Cervical Cancer

Symptoms, Doctors, Treatments, Advances & More

Cervical cancer is a type of slow-growing gynecological cancer that affects the opening of the uterus (cervix). The two main types of cervical cancer are squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma – This is the most common type of cervical cancer, which starts in the cells lining the outer part of the cervix that extends into the vagina. Adenocarcinoma – This type of cervical cancer starts in glandular cells lining the canal (opening) of the cervix. Occasionally, both the cells lining the outer part of the cervix and the glandular cells lining the canal are involved in cervical cancer. Cervical cancer is categorized by the following stages: Stage 0 (Carcinoma in situ) – The cervical cancer is only in the surface layer. Stage I – The cervical cancer stays within the cervix. Stage II – The cervical cancer has spread beyond the cervix, but not as far as the pelvic wall or the lower portion of the vagina. Stage III – The cervical cancer has spread into the pelvic wall, the lower portion of the vagina, or the ureters. Stage IV – The cervical cancer has spread beyond the pelvis or to the bladder, rectum, or both.

There are a few alternative names for cervical cancer, including cervical adenocarcinoma and gynecological cancer.

Cervical cancer occurs when abnormal cells lining the cervix (dysplasia) appear, which eventually (slowly) may become cancerous and spread (metastasize) deeper into the cervix and surrounding areas. Researchers believe that the main cause of cervical cancer is having been infected with the human papilloma virus (HPV). While many women may have been infected with HPV, the virus is usually prevented from causing harm by the body’s immune system; however, in a small percentage of women the HPV virus remains, eventually causing the cervical cells to become cancerous. Risk factors for developing cervical cancer include being exposed to the drug, diethylstilbestrol (DES), while in the mother’s womb, being sexually active at a young age, having many sexual partners, giving birth to many children, using long-term hormone-based contraceptives, smoking, having a weakened immune system or being on immunosuppressants, aging, and being infected with the human immunodeficiency virus (HIV).

Early cervical cancer usually has no symptoms; however, symptoms of more advanced cervical cancer include watery, bloody vaginal discharge that may be heavy with a foul odor, vaginal bleeding after intercourse, bleeding between periods or after menopause, heavier, longer periods, and pelvic pain during intercourse. Symptoms of more advanced cervical cancer may include loss of appetite, unexplained weight loss, anemia, and pelvic pain.

The treatment for cervical cancer is determined by the stage of the cancer, the patient’s age, and whether the patient wants to have children. If a woman who is pregnant is diagnosed with cervical cancer, treatment may be postponed until after the birth. Treatments for cervical cancer include surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. Surgery – The type of surgery used for cervical cancer depends on the stage of the cancer and includes conization (removal of cone-shaped portion of the cervix; cone biopsy) for early stage cervical cancer, using a scalpel, electrosurgical current, or laser; total hysterectomy (removal of the uterus) either through the abdomen, the vagina, or with a laparoscope; radical hysterectomy (removal of the uterus, cervix, part of the vagina, and the ligaments and tissues surrounding these organ, and which often includes removal of the ovaries, fallopian tubes, or nearby lymph nodes) for advanced stage cervical cancer; modified radical hysterectomy (removal of the uterus, cervix, upper part of the vagina, and ligaments and tissues surrounding these organs and some lymph nodes); radical trachelectomy (removal of the cervix, nearby tissue and lymph nodes, and upper part of the vagina); bilateral salpingo-oophorectomy (removal of the fallopian tubes and both ovaries); and pelvic exenteration (removal of the cervix, vagina, ovaries, and nearby lymph nodes, lower colon, rectum, and bladder, with the placement of artificial urine and stool openings with collection bags); and artificial vagina construction. Radiation therapy – Radiation therapy uses high-energy X-rays, protons, or other types of radiation to kill cancer cells. Types of radiation therapy used for cervical cancer include external radiation therapy (intensity-modulated radiation therapy; IMRT), which directs radiation at the cancer, and internal radiation therapy, in which radioactive needles, seeds, wires, or catheters are placed directly in the cancer. In addition to treatment, radiation therapy can be used to help alleviate the symptoms of cervical cancer. Patients with cervical cancer who have not yet had children should speak with their doctor about egg preservation before undergoing radiation therapy. Chemotherapy – Chemotherapy uses drugs that kill cancer cells or prevent them from growing and can be administered orally (pill), intravenously (IV), intraabdominally (directly into the abdomen), or intrathecally (into the spinal canal) and may be combined with other treatments. Targeted therapy – Targeted therapy uses drugs that target specific proteins on cancer cells to prevent them from growing or to kill cancer cells and include monoclonal antibodies (bevacizumab), which can be given by infusion and is used to treat cervical cancer that has spread (metastasized) and recurrent cervical cancer. Immunotherapy (Biotherapy or Biologic therapy) – Immunotherapy uses a patient’s immune system to kill cancer cells and uses the immune checkpoint inhibitor, pembrolizumab, for the treatment of recurrent cervical cancer. Palliative (Supportive) care – Palliative care for cervical cancer focuses on relief of pain and other symptoms while undergoing cancer treatment and may also be used to help improve patient quality of life.

There are several online, local, national, and international support groups for cervical cancer, including the following: CancerCare - https://www.cancercare.org/support_groups/46-gynecologic_cancers_patient_support_group Cancer Support Community - https://www.cancersupportcommunity.org/learn-about-cancer-types/cervical-cancer The National Cervical Cancer Coalition - https://www.nccc-online.org/find-support/

The prognosis for cervical cancer depends on the stage of the cancer when diagnosed, the type of cervical cancer, whether the patient is infected with a certain type of Human Papilloma Virus (HPV), whether the patient has human immunodeficiency virus (HIV), whether the cancer has recurred, and the patient’s overall health. Stage 0 cervical cancer (Carcinoma in situ) is 100% curable. Stages 1 and 2 cervical cancer have a good chance of cure. The cure rates for cervical cancer decrease significantly for more advanced stages. Cervical cancer that has been treated may recur or appear in other parts of the body. For this reason, regular follow-up tests are needed.

Possible complications of early cervical cancer are usually treatment-related and may include early menopause from removal of the ovaries and narrowing of the vagina, in addition to cancer treatment-related side effects, such as fatigue and hair loss. Complications of advanced cervical cancer may include swelling of the lymph nodes (lymphedema), pain, kidney failure, and the development of fistulas (abnormal openings) between the vaginal and rectum or other areas.

If you experience any of the following symptoms of cervical cancer, such as unexplained weight loss, unusual or bloody vaginal discharge, bleeding between periods, pain or bleeding during or after intercourse, or abdominal pain, make an appointment with your doctor as soon as possible. Any extreme vaginal bleeding requires immediate medical attention.

Since early cervical cancer often has no symptoms, women should have regular pap smears (tests) to screen for cervical cancer, which can be detected early. In addition, receiving the HPV vaccine may reduce the risk or cervical cancer or other HPV-related cancers, which is recommended by the Centers for Disease Control and Prevention (CDC) for all females ages 11-to-12 and young women up to age 26. The risk of developing cervical cancer can also be reduced by preventing sexually-transmitted infections by using condoms and limiting the number of sexual partners. Quitting smoking can help to reduce the risk of cervical and other cancers. Early detection of cervical cancer greatly increases the chances of the cancer being cured.