Cervical Cancer

The cervix is the opening and bottom part of the uterus between the vagina and the uterus. Cervical cancer is a fairly common cancer. It occurs most often in women between the ages of 40 years and 55 years. Cells of the cervix act very much like skin cells. These cells are exposed to toxins, viruses, and bacteria that may cause abnormal changes.

There are two kinds of cancers of the cervix:

  • Squamous cell carcinoma—This type of cancer starts in the flat or scale-like cells that line the cervix. Squamous cell carcinoma can develop from a sexually transmitted infection caused by the human papillomavirus (HPV).  

  • ExitCare ImageAdenocarcinoma—This type of cervical cancer starts in glandular cells that line the cervix.

RISK FACTORS

The risk of getting cancer of the cervix is related to your lifestyle, sexual history, health, and immune system. Risks for cervical cancer include:

  • Having a sexually transmitted viral infection. These include:

  • Chlamydia.  

  • Herpes.  

  • HPV.

  • Becoming sexually active before age 18 years.  

  • Having more than one sexual partner or having sex with someone who has more than one sexual partner.  

  • Not using condoms with sexual partners.  

  • Having had cancer of the vagina or vulva.  

  • Having a sexual partner who has or had cancer of the penis or who has had a sexual partner with cervical dysplasia or cervical cancer.  

  • Using oral contraceptives (also called birth control pills).

  • Smoking.  

  • Having a weakened immune system. For example, human immunodeficiency virus (HIV) or other immune deficiency disorders.  

  • Being the daughter of a woman who took diethylstilbestrol (DES) during pregnancy.  

  • Having a sister or mother who has had cancer of the cervix.  

  • Being African American, Hispanic, Asian, or a woman from the Pacific Islands.  

  • A history of dysplasia of the cervix.

SIGNS AND SYMPTOMS

Symptoms are usually not present in the early stages of cervical cancer. Once the cancer invades the cervix and surrounding tissues, the woman may have:

  • Abnormal vaginal bleeding or menstrual bleeding that is longer or heavier than usual.  

  • Bleeding after intercourse, douching, or a Pap test.  

  • Vaginal bleeding following menopause.  

  • Abnormal vaginal discharge. 

  • Pelvic discomfort or pain. 

  • An abnormal Pap test.

  • Pain during sexual intercourse.

Symptoms of more advanced cervical cancer may include:

  • Loss of appetite or weight loss.  

  • Tiredness (fatigue).  

  • Back and leg pain.  

  • Inability to control urination or bowel movements.

DIAGNOSIS

A pelvic exam and Pap test are done to diagnose the condition. If abnormalities are found during the exam or Pap test, the Pap test may be repeated in 3 months, or your health care provider may do additional tests or procedures, such as:

  • A colposcopy—This is a procedure that uses a special microscope that allows the health care provider to magnify and closely examine the cells of the cervix, vagina, and vulva.  

  • Cervical biopsies—This is a procedure where small tissue samples are taken from the cervix to be examined under a microscope by a specialist.  

  • A cone biopsy—This is a procedure to test for or remove cancerous tissue.  

Other tests may be needed, including:

  • Cystoscopy.  

  • Proctoscopy or sigmoidoscopy.  

  • Ultrasound.  

  • CT scan.  

  • MRI.  

  • Laparoscopy.  

There are different stages of cervical cancer:

  • Stage 0, carcinoma in situ (CIS)—This first stage of cancer is the last and most serious stage of dysplasia.  

  • Stage 1—This means the tumor is in the uterus and cervix only.  

  • Stage 2—This means the tumor has spread to the upper vagina. The cancer has spread beyond the uterus, but not to the pelvic walls or lower third of the vagina.  

  • Stage 3—This means the tumor has invaded the side wall of the pelvis and the lower third of the vagina. Blockage of the tubes that carry urine (ureters) from the tumor may cause urine to back up and cause the kidneys to swell (hydronephrosis).  

  • Stage 4—This means the tumor has spread to the rectum or bladder. In the later part of this stage, it has also spread to distant organs, like the lungs.  

TREATMENT

Treatment options can include:

  • Cone biopsy to remove the cancerous tissue.  

  • Removal of the entire uterus and cervix.  

  • Removal of the uterus, cervix, upper vagina, lymph nodes, and surrounding tissue (modified radical hysterectomy). The ovaries may be left in place or removed.  

  • Medicines to treat cancer.  

  • A combination of surgery, radiation, and chemotherapy.  

  • Biological response modifiers. These are substances that help strengthen your immune system's fight against cancer or infection. They may be used in combination with chemotherapy.  

HOME CARE INSTRUCTIONS

  • Get a gynecology exam and Pap test once every year or as directed by your health care provider.  

  • Get the HPV vaccine.  

  • Do not smoke.

  • Do not have sexual intercourse until your health care provider says it is okay.

  • Use a condom every time you have sex. 

SEEK MEDICAL CARE IF:

  • You have increased pelvic pain or pressure.  

  • Your are becoming increasingly tired.  

  • You have increased leg or back pain.  

  • You have a fever.

  • You have abnormal bleeding or discharge.

  • You lose weight.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You cannot urinate.

  • You have blood in your urine.  

  • You have blood or pressure with a bowel movement.  

  • You develop severe back, stomach, or pelvic pain.