Cervical Cancer

WHAT YOU SHOULD KNOW

Like all forms of cancer, this variety is the result of unrestrained multiplication of cells---in this case, the cells that line the surface of the opening between the uterus and the vagina. Normal cells divide in a planned way, creating more cells only when needed. Cancerous cells reproduce without order or limits, often creating excess tissue that becomes a tumor. Cervical cancers usually grow slowly, but if left untreated, they will invade deeper layers of tissue and eventually spread to nearby organs, or even other parts of the body.

Abnormal cervical cells that may warn of cancer can be detected with a simple screening procedure called a Pap test. If you are a woman over 18, the American Cancer Society recommends that you get a Pap test for 3 years in a row, and if no problem is detected, every 2 or 3 years thereafter. If you have any of the risk factors for cervical cancer (see "Causes," below), an annual test is advisable.

Causes

Almost all the women who develop cervical cancer have suffered an infection with certain strains of the human papillomavirus (HPV), a common sexually transmitted disease. This infection and conditions related to it are among the primary risk factors for cervical cancer. You are considered at increased risk if you:

• Have ever been diagnosed with HPV
• Have ever had genital warts, which are caused by HPV
• Have had multiple sexual partners or a male partner who's had multiple partners
• Have had a male partner whose previous partner had cervical cancer
• Began having sex as a teenager
• Have had any sexually transmitted disease or a herpes simplex infection
• Have had an abnormal Pap test
• Have HIV or AIDS
• Are taking drugs that suppress the immune system
• Smoke or abuse alcohol or drugs
• Were born after your mother took a drug called DES while carrying you

Signs/Symptoms

During its early stages, cervical cancer gives no warning signs. In later stages, the most common symptoms are abnormal or persistent vaginal bleeding, and pain and bleeding after intercourse. In advanced stages, the disease can cause pain in the pelvic area, legs, and back, as well as blood in the urine or discomfort while urinating.

Care

If you have an abnormal Pap test, the next step will probably be a Hybrid Capture HPV test. This test is highly effective at detecting the types of human papillomavirus that can cause cancer. If this second test also signals a potential problem, the doctor will then perform a colposcopy, examining the cervix with a magnifying scope and taking a sample of any abnormal tissue for laboratory examination (a biopsy).

Depending on the stage of the cancer, treatment options include minor to major surgery, radiation, and chemotherapy.

• Surgery: There are several surgical options available for cervical cancer. If the abnormal tissue is confined to the cervix, it often can be removed in the doctor's office or an outpatient surgery department. In the loop electrocautery excision procedure , the doctor removes the tissue with a sharp wire loop, then burns the site electrically. In conization , he removes a cone-shaped section of the cervix with a scalpel or laser. In laser surgery, he burns away the tissue with a laser beam. Cryosurgery freezes the tissue away.
      For more advanced cancers, the doctor may recommend a hysterectomy. There are two types. A total hysterectomy calls for complete removal of the cervix and uterus. A radical hysterectomy includes removal of the cervix, uterus, upper vagina, and surrounding lymph nodes. Pregnancy is impossible once the hysterectomy has been performed.
• Radiation: High energy rays such as x-rays or gamma rays kill cancer cells and help prevent them from spreading. Depending on the stage of the cancer, radiation can be used instead of surgery or as a backup after surgery has been completed. The radiation can be given two ways. External radiation beams the rays at the cancer from outside the body. Internal radiation uses radioactive implants placed directly into the uterus or cervix.
• Chemotherapy: Often called "chemo," this type of therapy uses drugs to kill cancer cells. Chemo medicines flow through the body via the bloodstream and are therefore typically used when cervical cancer has begun to spread. By itself, chemotherapy is not very effective for cervical cancer. However, it improves results when given with radiation.
      Many different chemo medicines are available. They may be taken as a pill or shot, or given through an IV. You will probably need frequent blood tests to determine how your body is doing and how much chemo you need. The drugs can produce many side effects and may leave you susceptible to infection for a while.

Risks

Left untreated, cervical cancer will eventually spread and prove fatal. When treated early enough, however, this particular type of cancer can usually be completely cured. Your chances of a cure are better than 95 percent if the cancer is removed before it invades the deeper tissues of the cervix, and the odds are still better than even if the cancer hasn't spread away from the cervix.

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