Cervical Cancer Introduction Cervical cancer is a very common cancer. Nearly one half million cases are diagnosed worldwide each year. Most cases of cervical cancer can be prevented by getting regular Pap tests. The Pap test can detect abnormal cells that may develop into cancer if they are not removed. This reference summary will help you better understand what cervical cancer is and what treatment options are available. The Cervix The cervix is a part of a woman s reproductive system. The reproductive system is made up of organs involved in producing babies. The female reproductive organs are located in the pelvis, between the urinary bladder and the rectum. The cervix is the lower, narrower part of the uterus. It is a passageway that 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 The cervix makes thick, slippery fluid called mucus. During sex, mucus helps sperm move from the vagina, through the cervix into the uterus. When an egg is released from an ovary, it goes down to the uterus through the Fallopian tube, where it may be fertilized by sperm. A fertilized egg will attach to the wall of the uterus so that it may continue growing. If a woman gets pregnant, the fetus stays in the uterus until delivery. The uterus is able to expand a lot. 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. 1
Cervical Cancer The body is made up of very small cells. Normal cells in the body grow and die in a controlled way. Sometimes cells keep dividing and growing in an uncontrolled way, causing an abnormal growth called a tumor. If the tumor does not invade nearby tissues and body parts, it is called a benign tumor, or non-cancerous growth. Benign tumors are usually not life threatening. If the tumor invades nearby tissues and body parts, it is called a malignant tumor or cancer. Cancerous cells spread to different parts of the body through blood vessels and lymph channels. Lymph is a clear fluid produced by the body that drains waste from cells. It travels through special vessels and bean-shaped structures called lymph nodes. Cancer that moves from one tissue to other body parts is known as metastatic cancer. For instance, a cervical tumor may grow through the pelvic wall and nearby tissues over time. Cancers in the body are given names, depending on where the cancer started. Cancer that begins in the cervix will always be called cervical cancer, even if it spreads to other places. Cervical cancer begins on cells on the surface of the cervix. Over time, the cancerous cells can invade more deeply into the cervix and nearby tissues. Causes and Risk Factors It is usually impossible to specify the cause of cancer in an individual patient. However, we do know what causes cancer in general. Doctors also know factors that can increase the chances of getting cancer. These are known as risk factors. Being infected with a virus called human papilloma virus is a major risk factor for cervical cancer. Nearly all cases of cervical cancer are linked to the human papilloma virus or HPV. HPV is a virus that can cause abnormal tissue growth and other changes to cells. It is passed during skin-to-skin contact with an infected area. An HPV infection that doesn t go away can cause cervical cancer in some women. HPV infections are very common. 2
Women who do not get regular Pap tests are at an increased risk of developing cervical cancer. The Pap test helps doctors find abnormal cells. Removing or killing the abnormal cells usually prevents cervical cancer. Smoking can also increase a woman s risk for cervical cancer if she is infected with HPV. Having a weakened immune system, such as patients with HIV/AIDS, also raises the risk of cervical cancer. The immune system is the body s natural defense system. Another risk factor for cervical cancer is a woman s sexual history. Women who have had multiple sex partners or sex with a man who has had many sex partners may be at higher risk for cervical cancer. Using birth control pills for 5 or more years may slightly increase the risk of cervical cancer for women who are infected with HPV. This risk decreases quickly after stopping birth control pills. Women with an HPV infection are also at a slightly increased risk of cervical cancer if they have given birth to 5 or more children. DES is a synthetic hormone that used to be given to pregnant women because it was thought to prevent miscarriage. Daughters of women who took DES during pregnancy are at an increased risk of cervical cancer. Not everybody who has risk factors for cervical cancer develops cervical cancer. Some people who have no risk factors for cervical cancer can still develop the cancer. Symptoms Abnormal bleeding is a common symptom of cervical cancer. It is: Bleeding that happens between regular menstrual periods Bleeding after sex, douching, or a pelvic exam Menstrual periods that last longer and are heavier than normal Bleeding after going through menopause 3
Other common symptoms of cervical cancer include: Increased vaginal discharge Pelvic pain Pain during sex These symptoms may not be caused by cervical cancer. Infections or other health problems may cause these symptoms. If you are having any of these symptoms, make sure to see a doctor to find out what is causing them. Diagnosis Pap tests can find cervical cancer or abnormal cells that can lead to cervical cancer. The cervical cells taken during a Pap test are checked under a microscope. Most often, abnormal cells found by a Pap test are not cancerous. The same sample of cells may be tested for HPV infection. If you have abnormal Pap or HPV test results, your doctor may suggest other tests. A colposcopy uses a lighted magnifying instrument to examine the vagina and cervix. This makes the tissue easier to see. Pap Test A biopsy is a removal of cells or tissue for examination by a pathologist. A pathologist will examine the tissue under a microscope to look for cancer cells. There are many ways in which a cervical biopsy may be done. A biopsy is the only sure way to know if cancer cells are present. Staging If you have cervical cancer, your doctor will determine the stage of the cancer. Staging is an attempt to find out if the cancer has spread and, if so, to which parts of the body. Stages are usually described using the numbers 1-4; a lower number indicates an earlier stage. Staging is helpful in deciding the best course of treatment. 4
When staging cervical cancer, doctors want to find out: Whether the tumor has invaded tissues outside the cervix Whether the tumor has spread, and if so, to what parts of the body If cervical cancer has spread to nearby lymph nodes, it can spread to other areas of the body. Cervical cancer most often spreads to nearby tissues in the pelvis, lymph nodes, or the lungs. It may also spread to the liver or bones. A chest x-ray is helpful in showing if cervical cancer has spread. Tumors can show up on a CT scan. A CT scan is an x- ray machine linked to a computer. A CT scan takes a series of detailed pictures of your organs. You may receive contrast material to make abnormal areas easier to see. An MRI is also used to make detailed pictures of areas inside your body. It uses strong magnets to create images of the inside of the body. You may receive contrast material to make abnormal areas easier to see. A PET scan can show if the cervical cancer has spread elsewhere in the body. For this test, you are injected with a small and safe amount of radioactive sugar. The PET scanner makes a picture of the places in your body where the sugar is being taken up. Cancer cells show up brighter because they use sugar faster than normal cells. Treatment and Supportive Care The type of treatment used depends on the size and location of the tumor, the stage of the disease, and the health of the patient. Treatment for cervical cancer may involve surgery, radiation therapy, chemotherapy, or some combination of these treatments. Surgery for cervical cancer is an option for women with Stage I or II cervical cancer. The surgeon will remove the cervix. Depending on the surgery, the surgeon may also remove part of the vagina, the lymph nodes in the pelvis, the uterus, the Fallopian tubes, and the ovaries. 5
Radiation therapy uses high-energy rays to kill cancer cells and stop them from growing and spreading. External radiation comes from a machine that aims the rays at a specific area of the body. Internal radiation uses radioactive liquids to treat specific areas. This is done by placing a thin tube that is loaded with the radioactive liquid into the vagina. Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy is usually given in the blood stream through an IV. Chemotherapy and radiation therapy is usually done together to treat cervical cancer. However, these treatments may be used on their own, before surgery or after surgery. Cervical cancer and its treatment can lead to other health problems. It is important to have supportive care before, during, and after cancer treatment. Supportive care is treatment to control pain and other symptoms, to relieve the side effects of therapy, and to help you cope with emotions. Prevention Two kinds of vaccines can protect against the types of HPV that cause most cervical cancers: Cervarix Gardasil Cervarix and Gardasil are effective for females ages 9 through 26 years. It is recommended that all girls who are 11 or 12 years old get 3 doses of either brand of HPV vaccine to protect against cervical cancer and pre-cancer. Girls and young women ages 13 through 26 should get all 3 doses of an HPV vaccine if they have not received all doses yet. People who have already had sexual contact before getting all 3 doses of an HPV vaccine might still benefit, but only if they were not infected with the HPV types included in the vaccine they received. 6
The best way to be sure that a person gets the most benefit from HPV vaccination is to complete all three doses before sexual activity begins. Ask your healthcare provider which brand of the vaccine is best for you. The vaccine does not replace the need to wear condoms to lower your risk of getting other types of HPV and other sexually transmitted infections. The best way to prevent any sexually transmitted infection is to not have vaginal, oral, or anal sex. Don't have sex. Practicing safer sex is also important. Be monogamous. Having sex with just one partner can also lower your risk. Being monogamous means that you only have sex with each other and no one else. Use condoms. HPV can happen in both female and male genital areas that are not covered by condoms. However, research has shown that condom use is linked to lower cervical cancer rates. Protect yourself with a condom every time you have vaginal, anal, or oral sex. Women who have had the HPV vaccine still need to have regular Pap tests. Summary Cervical cancer is a very common cancer for women. Nearly one half million cases are diagnosed worldwide each year. Most cases of cervical cancer can be prevented by getting regular Pap tests. The Pap test can detect abnormal cells that may develop into cancer if they are not removed. Treatment options for cervical cancer usually include surgery, radiation therapy, chemotherapy, or some combination of these three. Cervical cancer is most treatable in its early stages. Research already has led to advances that have helped people live longer, and research continues to find better ways to care for people with cervical cancer. 7