DefinitionCervical cancer is cancer that starts in the cervix. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina.
Alternative NamesCancer - cervix
Causes, incidence, and risk factorsWorldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the United States because of the routine use of Pap smears.Cervical cancers start in the cells on the surface of the cervix. There are two types of cells on the surface of the cervix, squamous and columnar. Most cervical cancers are from squamous cells.Cervical cancer usually develops slowly. It starts as a precancerous condition called dysplasia. This condition can be detected by a Pap smear and is 100% treatable. It can take years for these changes to turn into cervical cancer. Most women who are diagnosed with cervical cancer today have not had regular Pap smears or they have not followed up on abnormal Pap smear results.Almost all cervical cancers are caused by HPV (human papilloma virus). HPV is a common virus that is spread through sexual intercourse. There are many different types (also called strains) of HPV. Some strains lead to cervical cancer. Other strains can cause genital warts. Yet others do not cause any problems at all.A woman's sexual habits and patterns can increase her risk of developing cervical cancer. Risky sexual practices include: Having sex at an early age Having multiple sexual partnersHaving a partner or many partners who are active in high-risk sexual activitiesRisk factors for cervical cancer include:Not getting the HPV vaccineBeing poorWomen whose mothers took the drug DES (diethylstilbestrol) during pregnancy in the early 1960s to prevent miscarriageWeakened immune system
SymptomsMost of the time, early cervical cancer has no symptoms. Symptoms that may occur include:Abnormal vaginal bleeding between periods, after intercourse, or after menopauseVaginal discharge that does not stop, and may be pale, watery, pink, brown, bloody, or foul-smellingPeriods that become heavier and last longer than usual Cervical cancer may spread to the bladder, intestines, lungs, and liver. Often there are no problems until the cancer is advanced and has spread. Symptoms of advanced cervical cancer may include:Back painBone pain or fracturesFatigueLeaking of urine or feces from the vaginaLeg painLoss of appetitePelvic painSingle swollen legWeight loss
Signs and testsPrecancerous changes of the cervix and cervical cancer cannot be seen with the naked eye. Special tests and tools are needed to spot such conditions.Pap smears screen for precancers and cancer, but do not make a final diagnosis.If abnormal changes are found, the cervix is usually examined under magnification. This procedure is called colposcopy. Pieces of tissue are surgically removed (biopsied) during this procedure. The tissue is sent to a laboratory for examination. A procedure called cone biopsy may also be done.If cervical cancer is diagnosed, the health care provider will order more tests. These help determine how far the cancer has spread. This is called staging. Tests may include:Chest x-rayCT scan of the pelvisCystoscopyIntravenous pyelogram (IVP)MRI of the pelvis
TreatmentTreatment of cervical cancer depends on:The stage of the cancerThe size and shape of the tumorThe woman's age and general healthHer desire to have children in the futureEarly cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. There are various surgical ways to do this without removing the uterus or damaging the cervix, so that a woman can still have children in the future.Types of surgery for early cervical cancer include:Loop electrosurgical excision procedure (LEEP) -- uses electricity to remove abnormal tissueCryotherapy -- freezes abnormal cellsLaser therapy -- uses light to burn abnormal tissue A hysterectomy (surgery to remove the uterus but not the ovaries) is not often done for cervical cancer that has not spread. It may be done in women who have repeated LEEP procedures.Treatment for more advanced cervical cancer may include:Radical hysterectomy, which removes the uterus and much of the surrounding tissues, including lymph nodes and the upper part of the vagina.Pelvic exenteration, an extreme type of surgery in which all of the organs of the pelvis, including the bladder and rectum, are removed. Radiation may be used to treat cancer that has spread beyond the cervix or cancer that has returned.One type of radiation therapy uses a device filled with radioactive material. The device is placed inside the vagina next to the cervical cancer. The device is removed before the patient goes home.Another type of radiation beams radiation from a large machine onto the body where the cancer is located. It is similar to an x-ray. Chemotherapy uses drugs to kill cancer. Some of the drugs used for cervical cancer chemotherapy include 5-FU, cisplatin, carboplatin, ifosfamide, paclitaxel, and cyclophosphamide. Sometimes radiation and chemotherapy are used before or after surgery.
Support GroupsYou can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.
Expectations (prognosis)How well the patient does depends on many things, including:Type of cervical cancer--some types do not respond well to treatment Stage of cancerAge and general healthIf the cancer comes back after treatment Precancerous conditions can be completely cured when followed up and treated properly. Most women are alive in 5 years (5-year survival rate) for cancer that has spread to the inside of the cervix walls but not outside the cervix area. The 5-year survival rate falls as the cancer spreads outside the walls of the cervix into other areas.
ComplicationsWomen who have treatment to save the uterus have a high risk of the cancer coming back. Surgery and radiation can cause problems with sexual, bowel, and bladder function.
Calling your health care providerCall your health care provider if you:Have not had regular Pap smearsHave abnormal vaginal bleeding or discharge
PreventionCervical cancer can be prevented by doing the following:Get the HPV vaccine. Two types of vaccines are approved, Gardasil and Cervarix. They prevent against most types of HPV infection that cause cervical cancer. Your health care provider can tell you if the vaccine is right for you.Practice safer sex. Using condoms during sex reduces the risk of HPV and other sexually transmitted infections (STIs).Limit the number of sexual partners you have. Avoid partners who are active in high-risk sex.Get regular Pap smears as often as your health care provider recommends. Pap smears can help detect early changes, which can be treated before they turn into cervical cancer.If you smoke, quit. Smoking increases your chance of getting cervical cancer.
ReferencesJhingran A, Russell AH, Seiden MV et al. Cancers of the cervix, vulva, and vagina. In: Abeloff MD, Armitage JO, Niederhuber JE, et al. eds. Abeloff’s Clinical Oncology.4thed. Philadelphia, PA: Elsevier Churchill-Livingstone; 2008:chap 91.National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Cervical cancer. Version 2.2013. Available at http://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf. Accessed November 16, 2012.Noller KL. Intraepithelial neoplasia of the lower genital tract (cervix, vulva): Etiology, screening, diagnostic techniques, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 28.