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. Human papillomavirus (HPV) infection is the major risk factor for development of cervical cancer. Infection of the cervix with human papillomavirus (HPV) is the most common cause of cervical cancer. Not all women with HPV infection, however, will develop cervical cancer. Women who do not regularly have a Pap smear to detect HPV or abnormal cells in the cervix are at increased risk of cervical cancer.
Other possible risk factors include the following:
- Giving birth to many children.
- Having many sexual partners.
- Having first sexual intercourse at a young age.
- Smoking cigarettes.
- A diet lacking in vitamins A and C.
- Oral contraceptive use (ithe Pilli).
- Weakened immune system.
There are usually no noticeable signs of early cervical cancer but it can be detected early with yearly check-ups.
Early cervical cancer may not cause noticeable signs or symptoms. Women should have yearly check-ups, including a Pap smear to check for abnormal cells in the cervix. The prognosis (chance of recovery) is better when the cancer is found early.
Possible signs of cervical cancer include vaginal bleeding and pelvic pain.
These and other symptoms may be caused by cervical cancer or by other conditions. A doctor should be consulted if any of the following problems occur:
- Vaginal bleeding.
- Unusual vaginal discharge.
- Pelvic pain.
- Pain during sexual intercourse.
Tests that examine the cervix are used to detect (find) and diagnose cervical cancer.
- Pap smear: A piece of cotton, a brush, or a small wooden stick is used to collect cells from the cervix and vagina. The cells are viewed under a microscope. Abnormal (precancerous) cells in the tissues of the cervix can usually be found by a Pap smear.
- Colposcopy: The tissues of the vagina and cervix are examined using a lighted magnifying instrument called a colposcope.
- Biopsy: If abnormal cells are found in a Pap smear, the doctor may do a biopsy. A sample of tissue is cut from the cervix and viewed under a microscope. A biopsy that removes only a small amount of tissue is usually done in the doctoris office. A woman may need to go to a hospital for a cervical cone biopsy (removal of a larger, cone-shaped sample of cervical tissue).
- Pelvic exam: A procedure to check the uterus, vagina, ovaries, fallopian tubes, bladder, and rectum to find any abnormality in their shape or size.
- Endocervical curettage: A curette (a spoon-shaped instrument) is used to collect cells from the cervical canal. The cells are viewed under a microscope. This procedure is sometimes done at the same time as the colposcopy.
Certain factors affect treatment options and prognosis (chance of recovery).
The treatment options and prognosis (chance of recovery) depend on the stage of the cancer (whether it affects part of the cervix, involves the whole cervix, or has spread to the lymph nodes or other places in the body), the type of cervical cancer, the size of the tumor, and the patientis desire to have children. Lymph nodes are small, bean-shaped structures found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease.
Treatment of cervical cancer during pregnancy depends on the stage of the cancer and the stage of the pregnancy. For cervical cancer found early or for cancer found during the last trimester of pregnancy, treatment may be delayed until after the baby is born.
Stages of Cervical Cancer
After cervical cancer has been diagnosed, tests are done to find out if cancer cells have spread within the cervix or to other parts of the body.
The process used to find out if cancer has spread within the cervix or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment. The following tests and procedures may be used in the staging process:
- Chest x-ray: Brief exposure of the chest to radiation to produce an image of the chest and its internal structures.
- CT scan (CAT scan): A CT scan creates a series of detailed pictures of areas inside the body, taken from different angles. The pictures are created by a computer linked to an x-ray machine. This test is also called computed tomography, computerized tomography, or computerized axial tomography.
- Lymphangiography: An x-ray is made of the lymph system. A dye is injected into a lymph vessel and travels through the lymph system. The dye outlines the lymph vessels and organs on the x-ray. This test helps determine whether cancer has spread to the lymph nodes.
- Pretreatment surgical staging: Surgery (an operation) is done to find out if the cancer has spread within the cervix or to other parts of the body. In some cases, the cervical cancer can be removed at the same time. Pretreatment surgical staging is usually done only as part of a clinical trial.
- Ultrasound: A test that uses sound waves to create images of body tissues.
- MRI (magnetic resonance imaging): A procedure in which a magnet linked to a computer is used to create detailed pictures of areas inside the body. This test is also called nuclear magnetic resonance imaging (NMRI).
The results of these tests are viewed together with the results of the original tumor biopsy to determine the cervical cancer stage.
The following stages are used for cervical cancer:
Stage 0 (Carcinoma in Situ)
In stage 0, the cancer is found in the first layer of cells lining the cervix only and has not invaded the deeper tissues of the cervix. Stage 0 is also called carcinoma in situ.
Stage I
In stage I, cancer is found in the cervix only. Stage I is divided into stages IA and IB, based on the amount of cancer that is found.
- 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 (less than o inch) and not wider than 7 millimeters (about o inch).
Stage IB: In stage IB, the tumor is still within the cervix and either:
can only be seen with a microscope and is deeper than 5 millimeters (less than o inch) or wider than 7 millimeters (about o inch); or
- can be seen without a microscope and may be larger than 4 centimeters (about 1 Ohm inches).
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). Stage II is divided into stages IIA and IIB, based on how far the cancer has spread from the cervix into nearby tissue.
- Stage IIA: Cancer has spread beyond the cervix to the upper two thirds of the vagina but not to tissues around the uterus.
- 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. Stage III is divided into stages IIIA and IIIB, based on how far the cancer has spread.
- Stage IIIA: Cancer cells have spread to the lower third of the vagina but not to the pelvic wall.
- Stage IIIB: Cancer cells have 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. Cancer cells may also have spread to lymph nodes in the pelvis.
Stage IV
In stage IV, cancer has spread to the bladder, rectum, or other parts of the body. Stage IV is divided into stages IVA and IVB, based on where the cancer is found.
- Stage IVA: Cancer has spread to the bladder or rectal wall and may have spread to lymph nodes in the pelvis.
- Stage IVB: Cancer has spread beyond the pelvis and pelvic lymph nodes to other places in the body, such as the abdomen, 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.
Treatment Option Overview.
Different types of treatment are available for patients with cervical cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.
Three types of standard treatment are used:
Surgery
Surgery (removing the cancer in an operation) is sometimes used to treat cervical cancer. The following surgical procedures may be used:
- Conization: Surgery to remove a cone-shaped piece of tissue from the cervix and cervical canal for biopsy. Also called cone biopsy.
- Hysterectomy: The uterus and cervix are removed in a hysterectomy. If the uterus is taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus is taken out through an incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy.
- Bilateral*salpingo-oophorectomy: The removal of both ovaries and both fallopian tubes.
- Radical hysterectomy: This surgery involves removing the cervix, uterus, fallopian tubes, ovaries, and part of the vagina. Lymph nodes may also be removed.
- Pelvic exenteration: If the cancer has spread throughout the pelvis, then the lower colon, rectum, or bladder (depending on where the cancer has spread) may be removed along with the cervix, uterus, and vagina. Plastic surgery may be needed to make an artificial vagina after this operation.
- Cryosurgery: An instrument is used to freeze and destroy the abnormal tissue. This procedure is also called cryotherapy. Carcinoma in situ may be treated with cryosurgery.
- Laser surgery : A laser beam (a narrow beam of intense light) is used as a knife to remove the cancer. A laser beam can also be used to kill the cancer cells. This may be called laser therapy.
- Loop electrosurgical excision procedure (LEEP): An electrical current passed through a thin wire loop is used as a knife to remove abnormal tissue.
Radiation therapy
Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Both external and internal radiation are used for cervical cancer.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.
Other types of treatment are being tested in clinical trials.
Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.
Treatment Options By Stage
Stage 0 Cervical Cancer (Carcinoma in Situ)
- Loop electrosurgical excision procedure (LEEP).
- Laser surgery.
- Conization.
- Cryosurgery.
- Hysterectomy for women who cannot or no longer want to have children.
- Internal radiation therapy for women who cannot have surgery.
Stage IA Cervical Cancer
- Hysterectomy with or without bilateral*salpingo-oophorectomy.
- Conization.
- Radical hysterectomy and removal of lymph nodes.
- Internal radiation therapy.
Stage IB Cervical Cancer
- A combination of internal radiation therapy and external radiation therapy.
- Radical hysterectomy and removal of lymph nodes.
- Radical hysterectomy and removal of lymph nodes followed by radiation therapy plus chemotherapy.
- Radiation therapy plus chemotherapy.
- A clinical trial of high-dose internal radiation therapy combined with external radiation therapy.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.
Stage IIA Cervical Cancer
- A combination of internal radiation therapy and external radiation therapy.
- Radical hysterectomy and removal of lymph nodes.
- Radical hysterectomy and removal of lymph nodes followed by radiation therapy plus chemotherapy.
- Radiation therapy plus chemotherapy.
- A clinical trial of high-dose internal radiation therapy combined with external radiation therapy.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.
Stage IIB Cervical Cancer
- Internal and external radiation therapy combined with chemotherapy.
Stage III Cervical Cancer
- Internal and external radiation therapy combined with chemotherapy.
Stage IVA Cervical Cancer
- Internal and external radiation therapy combined with chemotherapy.
Stage IVB Cervical Cancer
- Radiation therapy as palliative therapy to relieve symptoms caused by the cancer and improve quality of life.
- Chemotherapy.
- Clinical trials of new anticancer drugs or drug combinations.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.
Treatment Options for Recurrent Cervical Cancer
- Pelvic exenteration followed by radiation therapy combined with chemotherapy.
- Chemotherapy as palliative therapy to relieve symptoms caused by the cancer and improve quality of life.
- Clinical trials of new anticancer drugs or drug combinations.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site.
SOURCE: National Cancer Institute, National Institutes of Health
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