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Cervical cancer

Cancer - cervix; Cervical cancer - HPV; Cervical cancer - dysplasia

 

Cervical 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.

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 the routine use of Pap smears .

Cervical cancer starts in the cells on the surface of the cervix. There are 2 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 dysplasia to develop 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 papillomavirus). HPV is a common virus that is spread through sexual intercourse. There are many different types (strains) of HPV. Some strains lead to cervical cancer. Other strains can cause genital warts . 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 partners
  • Having a partner or many partners who take part in high-risk sexual activities

Other risk factors for cervical cancer include:

  • Not getting the HPV vaccine
  • Being economically disadvantaged
  • Having a mother who took the drug diethylstilbestrol (DES) during pregnancy in the early 1960s to prevent miscarriage
  • Having a weakened immune system

 

Symptoms

 

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

  • Abnormal vaginal bleeding between periods, after intercourse, or after menopause
  • Vaginal discharge that does not stop, and may be pale, watery, pink, brown, bloody, or foul-smelling
  • Periods 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 pain
  • Bone pain or fractures
  • Fatigue
  • Leaking of urine or feces from the vagina
  • Leg pain
  • Loss of appetite
  • Pelvic pain
  • Single swollen leg
  • Weight loss

 

Exams and Tests

 

Precancerous changes of the cervix and cervical cancer cannot be seen with the naked eye. Special tests and tools are needed to spot such conditions:

  • A Pap smear screens for precancers and cancer, but does not make a final diagnosis.
  • The human papillomavirus (HPV) DNA test may be done along with a Pap test. Or it may be used after a woman has had an abnormal Pap test result. It may also be used as the first test.
  • If abnormal changes are found, the cervix is usually examined under magnification. This procedure is called colposcopy . Pieces of tissue are removed (biopsied) during this procedure. This tissue is then sent to a lab for examination.
  • A procedure called a  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-ray
  • CT scan of the pelvis
  • Cystoscopy
  • Intravenous pyelogram (IVP)
  • MRI of the pelvis

 

Treatment

 

Treatment of cervical cancer depends on:

  • The stage of the cancer
  • The size and shape of the tumor
  • The woman's age and general health
  • Her desire to have children in the future

Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. This is why routine Pap smears are so important to prevent cervical cancer. There are 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 tissue
  • Cryotherapy: Freezes abnormal cells
  • Laser 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 had 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.

Chemotherapy uses drugs to kill cancer. It may be given alone or with surgery or radiation.

 

Support Groups

 

You 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.

 

Outlook (Prognosis)

 

How well the person does depends on many things, including:

  • Type of cervical cancer
  • Stage of cancer (how far it has spread)
  • Age and general health
  • If 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.

 

Possible Complications

 

Complications can include:

  • Risk of the cancer coming back in women who have treatment to save the uterus
  • Problems with sexual, bowel, and bladder function after surgery or radiation

 

When to Contact a Medical Professional

 

Call your provider if you:

  • Have not had regular Pap smears
  • Have abnormal vaginal bleeding or discharge

 

Prevention

 

Cervical cancer can be prevented by doing the following:

  • Get the HPV vaccine . The vaccine prevents most types of HPV infection that cause cervical cancer. Your provider can tell you if the vaccine is right for you.
  • Practice safer sex. Using condoms during sex reduces the risk for HPV and other sexually transmitted infections (STIs).
  • Limit the number of sexual partners you have. Avoid partners who are active in high-risk sexual behaviors.
  • Get Pap smears as often as your provider recommends. Pap smears can help detect early changes, which can be treated before they turn into cervical cancer.
  • Get the HPV test if recommended by your provider. It can be used along with the Pap test to screen for cervical cancer in women 30 years and older.
  • If you smoke, quit . Smoking increases your chance of getting cervical cancer.

 

 

Open References

References

Committee on Adolescent Health Care of the American College of Obstetricians and Gynecologists: Immunization Expert Work Group of the American College of Obstetricians and Gynecologists. Committee Opinion No. 588: human papillomavirus vaccination. Obstet Gynecol . 2014;123:712-718. PMID: 24553168 www.ncbi.nlm.nih.gov/pubmed/24553168 .

Hacker NF. Cervical dysplasia and cancer. In: Hacker NF, Gambone JC, Hobel CJ, eds. Hacker and Moore's Essentials of Obstetrics and Gynecology . 6th ed. Philadelphia, PA: Elsevier; 2016:chap 38.

Jhingran A, Russell AH, Seiden MV, et al. Cancers of the cervix, vulva, and vagina. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology . 5th ed. Philadelphia, PA: Elsevier; 2013:chap 87.

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines): cervical cancer. Version 1.2016. www.nccn.org/professionals/physician_gls/pdf/cervical.pdf . Accessed: January 18, 2016.

U.S. Preventive Services Task Force. Screening for Cervical Cancer: U.S. Preventive Services Task Force recommendation statement. AHRQ Publication No. 11-05156-EF-2, March 2012. www.uspreventiveservicestaskforce.org/uspstf11/cervcancer/cervcancerrs.htm . Accessed: January 18, 2016.

 
  • Cervical cancer

    Cervical cancer

    Animation

    •  

    Cervical cancer - Animation

    Worldwide, cervical cancer is the third most common type of cancer in women. Luckily, it's much less common in the United States due to women receiving recommended routine Pap smears, the test designed to find cervical cancer sometimes even before abnormal cells turn to cancer. Cervical cancer starts in the cells on the surface of the cervix, the lower portion of the uterus. There are two types of cells on the surface of the cervix, squamous and columnar. Most cervical cancers come from these squamous cells. The cancer usually starts very slowly as a condition called dysplasia. This precancerous condition can be detected by Pap smear and is 100% treatable. Undetected, precancerous changes can develop into cervical cancer and spread to the bladder, intestines, lungs, and liver. It can take years for these precancerous changes to turn into cervical cancer. However, patients with cervical cancer do not usually have problems until the cancer is advanced and has spread. Most of the time, early cervical cancer has no symptoms. Symptoms of advanced cancer may include back pain, bone fractures, fatigue, heavy vaginal bleeding, urine leakage, leg pain, loss of appetite, and pelvic pain. If after having a Pap smear, the doctor finds abnormal changes on the cervix, a colposcopy can be ordered. Using a light and a low-powered microscope, the doctor will view the cervix under magnification. The doctor may remove pieces of tissue, called a biopsy, and send the sample to a laboratory for testing. If the woman is diagnosed with cervical cancer, the doctor will order more tests to determine how far the cancer has spread. This is called Staging. Treatment will depend on the stage of the cancer, the size and shape of the tumor, the woman's age and general health, and her desire to have children in the future. Early cervical cancer can be treated with surgery just to remove abnormal tissue, freeze abnormal cells, or burn abnormal tissue. Treatment for more advanced cervical cancer may include radical hysterectomy, removal of the uterus and much of the surrounding tissue, including lymph nodes and the upper part of the vagina. Radiation may be used to treat cancer that has spread beyond the pelvis, or if cancer returns. The woman may also have chemotherapy to kill cancer cells. Almost all cervical cancers are caused by human papilloma virus, or HPV. This common virus is spread through sexual intercourse. HPV vaccines can prevent infection against the two types of HPV responsible for about 70% of cervical cancer. Practicing safe sex also reduces the risk of getting HPV. But, keep in mind most women diagnosed with cervical cancer have not had their regular Pap smears. Because Pap smears can find precancerous growths that are 100% treatable, it's very important for women to get Pap smears at regular intervals.

  • Cervical cancer

    Cervical cancer - illustration

    The development of cervical cancer is gradual and begins as a pre-cancerous condition called dysplasia. It is usually a slow-growing cancer and if caught early can be successfully treated. Routine Pap smears can detect early changes in the cells of the cervix allowing cervical cancer to be caught early.

    Cervical cancer

    illustration

  • Cervical neoplasia

    Cervical neoplasia - illustration

    Cervical intraepithelial neoplasia (CIN) is the presence of abnormal cells on the surface of the cervix. A Pap smear and colposcopy are two of the procedures performed to monitor the cells and appearance of the cervix.

    Cervical neoplasia

    illustration

  • Pap smear

    Pap smear - illustration

    A Pap test is a simple, relatively inexpensive procedure that can easily detect cancerous or precancerous conditions.

    Pap smear

    illustration

  • Cervical biopsy

    Cervical biopsy - illustration

    In a cervical punch biopsy, the cervix may be stained with iodine solution in order to see abnormalities better. These areas of tissue are then sampled and examined.

    Cervical biopsy

    illustration

  • Cold cone biopsy

    Cold cone biopsy - illustration

    The cold cone biopsy is a surgical procedure requiring general anesthesia and is indicated by the presence of precancerous changes in the cervix.

    Cold cone biopsy

    illustration

  • Cervical cancer

    Cervical cancer - illustration

    Cervical cancer is the third most common type of cancer in women. Approximately 2-3% of all women over age 40 years will develop some form of cervical cancer.

    Cervical cancer

    illustration

  • Pap smears and cervical cancer

    Pap smears and cervical cancer - illustration

    An instrument called a speculum holds the walls of the vagina open so that the cervix may be viewed and a swab of cells obtained for analysis.

    Pap smears and cervical cancer

    illustration

  • Cervical cancer

    Animation

    •  

    Cervical cancer - Animation

    Worldwide, cervical cancer is the third most common type of cancer in women. Luckily, it's much less common in the United States due to women receiving recommended routine Pap smears, the test designed to find cervical cancer sometimes even before abnormal cells turn to cancer. Cervical cancer starts in the cells on the surface of the cervix, the lower portion of the uterus. There are two types of cells on the surface of the cervix, squamous and columnar. Most cervical cancers come from these squamous cells. The cancer usually starts very slowly as a condition called dysplasia. This precancerous condition can be detected by Pap smear and is 100% treatable. Undetected, precancerous changes can develop into cervical cancer and spread to the bladder, intestines, lungs, and liver. It can take years for these precancerous changes to turn into cervical cancer. However, patients with cervical cancer do not usually have problems until the cancer is advanced and has spread. Most of the time, early cervical cancer has no symptoms. Symptoms of advanced cancer may include back pain, bone fractures, fatigue, heavy vaginal bleeding, urine leakage, leg pain, loss of appetite, and pelvic pain. If after having a Pap smear, the doctor finds abnormal changes on the cervix, a colposcopy can be ordered. Using a light and a low-powered microscope, the doctor will view the cervix under magnification. The doctor may remove pieces of tissue, called a biopsy, and send the sample to a laboratory for testing. If the woman is diagnosed with cervical cancer, the doctor will order more tests to determine how far the cancer has spread. This is called Staging. Treatment will depend on the stage of the cancer, the size and shape of the tumor, the woman's age and general health, and her desire to have children in the future. Early cervical cancer can be treated with surgery just to remove abnormal tissue, freeze abnormal cells, or burn abnormal tissue. Treatment for more advanced cervical cancer may include radical hysterectomy, removal of the uterus and much of the surrounding tissue, including lymph nodes and the upper part of the vagina. Radiation may be used to treat cancer that has spread beyond the pelvis, or if cancer returns. The woman may also have chemotherapy to kill cancer cells. Almost all cervical cancers are caused by human papilloma virus, or HPV. This common virus is spread through sexual intercourse. HPV vaccines can prevent infection against the two types of HPV responsible for about 70% of cervical cancer. Practicing safe sex also reduces the risk of getting HPV. But, keep in mind most women diagnosed with cervical cancer have not had their regular Pap smears. Because Pap smears can find precancerous growths that are 100% treatable, it's very important for women to get Pap smears at regular intervals.

  • Cervical cancer

    Cervical cancer - illustration

    The development of cervical cancer is gradual and begins as a pre-cancerous condition called dysplasia. It is usually a slow-growing cancer and if caught early can be successfully treated. Routine Pap smears can detect early changes in the cells of the cervix allowing cervical cancer to be caught early.

    Cervical cancer

    illustration

  • Cervical neoplasia

    Cervical neoplasia - illustration

    Cervical intraepithelial neoplasia (CIN) is the presence of abnormal cells on the surface of the cervix. A Pap smear and colposcopy are two of the procedures performed to monitor the cells and appearance of the cervix.

    Cervical neoplasia

    illustration

  • Pap smear

    Pap smear - illustration

    A Pap test is a simple, relatively inexpensive procedure that can easily detect cancerous or precancerous conditions.

    Pap smear

    illustration

  • Cervical biopsy

    Cervical biopsy - illustration

    In a cervical punch biopsy, the cervix may be stained with iodine solution in order to see abnormalities better. These areas of tissue are then sampled and examined.

    Cervical biopsy

    illustration

  • Cold cone biopsy

    Cold cone biopsy - illustration

    The cold cone biopsy is a surgical procedure requiring general anesthesia and is indicated by the presence of precancerous changes in the cervix.

    Cold cone biopsy

    illustration

  • Cervical cancer

    Cervical cancer - illustration

    Cervical cancer is the third most common type of cancer in women. Approximately 2-3% of all women over age 40 years will develop some form of cervical cancer.

    Cervical cancer

    illustration

  • Pap smears and cervical cancer

    Pap smears and cervical cancer - illustration

    An instrument called a speculum holds the walls of the vagina open so that the cervix may be viewed and a swab of cells obtained for analysis.

    Pap smears and cervical cancer

    illustration

A Closer Look

 

Talking to your MD

 

    Self Care

     

    Tests for Cervical cancer

     
     

    Review Date: 12/4/2015

    Reviewed By: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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