Cervical Cancer

Cervical cancer is a common type of slow-growing cancer that affects the mouth of the womb (uterus). The cervix connects the uterus to the vagina. Each year in the U.S., about 16,000 new cases of cervical cancer are diagnosed. The condition may start with changes in the shape, size or formation of cervical cells, called dysplasia.

A Pap smear detects cells that look suspicious and may become cancerous and spread beyond the cervix. Pre-cancerous conditions can easily be detected by Pap smear and treated before cancer develops. Since the introduction of the Pap smear, the number of cervical cancer cases reported every year has decreased. However, the number of cases diagnosed in younger women has been on the rise. That may be caused by the fact that fully one third of adult women fail to get regular Pap smear tests.

Risk Factors

A virus called human papillomavirus (HPV) is believed to cause cells and tissues in the cervix to grow abnormally and to develop into cervical cancer. About 6 million women in the U.S. are infected with HPV. While researchers work to learn more about this form of cancer, certain risk factors are known, including:

  • Having many sexual partners
  • First intercourse at a young age
  • A history of smoking

Signs and Symptoms

Pre-cancerous cervical conditions are generally painless. They are not easily detected unless the patient has a pelvic exam and a Pap smear. Symptoms include:

  • Abnormal bleeding, occuring only after the cervical cells become cancerous and invade neighboring tissues
  • Unusual vaginal discharge
  • Increased bleeding during menstruation
  • Bleeding between regular menstrual periods or after sexual intercourse, douching or a pelvic exam
  • Difficulty or pain in urination
  • Pain during intercourse
  • Pain in the pelvic area
  • Pre- or postmenopausal bleeding

These symptoms may also be caused by other less serious health problems. Patients are encouraged to visit their doctors when experiencing similar symptoms.

Diagnosis

Pelvic exams, Pap smears and biopsies are methods used to detect cervical cancer and abnormal, pre-cancerous cervical lesions.

  • Pelvic exam. Probing for lumps or abnormalities in shape or size, the doctor checks the uterus, vagina, ovaries, fallopian tubes, bladder and rectum using a speculum. (This instrument enlarges the vagina and allows the doctor to see the upper portion of the vagina and the cervix.)
  • Pap smear. Simple and painless, this test is often done during a pelvic exam. A small wooden scraper (spatula) and/or a small brush is used to collect cell samples from the upper portion of the vagina and the cervix. Samples are looked at under a microscope to check for abnormal cells. (Pap smears examine only cervical cells and are not indicators of uterine cancer.)
  • Biopsy. A doctor may scrape or remove a small amount of tissue from the cervix while the patient is under anesthesia. The sample is sent to the laboratory to see if cancer cells are present.

Treatment

After test and examination results are in, the doctor will discuss with the patient what treatments will likely work best for her condition. Treatment plans depend on:

  • Patient's age
  • Patient's general health
  • Tumor size
  • Stage of the disease
  • Speed of cell growth and degree of spreading (tumor grade)
  • Effect of female hormones on tumor size
  • Patient's desire to have children in the future

Treatments for cervical cancer include surgery, radiation therapy, chemotherapy and/or biologic therapy.

Surgery

Surgery involves removal of abnormal tissue in or around the cervical area. If only the surface of the cervix is affected, the doctor may treat the cancer cells in the same way he treats pre-cancerous lesions. If cancer cells have gone deeper into the cervical tissue, the doctor may remove the tumor but leave the uterus and the ovaries intact. In some cases, particularly when patients do not plan to have children, the patient may choose to have a hysterectomy, in which the doctor removes the uterus and sometimes the ovaries and the fallopian tubes.

Radiation Therapy

During radiation therapy, high doses of X-rays destroy or shrink cancer cells in specifically targeted areas. Radiation may be given externally through special
X-ray equipment, by radiation-producing materials placed directly into the cervical area or by both. Radiation therapy may be used alone or in addition to surgery.

Chemotherapy

Patients receive chemotherapy either by taking pills or by injecting drugs directly into the vein. Drugs enter the bloodstream and travel throughout the body, killing cancer cells inside and outside the cervix. Chemotherapy is often used to treat cervical cancer that has spread to other parts of the body (metastasis).

Biologic Therapy

Biologic therapy is often used to treat cancer that has spread. The use of substances, such as interferon, can boost the body's immune system. Interferon is a type of protein that is normally produced by the body and that can also be made in large quantities in the lab. Interferon is commonly used with other drugs when treating cervical cancer.

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