Cervical Cancer

Cervical cancer is a type of cancer that occurs in the cells of the cervix — the lower part of the uterus that connects to the vagina.

Various strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cervical cancer. Long-lasting infections with certain types of human papillomavirus (HPV) cause almost all cases of cervical cancer. Vaccines that protect against infection with these types of HPV can greatly reduce the risk of cervical cancer. Having a Pap test to check for abnormal cells in the cervix or a test to check for HPV can find cells that may become cervical cancer. These cells can be treated before cancer forms.

When exposed to HPV, a woman's immune system typically prevents the virus from doing harm. In a small group of women, however, the virus survives for years, contributing to the process that causes some cells on the surface of the cervix to become cancer cells.

You can reduce your risk of developing cervical cancer by having screening tests and receiving a vaccine that protects against HPV infection.

Cervical cancer can usually be cured if it is found and treated in the early stages. Surgery, radiation therapy, and chemotherapy are often used to treat cervical cancer.

Early-stage cervical cancer generally produces no signs or symptoms. Women with early cervical cancers and pre-cancers usually have no symptoms. Symptoms often do not begin until the cancer becomes invasive and grows into nearby tissue. When this happens, the most common symptoms are:

• Vaginal bleeding after intercourse, between periods or after menopause
• Watery, bloody vaginal discharge that may be heavy and have a foul odor
• Pelvic pain or pain during intercourse

These signs and symptoms can also be caused by conditions other than cervical cancer. For example, an infection can cause pain or bleeding. Still, if you have any of these signs or other suspicious symptoms, you should see your health care professional right away. Ignoring symptoms may allow the cancer to progress to a more advanced stage and lower your chance for effective treatment.

Cervical cancer begins when healthy cells acquire a genetic change (mutation) that causes them to turn into abnormal cells.

Healthy cells grow and multiply at a set rate, eventually dying at a set time. Cancer cells grow and multiply out of control, and they do not die. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can break off from a tumor to spread (metastasize) to other places in the body.

It is not clear exactly what causes cervical cancer, but HPV plays a role. HPV is very common, and most women with the virus never develop cervical cancer. This means other factors — such as your environment or your lifestyle choices — also determine whether you'll develop cervical cancer.

Risk factors for cervical cancer include:

• Many sexual partners. The greater your number of sexual partners — and the greater your partner's number of sexual partners — the greater your chance of acquiring HPV.
• Early sexual activity. Having sex at an early age increases your risk of HPV.
• Other sexually transmitted infections (STIs). Having other STIs, such as chlamydia, gonorrhea, syphilis and HIV/AIDS, increases your risk of HPV.
• A weak immune system. You may be more likely to develop cervical cancer if your immune system is weakened by another health condition and you have HPV.
• Smoking. Smoking is associated with squamous cell cervical cancer.

The best way to find cervical cancer early is to have regular screening with a Pap test (which may be combined with a test for human papilloma virus or HPV). As Pap testing became routine in this country during the past half century, finding pre-invasive lesions (pre-cancers) of the cervix became far more common than finding invasive cancer. Being alert to any signs and symptoms of cervical cancer can also help avoid unnecessary delays in diagnosis. Early detection greatly improves the chances of successful treatment and prevents any early cervical cell changes from becoming cancerous.

If cervical cancer is suspected, your doctor is likely to start with a thorough examination of your cervix. A special magnifying instrument (colposcope) is used to check for abnormal cells.

During the colposcopic examination, your doctor is likely to take a sample of cervical cells (biopsy) for laboratory testing. To obtain tissue, your doctor may use:

• Punch biopsy, which involves using a sharp tool to pinch off small samples of cervical tissue.
• Endocervical curettage, which uses a small, spoon-shaped instrument (curet) or a thin brush to scrape a tissue sample from the cervix.

If the punch biopsy or endocervical curettage is worrisome, your doctor may perform one of the following tests:

• Electrical wire loop, which uses a thin, low-voltage electrical wire to obtain a small tissue sample. Generally this is done under local anesthesia in the office.
• Cone biopsy, which is a procedure that allows your doctor to obtain deeper layers of cervical cells for laboratory testing. Cone biopsy may be done in a hospital under general anesthesia.

Once cancer is diagnosed, imagining tests and visual inspection of the bladder and rectum will determine the extent (stage) of the cancer.

If you have or have had cervical cancer, you can take steps to manage the stress that accompanies the diagnosis:

• Learn about cervical cancer so you can make informed decisions about your care.
• Have a schedule of follow-up tests and go to each appointment.
• Take care of yourself so that you are ready to fight cancer. This includes eating a healthy that includes plenty of fruits, vegetables and whole grains, exercising for at least 30 minutes most days of the week, and getting enough sleep so that you wake feeling rested.
• Accept help and support from family and friends.
• Talk with other cancer survivors or attend support groups.

The treatments for cervical cancer are based on the stage of the cancer, your overall health, and your preferences. Four types of standard treatment are used, alone or in combination: surgery, radiation, therapy, chemotherapy, and targeted therapy.

• Surgery. Early-stage cervical cancer is typically treated with surgery to remove the uterus (hysterectomy). A hysterectomy can cure early-stage cervical cancer and prevent recurrence. But removing the uterus makes it impossible to become pregnant. A hysterectomy can be a simple hysterectomy, in which the cervix and uterus are removed along with the cancer. Simple hysterectomy is usually an option only in very early-stage cervical cancer. Alternatively, surgery may be a radical hysterectomy, in which the cervix, uterus, part of the vagina and lymph nodes in the area are removed with the cancer. Minimally invasive surgery may be an option for early-stage cervical cancer. Surgery that preserves the possibility of becoming pregnant also may be an option, if you have very early-stage cervical cancer without lymph node involvement.
• Radiation. Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. Radiation therapy may be used alone or with chemotherapy before surgery to shrink a tumor or after surgery to kill any remaining cancer cells.Radiation therapy can be given externally, by directing a radiation beam at the affected area of the body (external beam radiation therapy), or internally, by placing a device filled with radioactive material inside your vagina, usually for only a few minutes.
• Chemotherapy. Chemotherapy uses medications, usually injected into a vein, to kill cancer cells. Low doses of chemotherapy are often combined with radiation therapy, since chemotherapy may enhance the effects of the radiation. Higher doses of chemotherapy are used to control advanced cervical cancer that may not be curable.
• Drugs approved to treat cervical cancer include:
  • Bleomycin (Blenoxane)
  • Cisplatin (Platinol, Platinol-AQ)
  • Topotecan Hydrochloride (Hycamtin)
• Targeted therapy. Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibody therapy is a type of targeted therapy that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.
  • Bevacizumab (Avastin) is a monoclonal antibody that binds to a component of a protein and prevents the growth of new blood vessels that tumors need to grow. Bevacizumab is used to treat cervical cancer that has metastasized (spread to other parts of the body) and recurrent cervical cancer.