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Understanding Cervical Cancer | Early Dectection | Types | Symptoms | Resources
Cervical cancer starts on the surface of a person's cervix. When normal cells first begin to change and grow abnormally, it is called dysplasia, which is not yet cancerous. However, if undetected, these cells may become cancerous and move deeper into surrounding tissues and organs.
Today, women facing cervical cancer have better treatment options with better outcomes than they did even a few years ago. Most of the people who come to Fred Hutchinson Cancer Center for treatment for cervical cancer will be treated with surgery or radiation paired with chemotherapy.
Early Detection for Cervical Cancer
Cervical cancer used to be one of the most common causes of cancer death for American women, but widespread use of the Pap test has dramatically shifted detection to early precancerous and highly curable stages.
If a Pap test shows an abnormality in the cells on the cervix, a physician will perform a biopsy. A gynecologist will often use a colposcope — a viewing tube attached to magnifying binoculars--to find the abnormal area and remove a tiny section of the cervix surface.
The American Cancer Society recommends that women get a pap test every three years from their primary care physician. If you don't have a primary doctor, you are welcome to review the University of Washington Physicians site to select a physician that meets your needs at a neighborhood clinic close to you.
Cervical cancer is usually the result of a common virus: the human papilloma virus (HPV). In 2006, a vaccine, called Gardasil, became available that prevents the HPV virus, and thus the leading cause of cervical cancer, thanks in part to researchers from Fred Hutch. Our doctors suggest that young women follow the advice of their family practitioners or pediatricians about whether Gardasil is the right choice for them.
Risk Factors
The biggest risk for cervical cancer is exposure to the human papilloma virus (HPV), now considered the cause in 95 percent of cervical cancer cases. Most people have the virus at some time during their lifetimes, but for many their immune system will get rid of the virus without them even knowing that it was there. Some types of the virus can cause genital warts, and other types can cause changes in the cells of the cervix.
The changes in the cervix usually clear up once the immune system has rid the body of the virus. In some people, however, the virus remains present for a number of years, and in a few of these cases, the changes in the cervix will develop into cancer if left untreated.
Other risk factors include smoking, HIV, a high number of sexual partners and becoming sexually active at an early age.
Squamous Cell Carcinomas
About 85 percent to 90 percent of cervical cancers are squamous cell carcinomas. They begin in the ectocervix, the part of the cervix next to the vagina.
Adenocarcinomas
The remaining 10 percent to 15 percent of cervical cancers are adenocarcinomas, which develop from the mucus-producing gland cells of the endocervix, the part of the cervix next to the body.
Adenosquamous Carcinomas
This type of cancer is more rare and has features of both squamous cell carcinomas and adenocarcinomas.
Types of Treatment for Cervical Cancer
Today, people facing cervical cancer have better treatment options than they did even a few years ago. If detected in the precancerous stage (dysplasia), cervical cancer can often be halted with a simple procedure such as a loop electrosurgical excision procedure (LEEP) or cone biopsy can be used.
Symptoms
The most common symptoms of cervical cancer are usually detectable after abnormal cervical cells have become cancerous and have invaded nearby tissue. According to the American Society of Clinical Oncology, these symptoms are:
- Blood spots or light bleeding between or following periods
- Menstrual bleeding that is longer and heavier than usual
- Bleeding after intercourse, douching, or a pelvic examination
- Pain during sexual intercourse
- Bleeding after menopause
- Increased vaginal discharge
Precancerous changes of the cervix usually do not cause pain.
Regular Pap Tests
Regular Pap tests are important to your survival: about 90 percent of women whose cervical cancer was detected by a Pap test will survive. The figure is much lower--only 40 percent--for women whose cancer was not diagnosed until they experienced vaginal bleeding.
Diagnosis
To diagnose cervical cancer, the physician will perform a physical examination, a pelvic examination, and a Pap test. The physician may also perform a colposcopy. Similar to a microscope, a colposcope magnifies the cells of the cervix and vagina.
If abnormal cells on the cervix are detected, the doctor may perform a biopsy. A gynecologist will often use a colposcope — a viewing tube attached to magnifying binoculars — to find the abnormal area and remove a tiny section of the cervix surface in an office biopsy.
If the diagnosis isn't clear, a surgeon may perform a cone biopsy--removal of a larger, cone-shaped piece of tissue. This can be done in the office or in the operating room. More than 90 percent of cervical cancers can be halted by removing the precancerous tissue in this way, and no further treatment is necessary.
To determine if cancer has invaded or spread to other organs, physicians may use a cytoscope to see the inside of the bladder or urethra; a sigmoidoscope to see the inside of the colon and rectum; or a laparoscope to see the inside of the abdomen. Other test which may be used include X-ray, computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET).
Stages
The most common cancer grading system used for gynecological cancers, which is used by Fred Hutch gynecologic oncologists, is the International Federation of Gynecology and Obstetrics (FIGO) system.
Stage 0 – Refers to the "precancer," stage, which is common with cervical cancer, known as dysplasia.
Stage I – Cancer is confined to the cervix.
Stage II – Cancer has invaded nearby tissues (parametria) and upper vagina.
Stage III – Cancer has spread to the pelvic sidewalls or is blocking the ureters, the tubes that connect the kidney to the bladder.
Stage IV – Cancer has either deeply invaded the bladder or rectum or has metastasized to more distant locations, such as the lungs.
Cancer that has spread to the lymph nodes does not change the stage, but is an important prognostic factor and guides treatment planning.
Resources
There are many resources online for learning about your disease. Health educators at the Fred Hutch Patient and Family Resource Center have compiled a list of trusted sources to help you get started.
Whether you are newly diagnosed, going through treatment or know someone with cancer, our staff are available to tailor personalized resources and answer questions about support options in the community.
American Cancer Society
American Cancer Society (ACS): Overview of Cervical Cancer
If you have cervical cancer or are a caregiver for someone who does, knowing what to expect can be helpful. Here you can find out all about cervical cancer in adults, including risk factors, symptoms and how they are found and treated.
American Society of Clinical Oncology
American Society of Clinical Oncology (ASCO): Guide to Cervical Cancer
This is Cancer.Net's Guide to cervical cancer. Here you can learn more about cervical cancer, treatment, the latest research and clinical trials.
National Cancer Institute
National Cancer Institute (NCI): Cervical Cancer-Patient Version
The NCI is the federal government's principal agency for cancer research and training. Here you can find more information about cervical cancer treatment, research and coping with cancer.