Cervical cancer is a cancer that begins in the cervix, the part of the uterus or womb that opens into the vagina. It is the part of the uterus that dilates and opens fully to allow a baby to pass into the birth canal. The normal cervix has two main types of cells: squamous or flat cells, that protect the outside of the cervix and glandular cells that are mostly inside the cervix, that make the fluid and mucus commonly seen during ovulation. Cervical cancer is caused by abnormal changes in either of these cell types in the cervix, and is the only gynecologic cancer that can be prevented by regular screening and preventive vaccination. Since nearly all cervical cancers are caused by persistent infection with the Human Papillomavirus (HPV), vaccinating women and young girls before they become sexually active (currently recommended at 11 and 12 years of age) leads to the greatest prevention of pre-cancer and cancer. Also, it is recommended that young boys be vaccinated as well. Early vaccination along with regular Pap tests and HPV testing when recommended is now the best way to prevent cervical cancer. Cervical cancer usually affects women between the ages of 30 and 55.
Cervical cancer and cervical pre-cancers usually have no symptoms. That is why it is important to have a Pap test. A woman usually does not have any symptoms until the cells turn into cancer and invade the deepest parts of the cervix or other pelvic organs. These are common symptoms in women who have developed cervical cancer.
- Vaginal discharge
- Abnormal vaginal bleeding
- Vaginal odor
These symptoms may be caused by cancer or by other health problems. It is important for a woman to see her doctor if she is having any of these symptoms. When a woman experiences concerning symptoms, a pelvic exam, including a rectogvaginal exam, and a general physical should be performed. If the exam is abnormal, the woman might be recommended to undergo an HPV test, colposcopy (observing the cervix through a magnifying scope) and a biopsy, depending upon the results of the colposcopy. If cervical cancer is suspected or diagnosed, it is important to seek care first from a gynecologic oncologist.
Cervical cancer is grouped into four stages.
Stage I: The cancer is found only in the cervix.
Stage II: The cancer has spread from the cervix to the upper part of the vagina or the tissue around the uterus. It has not spread to the pelvic wall. The pelvic wall is the muscle and connective tissues that line the insides of the pelvic bones. Cancer cells may also be found in the lymph nodes in the pelvis. Stage III: The cancer has spread to the lower part of the vagina or to the pelvic wall. It may block the flow of urine to the bladder. Cancer cells may also be found in the lymph nodes in the pelvis. Stage IV: The cancer has spread to other body parts within or outside of the pelvis. Cancer cells may be found in the bladder, rectum, abdomen, liver, intestines or lungs.
During your treatment, you will come in contact with many health care professionals. These people make up your treatment team. They will work with each other and you to provide the special care you need. Your treatment team may include some of the healthcare professionals listed below. Ideally, your treatment will be provided and managed by a gynecologic oncologist. Gynecologic oncologists are obstetrician-gynecologists who have an additional 3-4 years of special training in the comprehensive surgical care and medical treatment of female reproductive cancers. A gynecologic oncologist can manage your care from diagnosis to completion of treatment. Cervical cancer may be treated with surgery, radiation therapy and/or chemotherapy. Depending on a number of factors, your treatment team may recommend using a combination of treatments to treat your cancer. Your specific treatment plan will depend on several factors, including:
- The stage of your cancer
- The size and location of your cancer
- age and general health
All treatments for cervical cancer have side effects. Most side effects can be managed or minimized. Some treatments may affect your sexual function or your ability to have children. Before beginning treatment, it is important to learn about the possible side effects and talk with your treatment team members about your feelings or concerns. They can prepare you for what to expect and tell you which side effects should be reported to them immediately. They can also help you find ways to manage the side effects that you experience.
Surgery is the most common treatment for early cervical cancer, although radiation can also be used and typically works equally as well. Several types of surgery can be performed, but the final choice for you will depend on several factors that your gynecologic ongologist will consider, especially the stage and size of your cancer as well as your general health.
Cervical conization: Conization means surgical removal of just the cancerous (or precancerous in many cases) part of the cervix. Conization is an option only for the earliest cancers, the ones that are microscopic. This is the preferred treatment for women with very small cancers who wish to preserve fertility.
Vaginal or abdominal hysterectomy: In a vaginal hysterectomy, the uterus and cervix are removed through the vagina. In an abdominal hysterectomy, these organs are removed through an incision on the abdomen.
Laparoscopic hysterectomy: This involves the removal of the uterus and cervix in a procedure that is performed through several very small incisions on your abdomen, and the uterus and cervix are brought out through the vagina. This procedure allows for quicker recovery than abdominal hysterectomy.
Robotic hysterectomy: This procedure is essentially the same as a laparoscopic hysterectomy using several small incisions, but in this procedure your surgeon uses the assistance of a robotic technology (robot) which s/he is in control of at all times to perform your surgery.
Radical abdominal hysterectomy: This procedure may be performed through an abdominal incision, but sometimes it can be recommended to be performed through small incisions either laparoscopically or with the assistance of robotic technology. The word radical means that the uterus and the tissue between the uterus and pelvic wall, as well as part of the upper vagina, are removed. Lymph nodes in the pelvis are also removed and examined to determine if the cancer has spread (radical pelvic lymphadenectomy). In some cases, both ovaries and both fallopian tubes must be removed. This procedure is called a bilateral salpingo-oophorectomy.
Radical trachelectomy: This is a surgery where your cervix and surrounding tissues are removed but the upper uterus is preserved for future pregnancy. This operation is only available for carefully selected women and is dependent on several factors.
Radiation therapy (also called radiotherapy) uses high-energy radiation to kill cancer cells or stop them from growing. Radiation therapy can be an effective treatment for early stage cervical cancers. However, in early cervical cancer, it is more commonly used as extra treatment after surgery for patients at highest risk for recurrence of their cancer such as when the tumor might have spread beyond the cervix. Radiation is also used to treat larger or higher stage cancers where it is actually works better than surgery. Your individual need for radiation therapy will be determined using information from your staging tests, examinations, and surgery, if an operation was performed from findings at the time of your evaluation.
Two types of radiation therapy are used to treat cervical cancer. Radiation therapy for cervix cancer is most often given in combination with chemotherapy. External radiation therapy- uses a machine that directs the radiation toward a precise region of the body. The therapy is usually given daily, Monday through Friday, for about six weeks. Radiation does not hurt during the treatment and only takes a few minutes each day. You can be treated at a clinic, hospital, or radiation oncology office, and typically you return home each day after treatment. Internal radiation therapy-(also called brachytherapy) involves placing a small capsule of radioactive material inside the vagina or near the cervix. This procedure can sometimes be performed on an outpatient basis, and other times it requires hospitalization for a night or two. Medication is given to alleviate the discomfort from these procedures. During the time the radiation capsules are in, your family may only be allowed limited time next to you, but the radiation capsules are removed prior to going home.
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for cervical cancer is usually given intravenously, this means injected into a vein. You may be treated in the doctor’s office or the outpatient part of a hospital. The drugs travel through the bloodstream to reach all parts of the body. This is why chemotherapy can be effective in treating cervical cancer that has spread beyond the cervix. However, the same drugs that kill cancer cells may also damage healthy cells. To limit the damage to healthy cells, chemotherapy is usually given in cycles. Periods of chemotherapy treatment are alternated with rest periods when no chemotherapy is given. Side effects usually still occur, but are manageable.
Tips for Coping with cervical cancer treatment
Communicate with your partner. Having cancer can strain both partners in a relationship. Talking about the sexual and emotional effects cancer has on your relationship can be difficult. But you may find it easier to work through the challenges if you talk through them together. Be prepared to share your own feelings and to listen to what your partner has to say.
Shift your focus to intimacy. Sexual intercourse is only one part of intimacy. You may find that touching, kissing and cuddling are equally fulfilling.
Be patient with yourself. Understand that a return to a sexual relationship may take time. Your treatment team can tell you if and how long you should wait to have sex after treatment. It may be longer before you feel emotionally ready. Give yourself the time you need. Having an open mind and a sense of humor about ways to improve your sexuality may help you and your partner find what works best for you.
There are many resources available to help you deal with any sexual or emotional issues you may have as result of cancer and its treatment. Specially trained counselors can help you deal with the impact of cancer on your life. Support groups are another good resource. People who are facing a situation similar to yours can come together to share their experiences and give one another advice and emotional support.
During treatment you may find that even the stairs to your bedroom are a challenge, even if you have worked hard during your adult life to keep fit. It’s discouraging, but normal, to have to reduce or interrupt your fitness routine. If you’ve had surgery, ask your doctor for specific guidelines about exercise. During chemotherapy or radiation, adjust your exercise according to how you feel.
For women who are facing the predicament of cervical cancer, it is prudent that they get themselves in groups where they can openly share their experience. Coming into contact with other women who have had similar experiences to you can be beneficial. You may feel supported and relieved to know that others understand what you are going through and that you are not alone. Women often feel they can speak openly and share tips with others who have gone through a similar experience. These groups are vital in helping women accept their condition, get positive minded talks as well as share counseling and healing discussions which works effective mental therapies. Additionally, in a support group, you may find that you are comfortable talking about your diagnosis and treatment, relationships with friends and family, and hopes and fears for the future. Some women say they can be even more open and honest in these support settings because they aren’t trying to protect their loved ones.