Cervical cancer forms in tissues of the cervix (the organ connecting the uterus and vagina). It is usually a slow-growing cancer that may not have symptoms but can be found with regular Pap tests (a procedure in which cells are scraped from the cervix and looked at under a microscope).
Researchers have identified HPV, which is transmitted through sexual contact, as the main cause of cervical cancer.
Precancerous changes and early cancers of the cervix generally do not cause pain or other symptoms. It is important not to wait to feel pain before seeing a doctor.
When the disease gets worse, women may notice one or more of these symptoms:
- Abnormal vaginal bleeding
- Bleeding that occurs between regular menstrual periods
- Bleeding after sexual intercourse, douching, or a pelvic exam
- Menstrual periods that last longer and are heavier than before
- Bleeding after menopause
- Increased vaginal discharge
- Pelvic pain
- Pain during sexual intercourse
Infections or other health problems may also cause these symptoms. Only a doctor can tell for sure. A woman with any of these symptoms should tell her doctor so that problems can be diagnosed and treated as early as possible.
If a woman has a symptom or Pap test results that suggest precancerous cells or cancer of the cervix, her doctor will suggest other procedures to make a diagnosis.
These may include:
- Colposcopy: The doctor uses a colposcope to look at the cervix. The colposcope combines a bright light with a magnifying lens to make tissue easier to see. It is not inserted into the vagina. A colposcopy is usually done in the doctor's office or clinic.
- Biopsy : The doctor removes tissue to look for precancerous cells or cancer cells. Most women have their biopsy in the doctor's office with local anesthesia. A pathologist checks the tissue with a microscope.
- Punch biopsy: The doctor uses a sharp, hollow device to pinch off small samples of cervical tissue.
- LEEP: The doctor uses an electric wire loop to slice off a thin, round piece of tissue.
- Endocervical curettage: The doctor uses a curette (a small, spoon-shaped instrument) to scrape a small sample of tissue from the cervical canal. Some doctors may use a thin, soft brush instead of a curette.
- Conization: The doctor removes a cone-shaped sample of tissue. A conization, or cone biopsy, lets the pathologist see if abnormal cells are in the tissue beneath the surface of the cervix. The doctor may do this test in the hospital under general anesthesia. Conization also may be used to remove a precancerous area.
Removing tissue from the cervix may cause some bleeding or other discharge. The area usually heals quickly. Women may also feel some pain similar to menstrual cramps. Medicine can relieve this discomfort.
You may want to ask the doctor these questions before having a procedure:
- Which test(s) do you recommend?
- How will the test be done?
- Will I have to go to the hospital?
- How long will it take? Will I be awake? Will it hurt?
- Are there any risks? What are the chances of infection or bleeding after the procedure?
- Can the test affect my ability to get pregnant and have children?
- How soon will I know the results? Who will explain them to me?
- If I do have cancer, who will talk to me about the next steps? When?
Many women with cervical cancer want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and your treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything you want to ask the doctor. It often helps to make a list of questions before an appointment.
To help remember what the doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to the doctor - to take part in the discussion, to take notes, or just to listen.
You do not need to ask all your questions at once. You will have other chances to ask your doctor to explain things that are not clear and to ask for more information.
Your doctor may refer you to a specialist, or you may ask for a referral. Gynecologists, gynecologic oncologists, medical oncologists, and radiation oncologists are specialists who treat cervical cancer.
Getting a Second Opinion
Before starting treatment, you might want a second opinion about the diagnosis and treatment plan. Many insurance companies cover a second opinion if you or your doctor requests it. It may take some time and effort to gather medical records and arrange to see another doctor. Usually it is not a problem to take several weeks to get a second opinion. In most cases, the delay in starting treatment will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Some women with cervical cancer need treatment right away.
There are a number of ways to find a doctor for a second opinion:
- Your doctor may refer you to one or more specialists. At cancer centers, several specialists often work together as a team.
- A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists in your area.
Preparing for Treatment
The choice of treatment depends mainly on the size of the tumor and whether the cancer has spread. If a woman is of childbearing age, the treatment choice may also depend on whether she wants to become pregnant someday.
Your doctor can describe your treatment choices and the expected results of each. You and your doctor can work together to develop a treatment plan that meets your medical needs and personal values.
You may want to ask your doctor these questions before your treatment begins:
- What is the stage of my disease? Has the cancer spread? If so, where?
- What are my treatment choices? Which do you recommend for me? Will I have more than one kind of treatment?
- What are the expected benefits of each kind of treatment?
- What are the risks and possible side effects of each treatment? What can we do to control my side effects?
- How will treatment affect my normal activities?
- What can I do to take care of myself during treatment?
- How long will treatment last?
- Will I have to stay in the hospital?
- What is the treatment likely to cost? Does my insurance cover this treatment?
- How often should I have checkups?
- Would a clinical trial (research study) be appropriate for me?
Methods of Treatment
Women with cervical cancer may be treated with surgery, radiation therapy, chemotherapy, radiation therapy and chemotherapy, or a combination of all three methods.
At any stage of disease, women with cervical cancer may have treatment to control pain and other symptoms, to relieve the side effects of therapy, and to ease emotional and practical problems. This kind of treatment is called supportive care, symptom management, or palliative care.
You may want to talk to your doctor about taking part in a clinical trial, a research study of new treatment methods.
Surgery treats the cancer in the cervix and the area close to the tumor.
Most women with early cervical cancer have surgery to remove the cervix and uterus (total hysterectomy). However, for very early (Stage 0) cervical cancer, a hysterectomy may not be needed. Other ways to remove the cancerous tissue include conization, cryosurgery, laser surgery, or LEEP.
Some women need a radical hysterectomy. A radical hysterectomy is surgery to remove the uterus, cervix, and part of the vagina.
With either total or radical hysterectomy, the surgeon may remove both fallopian tubes and ovaries. (This procedure is a salpingo-oophorectomy.)
The surgeon may also remove the lymph nodes near the tumor to see if they contain cancer. If cancer cells have reached the lymph nodes, it means the disease may have spread to other parts of the body.
You may want to ask the doctor these questions about surgery:
- What kind of operation will I have? Will my ovaries be removed?
- Do I need to have lymph nodes removed? Will other tissues be removed? Why?
- How will I feel after the operation?
- If I have pain, how will it be controlled?
- How long will I have to stay in the hospital?
- Will I have any lasting side effects? If I don't have a hysterectomy, will I be able to get pregnant and have children? Is there increased risk of miscarriage?
- When will I be able to resume normal activities?
- How will the surgery affect my sex life?
Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area.
Women have radiation therapy alone, with chemotherapy, or with chemotherapy and surgery. The doctor may suggest radiation therapy instead of surgery for the small number of women who cannot have surgery for medical reasons. Most women with cancer that extends beyond the cervix have radiation therapy and chemotherapy. For cancer that has spread to distant organs, radiation therapy alone may be used.
Doctors use two types of radiation therapy to treat cervical cancer. Some women receive both types:
- External radiation: The radiation comes from a large machine outside the body. The woman usually has treatment as an outpatient in a hospital or clinic. She receives external radiation 5 days a week for several weeks.
- Internal radiation (intracavitary radiation): Thin tubes (also called implants) containing a radioactive substance are left in the vagina for a few hours or up to 3 days. The woman may stay in the hospital during that time. To protect others from the radiation, the woman may not be able to have visitors or may have visitors for only a short period of time while the tubes are in place. Once the tubes are removed, no radioactivity is left in her body. Internal radiation may be repeated two or more times over several weeks.
You may want to ask the doctor these questions before having radiation therapy:
- What is the goal of this treatment?
- How will the radiation be given?
- Will I need to stay in the hospital? If so, for how long?
- When will the treatments begin? When will they end?
- How will I feel during therapy? Are there side effects?
- How will we know if the radiation therapy is working?
- Will I be able to continue my normal activities during treatment?
- How will radiation therapy affect my sex life?
- Will I be able to get pregnant and have children after my treatment is over?
Chemotherapy uses anticancer drugs to kill cancer cells. It is called systemic therapy because the drugs enter the bloodstream and can affect cells all over the body. For treatment of cervical cancer, chemotherapy is generally combined with radiation therapy. For cancer that has spread to distant organs, chemotherapy alone may be used.
Anticancer drugs for cervical cancer are usually given through a vein. Women usually receive treatment in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, a woman needs to stay in the hospital during treatment.
You may want to ask the doctor these questions before having chemotherapy:
- Why do I need this treatment?
- Which drug or drugs will I have?
- How do the drugs work?
- What are the expected benefits of the treatment?
- What are the risks and possible side effects of treatment? What can we do about them?
- When will treatment start? When will it end?
- How will treatment affect my normal activities?
Doctors cannot always explain why one woman develops cervical cancer and another does not. However, we do know that a woman with certain risk factors may be more likely than others to develop cervical cancer. A risk factor is something that may increase the chance of developing a disease.
Studies have found a number of factors that may increase the risk of cervical cancer. These factors may act together to increase the risk even more:
- Human papillomaviruses (HPVs): HPV infection is the main risk factor for cervical cancer. HPV is a group of viruses that can infect the cervix. HPV infections are very common. These viruses can be passed from person to person through sexual contact. Most adults have been infected with HPV at some time in their lives. Some types of HPV can cause changes to cells in the cervix. These changes can lead to genital warts, cancer, and other problems. Doctors may check for HPV even if there are no warts or other symptoms.
If a woman has an HPV infection, her doctor can discuss ways to avoid infecting other people. The Pap test can detect cell changes in the cervix caused by HPV. Treatment of these cell changes can prevent cervical cancer. There are several treatment methods, including freezing or burning the infected tissue. Sometimes medicine also helps.
- Lack of regular Pap tests: Cervical cancer is more common among women who do not have regular Pap tests. The Pap test helps doctors find precancerous cells. Treating precancerous cervical changes often prevents cancer.
- Weakened immune system (the body's natural defense system): Women with HIV (the virus that causes AIDS) infection or who take drugs that suppress the immune system have a higher-than-average risk of developing cervical cancer. For these women, doctors suggest regular screening for cervical cancer.
- Age: Cancer of the cervix occurs most often in women over the age of 40.
- Sexual history: Women who have had many sexual partners have a higher-than-average risk of developing cervical cancer. Also, a woman who has had sexual intercourse with a man who has had many sexual partners may be at higher risk of developing cervical cancer. In both cases, the risk of developing cervical cancer is higher because these women have a higher-than-average risk of HPV infection.
- Smoking cigarettes: Women with an HPV infection who smoke cigarettes have a higher risk of cervical cancer than women with HPV infection who do not smoke.
- Using birth control pills for a long time: Using birth control pills for a long time (5 or more years) may increase the risk of cervical cancer among women with HPV infection.
- Having many children: Studies suggest that giving birth to many children may increase the risk of cervical cancer among women with HPV infection.
Diethylstilbestrol (DES) may increase the risk of a rare form of cervical cancer and certain other cancers of the reproductive system in daughters exposed to this drug before birth. DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.)
Women who think they may be at risk for cancer of the cervix should discuss this concern with their doctor. They may want to ask about a schedule for checkups.