Cervical Cancer

Services: Cancer

Cervical Cancer

Cancer of the cervix occurs when cells become abnormal. Cancer cells divide more rapidly. They may grow into deeper cell layers or spread to other organs. The cancer cells eventually form a mass of tissue called a tumor.

It takes several years for cervical cancer to develop. During this time, the cells on or around the cervix become abnormal. The early cell changes before cancer are present are called dysplasia or cervical intraepithelial neoplasia (CIN).

An estimated 12,000 new cases of cervical cancer occur each year in the United States

Robert Lemert, MD, FACOG

What is cancer of the cervix?

A woman’s cervix is covered by a thin layer of tissue made up of cells. Healthy cells grow, divide, and are replaced as needed. Cancer of the cervix occurs when cells become abnormal. Cancer cells divide more rapidly. They may grow into deeper cell layers or spread to other organs. The cancer cells eventually form a mass of tissue called a tumor.

An estimated 12,000 new cases of cervical cancer occur each year in the United States, and each year about 4,000 U.S. women will die from this disease.

It takes several years for cervical cancer to develop. During this time, the cells on or around the cervix become abnormal. The early cell changes before cancer are present are called dysplasia or cervical intraepithelial neoplasia (CIN).

What is the leading cause of cervical cancer?

The leading cause of cervical cancer is human papillomavirus (HPV) infection. There are many types of HPV. Some types of HPV, called “high-risk types,” can cause cancer of the anus, cervix, vulva, vagina, and penis. They also can cause cancer of the head and neck. Other HPV types have been linked to genital warts.

HPV infection is widespread. It is passed from person to person through sexual contact. Some research suggests that at least 3 in 4 people who have sex will get a genital HPV infection. However, being infected with HPV does not necessarily mean that a person will get genital warts or develop cancer.

Is there a screening test for cervical cancer?

Yes. Cervical cancer is largely preventable by having regular cervical cancer screening. About one-half of cervical cancer cases occur in women who have never had screening.

Cervical cancer screening includes the Pap test, an HPV test, or both. The Pap test checks for abnormal cell changes in the cervix. The HPV test can detect many high-risk types of HPV even before there are visible changes to cervical cells. See Cervical Cancer Screening for more information.

What are some of the symptoms of cervical cancer?

Cervical dysplasia and cancer of the cervix often have no symptoms. By the time symptoms appear, the cancer cells may have already spread. The first signs may be abnormal bleeding, spotting, or watery discharge from the vagina when symptoms occur. Menstrual bleeding may be heavier than usual, and bleeding may occur after sex. Most of the time, these signs are caused by other health problems besides cancer. However, if you have any of these symptoms, you should see your health care practitioner.

Signs of advanced cancer can include pelvic pain, problems urinating, and swollen legs. If cancer has spread to nearby organs or the lymph nodes, the tumors can affect how those organs work. For example, a tumor might press on your bladder or block blood flow. These symptoms do not always mean cancer. If you have any of these symptoms, see your health care practitioner right away.

How is cervical cancer diagnosed?

If your health care practitioner suspects that you have cancer of the cervix, a biopsy may be done. Cancer can be detected with a Pap test, but a biopsy is needed.

If cervical cancer is diagnosed, your health care practitioner will assess the size of cancer and the extent (if any) to which the disease has spread. This process may include the following tests:

  • A pelvic exam (which may include a rectal exam)—An examination of the uterus, ovaries, and other organs near the cervix
  • Cystoscopy—A test in which the inside of the urethra and bladder are studied with a lighted device
  • Colonoscopy—A test in which the entire colon is examined with a slender, lighted instrument called a colonoscope

Because cervical cancer can spread to other body areas, you may need other tests to check these areas.

What are the types of treatment?

Invasive cancer of the cervix is treated with surgery, radiation therapy, and chemotherapy (using cancer-killing drugs). The type of treatment chosen depends on the cancer stage. You may receive more than one type of treatment.

Treatment works best in the early stages of cancer. The 5-year survival rate for stage I cancer is 91 percent. The 5-year survival rate for stage IV cancer is 17 percent.

What is involved in surgical treatment for cervical cancer?

If surgery is recommended, the goal is to remove the tumor and any tissues where it may spread. In a simple hysterectomy, the cervix and uterus are removed. The ovaries may not be removed if they appear normal. In a radical hysterectomy, the structures that support the uterus and a small part of the upper vagina also are removed. The ovaries, fallopian tubes, and nearby lymph nodes also may be removed.

What is involved in radiation therapy for cervical cancer?

Radiation therapy stops cancer cells from growing by exposing them to particular radiation. Two methods can be used:

  • In one method, radiation from outside the body is directed at the tumor through the skin. This treatment can require daily visits to a clinic for several weeks.
  • In the second method, a device that directs radiation at the tumor from inside the body is placed in the cervix. This treatment may be done as an outpatient procedure, or it may require a stay in the hospital.

Complications of radiation therapy include vaginal dryness, narrowing of the vagina, and damage to the ovaries, bladder, or bowel.

What is involved in chemotherapy for cervical cancer?

Chemotherapy is the use of cancer-killing drugs. Chemotherapy drugs travel through the blood and destroy different cells, including cancer cells. The treatments may be given in cycles either in a doctor’s office or clinic or require a hospital stay. It can be given alone or with radiation to make the radiation therapy more successful.

Is exceptional follow-up required after treatment?

Depending on the cancer stage and the type of treatment, cervical cancer usually does not return. However, close follow-up is needed. Routine checkups and cervical cancer screening tests are essential even after treatment ends.

Your health care practitioner may suggest more frequent cervical cancer screening tests for the first few years after treatment to remove all the cancer cells. Even if your cervix has been removed to treat your cancer, you still need cervical cancer screening. Cells are taken from the upper vagina instead of the cervix.

You also may need other tests and procedures. You and your health care practitioner will work together to plan your follow-up care.

What are BRCA1 and BRCA2 Genes?

BRCA1 and BRCA2 are tumor suppressor genes, which means that they keep cells from growing too rapidly. Everyone has these genes. Changes or mutations in these genes mean they do not work properly and cells can grow out of control, which can lead to cancer.

How much do BRCA mutations increase the risk of cancer?

The risk of breast cancer for the average American woman is about 12% in her lifetime. Having a BRCA mutation greatly increases the risk. The estimated risk of breast cancer in women with a BRCA mutation is 45–85% by age 70 years.

The risk of ovarian cancer for the average American woman is about 2% in her lifetime. The estimated risk of ovarian cancer in women with a BRCA1 mutation is 39–46% by age 70 years. For women with a BRCA2 mutation, the risk of ovarian cancer by age 70 years is 10–27%.

Women who have a BRCA mutation also have an increased risk of cancer of the fallopian tube, peritoneum, pancreas, and skin (melanoma). Men who have a BRCA mutation have an increased risk of cancer of the breast, prostate, and pancreas.

Why don’t doctors test everyone for BRCA mutations?

BRCA testing is only recommended for people with a high risk of having BRCA mutations. It is important to remember that most cases of breast and ovarian cancer are not caused by gene mutations. If there is a low chance of finding a BRCA mutation, your ob-gyn or other health care professional may not recommend genetic testing.

What is multigene panel testing?

Multigene panel testing is a type of genetic testing that looks for mutations in several genes at once. This is different from single-gene testing, which looks for a mutation in a specific gene. Single-gene testing is often used when a known gene mutation is already in a family. You may consider genetic testing if your personal or family history shows an increased cancer risk.

How can I prevent cancer if I test positive for a gene mutation?

If you test positive for a gene mutation, you can discuss cancer screening and prevention options with your ob-gyn, genetic counselor, or other healthcare professionals. It may be helpful to have earlier or more frequent cancer screening tests to find cancer at an early and more curable stage. Risk reduction steps like medication, surgery, and lifestyle changes also may be recommended.

If I have a gene mutation, should I tell my family?

Having a gene mutation means you can pass the mutation to your children. Your siblings also may have the gene mutation. Although you do not have to tell your family members, sharing the information could be life-saving. With this information, your family members can decide whether to be tested and get cancer screenings early.

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