Cervical cancer facts*
*Cervical cancer facts medical author: Melissa Conrad Stöppler, MD
Learn more about: Cervarix
What is the cervix?
The cervix is part of a woman's reproductive system. It's in the pelvis. The cervix is the lower, narrow part of the uterus (womb).
The cervix is a passageway:
What is cancer?
Cancer begins in cells, the building blocks that make up tissues. Tissues make up the cervix and other organs of the body.
Normal cervical cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, and new cells take their place.
Sometimes, this process goes wrong. New cells form when the body does not need them, and old or damaged cells do not die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.
Growths on the cervix can be benign (not cancer) or malignant (cancer):
Cervical cancer begins in cells on the surface of the cervix. Over time, the cervical cancer can invade more deeply into the cervix and nearby tissues.
Cervical cancer cells can spread by breaking away from the cervical tumor. They can travel through lymph vessels to nearby lymph nodes. Also, cancer cells can spread through the blood vessels to the lungs, liver, or bones. The process of spreading of cancer cells from the tissue in which they arise to other tissues elsewhere is called metastasis.
After spreading, cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. See the Staging section for information about cervical cancer that has spread.
Risk factors
When you get a diagnosis of cervical cancer, it's natural to wonder what may have caused the disease. Doctors usually can't explain why one woman develops cervical cancer and another doesn't.
However, we do know that a woman with certain risk factors may be more likely than other women to develop cervical cancer. A risk factor is something that may increase the chance of developing a disease.
Studies have found that infection with the virus called HPV is the cause of almost all cervical cancers. More than half of women by the age of 50 have been exposed to HPV, but most HPV infections clear up on their own. An HPV infection with a high risk type of HPV that doesn't go away can cause cervical cancer in some women.
Other risk factors, such as smoking, can act to increase the risk of cervical cancer among women infected with HPV even more.
A woman's risk of cervical cancer can be reduced by getting regular cervical cancer screening tests. If abnormal cervical cell changes are found early, cancer can be prevented by removing or killing the changed cells before they become cancer cells.
Another way a woman can reduce her risk of cervical cancer is by getting an HPV vaccine before becoming sexually active (between the ages of 9 and 26). Even women who get an HPV vaccine need regular cervical cancer screening tests. Vaccines reduce a person's risk of getting an infection, but do not prevent such infections in every vaccinated person.
Symptoms
Early cervical cancers usually don't cause symptoms. When the cancer grows larger, women may notice abnormal vaginal bleeding:
Women may also notice...
Cervical cancer, infections, or other health problems may cause these symptoms. A woman with any of these symptoms should tell her doctor so that problems can be diagnosed and treated as early as possible.
Diagnosis
If you have symptoms of cervical cancer, your doctor will try to find out what's causing the problems. You may have the following tests:
The doctor will remove tissue in one of the following ways:
A pathologist checks the tissue under a microscope for cancer cells. In most cases, a biopsy is the only sure way to tell whether cancer is present.
Removing tissue from the cervix may cause some bleeding or other discharge. The area usually heals quickly. Some women also feel some pain similar to menstrual cramps. Your doctor can suggest medicine that will help relieve any pain.
You may want to ask the doctor these questions before having a biopsy:
Staging
If the biopsy shows that you have cancer, your doctor will need to learn the extent (stage) of the disease to help you choose the best treatment. The stage is based on whether the cancer has invaded nearby tissues or spread to other parts of the body. Cervical cancer spreads most often to nearby tissues in the pelvis or to lymph nodes. It may also spread to the lungs, liver, or bones.
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of cancer cells and the same name as the original tumor. For example, if cervical cancer spreads to the lungs, the cancer cells in the lungs are actually cervical cancer cells. The disease is metastatic cervical cancer, not lung cancer. It's treated as cervical cancer, not as lung cancer. Doctors sometimes call the new tumor in the lung "distant" disease or a distant metastasis.
Your doctor will do a pelvic exam, will feel for swollen lymph nodes, and may remove additional tissue. To learn the extent of disease, your doctor may order one or more tests:
The stage is based on where cancer is found. These are the stages of invasive cervical cancer:
Treatment
Treatment options for women with cervical cancer are...
The choice of treatment depends mainly on the size of the tumor and whether the cancer has spread. The treatment choice may also depend on whether you would like to become pregnant someday.
Your doctor may refer you to a specialist, or you may ask for a referral. You may want to see a gynecologic oncologist, a doctor who specializes in treating female cancers. Other specialists who treat cervical cancer include gynecologists, medical oncologists, and radiation oncologists.
Your health care team may also include an oncology nurse and a registered dietitian. Your health care team can describe your treatment choices, the expected results of each, and the possible side effects. Because cancer treatments often damage healthy cells and tissues, side effects are common. These side effects depend on many factors, including the type of treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. You and your health care team can work together to develop a treatment plan that meets your medical and personal needs.
At any stage of the disease, supportive care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns. You can get information about coping on NCI's website at http://www.cancer.gov/cancertopics/coping.
Also, you can get information about supportive care from NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237). Or, chat using LiveHelp, NCI's instant messaging service, at http://www.cancer.gov/livehelp.
You may want to talk with your doctor about taking part in a clinical trial. Clinical trials are research studies testing new treatments. They are an important option for women with all stages of cervical cancer. See the section on Taking Part in Cancer Research 4.
You may want to ask the doctor these questions before treatment begins:
Surgery
Surgery is an option for women with Stage I or II cervical cancer. You and your surgeon can talk about the types of surgery and which may be right for you.
If you have a small tumor, the type of surgery may depend on whether you want to get pregnant and have children later on. Some women with very early cervical cancer may decide with their surgeon to have only the cervix, part of the vagina, and the lymph nodes in the pelvis removed (radical trachelectomy).
Other women may choose to have the cervix and uterus removed (complete hysterectomy). The surgeon may also remove some tissue around the cervix, part of the vagina, the fallopian tubes, or the ovaries. In addition, the surgeon may remove lymph nodes near the tumor.
It's common to feel tired or weak for a while after surgery for cervical cancer. The time it takes to heal is different for each woman. You'll probably be able to leave the hospital within a couple of days. Most women return to their normal activities within 4 to 8 weeks after surgery.
You may have pain or discomfort for the first few days after surgery. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your health care team. After surgery, they can adjust the plan if you need more pain control.
After a trachelectomy, some women need to have a tube put into the bladder to drain urine. It usually can be removed a few days after surgery.
After a hysterectomy, some women become constipated or have nausea and vomiting. In addition, some women lose control of their bladder or have trouble emptying their bladder. These effects are usually temporary. After a hysterectomy, you'll stop having menstrual periods, and you won't be able to become pregnant.
After the ovaries are removed, menopause occurs at once. You may have hot flashes, vaginal dryness, and night sweats. These symptoms are caused by the sudden loss of female hormones. Talk with your health care team about your symptoms so that you can develop a treatment plan together. There are drugs and lifestyle changes that can help, and most symptoms go away or lessen with time.
Surgery to remove lymph nodes may cause swelling (lymphedema) in one or both legs. Ask your health care team about how you may prevent or control the swelling. Information about lymphedema is available on NCI's website at http://www.cancer.gov/cancertopics/coping.
For some women, surgery to remove the cervix and nearby tissues can affect sexual intimacy. You may have feelings of loss that make intimacy difficult. Sharing these feelings with your partner may be helpful. Sometimes couples talk with a counselor to help them express their concerns.
You may want to ask the doctor these questions before having surgery:
Radiation therapy uses high-energy rays to kill cancer cells. It's an option for women with any stage of cervical cancer. Women with early cervical cancer may choose radiation therapy instead of surgery. It also may be used after surgery to destroy any cancer cells that remain in the area. Women with cancer that extends beyond the cervix may have radiation therapy and chemotherapy.
Doctors use two types of radiation therapy to treat cervical cancer. Some women receive both types:
Although radiation therapy is painless, it may cause side effects. The side effects depend mainly on how much radiation is given and which part of your body is treated. Radiation to the abdomen and pelvis may cause nausea, vomiting, diarrhea, or urinary problems. You may lose hair in your genital area. Also, skin on the abdomen and pelvis may become red, dry, and tender.
You may have dryness, itching, or burning in your vagina. Your doctor may advise you to wait until a few weeks after radiation treatment ends to have sex.
You are likely to become tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.
Although the side effects of radiation therapy can be upsetting, they can usually be treated or controlled. Talk with your doctor or nurse about ways to relieve discomfort.
It may also help to know that most side effects go away when treatment ends. However, you may want to discuss with your doctor the possible long-term effects of radiation therapy. For example, radiation therapy may make the vagina narrower. A narrow vagina can make sex or follow-up exams difficult. There are ways to prevent this problem. If it does occur, however, your health care team can tell you about ways to expand the vagina.
Another possible long-term effect is damage to the ovaries. Menstrual periods usually stop, and women may have hot flashes and vaginal dryness. Menstrual periods may return for some women, especially younger women. Women who may want to get pregnant after radiation therapy should ask their health care team about ways to preserve their eggs before treatment starts.
You may want to ask the doctor these questions before having radiation therapy:
Chemotherapy uses drugs to kill cancer cells. For the treatment of cervical cancer, chemotherapy is usually combined with radiation therapy. For cancer that has spread to distant organs, chemotherapy may be used alone.
Most drugs for cervical cancer are given directly into a vein (intravenously) through a thin needle. Some drugs can be taken by mouth. Most women receive chemotherapy in a clinic or at the doctor's office. Drugs that are swallowed may be taken at home instead. Some women need to stay in the hospital during treatment.
The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:
Other side effects include skin rash, tingling or numbness in your hands and feet, hearing problems, loss of balance, joint pain, or swollen legs and feet. Your health care team can suggest ways to control many of these problems. Most go away when treatment ends.
You may want to ask the doctor these questions before having chemotherapy:
Second opinion
Before starting treatment, you might want a second opinion about your diagnosis, stage of cancer, and treatment plan. Some people worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it. Some companies require a second opinion.
If you get a second opinion, the second doctor may agree with your first doctor's diagnosis and treatment plan. Or, the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at all of your options.
It may take some time and effort to gather your medical records and see another doctor. In most cases, it's not a problem to take several weeks to get a second opinion. The delay in starting treatment usually will not make treatment less effective. To make sure, you should discuss this delay with your doctor.
There are many ways to find a doctor for a second opinion. You can ask your doctor, a local or state medical society, or a nearby hospital or medical school for names of specialists.
NutritionEating well is important before, during, and after cancer treatment. You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.
Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods don't taste as good as they used to. In addition, poor appetite, nausea, vomiting, mouth blisters, and other side effects of treatment can make it hard for you to eat.
Your doctor, a registered dietitian, or another health care provider can suggest ways to help you meet your nutrition needs.
What is the cervix?
The cervix is part of a woman's reproductive system. It's in the pelvis. The cervix is the lower, narrow part of the uterus (womb).
The cervix is a passageway:
What is cancer?
Cancer begins in cells, the building blocks that make up tissues. Tissues make up the cervix and other organs of the body.
Normal cervical cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, and new cells take their place.
Sometimes, this process goes wrong. New cells form when the body does not need them, and old or damaged cells do not die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.
Growths on the cervix can be benign (not cancer) or malignant (cancer):
Cervical cancer begins in cells on the surface of the cervix. Over time, the cervical cancer can invade more deeply into the cervix and nearby tissues.
Cervical cancer cells can spread by breaking away from the cervical tumor. They can travel through lymph vessels to nearby lymph nodes. Also, cancer cells can spread through the blood vessels to the lungs, liver, or bones. The process of spreading of cancer cells from the tissue in which they arise to other tissues elsewhere is called metastasis.
After spreading, cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. See the Staging section for information about cervical cancer that has spread.
Risk factors
When you get a diagnosis of cervical cancer, it's natural to wonder what may have caused the disease. Doctors usually can't explain why one woman develops cervical cancer and another doesn't.
However, we do know that a woman with certain risk factors may be more likely than other women to develop cervical cancer. A risk factor is something that may increase the chance of developing a disease.
Studies have found that infection with the virus called HPV is the cause of almost all cervical cancers. More than half of women by the age of 50 have been exposed to HPV, but most HPV infections clear up on their own. An HPV infection with a high risk type of HPV that doesn't go away can cause cervical cancer in some women.
Other risk factors, such as smoking, can act to increase the risk of cervical cancer among women infected with HPV even more.
A woman's risk of cervical cancer can be reduced by getting regular cervical cancer screening tests. If abnormal cervical cell changes are found early, cancer can be prevented by removing or killing the changed cells before they become cancer cells.
Another way a woman can reduce her risk of cervical cancer is by getting an HPV vaccine before becoming sexually active (between the ages of 9 and 26). Even women who get an HPV vaccine need regular cervical cancer screening tests. Vaccines reduce a person's risk of getting an infection, but do not prevent such infections in every vaccinated person.
Symptoms
Early cervical cancers usually don't cause symptoms. When the cancer grows larger, women may notice abnormal vaginal bleeding:
Women may also notice...
Cervical cancer, infections, or other health problems may cause these symptoms. A woman with any of these symptoms should tell her doctor so that problems can be diagnosed and treated as early as possible.
Diagnosis
If you have symptoms of cervical cancer, your doctor will try to find out what's causing the problems. You may have the following tests:
The doctor will remove tissue in one of the following ways:
A pathologist checks the tissue under a microscope for cancer cells. In most cases, a biopsy is the only sure way to tell whether cancer is present.
Removing tissue from the cervix may cause some bleeding or other discharge. The area usually heals quickly. Some women also feel some pain similar to menstrual cramps. Your doctor can suggest medicine that will help relieve any pain.
You may want to ask the doctor these questions before having a biopsy:
Staging
If the biopsy shows that you have cancer, your doctor will need to learn the extent (stage) of the disease to help you choose the best treatment. The stage is based on whether the cancer has invaded nearby tissues or spread to other parts of the body. Cervical cancer spreads most often to nearby tissues in the pelvis or to lymph nodes. It may also spread to the lungs, liver, or bones.
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of cancer cells and the same name as the original tumor. For example, if cervical cancer spreads to the lungs, the cancer cells in the lungs are actually cervical cancer cells. The disease is metastatic cervical cancer, not lung cancer. It's treated as cervical cancer, not as lung cancer. Doctors sometimes call the new tumor in the lung "distant" disease or a distant metastasis.
Your doctor will do a pelvic exam, will feel for swollen lymph nodes, and may remove additional tissue. To learn the extent of disease, your doctor may order one or more tests:
The stage is based on where cancer is found. These are the stages of invasive cervical cancer:
Treatment
Treatment options for women with cervical cancer are...
The choice of treatment depends mainly on the size of the tumor and whether the cancer has spread. The treatment choice may also depend on whether you would like to become pregnant someday.
Your doctor may refer you to a specialist, or you may ask for a referral. You may want to see a gynecologic oncologist, a doctor who specializes in treating female cancers. Other specialists who treat cervical cancer include gynecologists, medical oncologists, and radiation oncologists.
Your health care team may also include an oncology nurse and a registered dietitian. Your health care team can describe your treatment choices, the expected results of each, and the possible side effects. Because cancer treatments often damage healthy cells and tissues, side effects are common. These side effects depend on many factors, including the type of treatment. Side effects may not be the same for each person, and they may even change from one treatment session to the next. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. You and your health care team can work together to develop a treatment plan that meets your medical and personal needs.
At any stage of the disease, supportive care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns. You can get information about coping on NCI's website at http://www.cancer.gov/cancertopics/coping.
Also, you can get information about supportive care from NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237). Or, chat using LiveHelp, NCI's instant messaging service, at http://www.cancer.gov/livehelp.
You may want to talk with your doctor about taking part in a clinical trial. Clinical trials are research studies testing new treatments. They are an important option for women with all stages of cervical cancer. See the section on Taking Part in Cancer Research 4.
You may want to ask the doctor these questions before treatment begins:
Surgery
Surgery is an option for women with Stage I or II cervical cancer. You and your surgeon can talk about the types of surgery and which may be right for you.
If you have a small tumor, the type of surgery may depend on whether you want to get pregnant and have children later on. Some women with very early cervical cancer may decide with their surgeon to have only the cervix, part of the vagina, and the lymph nodes in the pelvis removed (radical trachelectomy).
Other women may choose to have the cervix and uterus removed (complete hysterectomy). The surgeon may also remove some tissue around the cervix, part of the vagina, the fallopian tubes, or the ovaries. In addition, the surgeon may remove lymph nodes near the tumor.
It's common to feel tired or weak for a while after surgery for cervical cancer. The time it takes to heal is different for each woman. You'll probably be able to leave the hospital within a couple of days. Most women return to their normal activities within 4 to 8 weeks after surgery.
You may have pain or discomfort for the first few days after surgery. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your health care team. After surgery, they can adjust the plan if you need more pain control.
After a trachelectomy, some women need to have a tube put into the bladder to drain urine. It usually can be removed a few days after surgery.
After a hysterectomy, some women become constipated or have nausea and vomiting. In addition, some women lose control of their bladder or have trouble emptying their bladder. These effects are usually temporary. After a hysterectomy, you'll stop having menstrual periods, and you won't be able to become pregnant.
After the ovaries are removed, menopause occurs at once. You may have hot flashes, vaginal dryness, and night sweats. These symptoms are caused by the sudden loss of female hormones. Talk with your health care team about your symptoms so that you can develop a treatment plan together. There are drugs and lifestyle changes that can help, and most symptoms go away or lessen with time.
Surgery to remove lymph nodes may cause swelling (lymphedema) in one or both legs. Ask your health care team about how you may prevent or control the swelling. Information about lymphedema is available on NCI's website at http://www.cancer.gov/cancertopics/coping.
For some women, surgery to remove the cervix and nearby tissues can affect sexual intimacy. You may have feelings of loss that make intimacy difficult. Sharing these feelings with your partner may be helpful. Sometimes couples talk with a counselor to help them express their concerns.
You may want to ask the doctor these questions before having surgery:
Radiation therapy uses high-energy rays to kill cancer cells. It's an option for women with any stage of cervical cancer. Women with early cervical cancer may choose radiation therapy instead of surgery. It also may be used after surgery to destroy any cancer cells that remain in the area. Women with cancer that extends beyond the cervix may have radiation therapy and chemotherapy.
Doctors use two types of radiation therapy to treat cervical cancer. Some women receive both types:
Although radiation therapy is painless, it may cause side effects. The side effects depend mainly on how much radiation is given and which part of your body is treated. Radiation to the abdomen and pelvis may cause nausea, vomiting, diarrhea, or urinary problems. You may lose hair in your genital area. Also, skin on the abdomen and pelvis may become red, dry, and tender.
You may have dryness, itching, or burning in your vagina. Your doctor may advise you to wait until a few weeks after radiation treatment ends to have sex.
You are likely to become tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.
Although the side effects of radiation therapy can be upsetting, they can usually be treated or controlled. Talk with your doctor or nurse about ways to relieve discomfort.
It may also help to know that most side effects go away when treatment ends. However, you may want to discuss with your doctor the possible long-term effects of radiation therapy. For example, radiation therapy may make the vagina narrower. A narrow vagina can make sex or follow-up exams difficult. There are ways to prevent this problem. If it does occur, however, your health care team can tell you about ways to expand the vagina.
Another possible long-term effect is damage to the ovaries. Menstrual periods usually stop, and women may have hot flashes and vaginal dryness. Menstrual periods may return for some women, especially younger women. Women who may want to get pregnant after radiation therapy should ask their health care team about ways to preserve their eggs before treatment starts.
You may want to ask the doctor these questions before having radiation therapy:
Chemotherapy uses drugs to kill cancer cells. For the treatment of cervical cancer, chemotherapy is usually combined with radiation therapy. For cancer that has spread to distant organs, chemotherapy may be used alone.
Most drugs for cervical cancer are given directly into a vein (intravenously) through a thin needle. Some drugs can be taken by mouth. Most women receive chemotherapy in a clinic or at the doctor's office. Drugs that are swallowed may be taken at home instead. Some women need to stay in the hospital during treatment.
The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:
Other side effects include skin rash, tingling or numbness in your hands and feet, hearing problems, loss of balance, joint pain, or swollen legs and feet. Your health care team can suggest ways to control many of these problems. Most go away when treatment ends.
You may want to ask the doctor these questions before having chemotherapy:
Second opinion
Before starting treatment, you might want a second opinion about your diagnosis, stage of cancer, and treatment plan. Some people worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it. Some companies require a second opinion.
If you get a second opinion, the second doctor may agree with your first doctor's diagnosis and treatment plan. Or, the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at all of your options.
It may take some time and effort to gather your medical records and see another doctor. In most cases, it's not a problem to take several weeks to get a second opinion. The delay in starting treatment usually will not make treatment less effective. To make sure, you should discuss this delay with your doctor.
There are many ways to find a doctor for a second opinion. You can ask your doctor, a local or state medical society, or a nearby hospital or medical school for names of specialists.
NutritionEating well is important before, during, and after cancer treatment. You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.
Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods don't taste as good as they used to. In addition, poor appetite, nausea, vomiting, mouth blisters, and other side effects of treatment can make it hard for you to eat.
Your doctor, a registered dietitian, or another health care provider can suggest ways to help you meet your nutrition needs.
Source: http://www.rxlist.com
The doctor will remove tissue in one of the following ways:
A pathologist checks the tissue under a microscope for cancer cells. In most cases, a biopsy is the only sure way to tell whether cancer is present.
Removing tissue from the cervix may cause some bleeding or other discharge. The area usually heals quickly. Some women also feel some pain similar to menstrual cramps. Your doctor can suggest medicine that will help relieve any pain.
You may want to ask the doctor these questions before having a biopsy:
Source: http://www.rxlist.com
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