CONDITIONS

Cervical Cancer

What Is Cervical Cancer

Cervical cancer is characterized by the abnormal and uncontrollable growth of cervical tissue cells. The cervix is the lower part of the uterus that connects the uterus to the vaginal canal. Cervical cancer is almost exclusively caused by Human Papilloma Virus (HPV), a sexually transmitted disease that is estimated to affect approximately 50% of the population at some point in their lives. HPV infections cause the benign growths, papillae, which can later lead to the development of cervical cancer.

There are two major types of cervical cancer:

     Squamous cell carcinoma, which occurs in the epithelial cells of the cervix and accounts for approximately 66% of        all cervical cancers.

    Adenocarcinoma, which develops from mucus secreting cells within the cervix and accounts for approximately 28%       of all cervical cancers.

Cervical cancer most often occurs in women ages 30-50, though it may develop at any age. Women who were sexually active from a young age or who have had a history of multiple sexual partners are at a higher risk of developing cervical cancer, most likely because of the increased risk of HPV contraction. Advancements in detection and prevention technologies, including the pap smear and HPV vaccines, have significantly increased the life expectancies for cervical cancer patients as well as overall incidence rates in the past few decades. Cervical cancer is relatively rare, as only 0.7% of women will develop it in a lifetime. 

What Causes Cervical Cancer

It is estimated that 99.7% of cervical cancers are caused by Human Papilloma Virus (HPV) infection. There are over 100 different types of HPV, though types 16 and 18 account for 70% of cervical cancers. Most other cases of cervical cancers are caused by infections with any of the 13 other “high-risk” HPV types. HPV is most often contracted through sexual contact, though it is possible to spread it with only skin to skin contact. HPV infections can cause genital warts and abnormal growth of cervical cells that can, if the infection persists, lead to cervical cancer. HPV infections typically go away on their own, though the risk of developing cervical cancer remains. There are several things you can do to prevent HPV infection and cervical cancer.

Risk Factors For Cervical Cancer

There are several factors that can influence your risk of developing cervical cancer. These include:

  • HPV infection. This is the main risk factor for cervical cancer. 99.7% of all cervical are caused by a previous HPV infection.
  • Chlamydia infection. Studies have shown that women with a history of chlamydia are more likely to develop cervical cancer.
  • Sexual history. A history of multiple partners or unprotected sex can increase a woman’s chance of contracting HPV, therefore increasing her risk of developing cervical cancer.
  • Smoking. Women who smoke are almost twice as likely to develop cervical cancer than those that do not.
  • Family History. Women with a close relative with cervical cancer are 2-3 times more likely to develop the disease than the general public.
  • Oral contraceptives. Oral contraceptive use has shown to increase the risk of cervical cancer, though the risk decreases after use ceases. However, oral contraceptives have been shown to decrease the risk of ovarian cancer. Consult with your doctor before choosing oral contraceptives to assess your riskss
  • Diethylstilbestrol (DES). Daughters of women who were given diethylstilbestrol during pregnancy to prevent miscarriages are at an increased risk for developing cervical cancer. About one out of 1,000 daughters whose mothers were given DES during pregnancy will develop cervical cancer. 

Diagnosing Cervical Cancer

A pap smear may be the first sign of cervical cancer though it is not a definitive diagnostic test. It is a relatively non-invasive test that can detect abnormalities in cervical cells that lead to cervical cancer. If the pap smear shows signs of abnormalities, further tests are needed before a diagnosis is made. These include:


Colposcopy. During this procedure, a speculum is inserted into the vagina to spread the vaginal walls and make the cervix visible. The vagina and cervix are then coated with a liquid to accent any abnormalities. The gynecologist then looks at the cervix, vulva, and vagina through a colposcope, a magnifying instrument that much resembles a pair of binoculars. A tissue biopsy may be taken during this procedure.


Biopsy. A tissue biopsy is a sample of tissue taken from an abnormal area. Tissue samples are then sent to a lab to determine whether or not they are cancerous. If the cancer cells have spread, a cone biopsy may be conducted. This involves taking a wider and deeper sample of tissue from the cervix, and generally requires anesthetic and an overnight hospital stay. A cone biopsy can also permanently affect the cervix, so future pregnancy plans should be considered before choosing this method.


Large loop excision of the transformation zone (LLETZ). During this relatively quick (approx. 10 minutes) a loop of wire charged with electric current is used to cut out portions of abnormal tissue. Local or general anesthesia can be used during this procedure.


Imaging techniques, including:

  • MRI scan (Magnetic resonance imaging). This uses a powerful magnet to produce images of your cervix and other reproductive organs.
  • PET scan (positron emission tomography). In this test, a radioactive substance that is more readily absorbed by cancer cells then by healthy cells is injected into the body and allowed to travel throughout the blood stream. A specialized scanner picks up on the concentrated locations of the solution, revealing where in the body the cancer is located.
  • CT scan (computerized tomography).This scan compiles a more detailed image of the cervix with a computer-generated combination of many x-ray images.

Blood tests. Various blood samples may be taken to gather general health information on the patient and check for other possible causes of the symptoms.

Symptoms of Cervical Cancer

Most cervical cancers do not present symptoms until the cancers are far advanced. Therefore, regular pap smears are recommended as part of your women’s health routine in order to detect potentially cancerous abnormalities before they progress. Symptoms that may be signs of advanced cervical cancer include:

  • Pain in pelvic area
  • Watery vaginal discharge
  • Vaginal discharge with unpleasant odor
  • Irregular vaginal bleeding
  • Pain during sex or urination

Prognosis

The prognosis for cervical cancer largely depends on the stage at which it is found. According to the American Cancer Society, 5 year survival rates for cervical cancer stages are as follows:

  • 0 – 93%
  • IA – 93%
  • IB – 80%
  • IIA – 63%
  • IIB – 58%
  • IIIA – 35%
  • IIIB – 32%
  • IVA – 16%
  • IVB – 15%

Living With Cervical Cancer

Receiving a diagnosis of cervical cancer can be a challenging experience. The following tips can help you live well with cervical cancer:

  • Ask questions about your condition and prognosis.
  • Continue with regular visits to the gynecologist. Even if treatment has been successful, you should continue to visit you gynecologist for regular pap smears and check-ups. This will help determine whether or not the cancer has come back or if there are other abnormalities that should be treated.
  • Eat well and exercise regularly. A balanced diet and regular exercise are essential for maintaining a strong immune system and body during treatment and recovery.
  • Consider all of your options. Choosing a treatment plan can be a challenging decision to make. Consider all of your options, including alternative and complimentary therapies, and take into consideration your doctor’s recommendations.
  • Join a support group. Sharing stories and experiences with others can help you process the emotions that accompany treatment and recovery. 

Screening

The American Cancer Society recommends the following screening procedures for cervical cancers:

  • A pap test, or pap smear, which takes a sample of cervical cells and tests for abnormalities, every 3 years for women ages 21-29 and every 5 years for women ages 30-65.
  • An HPV test, which tests for human papilloma virus, the main cause of cervical cancer.  Tests should be conducted when abnormalities are detected on a pap test or every 5 years for women ages 30-65.

Who should and who should not be screened? Some women should not be screened, per the American Cancer Societywomen over age 65 should not be screened, and women who have had their uterus or cervix removed should not be screened.

And women who are at a high risk of cervical cancer should be screened more often. 

Prevention

Though there is no definite way of preventing cervical cancer, the following steps can be taken to lower the risk of developing the disease:

Schedule regular visits with your gynecologist for check-ups and pap tests. Pap tests should be conducted at least once every three years for women ages 21-29 and at least once every five years for women ages 30-65.

Get an HPV Vaccine. Currently, two vaccines are available for HPVGardasil and Cervarix. Both vaccines are recommended before adolescence and before sexual activity. Although aimed at prevention, these vaccines are also useful for patients with an existing HPV infections, as it may prevent further infection from other types of HPVGardasil, also known as Gardasil or Silgard, is a vaccine effective against 4 types of HPV (types 6 and 11, which are responsible for more than 90% of genital warts, and  types 16 and 18, which account for approximately 70% of cervical cancers). As other types of HPV besides those targeted by Gardasil, it is still recommended for females to obtain regular Pap smears. Currently, Gardasil is recommended for both males and females ages 9-26 years. Side effects are rare and generally include soreness at injection site, muscle fatigue, and malaise. The vaccine is administered over three separate injections over 6 months and provides up to 8 years of efficacy. Cervarix is also an HPV vaccine, which targets types 16 and 18 only. Currently, it is recommended only for females ages 10-25 years. Common side effects are pain, redness, and swelling at the injection site. Similar to GardasilCervarix also provides up to 8 years of protection against the specific types of HPV.

Use condoms during sex. HPV, the main cause of cervical cancer, is mainly spread through sexual contact.

Don’t smoke. Smokers are about twice as likely to develop cervical cancer as nonsmokers. 

Medication And Treatment

Each patient’s treatment plan depends on a combination of factors including overall health, age, cancer stage, and cancer type. A treatment plan can include any combination of the following:


Surgery. Surgical removal of part or all of the cancerous tissue is the most common form of treatment for cervical cancers. Possible surgical procedures include:

  • Cryosurgery. This less invasive form of treatment uses an instrument that freezes abnormal tissue, causing it to die.
  • Laser surgery. This procedure uses a laser to remove the abnormal tissue.
  • Total hysterectomy, in which the entire uterus and cervix are removed.
  • Radial hysterectomy,in which the uterus, cervix, part of the vagina, and many ligaments and tissues around these organs are removed. This procedure is for more advanced cases of cervical cancer and may include the removal of the ovaries, fallopian tubes, or lymph nodes.
  • Pelvic exenteration. This includes the surgical removal of the lower colon, rectum, and bladder as well as the vagina, cervix, uterus, ovaries, and lymph nodes.

Chemotherapy. Chemotherapy for ovarian cancer involves the intra-venous delivery of anti-cancer drugs that then travel throughout the body. Though each patient has an individualized chemo regimen based on her condition, the average chemotherapy will last 3 to 6 cycles of drug administration and rest periods.  Chemotherapy has some serious side effects, most of which discontinue after treatment has finished.

Common side effects of chemotherapy include:

  • Nausea/vomiting
  •  Mouth sores
  • Hand and foot rashes
  • Loss of appetite
  • Loss of hair
  • Increased chance of infection
  • Easy bleeding or bruising
  • Fatigue

Radiation therapy. Radiation therapy uses concentrated x-rays to kill cancer cells. External beam radiation therapy is the most common form of radiation treatment for cervical cancer, and involves x-rays being delivered from a machine outside the body in a procedure similar to a standard x-ray.

Complementary and Alternative Treatment

The best way to ensure successful treatment of cervical cancer is early detection and treatment of HPV infection. There are several alternative and complementary procedures that may also be useful in treating cervical cancers. These include:

ImmunotherapyImmunotherapy involves the stimulation of the immune system in order to strengthen the body’s immune response against the cancer cells. Agents of alternative modes of immunotherapy include:

  • Supplements such as folic acid, carotenoids, 13C, and coQ10.
  • Herbal tea consumption
  • Controlled diet high in whole grains and lean proteins and low in fat and dairy.

Acupuncture. Acupuncture can help reduce inflammation and the body and strengthen the immune system. Acupuncture treatments can also be useful in reducing the side effects of other cervical cancer treatments.

Mind/body approaches. Techniques such as Yoga, Tai-Chi, Reiki, and guided meditation can help regulate bodily energy and restore strength. 

Care Guide

The following tips can help you through cervical cancer treatment and recovery:

  • Consider all options for treatment, including alternative and complementary therapies. Consult with your doctor about all possible treatment options and consider his or her recommendations. Independent research may help you feel more confident in your decision, but be wary of information from unreliable sources. Internet forums and other non-professional sources may not always be accurate sources of knowledge.
  • Talk to trusted family and friends. Be honest with those that you love, but remember that you aren’t forced to tell anyone about your condition. Who you tell and when should be your decision.
  • Make arrangements with your boss to accommodate your treatment needs. Many ovarian cancer patients find that their bosses are willing to work around treatment schedules, and keeping your job can be an important source of continuity during treatment.
  • Eat a balanced diet and exercise. This will help your body remain strong throughout treatment.
  • Drink plenty of water. Water is essential for helping your body process the stresses of treatment.

Consider talking to a sex therapist. Some modes of treatment for cervical cancer can physically or emotionally change your ability to be intimate. Consider speaking to a sex therapist about ways to keep your sex life fulfilling for you and your partner.

When To Contact A Doctor

If you experience any of the following symptoms, call your doctor. These may be signs of cervical cancer or other serious diseases:

  • Pain in pelvic area
  • Watery vaginal discharge
  • Vaginal discharge with unpleasant odor
  • Irregular vaginal bleeding
  • Pain during sex or urination

If you are undergoing treatment for cervical cancer, call your doctor if you experience any of the following:

  • Prolonged vomiting or diarrhea
  • Excessive bleeding or bruising
  • Extreme fatigue
  • Fever higher than 100.5ºF
  • Persistent cough
  • Rapid or irregular heartbeat
  • Sudden onset pain (anywhere in body)
  • Inability to eat/extensive weight loss

Questions For Your Doctor

In addition to your primary care physician and your gynecologist, you may want to include a gynecologic oncologist in your care team.

To find a gynecologic oncologist recommended by the Foundation for Women’s Cancer, click here.

To find a gynecologist in your area, visit The American Congress of Obstetrics and Gynecology Physician Directory

Questions For A Doctor

If you have received a cervical cancer diagnosis, you probably have many questions for your doctor. You may want to write these questions down beforehand on a piece of paper and bring it to your appointment with you. This will help you remember to ask all of your questions while you are with your doctor.

Some questions you may want to ask include:

  • What stage is my cancer?
  • What are my treatment options?
  • What are the success rates of the treatment options?
  • Are there alternative or complementary treatment options I should pursue?
  • What is the survival rate for my cancer stage?
  • Should my family concerned about their risk for the disease?
  • What can I do to help along my treatment?
  • How long will treatment last?
  • What are the side effects of treatment?
  • Should I consider surgery?
  • What if I want to have children in the future?
  • How will this affect my sex life?
  • Are there things that I can do to continue enjoying intimacy?

Resources

For more information about cervical cancer, available treatments, and disease statistics, visit The National Institute of Health

For statistics on cervical cancer incidence and prognosis, visit Every Woman Counts: Resources for Health Professionals

For more information about what causes cervical cancer and cervical cancer risk factors, visit The American Cancer Society

For more information on Human Papilloma Virus (HPV) visit the Center for Disease Control

For more information about cervical cancer diagnostic techniques, visit Cancer Center Victoria.