Cervical Cancer

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What is Cervical Cancer?

Cervical cancer is cancer that starts in the cervix, the lower part of the uterus (womb) that opens at the top of the vagina. 



Alternative names

Cancer - cervix



Causes

Worldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the United States because of 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 cervix's surface: squamous and columnar. The majority of cervical cancers are from squamous cells. The development of cervical cancer is usually very slow. It starts as a pre-cancerous condition called dysplasia. This pre-cancerous c...



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What is Cervical Cancer?

Cervical cancer is cancer that starts in the cervix, the lower part of the uterus (womb) that opens at the top of the vagina. 

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Alternative names

Cancer - cervix

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Causes

Worldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the United States because of 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 cervix's surface: squamous and columnar. The majority of cervical cancers are from squamous cells.

The development of cervical cancer is usually very slow. It starts as a pre-cancerous condition called dysplasia. This pre-cancerous condition can be detected by a Pap smear and is 100% treatable. That is why it is so important for women to get regular Pap smears. Most women that are diagnosed with cervical cancer today have not had regular Pap smears or they have not followed up on abnormal results.

Undetected, pre-cancerous changes can develop into cervical cancer and spread to the bladder, intestines, lungs, and liver. It can take years for pre-cancerous changes to turn into cervical cancer. Patients with cervical cancer do not usually have problems until the cancer is advanced and has spread.

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 of HPV, and many do not cause problems. However, only certain strains of HPV actually lead to cervical cancer. (Other strains may cause genital warts.)

Other risk factors for cervical cancer include:

  • Having sex at an early age
  • Multiple sexual partners
  • Sexual partners who have multiple partners or who participate in high-risk sexual activities
  • Women whose mothers took the drug DES (diethylstilbestrol) during pregnancy in the early 1960s to prevent miscarriage
  • Weakened immune system
  • Poor economic status (may not be able to afford regular Pap smears)
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Symptoms & Signs

Most ot the time, early cervical cancer has no symptoms. Symptoms that may occur can include:

  • Continuous vaginal discharge, which may be pale, watery, pink, brown, bloody, or foul-smelling
  • Abnormal vaginal bleeding between periods, after intercourse, or after menopause
  • Periods become heavier and last longer than usual
  • Any bleeding after menopause

Symptoms of advanced cervical cancer may include:

  • Loss of appetite
  • Weight loss
  • Fatigue
  • Pelvic pain
  • Back pain
  • Leg pain
  • Single swollen leg
  • Heavy bleeding from the vagina
  • Leaking of urine or feces from the vagina
  • Bone fractures
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Exams and Tests

Pre-cancerous changes of the cervix and cervical cancer can not be seen with the naked eye. Special tests and tools are needed to spot such conditions.

Pap smears screen for pre-cancers and cancer, but do not offer the final diagnosis. If abnormal changes are found, the cervix is usually examined under magnification. This is called colposcopy. Pieces of tissue are surgically removed (biopsied) during this procedure and sent to a laboratory for examination.  

Other tests may include:

  • Endocervical curettage (ECC) to examine the opening of the cervix
  • Cone biopsy

If the woman is diagnosed with cervical cancer, the health care provider will order more tests to determine how far the cancer has spread. This is called staging. Tests may include:

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Treatments

Treatment of cervical cancer depends on the stage of the cancer, the size and shape of the tumor, the age and general health of the woman, and her desire to have children in the future.

Early cervical cancer can be cured by removing or destroying the pre-cancerous 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:

  • LEEP (Loop Electrosurgical Excision Procedure) -- uses electricity to remove abnormal tissue
  • Cryotherapy -- freezes abnormal cells
  • Laser therapy -- uses light to burn abnormal tissue

A hysterectomy (removal of the uterus but not the ovaries) is not often performed for cervical cancer that has not spread. It may be done in women who have repeated LEEP procedures. However, in more advanced disease, a radical hysterectomy may be performed. This type of hysterectomy removes the uterus and much of the surrounding tissues, including internal lymph nodes and upper part of the vagina. In the most extreme surgery, called a pelvic exenteration, 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 pelvis, or cancer that has returned. Radiation therapy is either external or internal. Internal radiation therapy uses a device filled with radioactive material, which is placed inside the woman's vagina next to the cervical cancer. The device is removed when she goes home. External radiation therapy 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 chemotherapy for cervical cancer include 5-FU, Cisplatin, Carboplatin, Ifosfamide, Paclitaxel, and Cyclophosphamide. Sometimes radiation and chemotherapy are used before or after surgery.

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Where to get support

National Cervical Cancer Coalition - http://www.nccc-online.org/

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Prognosis

Many factors influence the outcome of cervical cancer. These include: 

  • The type of cancer
  • The stage of the disease
  • The age and general physical condition of the woman

Pre-cancer conditions are completely curable when followed up and treated properly. The chance of being 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 is 92%.

However, the 5-year survival rate falls steadily as the cancer spreads into other areas.

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Possible Complications

  • Some types of cervical cancer do not respond well to treatment.
  • The cancer may come back (recur) after treatment.
  • Women who have treatment to save the uterus have a high risk of the cancer coming back (recurrence). 
  • Surgery and radiation can cause problems with sexual, bowel, and bladder function.
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When to contact a medical professional

Call your health care provider if you:

  • Are a sexually active woman who has not had a Pap smear in the past year
  • Are at least 20 years old and have never had a pelvic examination and Pap smear
  • Think your mother may have taken DES when she was pregnant with you
  • Have not had regular Pap smears (ask your health care provider how often you should have one performed)
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Prevention

A new vaccine to prevent cervical cancer is now available. In June 2006, the U.S. Food and Drug Administration approved the vaccine called Gardasil, which prevents infection against the two types of HPV responsible for the majority of cervical cancer cases. Studies have shown that the vaccine appears to prevent early-stage cervical cancer and precancerous lesions. Gardasil is the first approved vaccine targeted specifically to prevent any type of cancer.

Practicing safe sex (using condoms) also reduces your risk of HPV and other sexually-transmitted diseases. HPV infection causes genital warts. These may be barely visible or several inches wide. If a woman sees warts on her partner's genitals, she should avoid intercourse with that person.

To further reduce the risk of cervical cancer, women should limit their number of sexual partners and avoid partners who participate in high-risk sexual activities.

Getting regular Pap smears can help detect pre-cancerous changes, which can be treated before they turn into cervical cancer. Pap smears work very well in spotting such changes, but they must be done regularly. Annual pelvic examinations, including a pap smear, should start when a woman becomes sexually active, or by the age of 20 in a non-sexually active woman. If abnormal changes are seen, a colposcopy with biopsy should be performed.

See also: Physical exam frequency.

If you smoke, quit. Cigarette smoking is associated with an increased risk of cervical cancer.

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References

Armstrong C. ACIP Releases Recommendations on Quadrivalent Human Papillomavirus Vaccine. Am Fam Physician. May 1, 2007;75(9);1391-1380.

Diaz ML. Human Papilloma Virus - Prevention and Treatment. Obstet Gynecol Clin North Am. June 2008;35(2);199-217.

NCCN Clinical Practical Guidelines in Oncology: Cervical cancer. 1st ed. 2008. Accessed June 10, 2008.

Content provided by:

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch). The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Review Date: 12/24/2008

Reviewed By: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Previously reviewed by James R. Mason, MD, Oncologist, Director, Blood and Marrow Transplantation Program and Stem Cell Processing Lab, Scripps Clinic, Torrey Pines, California; and David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. (6/10/2008)12/24/2008

Cervical Cancer Articles

  • 5 Things You Need to Know About Cervical Cancer

    ...ings that we know to be associated with Cervical cancer are within your control. Cervical cancer has several lifestyle factors that increase your risk, and regular pap smears are simple and reli...

  • 5 Things You Need to Know About Causes Of Cervical Cancer

    The actual causes of cervical cancer are unknown; however, doctors and researchers do know that a mutation occurs, causing normal cells to become abnormal. Abnormal cells, also known as cancer cel...

  • Cervical Cancer

    ...elps keep us healthy. Ninety percent of cervical cancers arise from the flattened or "squamous" cells covering the cervix. Most of the remaining 10 percent arise from the glandular, mucus-secret...

  • Cervical Cancer - Preventing Cervical Cancer

    ... cancer Institute, the vast majority of cervical cancers can be prevented. Since the most common form of cervical cancer starts with preventable and easily detectable pre-cancerous changes, ther...

Images provided by Google

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  • Cervical cancer

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  • Cervical dysplasia

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Cervical Cancer Blogs

FDA approves 2 cervical cancer virus tests - HPV

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Cervical Cancer Screening Provided To Underprivileged Chinese Women

To mark International Women's Day on March 8, Qiagen is providing human papillomavirus products for the testing of underprivileged women at 29 hospitals across China. The free testing program is part of the larger "3.8 Program", a nationwide prevention...

Cancer Research Blog Carnival #21 now online

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Jade Goody Reported As Having Cervical Cancer

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Show More

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Cervical Cancer Topic Guide

Topic Guide

Name: Tamika Felder

Profession: Cervical Cancer Survivor & Activist

About Me: Tamika Felder, the founder of Tamika and Friends, Inc., is a cervical cancer survivor who has dedicated her life to teaching...

Cervical Cancer is preventable!

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Cervical cancer Images

Connect With People Who Have Cervical Cancer

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Connect with Cervical Cancer Dares & Groups

Cycling for cancer

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Logging cycling miles to help raise funds for the Lance Armstrong Foundation.

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Create a Cancer Diet by exploring natural and organic foodstuffs and adding them to your weekly menu. Eating a diet rich in whole grains, healthy fats and fresh foods can keep the immune system an...

LIVESTRONG: Cervical Cancer

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...IVESTRONG group for conversations about Cervical Cancer

LIVESTRONG: Cervical Dysplasia

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...IVESTRONG group for conversations about Cervical Dysplasia

Write for LIVESTRONG.COM

Write for us

Do you work in health, fitness or nutrition? Share your expertise by writing for LIVESTRONG.COM

Learn More

Talk

drwalker_rph: first mammograms, now new Guidelines Push Back Age for Cervical Cancer Tests - http://ow.ly/E37K #health #healthcare #wellness

dramaqueene: Why do they release these new guidelines for breast and cervical cancer tests now? Are they trying to derail the public option?

The_Historian: OYE News: First Cervical Cancer Screening Delayed Until Age 21 http://bit.ly/5LFx62

cancer_aware: Cervical Cancer: A Guide for Nurses http://bit.ly/4MIoEz

CancerLeft: ACOG Updates Cervical Cancer Screening Guidelines | CancerConsultants http://bit.ly/4VFU7C



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