Cervical Cancer Overview
This information is only about invasive cervical cancer. It’s not about pre-cancer, abnormal cells found only on the surface of the cervix, or other cervical changes. These cell changes are treated differently from invasive cervical cancer. Women with abnormal cervical cells only on the surface may want to read the NCI booklet Understanding Cervical Changes: A Health Guide for Women. It tells about abnormal cells and describes treatments.
For many women, a diagnosis of cervical cancer comes without warning since in its earliest stages there may be no signs or symptoms that something is wrong. Bleeding between periods, heavier bleeding during periods, unusual vaginal discharge, or pelvic pain may prompt a physician visit, and a subsequent pelvic exam and Pap smear may provide the diagnosis—but then what? Cervical Cancer treatment and prognosis depends largely on the stage of the disease. If found and treated early it often can be cured.
Diagnosing Cervical Cancer
Cervical cancer is a type of gynecologic cancer that begins in the cervix. 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.
If the biopsy shows that you have cancer, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. Staging is a careful attempt to find out whether the tumor has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body. Cervical cancer spreads most often to nearby tissues in the pelvis, lymph nodes, or the lungs. It may also spread to the liver or bones.
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of cancer cells and the same name as the original tumor. For example, if cervical cancer spreads to the lungs, the cancer cells in the lungs are actually cervical cancer cells. The disease is metastatic cervical cancer, not lung cancer. For that reason, it’s treated as cervical cancer, not lung cancer. Doctors call the new tumor “distant” or metastatic disease.
Your doctor will do a pelvic exam, feel for swollen lymph nodes, and may remove additional tissue. To learn the extent of disease, the doctor may order some of the following tests:
- Chest x-rays: X-rays often can show whether cancer has spread to the lungs.
- CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your organs. A tumor in the liver, lungs, or elsewhere in the body can show up on the CT scan. You may receive contrast material by injection in your arm or hand, by mouth, or by enema. The contrast material makes abnormal areas easier to see.
- MRI: A powerful magnet linked to a computer is used to make detailed pictures of your pelvis and abdomen. The doctor can view these pictures on a monitor and can print them on film. An MRI can show whether cancer has spread. Sometimes contrast material makes abnormal areas show up more clearly on the picture.
- PET scan: You receive an injection of a small amount of radioactive sugar. A machine makes computerized pictures of the sugar being used by cells in your body. Cancer cells use sugar faster than normal cells, and areas with cancer look brighter on the pictures.
Stages of Cervical Cancer
The stage is based on where cancer is found. These are the stages of invasive cervical cancer:
- 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.
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.
Finding the right treatment can make all the difference. Rocky Mountain Cancer Centers specializes in evidence-based, cutting-edge and personalized therapy for patients with cervical cancer. Our multidisciplinary team includes a gynecologic oncology surgeon, a sub-specialized medical oncologist, and a radiation oncologist all dedicated to developing individualized treatment plans for our patients to achieve the best possible outcomes. To determine the most appropriate and effective treatment approach we consider the whole person. Treatments vary based on the patient’s age, history, desire to preserve fertility and the stage and type of cervical cancer.
For very early-stage cancers (carcinoma in situ or stage 0 cervical cancer) surgery may be the only treatment necessary. This can often be done by an in-office procedure such as loop electrosurgical excision procedure (LEEP) or cold-knife cone biopsy procedure. If the disease is at a more advanced stage than more radical surgical options (such as a hysterectomy), radiation therapy, and chemotherapy may need to be considered.
Our board-certified gynecologic oncology surgeon performs minimally-invasive surgeries including laparoscopy and robot-assisted hysterectomy for eligible patients resulting in shorter hospital stays, less post-op pain, and faster return to routine activities. For some with extremely advanced or recurrent cervical cancers, pelvic exenteration may also be considered.
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 (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.
For women who are not surgical candidates, radiation therapy may be utilized to help stop cancer growth. Radiation therapy uses high-energy rays to kill cancer cells. It affects cells only in the treated area.
Doctors use two types of radiation therapy to treat cervical cancer. Some women receive both types:
- External radiation therapy: A large machine directs radiation at your pelvis or other tissues where the cancer has spread. The treatment usually is given in a hospital or clinic. You may receive external radiation 5 days a week for several weeks. Each treatment takes only a few minutes.
- Internal radiation therapy: A thin tube is placed inside the vagina. A radioactive substance is loaded into the tube. You may need to stay in the hospital while the radioactive source is in place (up to 3 days). Or the treatment session may last a few minutes, and you can go home afterward. Once the radioactive substance is removed, no radioactivity is left in your body. Internal radiation may be repeated two or more times over several weeks.
For the treatment of cervical cancer, chemotherapy is usually combined with radiation therapy. For cancer that has spread to distant organs, chemotherapy alone may be used.
Chemotherapy uses drugs to kill cancer cells. The drugs for cervical cancer are usually given through a vein (intravenous). You may receive chemotherapy in a clinic, at the doctor’s office, or at home. Some women need to stay in the hospital during treatment.
Clinical Trials Defining New Treatment Options
Great inroads in new drug therapies to treat cervical cancer are being made thanks to successful clinical research. At Rocky Mountain Cancer Centers access to clinical trials is part of our comprehensive service offering. We strongly believe in the advancement of research. You may be eligible to participate in one of our clinical trials and get early access to an up-and-coming therapy, so make sure to ask your oncologist about whether you qualify for a trial.
Our team of licensed oncology clinical social workers is here as a resource for you, your family and your caregivers, to assist with questions or concerns related to your cervical cancer diagnosis and its impact on your quality of life. They provide a safe, supportive and open environment for you to share your feelings, learn coping strategies and explore ways to live as fully and joyfully as possible. Their services also include referral to appropriate community resources, support groups and educational classes.
For more information about Cervical Cancer, visit the National Cancer Institute, Or ask your cancer care team about your individual situation.