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Cervical Cancer

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:

    > The cervix connects the uterus to the vagina. During a menstrual period, blood flows from the uterus through the cervix into the vagina. The vagina leads to the outside of the body.

    > The cervix makes mucus. During sex, mucus helps sperm move from the vagina through the cervix into the uterus.

    > During pregnancy, the cervix is tightly closed to help keep the baby inside the uterus. During childbirth, the cervix opens to allow the baby to pass through the vagina.

Signs and symptoms

  • Early cervical cancers usually don’t cause symptoms. When the cancer grows larger, 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 going through menopause

  • Increased vaginal discharge

    > Pelvic pain

    > Pain during sex

Causes

  • When you get a diagnosis of cancer, it’s natural to wonder what may have caused the disease. 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. For example, infection with HPV (human papillomavirus) is the main cause of cervical cancer. HPV infection and other risk factors may act together to increase the risk even more:

    > HPV infection: HPV is a group of viruses that can infect the cervix. An HPV infection that doesn’t go away can cause cervical cancer in some women. HPV is the cause of nearly all cervical cancers.
    HPV infections are very common. These viruses are passed from person to person through sexual contact. Most adults have been infected with HPV at some time in their lives, but most infections clear up on their own.
    Some types of HPV can cause changes to cells in the cervix. If these changes are found early, cervical cancer can be prevented by removing or killing the changed cells before they can become cancer cells. The NCI fact sheet Human Papillomaviruses and Cancer: Questions and Answers has more information.
    A vaccine for females ages 9 to 26 protects against two types of HPV infection that cause cervical cancer.

  • Human papillomavirus (HPV) infection of the cervix can lead to cervical cancer. A vaccine designed to prevent cervical cancer and other diseases caused by infection with HPVs was approved for use in the U.S. in June 2006. This is the first vaccine to be developed against a known risk factor for the development of a cancer.

Diagnosis

  • Doctors recommend that women help reduce their risk of cervical cancer by having regular Pap tests. A Pap test (sometimes called Pap smear or cervical smear) is a simple test used to look at cervical cells. Pap tests can find cervical cancer or abnormal cells that can lead to cervical cancer.
  • If you have abnormal Pap or HPV test results, your doctor will suggest other tests to make a diagnosis:

    > 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: Most women have tissue removed in the doctor’s office with local anesthesia. A pathologist checks the tissue under a microscope for abnormal cells.

Staging

  • Stage I: The tumor has invaded the cervix beneath the top layer of cells. Cancer cells are found only in the cervix
  • Stage II: The tumor extends to the upper part of the vagina. It may extend beyond the cervix into nearby tissues toward the pelvic wall (the lining of the part of the body between the hips). The tumor does not invade the lower third of the vagina or the pelvic wall.
  • Stage III: The tumor extends to the lower part of the vagina. It may also have invaded the pelvic wall. If the tumor blocks the flow of urine, one or both kidneys may not be working well.
  • Stage IV: The tumor invades the bladder or rectum. Or the cancer has spread to other parts of the body.
  • Recurrent cancer: The cancer was treated, but has returned after a period of time during which it could not be detected. The cancer may show up again in the cervix or in other parts of the body.

Treatment

  • Women with cervical cancer have many treatment options. The options are surgery, radiation therapy, chemotherapy, or a combination of methods.
  • 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 can describe your treatment choices, the expected results of each, and the possible side effects. You and your doctor can work together to develop a treatment plan that meets your medical and personal needs.
  • Surgery is an option for women with Stage I or II cervical cancer. The surgeon removes tissue that may contain cancer cells:

    > Radical trachelectomy: The surgeon removes the cervix, part of the vagina, and the lymph nodes in the pelvis. This option is for a small number of women with small tumors who want to try to get pregnant later on.

    > Total hysterectomy: The surgeon removes the cervix and uterus.

    > Radical hysterectomy: The surgeon removes the cervix, some tissue around the cervix, the uterus, and part of the vagina.
  • With either total or radical hysterectomy, the surgeon may remove other tissues:

    > Fallopian tubes and ovaries: The surgeon may remove both fallopian tubes and ovaries. This surgery is called a salpingo-oophorectomy.

    > Lymph nodes: The surgeon may 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.
  • Radiation therapy

    Radiation therapy (also called radiotherapy) is an option for women with any stage of cervical cancer. Women with early stage 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

    Radiation therapy uses high-energy rays to kill cancer cells. It affects cells only in the treated area.