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Cervical cancer

Overview

Cervical cancer is cancer that begins on the surface of your cervix. It happens when the cells on your cervix start to change to precancerous cells. HPV (human papillomavirus) infection causes almost all cases of cervical cancer. HPV is a virus that spreads through sexual contact. You can lower your risk of cervical cancer by getting regular cervical cancer screenings (like a Pap smear) and receiving the HPV vaccine.


Cervical cancer often doesn’t cause symptoms until it begins to spread. That’s why regular screenings and the HPV vaccine are so important. Cervical cancer is highly treatable when found in the early stages. A healthcare provider can treat it with surgery, radiation therapy, chemotherapy and other cancer medications.
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What is servical cancer

Cervical cancer is a growth of cells that starts in the cervix. The cervix is the lower part of the uterus that connects to the vagina.


Various strains of the human papillomavirus, also called HPV, play a role in causing most cervical cancers. is a common infection that’s passed through sexual contact. When exposed to , the body’s immune system typically prevents the virus from doing harm. In a small percentage of people, however, the virus survives for years. This contributes to the process that causes some cervical cells to become cancer cells.


You can reduce your risk of developing cervical cancer by having screening tests and receiving a vaccine that protects against infection.
When cervical cancer happens, it’s often first treated with surgery to remove the cancer. Other treatments may include medicines to kill the cancer cells. Options might include chemotherapy and targeted therapy medicines. Radiation therapy with powerful energy beams also may be used. Sometimes treatment combines radiation with low-dose chemotherapy.

Early stages of cervical cancer don’t usually involve symptoms and are hard to detect. The first signs of cervical cancer may take time to develop.

 

Signs and symptoms of Stage I cervical cancer can include:

 

  • Watery or bloody vaginal discharge that may be heavy and can have a foul odor.
  • Vaginal bleeding after sex, between menstrual periods or after menopause.
  • Pain during sex (dyspareunia).

If cancer has spread to nearby tissues or organs, symptoms may include:

 

  • Difficult or painful urination, sometimes with blood in urine.
  • Diarrhea, or pain or bleeding from your rectum when pooping.
  • Fatigue, loss of weight and appetite.
  • A general feeling of illness.
  • Dull backache or swelling in your legs.
  • Pelvic/abdominal pain.

If you experience abnormal bleeding, unusual vaginal discharge or any other unexplainable symptoms, you should contact a healthcare provider.

Cervical cancer begins when healthy cells in the cervix develop changes in their . A cell’s  contains the instructions that tell a cell what to do. The changes tell the cells to multiply quickly. The cells continue living when healthy cells would die as part of their natural life cycle. This causes too many cells. The cells might form a mass called a tumor. The cells can invade and destroy healthy body tissue. In time, the cells can break away and spread to other parts of the body.

 

Most cervical cancers are caused by HPV.  HPV is a common virus that’s passed through sexual contact. For most people, the virus never causes problems. It usually goes away on its own. For some, though, the virus can cause changes in the cells that may lead to cancer.

Cervical cancer is divided into types based on the type of cell in which the cancer begins. The main types of cervical cancer are:

 

  • Squamous cell carcinoma.This type of cervical cancer begins in thin, flat cells, called squamous cells. The squamous cells line the outer part of the cervix. Most cervical cancers are squamous cell carcinomas.
  • This type of cervical cancer begins in the column-shaped gland cells that line the cervical canal.

Sometimes, both types of cells are involved in cer

Risk factors for cervical cancer include:

 

  • Smoking tobacco.Smoking increases the risk of cervical cancer. When  infections happen in people who smoke, the infections tend to last longer and are less likely to go away.  causes most cervical cancers.
  • Increasing number of sexual partners.The greater your number of sexual partners, and the greater your partner’s number of sexual partners, the greater your chance of getting .
  • Early sexual activity.Having sex at an early age increases your risk of .
  • Other sexually transmitted infections.Having other sexually transmitted infections, also called s, increases the risk of , which can lead to cervical cancer. Other s that increase the risk include herpes, chlamydia, gonorrhea, syphilis and /.
  • A weakened immune system.You may be more likely to develop cervical cancer if your immune system is weakened by another health condition and you have .
  • Exposure to miscarriage prevention medicine.If your parent took a medicine called diethylstilbestrol, also known as DES, while pregnant, your risk of cervical cancer might be increased. This medicine was used in the 1950s to prevent miscarriage. It’s linked to a type of cervical cancer called clear cell adenocarcinoma.

Early detection and treatment of cervical cancer are key to avoiding life-threatening complications of the disease. That’s why regular Pap smears and HPV tests are critical.

 

Some possible complications of cervical cancer include:

 

  • Pain: Cancer can be painful when it spreads.
  • Bladder and bowel changes: Cervical cancer can cause urinary problems like difficulty peeing. It can also cause constipation.
  • Kidney damage:Kidney failure is a complication of advanced cervical cancer.
  • Blood clots: Your risk for blood clots increases because blood becomes “sticky” when you have cancer. This may slow your blood flow and lead to a clot developing.
  • Bleeding: You may experience bleeding from your vagina, rectum or bladder if cancer spreads to those organs.
  • Fertility or pregnancy challenges: Depending on the treatment you have, you could lose the ability to get pregnant. Surgery on your cervix to remove cancer cells could also increase your chance of miscarriage with future pregnancies.
  • Side effects of cancer treatment: Chemotherapy, radiation and other cancer treatments can cause unpleasant side effects like nausea and vomiting, fatigue and sexual dysfunction.

Cervical cancer usually develops slowly and over many years. Before turning into cancer, the cells in your cervix go through a lot of changes. The once normal cells in your cervix start to appear irregular or abnormal. These abnormal cells may go away, stay the same or turn into cancer cells.

 

Regular cervical cancer screenings with a Pap test can detect most cases of cervical cancer. The goal of cervical cancer screening is to detect cell changes on your cervix before they become cancer. A Pap test, or Pap smear, involves looking at cells from your cervix under a microscope. These cells are examined for signs of precancers or other irregularities.

 

If your Pap comes back as abnormal, further testing is necessary. This could include an HPV test, which is a specific test that checks the cells of your cervix for the HPV strains that are most likely to cause cancer.

 

Tests to diagnose cervical cancer

 

If your screenings come back as abnormal, your healthcare provider will want to run more tests to confirm you have cervical cancer. The first step in that is typically a colposcopy. A colposcope magnifies the cells of your cervix so your healthcare provider can see irregular cells. If the cells look suspicious or unusual, they’ll remove a sample of cervical cells and send them to a lab for further testing.

 

They can use any of the following methods to get a sample of tissue from your cervix:

 

  • Punch biopsy: Your provider uses a cutting tool with a round top to cut out the precancerous cells.
  • Endocervical curettage: A procedure that involves your provider scraping the lining of your cervix with a spoon-shaped tool called a curette.
  • Loop electrosurgical excision procedure (LEEP): Your provider uses an electrical wire loop to remove the abnormal cervical tissue.
  • Cone biopsy: Your provider removes a slightly larger, cone-shaped piece of tissue from your cervix.

If the results from these test confirms cervical cancer, further tests will determine whether the disease has spread (metastasized). These tests might include:

  • Liver and kidney function studies.
  • Blood and urine tests.
  • X-rays of your bladder, rectum, bowels and lungs.
  • CT scans.
  • MRL

The results of these tests also help your healthcare provider stage the cancer. Cervical cancer ranges from Stage I (least severe) to Stage IV (most severe). Staging helps your healthcare provider determine the best treatment plan.

There are four main stages of cervical cancer, and within each stage, there can be several different substages. The main stages of cervical cancer are:

 

  • Stage I: Cancer is found only in the neck of your cervix. It hasn’t spread to the deeper parts of your cervical tissue. 
  • Stage II: Cancer has spread beyond your cervix and uterus but hasn’t yet spread to your pelvic wall (the tissues that line the part of the body between your hips) or your lower vagina.
  • Stage III: Cancer has spread to the lower part of your vagina and may have spread to your pelvic wall, ureters (tubes that carry pee from your kidneys to your bladder) and nearby lymph nodes.
  • Stage IV: Cancer has spread to your bladder, rectum or other parts of the body like your bones or lungs.

Your healthcare provider is the best person to discuss what stage of cervical cancer you have and what it means.

The cervical cancer treatment team includes a gynecologic oncologist. Treatment for cervical cancer is based on many factors, including the stage of the disease, your age and general health, and if you want children in the future.

 

The treatments for cervical cancer are radiation, chemotherapy, surgery, targeted therapy and immunotherapy.

 

Clinical trials are another treatment option. They’re controlled research studies to test new treatments for cancer. Talk to your oncologist if you’d like to participate in a clinical trial.

 

Some people use alternative treatments like diet, herbs, acupuncture and other methods to supplement their cancer treatment. Talk to your healthcare provider about alternative methods that claim to relieve cancer symptoms. Some may help, but others could be harmful.

 

Radiation

 

Radiation therapy uses energy beams to kill cancer cells on your cervix. There are two types of radiation therapy:

 

  • External beam radiation therapy (EBRT): Aims high-powered radiation at cancer from a machine outside your body.
  • Brachytherapy: Puts the radiation in or just near cancer.

Chemotherapy

 

Chemotherapy (chemo) uses drugs injected into your veins or taken by mouth to kill cancer cells. It enters your blood and is effective for killing cells anywhere in your body. There are several drugs used for chemo and they can be combined. Chemo is often given in cycles. The length of the cycle and the schedule or frequency of chemotherapy varies depending on the drug used and where the cancer is in your body.

 

Surgery

 

Different kinds of surgery are used to treat cervical cancer. Your provider can remove just the cancerous tissues when the cancer is in its early stages. Some of the most common kinds of surgery for cervical cancer include:

 

  • Laser surgery: This surgery uses a laser beam to burn off just the cancer cells.
  • Cryosurgery: This surgery freezes cancer cells, destroying them.
  • Hysterectomy: This surgery involves the removal of your uterus and cervix.
  • Trachelectomy: This procedure removes your cervix and the upper part of your vagina but not your uterus.
  • Pelvic exenteration: This is the same as a hysterectomy but also includes your bladder, vagina, rectum and part of your colon, depending on where the cancer has spread.

Some people may have a combination of treatments. Your provider may use radiation or chemotherapy to treat cancer that has spread or come back (recurred). Sometimes, your provider will use radiation and chemotherapy before or after surgery.

 

Targeted therapy

 

Targeted drug treatment destroys specific cancer cells without damaging healthy cells. It works by targeting proteins that control how cancer cells grow and spread. As scientists learn more about cancer cells, they’re able to design better-targeted treatments that destroy these proteins.

 

Immunotherapy

 

Immunotherapy uses medicine to stimulate your immune system to recognize and destroy cancer cells. Cancer cells pretend to be healthy to hide from your immune system. Immunotherapy helps target these signals so the cancer cells can’t trick your body into thinking it’s a healthy cell.

Yes. It’s a highly treatable cancer, especially if it’s caught in the early stages. Healthcare providers typically use the term “remission” to describe a cancer that has gone away. But it can still come back.


Do you need chemo for Stage I cervical cancer?


No. You may not need chemotherapy for Stage I cervical cancer. Surgery is usually the first treatment your provider will recommend for Stage 1. But there are times when chemotherapy is also an option.


Is cervical cancer curable at Stage IV?


A cure at this stage is unlikely, but remission is possible. Stage IV is the most advanced stage of cervical cancer. It means the cancer cells have spread to other organs and tissues throughout your body. Your healthcare provider will still recommend the best ways to try to eliminate the cancer. Radiation therapy, chemotherapy and targeted treatment are still options for you.

To reduce your risk of cervical cancer:

 

  • Ask your doctor about the  vaccine.Receiving a vaccination to prevent  infection may reduce your risk of cervical cancer and other -related cancers. Ask your health care team if an  vaccine is right for you.
  • Have routine Pap tests.Pap tests can detect precancerous conditions of the cervix. These conditions can be monitored or treated in order to prevent cervical cancer. Most medical organizations suggest beginning routine Pap tests at age 21 and repeating them every few years.
  • Practice safe sex.Reduce your risk of cervical cancer by taking measures to prevent sexually transmitted infections. This may include using a condom every time you have sex and limiting the number of sexual partners you have.
  • Don’t smoke.If you don’t smoke, don’t start. If you do smoke, talk to a health care professional about ways to help you quit.