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Cervical Cancer
PLWC Guide to Cervical Cancer
* Overview
* Medical Illustrations
* Risk Factors
* Prevention
* Symptoms
* Diagnosis
* Staging
* Treatment
* Side Effects of Cancer and Cancer Treatment
* Questions to Ask the Doctor
* Current Research
* Patient Information Resources
* Clinical Trials Resources
News, Information, and Support
* PLWC Feature Article: ASCO Expert Corner: HPV Vaccination for Cervical Cancer, 1/07
* Statement by ASCO President Gabriel N. Hortobagyi, MD, on FDA Approval of HPV Vaccine, 6/8/06
* Ask the Expert Transcript: Top Advances in Cancer Research—News From ASCO's Annual Meeting, 6/06
* Cancer Advances: News from the 2006 ASCO Annual Meeting, 6/06
* Read more PLWC Feature Articles
* Upcoming Events: "Ask the ASCO Expert" Series
* Sign up for the e-newsletter PLWC Bulletin
* Read the latest cancer-related headlinesOverview
This section has been reviewed and approved by the PLWC Editorial Board, 06/05Cervical cancer starts in a woman's cervix, the lower, narrow part of the uterus. The uterus holds the growing fetus during pregnancy. The cervix connects the lower part of the uterus to the vagina and, with the vagina, forms the birth canal.Cervical cancer develops when normal cells on the surface of the cervix begin to change, grow uncontrollably, and eventually form a mass of cells called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous).At first, the changes in a cell are simply abnormal, not cancerous. Researchers believe, however, that some of these abnormal changes mark the first step in a series of slow changes that can lead to cancer. Some of the abnormal cells go away without treatment, but others begin to become cancerous. This phase of the disease is called dysplasia (an abnormal growth of cells). The precancerous tissue needs to be removed to keep cancer from developing. Often, the precancerous tissue can be removed or destroyed without harming healthy tissue, but in some cases, a hysterectomy (removal of the uterus and cervix) is needed to prevent cervical cancer. Treatment of a lesion (a precancerous area) depends on the following factors:
* How big the lesion is, and what type of changes have occurred in the cells
* If the woman wants to have children in the future
* The woman's age
* The woman's general health
* The preference of the woman and her doctorIf the precancerous cells change into true cancer cells and spread deeper into the cervix or to other tissues and organs, the disease is then called cervical cancer.Cervical cancer is divided into two main types, named for the type of cell where the cancer started.
* Squamous cell carcinoma, which make up about 85% to 90% of all cervical cancers
* Adenocarcinoma, which make up 10% to 15% of all cervical cancers
In addition, there are a few other rare types of cervical cancer.Statistics
In 2007, an estimated 11,150 women will be diagnosed with cervical cancer in the United States, and an estimated 3,670 women are expected to die of the disease. The number of new cases of cervical cancer is decreasing as screening with the Pap test becomes more prevalent. The number of cervical cancer deaths continues to drop at an average of 4% per year.
In addition, there are a few other rare types of cervical cancer.Statistics
In 2007, an estimated 11,150 women will be diagnosed with cervical cancer in the United States, and an estimated 3,670 women are expected to die of the disease. The number of new cases of cervical cancer is decreasing as screening with the Pap test becomes more prevalent. The number of cervical cancer deaths continues to drop at an average of 4% per year.
The one-year relative survival rate (percentage of patients who survive at least one year after the cancer is detected, excluding those who die from other diseases) of women with cervical cancer is 88%. The five-year relative survival rate (percentage of patients who survive at least five years after the cancer is detected, excluding those who die from other diseases) for all stages of cervical cancer is about 72%. When detected at an early stage, invasive cervical cancer has a five-year relative survival rate of 92%.
Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a woman how long she will live with cervical cancer. Because the survival statistics are measured in five-year (or sometimes one-year) intervals, they may not represent advances made in the treatment or diagnosis of this cancer.
Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2007.
< Previous Next > Medical IllustrationsLarger image
< Previous Next > Risk FactorsA risk factor is anything that increases a person's chance of developing a disease, including cancer. There are risk factors that can be controlled, such as smoking, and risk factors that cannot be controlled, such as age and family history. Although risk factors can influence disease, they do not cause cancer. Some people with several risk factors never develop the disease, while others with no known risk factors do. Knowing your risk factors and communicating with your doctor can help guide you in making wise lifestyle and health-care choices.The following factors can raise a person's risk of developing cervical cancer:Human papillomavirus (HPV) infection. The most important risk factor for cervical cancer is infection with HPV. HPV is passed from one person to another during sexual intercourse. Factors that raise the risk of being infected with HPV include becoming sexually active at an early age, having many sexual partners (or having sex with a man who has had many partners), and having sex with a man who has penile warts.Human immunodeficiency virus (HIV) infection. Infection with HIV, the virus that causes acquired immune deficiency syndrome (AIDS), is also a risk factor for cervical cancer. When a woman is infected with HIV, her immune system is less able to fight off early cancers. Women whose immune systems have been suppressed by corticosteroid medications, kidney transplantations, or therapy for other cancers or AIDS are also at greater risk.Herpes. Women who have genital herpes are at greater risk for developing cervical cancer.Smoking. Women who smoke are about twice as likely to develop cervical cancer as women who do not smoke.Age. Girls younger than 15 rarely develop cervical cancer. The risk goes up between the late teens and mid-30s. Women over 40 remain at risk and need to continue having regular Pap tests.Race. Cervical cancer is more common among blacks, Hispanics, and American Indians.Exposure to diethylstilbestrol (DES). Women whose mothers were given this drug during pregnancy to prevent miscarriage are also at increased risk for cervical cancer. DES was given for this purpose from about 1940 to 1970.
< Previous Next > PreventionMost cervical cancers can be prevented by preventing precancers and having regular Pap tests. Preventing precancers means controlling these risk factors:
* Delaying first sexual intercourse until the late teens or older
* Limiting the number of sex partners
* Avoiding sexual intercourse with people who have had many partners
* Avoiding sexual intercourse with people who are obviously infected with genital warts or other symptoms
* Having safe sex (condoms do not protect against HPV, but they do protect against HIV and AIDS)
* Quitting smokingThe Pap test is the most common test for cervical cancer. Researchers have found that combining it with a test to detect HPV lowers the error rate. In March 2003, a U.S. Food and Drug Administration (FDA) panel recommended that Pap tests and HPV tests be used together when screening for cervical cancer in women over 29 years old. The HPV test is already being used as a secondary test in people with abnormal Pap test results.In 2003, the American Cancer Society, American College of Obstetricians and Gynecologists, Association of Reproductive Health Professionals, Society of Gynecologic Oncologists, and the U.S. Preventive Task Force developed new screening guidelines with the Pap test for cervical cancer.
* All women should begin having yearly Pap tests within three years of beginning vaginal intercourse, but no later than age 21.
* Women should be screened annually with a conventional Pap test or every two years with liquid-based tests. Women with three consecutive normal tests can lengthen their screening intervals to every two to three years. Women with specific medical conditions, such as infection with HIV, should be screened more often.
* Women over the age of 70 can discontinue screening if their previous three Pap tests were normal and there were no abnormal tests within the previous 10 years. Certain medical conditions, such as HIV infection, are cause for the continuation of routine screening.
* Screening after a hysterectomy (removal of the uterus and cervix) is not necessary unless the surgery was done to treat cervical cancer or precancer. Women who have had a hysterectomy without removal of the cervix should continue screening until age 70.
< Previous Next >SymptomsWomen with cervical cancer often experience the following symptoms. Sometimes, women with cervical cancer do not show any of these symptoms. Or, these symptoms may be similar to those of other medical conditions. If you are concerned about a symptom on this list, please talk with your doctor.Most women do not have any signs or symptoms of a precancer or early stage cervical cancer. Symptoms usually do not appear until the cancer has invaded other tissues and organs.Any of the following could be signs or symptoms of cervical dysplasia or cancer:
* Blood spots or light bleeding between or following periods
* Menstrual bleeding that is longer and heavier than usual
* Bleeding after intercourse, douching, or a pelvic examination
* Pain during intercourse
* Bleeding after menopause
* Increased vaginal dischargeWhen these symptoms do appear, women sometimes dismiss them because they often look like symptoms of other, less serious conditions. The longer cancer or precancerous cells go undetected and untreated, the lower the chance that the cancer can be cured. Any of these six symptoms should be reported to the doctor.
< Previous Next >DiagnosisDoctors use many tests to diagnose cancer and determine if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
* Age and medical condition
* The type of cancer
* Severity of symptoms
* Previous test resultsIf the doctor finds abnormal changes to the cervix during a pelvic examination and a Pap test, the doctor may repeat the Pap test. The doctor may also test for HPV at the same time. Certain strains (kinds) of HPV, such as HPV 16, are seen more often in women with cervical cancer and may help confirm a diagnosis. Many women carry HPV, so HPV testing alone is not an accurate test for cervical cancer. But if the Pap tests show some cellular abnormality, and the HPV test is also positive, the doctor may suggest one or more of the following diagnostic tests:Colposcopy. The doctor may do a colposcopy to check the cervix for abnormal areas. A special instrument called a colposcope is inserted in the vagina. The colposcope gives the doctor a lighted, magnified view of the tissues of the vagina and the cervix. The examination is not painful, can be done in the doctor's office, and has no side effects. It can be done on pregnant women.Biopsy. A biopsy removes a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis.During a biopsy, the doctor removes a small sample of tissue and sends it to the laboratory. At the laboratory, a pathologist (a doctor who specializes in interpreting laboratory tests and diagnosing disease) will look at the tissue under a microscope to determine whether the cells are cancerous. If the lesion (suspicious area) is small, the doctor may remove all of it during the biopsy. There are several types of biopsies:
* One common method uses an instrument to pinch off small pieces of cervical tissue.
* Sometimes the doctor wants to check an area inside the opening of the cervix that cannot be seen during a colposcopy. To do this, the doctor uses a procedure called endocervical curettage (ECC). Using a small, spoon-shaped instrument called a curette, the doctor scrapes a small amount of tissue from inside the cervical opening.
* A loop electrosurgical excision procedure (LEEP) uses an electrical current passed through a thin wire hook. The hook removes tissue for examination in the laboratory. A LEEP may also be used to remove precancers and early stage cancers.
* Conization (a cone biopsy) removes a cone-shaped piece of tissue from the cervix. Conization may be done as treatment to remove precancers or early stage cancers.The first three procedures are usually done in the doctor's office using a local anesthetic. They may cause some bleeding and other discharge and, for some women, discomfort similar to menstrual cramps. Conization is done under a general or local anesthetic and may be done in the doctor's office or the hospital.If the biopsy indicates cervical cancer, the doctor will refer the woman to a gynecologic oncologist, who specializes in treating this type of cancer. The specialist may suggest additional tests to see if the cancer has spread beyond the cervix.Pelvic examination. The doctor examines the pelvic area under anesthetic to see if it has spread to organs near the cervix, including the uterus, vagina, bladder, and rectum.Cystoscopy. This procedure allows the doctor to view the inside of the bladder and urethra (canal that carries urine from the bladder) with a cystoscope (a thin, flexible tube with a camera). A cystoscopy is used to determine whether cancer has spread to the bladder.Proctoscopy (also called a sigmoidoscopy). This procedure allows the doctor to view the colon and rectum using a sigmoidoscope (a thin, flexible tube with a camera). A proctoscopy is used to see if the cancer has spread to the rectum.Imaging tests. The following tests are used to see if the cancer has spread to other areas of the body:
* An x-ray is a picture of the inside of the body. A chest x-ray can help doctors determine if the cancer has spread to the lungs.
* A computerized tomography (CT or CAT) scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a vein to provide better detail.
* A magnetic resonance imaging (MRI) uses magnetic fields, not x-rays, to produce detailed images of the body.
* An intravenous urography is a type of x-ray that is used to view the kidneys and bladder.
< Previous Next >StagingStaging is a way of describing a cancer, such as where it is located, where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer.One tool that doctors use to describe the stage is the TNM system. This system uses three criteria to judge the stage of the cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to the rest of the body. The results are combined to determine the stage of cancer for each person.
There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
* How large is the primary tumor and where is it located? (Tumor, T)
* Has the tumor spread to the lymph nodes? (Node, N)
* Has the cancer metastasized to other parts of the body? (Metastasis, M)Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are divided into smaller groups that help describe a patient's condition in more detail. (Roman numerals in parentheses are stages used in another widely used staging system from the Federation Internationale de Gynecologie et d' Obstetrique, or FIGO).TX: The primary tumor cannot be evaluated due to lack of information. More tests may be needed.T0 (T plus zero): There does not seem to be a primary tumor in the cervix.Tis: This stage is called carcinoma in situ, which means that the cancer is found only in the layer of cells lining the cervix and has not invaded deeper tissues of the cervix.T1/FIGO I: The carcinoma is found only in the cervix.T1a/FIGO IA: Invasive carcinoma was diagnosed only by microscopy (viewing cervical tissue/cells under a microscope). Note: Any tumor found macroscopically (large enough to be recognized by imaging tests or to be seen/felt by the doctor) is referred to as stage T1b or FIGO IB.T1a1/FIGO IA1: There is a cancerous area of 3.0 mm or smaller in depth and 7.0 mm or smaller in terms of how far it has spread horizontally.T1a2/FIGO IA2: There is a cancerous area larger than 3.0 mm but not larger than 5.0 mm, and a horizontal spread of 7.0 mm or smaller.T1b/FIGO IB: In this stage, there is a lesion (change in body tissue; sometimes used as another word for tumor), which is just found in the cervix, or there is a microscopic lesion (one able to be seen using a microscope) that is greater in size than a stage T1a2/FIGO IA2 tumor. The cancer may have been found because of a physical examination, laparoscopy, or other imaging methods.T1b1/FIGO IB1: The tumor is 4.0 cm or smaller.T1b2/FIGO IB2: The tumor is larger than 4.0 cm. T2/FIGO II: The cervical carcinoma has grown beyond the uterus but not to the pelvic wall or to the lower third of the vagina.T2a/FIGO IIA: The tumor has not invaded the tissue next to the cervix, also called the parametrial area.T2b/FIGO IIB: The tumor has invaded the tissue next to the cervix, also called the parametrial area.T3/FIGO III: The tumor extends to the pelvic wall, and/or involves the lower third of the vagina, and/or causes hydronephrosis (swelling of the kidney), nonfunctioning kidney, or blockage of the ureters (tubes that connect the kidneys to the bladder).T3a/FIGO IIIA: The tumor involves the lower third of the vagina, but it has not grown into the pelvic wall.T3b/FIGO IIIB: The tumor has grown into the pelvic wall and/or causes hydronephrosis or nonfunctioning kidney.T4/FIGO IVA: The tumor has invaded the mucosa (lining) of the bladder or rectum and grown beyond the true pelvis.Node. The "N" in the TNM staging system indicates whether the cancer has spread to the lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the cervix are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.NX: The regional lymph nodes (lymph nodes near the cervix) cannot be assessed.N0 (N plus zero): There is no regional lymph node metastasis.N1: The tumor has invaded the regional lymph node(s).Distant metastasis. The "M" in the TNM system indicates whether the cancer has spread to other parts of the body (to areas such as the lungs or the bones).MX: Distant metastasis cannot be evaluated.M0 (M plus zero): There is no distant metastasis.M1: There is distant metastasis.Cancer stage groupingDoctors assign the stage of the cancer by combining the T, N, and M classifications.Stage 0: The tumor is called carcinoma in situ. In other words, the cancer is found only in the first layer of cells lining the cervix, not in the deeper tissues (Tis, N0, M0).Stage I: The cancer has spread from the cervix lining into the deeper tissue but is still just found in the uterus. It has not spread to lymph nodes or other parts of the body (T1, N0, M0). This stage may be described in more detail.Stage IA: T1a, N0, M0Stage IA1: T1a1, N0, M0Stage IA2: T1a2, N0, M0Stage IB: T1b, N0, M0Stage IB1: T1b1, N0, M0Stage IB2: T1b2, N0, M0Stage II: The cancer has spread beyond the cervix to nearby areas, such as the vagina or tissue near the cervix, but it is still inside the pelvic area. It has not spread to lymph nodes or other parts of the body (T2, N0, M0). This stage may be described in more detail.Stage IIA: T2a, N0, M0Stage IIB: T2b, N0, M0Stage III: The cancer has spread outside of the cervix and vagina but not to the lymph nodes or other parts of the body (T3, N0, M0).Stage IIIa: The cancer has spread to the lower part of the vagina but not to other parts of the body (T3a, N0, M0).Stage IIIb: The cancer may have spread as far as the pelvic wall and to lymph nodes but not to other parts of the body (T1, T2, or T3a; N1, M0). If it has spread to the pelvic wall, it is called stage IIIb whether lymph nodes are involved (T3b, any N, M0).Stage IVa: The cancer has spread to the bladder or rectum and may or may not have spread to the lymph nodes, but it has not spread to other parts of the body (T4, any N, M0).Stage IVb: The cancer has spread to other parts of the body (any T, any N, M1).RecurrentRecurrent disease means that the cancer has recurred (come back) after it has been treated. It may come back in the cervix or in another place.Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Sixth Edition (2002) published by Springer-Verlag New York, www.springeronline.com .
< Previous Next >TreatmentThrough ongoing research, the medications used to treat cancer are constantly being evaluated in different combinations and to treat different cancers.
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