Cervical Cancer

Signs and Symptoms

Cervical cancers start as an abnormality of cells on the surface of the cervix. These abnormalities are not cancerous. They include dysplasia, squamous intraepithelial lesions (SIL) and carcinoma in situ. If undetected or untreated, these pre-invasive abnormalities eventually may invade normal cells of the cervix. As a result, cancer may develop, invading surrounding tissues or lymph nodes and possibly spreading to other parts of the body.

If these lesions have not invaded normal cells of the cervix, treatments may be relatively simple and straightforward.

Pre-cancerous changes of the cervix usually don't cause pain. In fact, they generally don't cause symptoms and aren't detected unless a woman has a pelvic exam and a Pap test.

Symptoms usually don't appear until abnormal cervical cells become cancerous and invade nearby tissue. When this happens, the most common symptom is abnormal bleeding, which may start and stop between regular menstrual periods or may occur after sexual intercourse, douching or a pelvic exam. Menstrual bleeding may last longer and be heavier than usual.

Bleeding after menopause also may be a symptom of cervical cancer. Increased vaginal discharge is another symptom of cervical cancer.

Diagnosis

Cervical cancer is diagnosed by having a pelvic exam and a Pap test.

• A pelvic exam is done to check a woman's vagina, uterus, bladder and rectum. The doctor feels these organs for any lumps or changes in their shape or size. To see the upper part of the vagina and the cervix, the doctor inserts an instrument called a speculum into the vagina.

• A Pap test is when the doctor collects cells from the cervix and upper vagina. A medical laboratory checks for abnormal cells.

Treatment

There are a number of ways to treat cervical cancer.

• Loop Electrosurgical Excision Procedure (LEEP) -- This simple procedure can be performed in the doctor's office under local anesthetic. An electrically charged wire loop is used to remove the outer portion of the cervix containing the abnormal tissue, which then can be examined under a microscope to confirm that no cancer remains. In the great majority of cases, women are cured after one LEEP procedure and are able to return to full activity shortly thereafter.

• Cryosurgery -- This is a procedure that freezes and kills the abnormal cells on the cervix. In this procedure, which is performed in the doctor's office and usually does not require an anesthetic, a silver probe that has been cooled with liquid nitrogen is placed against the cervix. This freezing kills the outer layer of cells that are abnormal on the cervix.

• Cryosurgery Hysterectomy -- The removal of the uterus through the abdomen or vagina is a major surgical procedure requiring at least an overnight stay in the hospital. There are very few reasons to perform a hysterectomy for pre-invasive lesions. It is sometimes used for women who have had more than one relapse and no longer have enough tissue to perform another LEEP.

Treatment of Invasive Cancer

The treatment of invasive cancer depends upon the extent of tumor growth. In cases where the tumor is small and confined to the cervix, a woman may be treated with either a radical hysterectomy or with radiation therapy. When tumors are large or extend to adjacent tissues or lymph nodes more intensive therapy is required, such as radiation therapy, sometimes with the addition of chemotherapy drugs.

• Radical Hysterectomy -- This is the surgical removal of the uterus, the upper portion of the vagina, and the ligaments and connective tissues that hold the uterus in place. During a radical hysterectomy, it also is common to remove the lymph nodes in the pelvic area, for microscopic cancer cells can spread to those lymph nodes and into the ligaments that hold the uterus in place.

  It is not necessary to remove the ovaries in a radical hysterectomy and the preservation of ovarian function is one of the benefits of this approach. This is important for younger women. Following a radical hysterectomy, a woman will no longer have menstrual periods and will not be able to bear children. However, she will continue to have the female hormone estrogen in her body. When patients are properly selected for this procedure, the cure rate of cervical cancer is between 85 percent and 95 percent.

• Radiation Therapy -- This treatment uses high-energy rays to damage cancer cells and stop them from growing. It is a localized treatment, which means that it works to attack cancer cells in one area. The radiation may come from a large machine, called external radiation, or from radioactive materials placed directly into the cervix, called implant radiation. Some patients receive both types of radiation therapy.

• Chemotherapy -- The use of drugs to kill cancer cells is most often used when cervical cancer has spread to other parts of the body. A patient may receive just one drug or a combination of drugs in cycles. Chemotherapy may be given by injection into a vein or by mouth. It is a systematic treatment, meaning that the drugs flow through the body in the bloodstream.

• Biological Therapy -- This treatment uses substances to strengthen a woman's immune system to better fight her cancer. It may be used to treat cancer that has spread from the cervix to other parts of the body. Interferon is the most common form of biological therapy for cervical cancer and may be used in combination with chemotherapy. Most patients who receive interferon do so on an outpatient basis.