Cervical cancer (patient information)

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 * Associate Editor(s)-In-Chief: Laura Linnemeier; Jinhui Wu, M.D.

Overview
Cancer that forms in tissues of the cervix (the organ connecting the uterus and vagina). It is usually a slow-growing cancer that may not have symptoms but can be found with regular Pap test (a procedure in which cells are scraped from the cervix and looked at under a microscope). The disease begins on the surface of the cervix. If not treated, the cancer invades more deeply into the cervix and nearby tissues. This is called invasive cervical cancer. The cancer cells can spread by breaking away from the original (primary) tumor. They enter blood vessels or lymph vessels, which branch into all the tissues of the body. The cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. The spread of cancer is called metastasis.

What are the symptoms of Cervical cancer?
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

Infections or other health problems may also cause these symptoms. Only a doctor can tell for sure. A woman with any of these symptoms should tell her doctor so that problems can be diagnosed and treated as early as possible.

Who is at highest risk?
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. A vaccine for females ages 9 to 26 protects against two types of HPV infection that cause cervical cancer.

Lack of Regular Pap Test:

Cervical cancer is more common among women who don't have regular Pap tests. The Pap test helps doctors find abnormal cells. Removing or killing the abnormal cells usually prevents cervical cancer.

Smoking:

Among women who are infected with HPV, smoking cigarettes slightly increases the risk of cervical cancer.

Weakened Immune System:

Infection with HIV (the virus that causes AIDS) or taking drugs that suppress the immune system increases the risk of cervical cancer.

Sexual History:

Women who have had many sexual partners have a higher risk of developing cervical cancer. Also, a woman who has had sex with a man who has had many sexual partners may be at higher risk of developing cervical cancer. In both cases, the risk of developing cervical cancer is higher because these women have a higher risk of HPV infection.

Using Birth Control Pills for a Long Time:

Using birth control pills for a long time (5 or more years) may slightly increase the risk of cervical cancer among women with HPV infection. However, the risk decreases quickly when women stop using birth control pills.

Having Many Children:

Studies suggest that giving birth to many children (5 or more) may slightly increase the risk of cervical cancer among women with HPV infection.

DES (diethylstilbestrol):

DES may increase the risk of a rare form of cervical cancer in daughters exposed to this drug before birth. DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.)

When to seek urgent medical care?
You should start getting regular Pap tests at age 21, or within three years of the first time you have sex—which ever happens first. The Pap test is one of the most reliable and effective cancer screening tests available. It also can find other conditions that might need treatment, such as infection or inflammation. In addition to the Pap test—the main test for cervical cancer—the HPV test may be used for screening women aged 30 years and older, or women of any age who have unclear Pap test results. If you are 30 or older, and your screening tests are normal, your chance of getting cervical cancer in the next few years is very low. For that reason, your doctor may tell you that you will not need another screening test for up to three years. But you should still go to the doctor regularly for a check-up that may include a pelvic exam. It also is important for you to continue getting a Pap test regularly—even if you think you are too old to have a child, or are not having sex anymore.

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. Finding and treating abnormal cells can prevent most cervical cancer. Also, the Pap test can help find cancer early, when treatment is more likely to be effective. For most women, the Pap test is not painful. It's done in a doctor's office or clinic during a pelvic exam. The doctor or nurse scrapes a sample of cells from the cervix. A lab checks the cells under a microscope for cell changes. Most often, abnormal cells found by a Pap test are not cancerous. The same sample of cells may be tested for HPV infection.

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.
 * Punch biopsy: The doctor uses a sharp tool to pinch off small samples of cervical tissue.
 * LEEP: The doctor uses an electric wire loop to slice off a thin, round piece of cervical tissue.
 * Endocervical curettage: The doctor uses a curette (a small, spoon-shaped instrument) to scrape a small sample of tissue from the cervix. Some doctors may use a thin, soft brush instead of a curette.
 * Conization: The doctor removes a cone-shaped sample of tissue. A conization, or cone biopsy, lets the pathologist see if abnormal cells are in the tissue beneath the surface of the cervix. The doctor may do this test in the hospital under general anesthesia.

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 your pain.

Treatment options
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. Your doctor may refer you to a specialist, or you may ask for a referral. You may want to see a gynecologic oncologist, a surgeon who specializes in treating female cancers. Other specialists who treat cervical cancer include gynecologists, medical oncologists, and radiation oncologists.

Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.

Where to find medical care for Cervical cancer?
Directions to Hospitals Treating Cervical cancer

What to expect (Outlook/Prognosis)?
It's important for you to take care of yourself by eating well and staying as active as you can during the sometimes rough treatment of cervical cancer. 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. However, you may not feel like eating during or soon after treatment. You may be uncomfortable or tired. You may find that foods don't taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth sores) can make it hard to eat well. Your doctor, a registered dietitian, or another health care provider can suggest ways to cope with these problems. Research shows that people with cancer feel better when they stay active. Walking, yoga, swimming, and other activities can keep you strong and increase your energy. Exercise may reduce nausea and pain and make treatment easier to handle. It also can help relieve stress. Whatever physical activity you choose, be sure to talk to your doctor before you start.

You'll need regular checkups after treatment for cervical cancer. Checkups help ensure that any changes in your health are noted and treated if needed. If you have any health problems between checkups, you should contact your doctor. Your doctor will check for the return of cancer. Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment. Checkups may include a physical exam, Pap tests, and chest x-rays.

Possible complications

 * Some types of cervical cancer do not respond well to treatment.
 * The cancer may come back (recur) after treatment.
 * Women who have treatment to save the uterus have a high risk of the cancer coming back (recurrence).
 * Surgery and radiation can cause problems with sexual, bowel, and bladder function.

Prevention
Avoid being exposed to HPV
 * Having sex at an early age
 * Having many sexual partners
 * Having a partner who has had many sex partners
 * Having sex with uncircumcised males

Delay sex: Waiting to have sex until you are older can help you avoid HPV.

Use condoms: Condoms provide some protection against HPV.

Avoidance of smoking:Clinical survey show no smoking is another important way to reduce the risk of cervical precancer and cancer.

Get vaccinated: Vaccines have been developed that can protect women from HPV infections.

Regular gynecological examinations
 * Pap test
 * Treatment of precancerous abnormalities