What is Cervical Cancer?

Cancer is the growth of abnormal cells, which can grow together to form masses called tumors. Cervical cancer begins in the cells that line the cervix. The main types of cervical cancer are:

• Squamous cell carcinoma, which is the most common type of cervical cancer, starts in the thin, flat cells that line the cervix.
• Adenocarcinoma, which starts in the cells that line the cervix that make mucus.

Baptist Health is known for advanced, superior care for patients with cancer and the diagnosis, treatment and management of cervical cancer. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Signs and Symptoms

Early stages of cervical cancer often do not produce signs or symptoms. That’s why getting a Pap test at regular gynecologic exams is important. Signs and symptoms of cervical cancer can include:

• Abnormal vaginal bleeding after intercourse, between periods or after menopause
• Pain during intercourse
• Vaginal discharge that can be bloody, pink, brown, watery or foul-smelling

Diagnosis

To determine if a patient has cervical cancer, we perform a physical examination, including a pelvic exam and PAP test, and ask questions about a person’s medical history. We then use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Diagnostic procedures can include:

Blood work: This test can include a complete blood count (CBC) and liver and renal function studies.

Colposcopy: During this test, the physician swabs the walls of the vagina with a special solution that makes abnormal cells easy to view. The physician then uses a special magnifier, called a colposcope, to view the walls of the cervix and vagina.

Cervical biopsy: During this test, a small section of the abnormal tissue is removed and examined for cancer cells.

Cone biopsy: This test may be done if a cervical biopsy does not provide enough information to determine how invasive the cervical cancer is. During this procedure, a cone-shaped wedge of tissue is removed from the cervix and examined under a microscope.

Cystoscopy:  During this procedure, a thin tube with a camera and light on the end is inserted through the urethra (the tube urine from the bladder passes through) and into the bladder to see if cervical cancer is present and help determine the stage of the cancer. This procedure is typically done when a large tumor is suspected of extending into the bladder  and not necessary if the cancer is found in early stages.

Imaging tests: Imaging tests can include X-rays, a computerized tomography (CT) scan, positron emission tomography (PET) scan, or magnetic resonance imaging (MRI) which helps to locate and determine the size of the cervical tumor.

Proctoscopy: During this procedure, a thin tube with a camera and light on the end is inserted into the rectum to see if cervical cancer is present and help determine the stage of the cancer. This procedure is typically done when a large tumor is suspected of extending into the rectum and not necessary if the cancer is found in early stages.

Causes

Lifestyle factors that contribute to the development of cervical cancer include:

• Sex at an early age, with multiple partners or with a partner who has had multiple sex partners
• Smoking
• Obesity
• Chlamydia infection

Risk Factors

Risk factors that can contribute to cervical cancer include:

Exposure to certain chemicals: Women whose mothers took a miscarriage prevention drug called diethylstilbestrol (DES) while pregnant have a higher risk of developing cervical cancer.

Not being vaccinated: Women who do not get the human papillomavirus (HPV) vaccine are at higher risk for developing HPV and cervical cancer.

Weakened immune system: Women with a weakened immune system cannot fight the human papillomavirus as well as healthier women and are at higher risk for developing HPV and cervical cancer.

Prevention

While some risk factors cannot be controlled, there are ways you can help to prevent cervical cancer:

Don’t smoke: Smoking is linked to cervical cancer. Women who smoke are nearly twice as likely as non-smoking women to develop cervical cancer.

Practice safe sex: Use a condom and avoid sexual intercourse with multiple partners or a partner who has had multiple partners.

Avoid HPV exposure: HPV can be spread through vaginal and anal intercourse, oral sex, and skin-to-skin contact. Take precautions to avoid exposure.

Pap test: Women age 21 to 29 should get Pap tests every three years during routine gynecologic exams to detect and treat abnormal cells before they become cancerous. Beginning at age 30, women should be screened with a Pap test combined with an HPV test every five years. This co-testing should continue until age 65. An alternative option for women age 30 to 65 is to continue a Pap test alone every three years. Women of increased risk may need to be screened more often.

Get vaccinated: Beginning as early as age 9, girls and boys should have the HPV vaccine to protect against the two most common types of HPV. The vaccine is a series of two to three shots given over a 6-to-12-month time frame.  The vaccine series is indicated for both girls and boys age 9 to 26 for the prevention of diseases caused by certain types of HPV, including the types of HPV considered high-risk for the development of cancer of the cervix.

Prognosis

Prognosis depends upon how early the cervical cancer is diagnosed, the size and location of the tumor, and if it has spread. When caught early, cervical cancer is highly treatable.

Treatment and Recovery

Cervical cancer treatment depends upon the stage of cancer, size of the tumor, age and health of the woman, and if she wishes to have children. The treatment of choice for early stage cervical cancer is either surgery or radiation therapy.

Surgery

Surgery is the most common treatment for cervical cancer. For early-stage treatment or treatment of small tumors, surgical procedures can include:

• Cone excision: Removal of a small cone-shaped piece of abnormal tissue is removed.
• Cryotherapy: During this procedure, abnormal cells are frozen and destroyed.
• Hysterectomy: The cervix and uterus, but not the ovaries or vagina, are removed during surgery.
• Bilateral salpingo-oophorectomy: During this procedure, the fallopian tubes and ovaries are removed at the same time as the hysterectomy.
• Laser surgery: This procedure uses a focused beam of light to burn away cancer cells.
• Loop electrosurgical excision procedure (LEEP): This procedure uses electricity to kill abnormal cells.

For more advanced cervical cancer, surgical treatment options can include:

• Pelvic exenteration: This surgery option is used in extreme cases to remove all organs of the pelvis, including those removed in a radical hysterectomy as well as bladder, vagina, part of the colon and rectum.
• Radical hysterectomy: In this procedure, the cervix, uterus, pelvic lymph nodes and part of the vagina are removed. In addition, patients may also undergo a bilateral salpingo-oophorectomy.
• Trachelectomy: In this procedure, the cervix and surrounding tissue are removed.

Radiation therapy

Radiation therapy is used for patients with locally advanced disease or those who are poor surgical candidates, as well as following radical hysterectomy in women who are at risk for further spread of cancer. The radiation is directed specifically to the cervix and other affected tissues or organs. Radiation can be given externally, where an external beam of radiation is directed at the targeted treatment area, or internally using radioactive devices placed temporarily next to the tumor. 

Chemotherapy

After surgery, or if cancer has spread elsewhere in the body, special drugs designed to kill cancer cells can be injected into the bloodstream.

Complications

Cervical cancer can recur and it can spread to other tissues and organs of the body.