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Most of the uterus lies in the pelvis, but part of the cervix is located in the vagina, where it connects the uterus with the vagina. Cancer of the cervix occurs when the cells of the cervix change in a way that leads to abnormal growth and invasion of other tissues or organs of the body. Like all cancers, cancer of the cervix is much more likely to be cured if it is detected early and treated immediately.
One of the key features of cervical cancer is its slow progression from normal cervical tissue, to precancerous (or dysplastic) changes in the tissue, to invasive cancer.
The slow progression through numerous precancerous changes is very important because it provides opportunities for prevention and early detection and treatment.
These opportunities have caused the decline of cervical cancer over the past decades in the United States.
Invasive cancer means that the cancer affects the deeper tissues of the cervix and may have spread to other parts of the body. This spread is called metastasis. Cervical cancers don't always spread, but those that do most often spread to thelungs, the liver, the bladder, the vagina, and/or the rectum.
Cervical Cancer Causes Cervical cancer begins with abnormal changes in the cervical tissue. The risk of developing these abnormal changes has been associated with certain factors, including previous infectionwith human papillomavirus (HPV), early sexual contact, multiple sexual partners, cigarette smoking, and taking oral contraceptives (birth control pills). Forms of HPV, a virus whose different types cause skin warts, genital warts, and other abnormal skin and body surface disorders, have been shown to lead to many of the changes in cervical cells that may eventually lead to cancer.
Genetic material that comes from certain forms of HPV has been found in cervical tissues that show cancerous or precancerous changes.
In addition, women who have been diagnosed with HPV are more likely to develop a cervical cancer that has genetic material matching the strain of virus that caused the infection.
These findings demonstrate a strong link between the virus and cervical cancer.
Because HPV can be transmitted by sexual contact, early sexual contact and having multiple sexual partners have been identified as strong risk factors for the development of cervical lesions that may progress to cancer.
Vaginal bleeding after menopause is never normal. . Very heavy bleeding during your period or frequent bleeding between periods warrants evaluation by your health care provider. This is any bleeding from the vagina other than during menstruation. although it may in very advanced stages. The chemicals in cigarette smoke interact with the cells of the cervix. causing precancerous changes that may over time progress to cancer. y The most common symptom is abnormalvaginal bleeding. see your health care provider as soon as possible. fertility. Cervical Cancer Symptoms As in many cancers. especially in women who use oral contraceptives for longer than 5 years. y Cervical cancer does not usually causepain. range in seriousness. you may have no signs or symptoms of cervical cancer until it has progressed to a dangerous stage. and vary based on your age. Oral contraceptives ("the pill") may increase the risk for cervical cancer. If you have gone through menopause and have vaginal bleeding. When to Seek Medical Care The range of conditions that can cause vaginal bleeding are diverse. y Abnormal vaginal discharge also may occur with cervical cancer. and medical history.Cigarette smoking is another risk factor for the development of cervical cancer.
feeling faint or light-headed. especially after vigorous sex.Bleeding after intercourse. Treating precancerous changes that affect only the surface of a small part of the cervix is much more likely to be successful than treating invasive cancer that affects a large portion of the cervix and has spread to other tissues. especially if the bleeding happens repeatedly. the Pap smear is a quick. it is probably nothing to worry about. or actual faint. Evaluation by your health care provider is advisable. If you have vaginal bleeding that is associated with weakness. y The Pap smear is done as part of a regularpelvic examination. If this occurs only occasionally. . The most important progress that has been made in early detection of cervical cancer is widespread use of the Papanicolaou test (Pap smear). Any abnormality found on a Pap smear mandates further evaluation. Exams and Tests As with all cancers. painless. early diagnosis is key to successful treatment and cure. y y Cells from the surface of the cervix are collected on a slide and examined. does occur in some women. Named after the pathologist who developed the test. and relatively inexpensive way of screening women for precancerous or cancerous changes in their cervix. go to a hospital emergency department for care.
y The colposcope magnifies the cervix by 8-10 times. y The loop electrosurgical excision procedure (LEEP) technique uses an electrified loop of wire to take a sample of tissue from the cervix. . The entire area of the cervix is stained with a harmless dye to make abnormal cells easier to see. y This tissue sample can be obtained in a number of ways. Colposcopy is a procedure similar to a pelvic examination. A cervical biopsy is usually done by a specialist in diseases of women's reproductive and sexual organs (a gynecologist). y This procedure can usually be done in your gynecologist's office. allowing easier identification of any abnormal-appearing tissue that may need biopsy. y Sometimes a larger biopsy is needed to fully check for invasive cervical cancer.Diagnosis of cervical cancer requires that a sample of cervical tissue (called a biopsy) be taken and analyzed under a microscope. y The examination uses a type of microscope called a colposcope to inspect the cervix. These abnormalities may be an early step in the slow series of changes that can lead to cancer. y y The biopsy is examined by a physician who specializes in diagnosing diseases by looking at cells and tissues under a microscope (a pathologist).
o SIL is also called mild dysplasia or cervical intraepithelial neoplasia 1 (CIN 1). . y A small cone-shaped sample of your cervix is removed for examination. y Low-grade SIL: Early. "Lesion" refers to an area of abnormal tissue. different terms have been used to refer to abnormal changes in the cells on the surface of the cervix. Precancerous changes Over the years. eventually becoming a high-grade lesion. A cone biopsy is performed in the operating room while you are under anesthesia.intraepithelial means that the abnormal cells are present only in the surface layer of cells. subtle changes in the size and shape of cells that form the surface of the cervix are considered low grade. they may become more abnormal. Changes in these cells can be divided into 2 categories. y Like LEEP. cone biopsy procedures result in tissue samples in which the types of cells and how much they have spread to underlying areas can be more fully determined. These changes are now most often calledsquamous intraepithelial lesion (SIL).y This procedure can often be performed in your gynecologist's office. but over time. o These lesions may go away on their own. o These early changes in the cervix most often occur in women aged 25-35 years but can appear in women of any age.
y High-grade SIL: A large number of precancerous cells. Cervical cancer occurs most often in women aged 40 years or older. usually do not become cancerous and invade deeper layers of the cervix for many months. or carcinoma in situ. these precancerous changes involve only cells on the surface of the cervix. even high-grade lesions. Ask you health care provider if you do not understand the way the result of your Pap smear is reported. o They develop most often in women aged 30-40 years but can occur at any age. CIN 2 or 3. 1 being the most mild changes and 5 being the most severe. which look very different from normal cells. perhaps years. This system classifies changes into 1 of 5 groups. o Like low-grade SIL. or invasive cervical cancer. the disease is then called cervical cancer. o These lesions are also called moderate or severe dysplasia. Precancerous cells. constitute a high-grade lesion. Invasive cancer If abnormal cells spread deeper into the cervix or to other tissues or organs. Some laboratories may still use an older system for describing abnormalities. .
y By finding out how far it has spread. all designed to see whether the cancer has spread and. y These tests are used to "stage" the cancer. a series of tests will be performed. your health care providers can make a reasonable guess about your prognosis and the kind of treatment you will need. . if so. A CT scan may be necessary if results are not definitive. y A chest x-ray looks for spread to the lungs. the most severe). y Cervical cancer is staged from stage 0 (least severe) to stage IV (metastatic disease. y Staging is based on size and depth of the cancerous lesion. how far. The vagina and rectum are also examined. y y Special x-rays or a CT scan can be used to look at the bladder. Cervical Cancer Treatment Treatment of cervical cancer is directed at preventing precancerous cells from becoming cancerous cells. sometimes under anesthesia. as well as degree of spread. Blood tests can indicate whether the liver is involved.If the biopsy results show invasive cancer.
they are checked for dysplastic change to be sure all the precancerous or cancerous cells have been removed from the body or are otherwise destroyed. and sores inside the mouth. The result is very often death.y This is usually a step-by-step process. Maintaining good nutrition is one of the best things you can do. Eventually vital body organs will not be able to function properly because the cancer will take their oxygen and nutrients. Self-Care at Home Self-treatment is not appropriate for cancer under most circumstances. y If the deepest cells removed by biopsy were cancerous or precancerous. or injure them. Although self-treatment is inappropriate. As these tissues are removed. there are things you can do to reduce the physical and mental stresses of your cancer and its treatment. In these cases. Without medical treatment. y . y You may lose your appetite during your treatment. such as nausea. can make eating difficult. Common side effects of chemotherapy. this means the cancer has invaded farther than the biopsy. vomiting. no further treatment may be needed. treatment generally starts with removal of additional tissues. involving the removal of cells or tissue to diagnose cancer and to find out how far it has invaded. the cancer will continue to grow and spread. crowd them out. y If the deepest cells removed by biopsy were normal.
You may not be able to drink alcohol with some of the medications you are taking. will have an easier time keeping their strength and energy during the therapy. taking in enough calories and protein. The following lifestyle changes may help keep you stronger and more comfortable during treatment: y Physical activity will also help keep your strength and energy level up.y However. Engage in mild physical activity that is comfortable but doesn't wear you out. y Rest is equally important. Be sure to ask your health care provider. people who eat well. y Your cancer specialist (oncologist) or gynecologist may be able to recommend a nutritionist who can provide suggestions for keeping up your calorie and protein intake. Precancerous lesions . Get plenty of sleep each night and rest during the day if you need to. Avoid alcohol. They are also better able to tolerate the side effects of therapy. y Medical Treatment Treatment for precancerous lesions differs from that of invasive cancer. y Quit smoking.
cryosurgery (freezing). y If you have a low-grade lesion. you may not need further treatment. You should have regular Pap smears and pelvic exams. especially if the abnormal area was completely removed during biopsy. sometimes may be treatment as well. Diagnostic procedures. bleeding.Choice of treatment for a precancerous lesion of the cervix depends on a number of factors. such as LEEP and cone biopsy. you may choose to have a hysterectomy for precancerous changes. Treatment for precancerous lesions may cause cramping or other pain. or laser surgery may be used to destroy the abnormal area without harming nearby healthy tissue. y In some cases. or a watery vaginal discharge.cauterization (burning. y Abnormal tissue also can be removed by LEEP or conization. This surgery is more likely to be done if you do not plan to have children in the future. particularly if abnormal cells are found inside the opening of the cervix. These factors include whether the lesion is low or high grade. y When a precancerous lesion requires treatment. and your preference and that of your health care provider. whether you want to have children in the future. . your age and general health. also calleddiathermy). y Both of these procedures involve taking away some of the cervical tissue for evaluation.
y The laser destroys these cells. y A laser beam is applied to either specific areas of cervical tissue or a whole layer of tissue at the surface of the cervix. and they eventually die and are sloughed off. to be replaced by new cervical cells. only follow-up may be needed. y In this procedure. y Tissue may also be removed by laser ablation. then further treatments may be required. y This ultracooled instrument is then applied to the surface of the cervix. y If there is uncertainty about whether all of the precancerous cells have been removed using a LEEP or cone biopsy procedure. The cells are frozen. a steel instrument is cooled to subzero temperatures by immersion in liquid nitrogen or a similar liquid.y If that evaluation finds that there were indeed abnormal cells but that those abnormal cells did not extend as far as the level where the tissue was cut. Cryocautery may be used in some cases. Invasive cancer . The success of cryocautery or laser ablation procedures is determined by a follow-up examination and Pap smear. leaving healthy cells in their place.
Cancerous cells typically invade surrounding tissues. surgery is usually required. The team generally includes a gynecologic oncologist and a radiation oncologist. y y You may choose to take part in a clinical trial (research study) to evaluate new treatment methods. which separates the surface layers of the cervix from other underlying layers. y If a biopsy shows that cancerous cells have invaded through a layer called thebasement membrane. Radiation therapy (also called radiotherapy) is also used to fight cervical cancer at some stages. depending on the stage of the cancer. See For More Information to find out about clinical trials on the Internet. . y Treatment for invasive cervical cancer usually involves a team of specialists. Chemotherapy or biological therapy is sometimes used. Participating in a clinical trial has both benefits and risks. y y These doctors may decide to use one treatment method or a combination of methods. y Radiation therapy uses high-energy rays to damage cancer cells and stop them from growing.The most widely used treatments for cervical cancer are surgery and radiation therapy. y The extent of the surgery varies. Such studies are designed to improve cancer treatment.
an extra dose of radiation called a "boost" may be applied to the tumor site. . At the end of that time. External radiation comes from a large machine. which aims a beam of radiation at your pelvis. y External radiation treatments usually are given 5 days a week for 5-6 weeks. radiation therapy is local therapy. y The implant puts cancer-killing rays close to the tumor while sparing most of the healthy tissue around it. y Each treatment takes only a few minutes. y Radiation may be applied externally or internally. y It is usually left in place for 1-3 days.y Like surgery. radiation therapy generally is offered only at certain large medical centers or hospitals. Some women receive both kinds. the radiation affects cancer cells only in the treated area. y You stay in the hospital while the implants are in place. and the treatment may be repeated several times over the course of 1-2 weeks. Because of safety concerns and expense of equipment. y Internal or implant radiation comes from a capsule containing radioactive material which is placed directly in the cervix.
y Most patients have chemotherapy as an outpatient (in an outpatient clinic at the hospital. . y Anticancer drugs used to treat cervical cancer may be given via an IV line or by mouth. at the doctor's office.Chemotherapy is the use of powerful drugs to kill cancer cells. Depending on which drugs are given and your general health. chemotherapy is systemic treatment. or at home). it is used most often when the cancer has spread to other parts of the body. y Chemotherapy is given in cycles: each cycle comprises a period of intensive treatment followed by a recovery period. the cancerous cells may be removed or destroyed by using methods similar to those used to treat precancerous lesions. you may need to stay in the hospital during treatment. Treatment usually consists of several cycles. however. Just one drug or a combination of drugs may be given. y y Either way. y If the cancer is only on the surface of the cervix. Surgery Surgery removes cancerous tissue in or near the cervix. meaning that the drugs flow through the body in the bloodstream. They can kill cancer cells anywhere in the body. In cervical cancer.
y Whether hysterectomy is necessary depends on the individual circumstances. a hysterectomy is usually recommended.y If the disease has invaded deeper layers of the cervix but has not spread beyond the cervix. Hysterectomy is major surgery. . In addition. Other women who do plan to have children may wish to preserve their reproductive organs even if this increases their risk somewhat. an operation may remove the tumor but leave the uterus and the ovaries. y In invasive disease. and her health care provider. sometimes the ovaries and fallopian tubes also are removed. including the cervix. y The decision to have a hysterectomy is made by a woman. y Hysterectomy requires a considerable recovery period. Hysterectomy is surgical removal of the entire uterus. y If the disease has spread into the uterus. lymph nodes near the uterus may be removed to check for spread of the cancer. Some women who do not plan to have children in the future may choose to undergo hysterectomy for preventive reasons. y Hysterectomy is also sometimes done to prevent spread of the cancer. her partner. hysterectomy is usually necessary.
y Sexual desire and the ability to have intercourse usually are not affected by hysterectomy. y Your activities should be limited for a period of time after the surgery to allow healing to take place.y For a few days after the operation. You may need to have a thin. You may want to discuss these issues with your health care provider. y Your view of your own sexuality may change. The pain can be controlled by medication. You may feel an emotional loss because you are no longer able to have children. many women have an emotionally difficult time after this surgery. y Follow-up . usually can be resumed in 4-8 weeks. medical social worker. y On the other hand. Normal activities. you will no longer have menstrualperiods. you may have pain in your lower abdomen. plastic tube called a catheter inserted into the bladder to drain the urine for a few days after surgery. y An understanding partner is important at this time. Once you have had your uterus removed. y You may have difficulty emptying your bladder. or counselor. You also may have trouble having normal bowelmovements. including sexual intercourse.
. you should have a Pap smear every year for at least 3 years. before they become cancerous. y Follow-up care should include a full pelvic examination. Pap smear. Cancer treatment may cause side effects many years later. y In both cases. These tests are no less important for a woman who has been treated for precancerous changes or for cancer of the cervix. Prevention The key to preventing invasive cervical cancer is to detect any cell changes early. no matter how old you are.Regular pelvic examinations and Pap smears are important for every woman. y These precautions are necessary to allow early detection should the cancer return. y You should have your first Pap smear when you become sexually active. How often you should have apelvic exam and Pap smear depends on your individual situation. For this reason. you should continue to have regular checkups and should report any health problems that appear. you should have your first Pap smear at age 18 years or earlier. Regular pelvic examinations and Pap smears are the best way to do this. y If you are not sexually active. and other tests as indicated on a regular schedule recommended by your gynecologist.
Avoidance of human papillomavirus infection is becoming increasingly important in the prevention of precancerous and cancerous changes of the cervix. y Early age at first intercourse is associated with increased risk. y Because a woman's risk factors may change with her lifestyle. such as condom use. barrier protection. your gynecologist will recommend a schedule of follow-up examinations and tests. The vaccine targets a strain of HPV. y A vaccine to protect women from cervical cancer may be available in 5 years. . Abstinence is recommended as one way to prevent the transmission of HPV.y If these Pap smears reveal no abnormal cells and you have few risk factors for cervical cancer. although this has not yet been fully studied. may prevent HPV infection. the US Guide to Clinical Preventive Services recommends a repeat Pap smear at least every 3 years. many medical professionals prefer that you have a Pap smear yearly through age 65 years and older. y Likewise. The vaccine would not be effective for women who already have HPV. Early tests found an experimental vaccine to be effective against the virus responsible for half of all cases of cervical cancer. y If you have had precancerous changes or cancer of the cervix. regardless of the number of negative tests you have had in the past.
more than 90% of women survive at least 5 years after diagnosis. y Most women diagnosed with precancerous changes in the cervix are in their 20s and 30s. The prognosis for invasive cervical cancer depends on the stage of the cancer when it is found. These statistics are the reason that prevention is stressed in this disease. Quitting smoking may decrease your chances of developing cervical cancer. . 20% or fewer of women with stage IV cervical cancer survive 5 years. y The average age for true cervical cancer to be diagnosed is in the mid 50s. y Later stages of cervical cancer have a significantly worse outlook. namely. the survival rate is close to 100%. what other organs or tissues have been invaded.Cigarette smoking is another risk factor for cervical cancer that can be prevented. Outlook When precancerous or early cancerous changes are found and treated. y For the earliest stage of cervical cancer. y This difference in the age at which precancerous changes are most frequently diagnosed and the age at which cancer is diagnosed highlights the slow progression of this disease and the reason why it can be prevented if adequate steps are taken. The stage of a cancer is a measure of how far it has progressed.
Some people feel angry and resentful." that is. to hold your job. They may be hesitant to offer support until they see how you are coping. counselor. medical professionals sometimes avoid the word "cure" because the disease can recur. others feel helpless and defeated. or they prefer talking about their concerns with a more neutral professional. talking about their feelings and concerns helps.) Support Groups and Counseling Living with cancer presents many new challenges for you and for your family and friends. let them know. y Your friends and family members can be very supportive." Although many women with cervical cancer recover completely. to care for your family and home. y Many people feel anxious and depressed. Don't wait for them to bring it up.Health care providers who treat cancer often use the term "remission" rather than "cure. For most people with cancer. A social worker. or member of the clergy can be helpful if you want to . y Some people don't want to "burden" their loved ones. If you want to talk about your concerns. (The return of cancer is called a recurrence. y You will probably have many worries about how the cancer will affect you and your ability to "live a normal life. and to continuing the friendships and activities you enjoy.
The American Cancer Society also has information about support groups all over the United States. Support groups of people with cancer may be available through the medical center where you are receiving your treatment. Your gynecologist or oncologist should be able to recommend someone.discuss your feelings and concerns about having cancer. Dysplasia human papillomavirus genital warts invasive cervical cancer Papanicolaou test Pap smear Pap test pelvic exam pelvic examination precancerous changes precancerous lesions squamous intraepithelial lesion . y y Many people with cancer are helped profoundly by talking to other people who have cancer. Sharing your concerns with others who have been through the same thing can be remarkably reassuring.
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