Cervical Cancer

What is cervical cancer?
Cervical cancer, also called cancer of the cervix, begins in the lining of the cervix. This cancer does not form suddenly. First, some cells begin to change from normal to pre-cancer and then to cancer. This can take a number of years, although sometimes it happens more quickly. These changes are referred to by several terms, including dysplasia. For some women, these changes may go away without any treatment. More often, they need to be treated to keep them from changing into true cancers.

What are risk factors for cervical cancer?
Risk factors for cervical cancer include:
> Smoking
> Sex at an early age
> Number of sexual partners or partner with multiple partners
> Sexually transmitted diseases – the most common are Chlamydia, gonorrhea, herpes, and human papillomavirus (HPV)
> Birth of two or more children

What are prevention strategies for cervical cancer?
> HPV is the cause of cervical cancer, though more than 90% of women with HPV will never get cervical cancer. Risk of exposure to HPV can be reduced by waiting to engage in sexual intercourse until an older age and reducing the number of sexual partners. Research indicates that condoms do not protect against HPV transmission, though they may speed clearance of HPV infections by a woman’s immune system. Condom use is also important to prevent risk from other sexually transmitted diseases such as HIV.
> Cervical cancer screening – Adhere to the recommended cervical cancer screening guidelines
Regular pap smears can detect changes in the cervix before they develop into cancer.
> Diet – Eating a healthy diet, which is low in fat and includes at least nine servings of fruits and vegetables each day.
> Smoking – Smoking increases risk for cervical cancer. Women who smoke should talk to their health care provider about smoking cessation.

Is screening available?
The Pap test is the most common method to detect changes in the cervix that may lead cervical cancer. Most invasive cervical cancers are found in women who have not had a regular Pap test. It is important to follow the screening guidelines for cervical cancer.

Click here to learn more about cervical cancer screening guidelines.

What are the symptoms of cervical cancer?
Cervical cancer often causes no pain or other symptoms during early stages. When symptoms do occur they are likely to include:
> Watery or bloody discharge, which may be heavy or foul smelling;
> Vaginal bleeding after intercourse, between menstrual periods, or after menopause;
> Periods may be heavier or longer than normal.
Some of these symptoms may be caused by other problems. Only a healthcare provider can know for sure. If you have any of these symptoms, see a healthcare provider immediately.

How is cervical cancer diagnosed?
There are several tests used to diagnose cervical cancer, such as biopsies and endocervical curettage. The decision about which of these tests to perform are often based on results of physical examination and initial biopsy. There are often no signs or symptoms in the early stages of cervical cancer or pre-cancer stage, so it’s important to be screened regularly. When cervical cancer screening is done regularly, changes to cervical cancer cells can be identified before they become cancerous.

What is staging?
Staging describes the extent of the cancer. It determines if the cancer has spread and if so, what parts of the body are affected. Staging a cancer is important to assist the healthcare provider with determining the appropriate course of treatment and assessing an accurate prognosis.
The most common staging system is the TNM.
> T – size of the tumor
> N – degree to which regional lymph nodes are involved
> M – the absence or presence of distant metastases
Once the TNM has been determined, then a stage of I, II, III or IV is assigned.
> Stage I – cancers are small and local and usually curable
> Stage II x III – typically these are locally advanced and could involve the lymph nodes
> Stage IV – cancer has metastasized and can be inoperable.

What are treatment options?
There are three types of standard treatment options for cervical cancer: surgery, radiation therapy and chemotherapy. Hysterectomy is an option for early cervical cancers, though larger tumors require more radical operations. Women with more advanced cancers survive more often with radiation therapy than with hysterectomy. Radiation is administered both as an external x-ray beam daily for 25-30 days, and as internal therapy. For most women with locally advanced cervical cancer, combining radiation and chemotherapy improves survival. Your treatment may include one or a combination of these types of treatment depending on factors such as stage of the cancer. Your healthcare provider will discuss with you your treatment options.

What clinical trials are available?
Clinical trials are studies that seek to find better ways to prevent, screen, diagnose and treat a disease such as cancer. Clinical trials test new approaches to treatment, such as, new drugs, new approaches to surgery or radiation therapy, or a combination of treatments.

Learn more about clinical trials.

What questions should I ask my healthcare provider?
It is often helpful to make a list of questions before an appointment. This will help to remember what the healthcare provider says. Patients and care givers can write notes or ask if they may use a tape recorder. Sometimes it is helpful to have a family member or friend at the appointment to take notes, ask questions or just listen. Below are a few suggested questions a patient may ask their healthcare provider.

Will you please write down the type of cancer that I have?
What stage is my cancer and what does that mean?
What are my treatment options?
What treatment do you recommend and why?
What are the risks and benefits of each treatment?
What are possible side effects of treatment?
How will you help manage my side effects?
How will treatment affect my normal activities?
Are there specific things I must do to get ready for treatment?
Are there other things I can be doing to help with my treatment, such as diet and exercise?
What resources can I use to learn more about my cancer and help me deal with it?

Make an appointment

Resources
National Cancer Institute – 1-800-4CANCER
American Cancer Society – 1-800-ACS-2345
Centers for Disease Control and Prevention (CDC), DES Update – 1-888-232-6789
Gynecologic Cancer Foundation – 1-800-444-4441 or 312-644-6610
National Cervical Cancer Public Education Campaign