The cervix is a part of a woman’s reproductive system. It makes mucus that helps sperm move from entering the uterus or keeps sperm from entering the uterus. Every month during your menstrual period blood flows from the uterus through the cervix into the vagina. During pregnancy, the cervix is closed to keep the baby inside the uterus. During childbirth the cervix opens (dilates) so that the baby can pass through the vagina.
Cervical cancer starts in the cells of the cervix. The cervix is the narrow, lower part of the uterus (or womb). It is the passage-way that connects the uterus to the vagina.
Before cervical cancer develops, the cells of the cervix start to change and become abnormal. These abnormal cells are precancerous, meaning that they are not cancer. Precancerous changes to the cervix are called dysplasia of the cervix (or cervical dysplasia).
Dysplasia of the cervix is not cancer. It is a common precancerous change that can develop into cancer if it isn’t treated. It is important to know that most women with dysplasia do not develop cancer.
Causes of Cervical Cancer
There is no single cause of cervical cancer, but some factors appear to increase the risk of developing it. The most important risk factor for developing cervical cancer is infection with the human papillomavirus (HPV).
HPV is a group of more than 100 types of viruses. Some types of HPV can be passed easily from person to person through sexual contact. HPV infections are common and usually go away without treatment because the immune system gets rid of the virus. However, certain types of sexually transmitted HPV can cause changes to cells in the cervix that may lead to cervical cancer.
Other factors that appear to increase the risk of developing cervical cancer are:
- Not having regular Pap tests (a test used to detect both dysplasia and cervical cancer)
- Becoming sexually active at a young age
- Having many sexual partners or a sexual partner who has had many partners
- Having a weakened immune system (for example, from taking drugs after an organ transplant or having a disease such as AIDS)
- Using birth control pills for a long time
- Giving birth to many children
Some women develop cervical cancer without any of these risk factors. Also, many women who do have risk factors do not get cervical cancer.
Symptoms of cervical cancer
Cervical cancer in its early or precancerous stages often does not cause any symptoms at all. That is why it is important for women who are sexually active to have a Pap test and pelvic examination every 1 to 3 years.
You may notice one or more of these symptoms:
- Abnormal bleeding from the vagina Bleeding or spotting between regular menstrual periods Bleeding after sex Menstrual periods that last longer and are heavier than before Bleeding after menopause
- More discharge from the vagina than normal
- Pain in the pelvis or lower back
- Pain during sexual intercourse
Often, these symptoms are caused by other health problems of infections, not cancer. Testing is needed to make a diagnosis.
Diagnosing cervical cancer
Your doctor most likely suspected you had cervical cancer after talking with you about your health and completing a physical examination. This will include an examination of your abdomen and pelvis. If your Pap test results suggest precancerous cells are or cancer of the cervix, your doctor will arrange more tests to confirm the diagnosis. These tests may also be used to “stage” and “grade” the cancer. You may have one or more of the following tests.
Colposcopy: A colposcopy is done in much the same way as a Pap test. A speculum (a clear plastic or metal device) is first inserted into the vagina to hold the vaginal walls open.
Then your doctor uses a special instrument called a colposcope to look at the inside surface of the cervix and vagina. A colposcope is like a magnifying lens with a light on the end. A liquid may be dabbed onto the cervix to make the abnormal areas show up more clearly. A sample of tissue from the cervix is often taken during a colposcopy. This is called biopsy. The biopsy may be uncomfortable, but it takes only a few minutes. You may have a mild cramping similar to menstrual pain and some light vaginal bleeding for a few days afterwards.
Biopsy: A biopsy is usually necessary to make a definite diagnosis of cancer. Cells are removed from the cervix and checked under a microscope. If the cells are cancerous, they may be studies further to see how fast they are growing. There are several ways to do a biopsy.
- A colposcopic biopsy is done during a colposcopy. Biopsy forceps are used to remove small amount of tissue from suspicious-looking areas, mainly in the lower part of the cervix. A local anesthetic (freezing) may be used to numb the cervix.
- Endocervical curettage may also be done during a colposcopy at the same time as a colposcopic biopsy to find out if there are precancerous cell changes or cancer cells in the upper part of the cervix. A narrow instrument shaped like a spoon, called a curette, is inserted into the upper part of the cervix leading into the uterus. Some of the tissue lining the upper cervix is removed by gently scrapping it with the curette. A local anesthetic may be used to numb the cervix.
- A cone biopsy removes a cone-shaped piece of tissue from the cervix. A cone biopsy is done if a deeper sample of tissue is needed. The cone-shaped piece of cervix may be removed using a thin wire loop heated by an electrical current (LEEP), a surgical scalped (cold-knife extension) or a laser (laser excision). A colposcope is used to help your doctor to view the area and guide the tools used to perform the biopsy. A cone biopsy is requires a general anesthetic (you will be unconscious). A cone biopsy may cause mild cramping, discomfort and some bleeding may continue for 2 to 4 weeks after the procedure. For several weeks after a cone biopsy, you shouldn’t have sex or insert anything into the vagina (such as tampons or vaginal douche). Sometimes all of the cancer can be completely removed by a cone biopsy and no further treatment is necessary.
Blood Tests: Blood is taken and studied to see if the different types of blood cells are normal in number and appearance. The results show how well your organs are working and may suggest whether or not you have cancer. Your red blood cell count may also be checked to see if you have anemia (low red blood cell count) from cervical bleeding.
Imaging Studies: From imaging studies allow tissues, organs and bones to be looked in more detail. Using x-ray, ultrasounds, CT scans, MRIs or bone scans, your healthcare team can get a picture of the size of the tumour and see if it has spread. These tests are usually painless and do not require an anesthetic.
Staging and grading
Once a definite diagnosis of cancer has been made and your healthcare team has the information it needs, the cancer will be given a stage and a grade.
The cancer stage describes the tumour size and tells whether it has spread beyond the place where it started to grow.
For cervical cancer there are five stages
Stage 0 - Cancer is found only in the top layer of cells in the tissue that lines the cervix. Stage 0 is also called carcinoma in situ.
Stage 1 - Cancer found only in the cervix, beneath the top layer of cells.
Stage 2 - Cancer has spread to nearby tissues such as the upper part of the vagina or tissues Such as the upper part of the vagina or tissues such next to the cervix.
Stage 3- Cancer has spread to the lower part of the vagina or the pelvic wall, or blocks the ureter (the tube that carries urine from kidneys to the bladder). It may also have spread to nearby lymph nodes.
Stage 4 -The cancer has spread to the bladder, rectum or other distant parts of the body.
To find out the grade of a tumour the biopsy sample is examined under a microscope. A grade is given based on how the cancer cells look and behave compared with normal cells. This can give your healthcare team an idea of how quickly the cancer may be growing.
There are three grades:
Grade 1 – Low grade – slow growing, less likely to spread
Grade 2 – Moderate grade
Grade 3 – High grade – tend to grow quickly, more likely to spread
It is important to know the stage and grade of the cancer. This information helps you and your healthcare team choose the best treatment for you.
Treatments for cervical cancer
Your healthcare team will consider your general health and the type, stage and grade of the cancer to recommend what treatments will be the best for you. Your healthcare team will help you make the final treatment choices. Talk to them if you have questions or concerns.
Treatments affect everyone in different ways. It’s hard to predict which side effects you will have. Your healthcare team will tell you what to expect with each treatment. They will also let you know what side effects you should report right away and which ones you can wait o tell them about at your next appointment. If you notice any side effects or symptoms that you did not expect, talk to a member of your healthcare teas as soon as possible.
Patients often worry about the side effects of treatment. However, side effects can often be well managed and even prevented with medicine. Be open with your healthcare team. Tell them your concerns and ask questions. They will help get the care and information you need.
Talk to your doctor about you fertility options before starting treatment Some treatments may affect your ability to have children. If you are of child-bearing age, your treatment choice may depend on whether you would like to become pregnant in the future. You should talk to your doctor about this before you start treatments.
For cervical cancer, you might receive one or more of the following treatments.
Surgery: A decision to have surgery depends on the tumour’s location and other factors, such as your age, your desire to have children in the future, your overall health and any treatment you have already had. During the operation, all or part of the tumour are removed. Surgery is done under a local or general anesthetic and you may stay in the hospital for several days after the surgery.
In the earliest stages of cervical cancer, the removal tissue during a cone biopsy may be all the treatment necessary.
In other situations it may be necessary to remove the entire uterus (an operation called a hysterectomy). Lymph nodes in the pelvis may also be removed during surgery.
After a hysterectomy you may have some pain, nausea or bladder and bowel problems. If you surgery to remove a small tumour on the surface of the cervix, you may have cramping, bleeding or watery vaginal discharge. These side effects are usually temporary. After a hysterectomy, you will no longer menstruate (have your period) and you will no longer be able to become pregnant. Having a hysterectomy may change how you feel about your body and your sexuality. It may help to talk about your feelings with your partner, a close family member or a friend. Your doctor can also refer you to a specialists and counselors who can help you and your partner with the emotional side effects of cervical cancer surgery.
Radiation Therapy: In external beam radiation therapy, a large machine is used to carefully aim a beam of radiation at a tumour. The radiation damages the cells in the path of the beam – normal cells as well as cancer cells. In brachytherapy, or internal radiation therapy, radioactive material is place directly into or near the tumour.
Radiation side effects will be different depending on what part of the body receives the radiation. You may feel more tired than usual or notice changes to the skin (it may be red or tender) where the treatment was given. You may have dryness, itching or burning in your vagina. These side effects will usually go away when treatment is finished.
Radiation therapy may make your vagina narrower. There are ways to expand the vagina, which will help make follow-up exam easier. Radiation may also cause early menopause. Menopause means you will no longer menstruate and you will no longer be able to become pregnant. Talk to your healthcare team about ways to reduce some of the symptoms of menopause.
Chemotherapy: Chemotherapy may be given as pills or by injection. Chemotherapy drugs interfere with the ability of cancer cells to grow and spread, but they also damage healthy cells. Although healthy cells can recover over time, you may experience side effects from your treatment like nausea, vomiting, loss of appetite, fatigue, hair loss and an increased risk of infection.
Clinical treatment trials: Clinical treatment trials investigate new approaches to treating cancer, such as new drugs, new types of treatments or combinations of existing treatments.
After treatments Flow-up care helps you and your healthcare team monitors your progress and your recovery from treatments. The schedule of follow-up visits is different for each person. You might see your doctor more often in the first year after treatment, and less often after that.
** It is important to continue having Pap tests every 1 to 3 years.
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