Gynecologic Cancers

Cervical Cancer

Background

Cervical cancer originates from the tissues of the cervix, the organ connecting the uterus and vagina. It is usually a slow-growing cancer that can be diagnosed with regular Pap tests, a procedure in which cells are scraped from the cervix and examined under a microscope. Women ages 35-55 make up about half of reported cervical cancer cases. Cervical cancer is almost always caused by human papillomavirus (HPV) infection. Today, most cases of cervical cancer can be prevented with a vaccine offered to young women.

Symptoms

Possible signs of cervical cancer include:

  • Vaginal bleeding (after sexual intercourse, menopause or in between periods)
  • Unusual vaginal discharge, typically watery, bloody accompanied by a foul odor
  • Pelvic pain
  • Pain during sexual intercourse

Risk Factors

Infection of the cervix with human papillomavirus (HPV) is the most common cause of cervical cancer. Not all women with HPV infection, however, will develop cervical cancer. Women who do not regularly have a Pap smear to detect HPV or abnormal cells in the cervix are at increased risk of cervical cancer.

Factors that may increase the risk of cervical cancer include:

  • STD (sexually transmitted diseases). Infection of the cervix with HPV (human papillomavirus) is the most common cause of cervical cancer. Other STDs (gonorrhea, Chlamydia, syphilis, HIV/AIDs) increase the chances of contracting HPV.
  • Having many sexual partners (increases the risk of HPV infection)
  • Having first sexual intercourse at a young age (increases the risk of HPV infection)
  • Smoking
  • Long-term use of oral contraceptives
  • Weakened immune system

Staging

Stage I: Cancer has formed and is found only in the cervix. Stage I is further divided into stages IA and IB, based on the amount of cancer that is found.

    Stage IA: A very small amount of cancer that can only be seen with a microscope is found in the tissue of the cervix. Stage IA is divided into Stages IA1 and IA2, based on the size of the tumor.

    Stage IA1: Cancer is not more than 3 millimeters deep and not more than 7 millimeters wide.

    Stage IA2: Cancer is more than 3 but not more than 5 millimeters deep, and not more than 7 millimeters wide.

    Stage IB: Cancer can only be seen with a microscope and is more than 5 millimeters deep or more than 7 millimeters wide, or can be seen without a microscope. Cancer that can be seen without a microscope is divided into Stages IB1 and IB2, based on the size of the tumor.

    Stage IB1: Cancer can be seen without a microscope and is not larger than 4 centimeters.

    Stage IB2: Cancer can be seen without a microscope and is larger than 4 centimeters.

Stage 2: Cancer has spread beyond the cervix but not to the pelvic wall or to the lower third of the vagina. Stage II is divided into Stages IIA and IIB, based on how far the cancer has spread.

    Stage IIA: Cancer has spread beyond the cervix to the upper two thirds of the vagina but not to tissues around the uterus.

    Stage IIB: Cancer has spread beyond the cervix to the upper two thirds of the vagina and to the tissues around the uterus.

Stage III: Cancer has spread to the lower third of the vagina, may have spread to the pelvic wall, and/or has caused the kidney to stop working. Stage III is divided into Stages IIIA and IIIB, based on how far the cancer has spread.

    Stage IIIA: Cancer has spread to the lower third of the vagina but not to the pelvic wall.

    Stage IIIB: Cancer has spread to the pelvic wall and/or the tumor has become large enough to block the ureters (the tubes that connect the kidneys to the bladder). This blockage can cause the kidneys to enlarge or stop working. Cancer cells may also have spread to lymph nodes in the pelvis.

Stage IV: Cancer has spread to the bladder, rectum, or other parts of the body. Stage IV is divided into Stages IVA and IVB, based on where the cancer is found.

    Stage IVA: Cancer has spread to the bladder or rectal wall and may have spread to lymph nodes in the pelvis.

    Stage IVB: Cancer has spread beyond the pelvis and pelvic lymph nodes to other places in the body, such as the abdomen, liver, intestinal tract, or lungs.

Treatment

Limited, noninvasive cancer
Treatment of cervical cancer that's confined to the superficial or outside layer of the cervix typically requires treatment to remove the abnormal area of cells. For most women in this situation, no additional treatments are needed. Procedures to remove noninvasive cancer include:

  • Cone biopsy (conization): A scalpel is used to remove a cone-shaped piece of cervical tissue where the abnormality is found.
  • Laser surgery: A laser using a high-energy beam of light destroys cancerous and precancerous cells.
  • Loop electrosurgical excision procedure (LEEP): A wire loop with an electrical current is used to excise and remove cells from the affected regions of the cervix.
  • Cryosurgery: A technique that involves freezing/destruction of the cancerous and precancerous cells.
  • Hysterectomy: A procedure that involves surgical removal of the cancerous and precancerous areas, the cervix and the uterus.

Invasive cancers
Cervical cancer that invades deeper than the superficial layer of the cervix is referred to as invasive cancer and requires more extensive treatment. Treatment options may include:

  • Surgery: Surgery to remove the uterus (hysterectomy) is typically used to treat the early stages of cervical cancer. A simple hysterectomy involves the removal of the cancer, the cervix, and the uterus. Simple hysterectomy is typically an option only when the cancer is very early stage, meaning invasion is less than 3 millimeters (mm) into the cervix. A radical hysterectomy involves removal of the cervix, uterus, part of the vagina, and lymph nodes and is the standard surgical treatment when there is invasion of greater than 3 mm into the cervix, but no evidence of pelvic wall involvement.
  • Radiation: Radiation therapy can be given externally using external beam radiation or internally (brachytherapy) using devices filled with radioactive material placed near the cervix. Radiation therapy can be as effective as surgery for early-stage cervical cancer. For women with more advanced cervical cancer, radiation combined with chemotherapy is considered the most effective treatment.
  • Chemotherapy: The chemotherapy drug called cisplatin is often combined with radiation therapy to treat more invasive cervical cancer. More than one chemotherapy drug can also be used in combination for treatment of more advanced disease.

References
National Cancer Institute, Mayo Clinic, Cancer Treatment Centers of America.