and feel very weak and tired. Your health care team
will check for low levels of blood cells. If the levels are low, your health
care team may stop the chemotherapy for a while or reduce the dose of drug.
They may also give you medicines that can help your body make new blood cells.
·
Cells
in hair roots: Chemotherapy may
cause hair loss. If you lose your hair, it will grow back,
but it may change in color and texture.
·
Cells
that line the digestive tract: Chemotherapy can cause a poor appetite, nausea and vomiting,
diarrhea, or mouth and lip sores. Your health care team can give you medicines
and suggest other ways to help with these problems.
Other side effects include skin rash, tingling or numbness in your hands and feet,
hearing problems, loss of balance, joint pain, or swollen legs and feet. Your health care
team can suggest ways to control many of these problems. Most go away when
treatment ends.
You may want to ask the doctor these questions
before having chemotherapy:
·
Why do I need this
treatment?
·
Which drug or drugs
will I have?
·
How do the drugs work?
·
What are the expected
benefits of the treatment?
·
What are the risks and
possible side effects of treatment? What can we do about them?
·
When will treatment
start? When will it end?
·
How will treatment
affect my normal activities?
·
Second
opinion
·
Before starting
treatment, you might want a second opinion about your diagnosis, stage of
cancer, and treatment plan. Some people worry that the doctor will be offended
if they ask for a second opinion. Usually the opposite is true. Most doctors
welcome a second opinion. And many health insurance companies will pay for a
second opinion if you or your doctor requests it. Some companies require a
second opinion.
·
If you get a second
opinion, the second doctor may agree with your first doctor's diagnosis and
treatment plan. Or, the second doctor may suggest another approach. Either way,
you have more information and perhaps a greater sense of control. You can feel
more confident about the decisions you make, knowing that you've looked at all
of your options.
·
It may take some time
and effort to gather your medical records and see another doctor. In most
cases, it's not a problem to take several weeks to get a second opinion. The
delay in starting treatment usually will not make treatment less effective. To
make sure, you should discuss this delay with your doctor.
·
There are many ways to
find a doctor for a second opinion. You can ask your doctor, a local or state
medical society, or a nearby hospital or medical school for names of
specialists.
·
Nutrition
·
Eating well is
important before, during, and after cancer treatment. You need the right amount
of calories to maintain a good weight. You also need enough protein to keep up
your strength. Eating well may help you feel better and have more energy.
·
Sometimes, especially
during or soon after treatment, you may not feel like eating. You may be
uncomfortable or tired. You may find that foods don't taste as good as they
used to. In addition, poor appetite, nausea, vomiting, mouth blisters, and other side effects of treatment can make
it hard for you to eat.
·
Your doctor, a
registered dietitian, or another health care provider can suggest ways to help
you meet your nutrition needs.
Follow-up care
You'll need regular checkups (such as every 3
to 6 months) after treatment for cervical cancer. Checkups help ensure that any
changes in your health are noted and treated if needed. If you have any health
problems between checkups, contact your doctor.
Cervical cancer may come back after treatment.
Your doctor will check for the return of cancer. Checkups may include a
physical exam, Pap test, and chest x-ray.
You may want to ask your doctor these
questions after you have finished treatment:
·
How often will I need
checkups?
·
How often will I need
a Pap test?
·
What other follow-up
tests do you suggest for me?
·
Between checkups, what
health problems or symptoms should I tell you about?
Learning that you have cervical cancer can
change your life and the lives of those close to you. These changes can be hard
to handle. It's normal for you, your family, and your friends to need help
coping with the feelings that a diagnosis of cancer can bring.
Concerns about treatments and managing side
effects, hospital stays, and medical bills are common. You may also worry about
caring for your family, keeping your job, or continuing daily activities.
Here's where you can go for support:
·
Doctors, nurses, and
other members of your health care team can answer questions about treatment,
working, or other activities.
·
Social workers,
counselors, or members of the clergy can be helpful if you want to talk about
your feelings or concerns. Often, social workers can suggest resources for
financial aid, transportation, home care, or emotional support.
·
Support groups also
can help. In these groups, patients or their family members meet with other
patients or their families to share what they have learned about coping with
cancer and the effects of treatment. Groups may offer support in person, over
the telephone, or on the Internet. You may want to talk with a member of your
health care team about finding a support group.
·
NCI's Cancer
Information Service can help you locate programs, services, and NCI
publications. Call 1-800-4-CANCER (1-800-422-6237). Or, chat using LiveHelp,
NCI's instant messaging service, at http://www.cancer.gov/livehelp.
·
Your doctor or a sex
counselor may be helpful if you and your partner are concerned about the
effects of cervical cancer on your sex life. Ask your doctor about possible treatment
of side effects and whether these effects are likely to last. Whatever the
outlook, you and your partner may find it helps to discuss your concerns.
Taking part in cancer research
Doctors all over the world are conducting many
types of clinical trials (research studies in which people volunteer to take
part). Research has already led to advances in the prevention, diagnosis, and treatment of cervical cancer.
Doctors continue to search for new and better
ways to treat cervical cancer. They are testing new treatments, including new
drugs, combinations, and schedules. Some studies are combining surgery,
chemotherapy, and radiation therapy.
Clinical trials are designed to find out
whether new treatments are safe and effective. Even if the women in a trial
don't benefit directly, they may still make an important contribution by
helping doctors learn more about cervical cancer and how to control it.
Although clinical trials may pose some risks, researchers do all they can to
protect their patients.
If you're interested in being part of a
clinical trial, talk with your doctor.
NCI's website includes a section on clinical
trials at http://www.cancer.gov/clinicaltrials. It has general information
about clinical trials as well as detailed information about specific ongoing
studies of cervical cancer.
NCI's Cancer Information Service can answer
your questions and provide information about clinical trials. Contact CIS at
1-800-4-CANCER (1-800-422-6237) or at LiveHelp at
http://www.cancer.gov/livehelp.
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