Each year, about 15,000 women in the United States learn they have cervical cancer. Cervical cancer is one of the most common types to affect a woman’s reproductive organs. Most cases of cervical cancer are caused by the human papillomavirus (HPV).
Before cervical cancer appears, the cells of the cervix go through precancerous changes known as dysplasia. It is these abnormal cell changes that an annual Pap test can help to detect. For some women, these changes may go away without any treatment. More often, they need to be treated to keep them from changing into cancer.
Because so many women do have Pap tests annually, deaths from cervical cancer have decreased greatly and are now rare in the United States. Chances of successfully treating cervical cancer are highest when detected early.
Why Choose MD Anderson Cancer Center at Cooper for Cervical Cancer Care
As a partner with MD Anderson Cancer Center, one of the nation's leading cancer centers, MD Anderson Cancer Center at Cooper offers cervical cancer treatment expertise. You’ll benefit from our:
- Cancer care expertise: Our doctors are experts in cervical cancer diagnosis and treatment. At our center, you have access to a broad range of innovative treatment options and the most up-to-date therapies.
- Team approach to treatment: At MD Anderson Cancer Center at Cooper, doctors from a variety of specialties work together on your care. Gynecologic oncologists, radiation oncologists, pathologists, and other specialists meet weekly to collaborate on your treatment. This cohesion ensures you receive the most effective regimen for your specific circumstances.
- Clinical research efforts: As a member of NRG Oncology, part of the National Cancer Institute’s National Clinical Trials Network, we provide patients with access to innovative gynecologic cancer clinical trials, such as new chemotherapy combinations.
- Dedicated nurse navigator: Our gynecologic oncology nurse navigator serves as your advocate and helps educate you about your diagnosis and treatment. She also helps you schedule appointments during what can be an overwhelming time in your life.
- Full range of support services: A cancer diagnosis can impact many aspects of your life. With this in mind, we offer a wide range of supportive care resources, including nutrition counseling, behavioral medicine, and complementary medicine therapies.
Causes of Cervical Cancer
A sexually transmitted virus called the human papillomavirus (HPV) causes almost all cases of cervical cancer. HPV usually goes away by itself. Most people with HPV never even know they have it. But sometimes a HPV infection can cause problems. HPV can be categorized into two groups: low risk and high risk. Some high-risk types of HPV may stimulate the growth of precancerous cells in the cervix. If these abnormal cells are not found and treated, they may become cancerous.
Two of the high-risk strains are HPV 16 and HPV 18. Two of the low-risk strains are HPV 6 and HPV 11. The HPV vaccine, Gardasil® , protects against these four strains. HPV 16 and HPV 18 account for about 70 percent of all cervical cancers, as well as, a smaller percentage of vaginal and vulvar cancers.
Studies are being conducted to develop vaccines to prevent the remaining 30 percent of cervical cancers. Some low-risk strains, such as HPV 6 and HPV 11 can cause genital warts, but do not cause cervical cancer. These low-risk strains account for about 90 percent of genital warts.
Risk Factors for Cervical Cancer
Women with certain risk factors may be more likely to develop cervical cancer. These factors include:
- Infected with human papillomavirus (HPV) – Some types of HPV can cause changes to cells in the cervix. The changes may lead to genital warts, precancerous growths or cancer.
- Age – The risk of cervical cancer increases with age and most often is diagnosed in women over 40. However, younger women are often diagnosed with precancerous lesions that require treatment to prevent cancer.
- Smoking – Cigarette smoke contains chemicals that damage the body’s cells. Smoking increases the risk of precancerous changes in the cervix, especially in women with HPV.
- Sex at an early age – Women who have had sex at an early age have a higher risk of cervical cancer. Researchers are not sure why, but they think HPV may more easily infect a younger woman’s cervix.
- Number of sexual partners – Women who have had more sexual partners have a greater chance of getting HPV.
- Sexually transmitted diseases (STDs) – Women who have an STD besides HPV have a higher risk of cervical cancer.
- Weakened immune system – Women who are HIV-positive or take drugs that suppress the immune system, such as those who have undergone organ transplant or take steroids for other reasons, have a higher than average risk.
- Lack of regular Pap tests – Cervical cancer is more common among women who do not have regular Pap tests. The Pap test helps doctors find precancerous cells. Treating precancerous cervical changes often prevents cancer. In most cases, cervical cancer is treatable or preventable if caught at an early stage.
Types of Cervical Cancers
There are two main types of cervical cancer each developing in different tissue. The most common (about 80 to 90 percent) are squamous cell carcinomas. The other 10 to 20 percent are adenocarcinomas.
Squamous cell carcinoma develops in the lining of the cervix. Adenocarcinoma develops in gland cells that produce cervical mucus. There is some controversy over whether patients with adenocarcinoma of the cervix have a worse prognosis than those with squamous cell carcinoma. Some types of adenocarcinoma are aggressive and are associated with a poor outcome.
The most important factor of prognosis is the stage of the cancer. The stage will determine the treatment options and outcomes. Treatment options are the same regardless if a cervical cancer is squamous or adenocarcinoma.
Symptoms of Cervical Cancer
Early cervical cancer usually has no noticeable symptoms, but it can be detected with yearly check-ups that include getting a Pap test to check for abnormal cells in the cervix.
Possible signs of cervical cancer include vaginal bleeding and pelvic pain or discharge, although other conditions may cause the same symptoms.
You should see your doctor if any of the following problems occur:
- Vaginal bleeding after intercourse, between periods or after menopause.
- Unusual vaginal discharge that is watery, bloody or has a foul odor.
- Pelvic pain or pain during intercourse.
Tests to Diagnose Cervical Cancer
If you have symptoms or Pap test results show precancerous cells or cancer, your doctor will suggest other procedures to make a diagnosis. In order to examine the cells of the cervix more closely, the doctor may perform a colposcopy. Another common test is a biopsy where the doctor takes a sample of cervical cells for further examination.
If the biopsy indicates cervical cancer, you will be referred to a gynecologic oncologist, a doctor who specializes in treating cervical cancer. The specialist may suggest other tests to see if the cancer has spread beyond the cervix.
Testing may include:
- Colposcopy: a diagnostic test used to evaluate an area of abnormal tissue on the cervix, vagina or vulva using an instrument called a colposcope that magnifies tissue so a health care practitioner can see abnormalities that cannot be seen with the naked eye.
- Biopsy: a procedure in which your doctor removes a small amount of tissue for examination under a microscope to look for precancerous or cancerous cells.
- Pelvic Examination: A pelvic examination is part of every gynecologic visit and should be done yearly. A pelvic exam includes a rectal exam. When a cancer diagnosis is made, the doctor examines the pelvic area to see if the cancer has spread to nearby organs, such as the uterus, vagina, bladder and rectum.
- Cystoscopy and Proctoscopy: If advanced cancer is diagnosed and your doctor suspects it may have spread beyond the cervix, a cytoscopy or proctoscopy may be done using a lighted tube to view the inside of the bladder (cystoscopy) or the anus, rectum and lower colon (proctoscopy).
To learn more about the extent of disease and suggest a course of treatment, the doctor may order some of the following imaging tests:
- Chest X-ray – This is a picture of the chest that shows your heart, lungs, airway, blood vessels and lymph nodes. A chest X-ray can often show whether cancer has spread to the lungs.
- Computerized Tomography (CT) Scan – This diagnostic test uses an X-ray machine and a computer to create detailed pictures of the body, including 3-D images. It is used to detect disease outside the cervix or abnormal organ structure.
- Magnetic Resonance Imaging (MRI) – This diagnostic test uses magnetic fields and radio waves to create computerized pictures of the pelvis and abdomen.
- Positron Emission Tomography (PET) Scan – This diagnostic test uses a radioactive chemical, called a tracer, to create 3-D images of the body.
Treatment for Cervical Cancer
Once a diagnosis of cervical cancer is made, your doctor will explain your prognosis and treatment options. Your prognosis is what the doctor thinks will happen with your cancer – your chance of recovery, the expected course of the cancer or the length of time you will be sick.
Your prognosis will depend on the following:
- The stage of the cancer. (The stage tells whether the tumor has spread to nearby tissues and other parts of the body.)
- The type of cervical cancer (squamous cell or adenocarcinomas).
- The size of the tumor.
- Lymph node involvement.
Treatment options will depend on the following:
- The stage of the cancer.
- The size of the tumor.
- The patient’s desire to have children.
- The patient’s age and overall health.
Treatment of cervical cancer during pregnancy depends on the stage of the cancer and the stage of the pregnancy. If cervical cancer is detected before it has spread or found in the last trimester of pregnancy, treatment may be delayed until after the baby is born.
Staging Cervical Cancer
If the biopsy shows you have cancer, your doctor will do a pelvic exam and may biopsy additional tissue to learn the stage of your disease. Staging may also include other tests, such as a chest Xray and cystoscopy or proctoscopy. The stage tells whether the tumor has spread to nearby tissues and other parts of the body.
The stages of cervical cancer are:
- Stage 0 – The cancer is found only in the top layer of cells lining the cervix and has not invaded deeper tissues of the cervix.
- Stage I – The cancer has invaded the cervix beneath the top layer of cells. It is found only in the cervix.
- Stage II – The cancer has spread beyond the cervix but not to the pelvic wall (the tissues that line the part of the body between the hips) or to the lower third of the vagina.
- Stage III – The cancer has spread to the lower part of the vagina and may have spread to the pelvic wall and nearby lymph nodes. The cancer may also be pressing on the ureter, the tube that carries urine from the kidney to the bladder.
- Stage IV – The cancer has spread to the bladder, rectum or other parts of the body.
Recurrent cervical cancer is cancer that comes back after it has been treated. The cancer may appear again in the cervix or in other parts of the body. The cancer’s stage never changes even if your cancer recurs.
Treatment for a precancerous lesion of the cervix depends on whether it is low or high grade, whether the woman wants to have children in the future and the woman’s age and general health. A woman with a low-grade lesion may not need further treatment, especially if the abnormal area was completely removed during biopsy. When a precancerous lesion requires treatment, the doctor may use cryosurgery (freezing) or laser surgery to destroy the abnormal area without harming nearby healthy tissue. More often, the doctor will remove the abnormal tissue by LEEP or conization. In some precancerous cases, a woman may have a hysterectomy (removal of the uterus, including the cervix), particularly if abnormal cells are found inside the opening of the cervix.
Precancerous lesions are usually curable if caught early. However, a woman should continue with regular Pap tests and pelvic exams, especially if she has HPV.
Surgery for Small Cancers
Surgery for small cancers and precancerous lesions that have not spread beyond the cervix include:
- Cryosurgery (Cryotherapy) – This surgical procedure uses an instrument to freeze and destroy precancerous tissue. This is not used on invasive cancer.
- LEEP (Loop Electrosurgical Excision Procedure) – This procedure uses electrical current passed through a thin, wire hook. The hook removes the tissue. This is primarily used on precancerous lesions under local anesthesia.
- Cone – A gynecologist uses the same procedure as a cone biopsy to remove all of the cancerous tissue. This procedure can be used in a woman who has a very small cervical cancer and who wishes to preserve the ability to have children.
- Hysterectomy – This procedure removes the uterus and the cervix. If a woman has a hysterectomy, she will no longer be able to have children. This kind of hysterectomy is used only on women with very small cervical cancers of less than three millimeters in depth.
- Bilateral Salpingo-Oophorectomy – In this procedure, the fallopian tubes and ovaries are removed at the same time as the hysterectomy. If a woman is close to the age of menopause, her doctor may discuss removing her ovaries and fallopian tubes to reduce the chance that the cancer will recur in one of those organs.
Surgery for Larger Cancers
The following surgical procedures may be used for larger lesions (usually up to four to five centimeters in width), but only if the cancer is all within the cervical tissue. If the cancer has spread beyond the cervix, doctors will usually recommend chemotherapy in combination with radiation therapy.
- Trachelectomy – This procedure removes the cervix and surrounding tissue but not the uterus. It is used in special circumstances for women who have a larger cancer but wish to preserve the ability to have children.
- Radical Hysterectomy – The surgeon removes the cervix, uterus, part of the vagina and the tissues surrounding the cervix called the parametria. At the same time, the surgeon also removes nearby lymph nodes.
- Laparoscopic Surgery – In some cases, these procedures can be done without open surgery, with the help of a small telescope called a laparoscope. The laparoscope is inserted through small incisions in the abdomen so the surgeon can see the area around the uterus. At the same time, surgical instruments can be inserted through another incision. Laparoscopy allows the surgeon to inspect the abdominal cavity for spread of cervical cancer and scar tissue without making a large incision.
- Robotic-Assisted Surgery – By using robotics, surgeons are able to perform surgeries in a precise and controlled manner using clear 3-D views of the abdominal cavity.
You should discuss your surgical options with your doctor.
Radiation therapy is used for cancers that have spread beyond the cervix (Stages II, III or IV) or very large lesions (larger than five centimeters).
Radiation therapy uses high energy X-rays or other types of radiation to kill cancer cells or shrink the tumor. Radiation therapy is used instead of surgery in most cases. However, it is sometimes necessary after surgery if it is discovered the cancer has spread outside the cervix or to reduce the risk that a cancer will come back after surgery.
There are two types of radiation therapy:
- External radiation therapy uses a machine outside the body to send radiation toward the cervical cancer. The type of radiation used depends on the stage of the cervical cancer. A radiation oncologist, a doctor who specializes in radiation therapy, will give you your treatments. The length of your radiation treatment will be determined by your radiation oncologist.
- Internal radiation therapy may follow external radiation therapy. Internal radiation therapy delivers high dose rate radiation (HDR) through a plastic sleeve sewn into your cervix. The sleeve is removed once treatments are complete.
Chemotherapy uses drugs to stop the growth of cancer cells either by killing them or stopping them from dividing. Chemotherapy can be given by mouth or injected into a vein or muscle. In most cases, it is given to a patient through a vein during an outpatient visit. The drugs enter the bloodstream to reach cancer cells throughout the body. This is called systemic chemotherapy. When chemotherapy is placed directly into an organ or a body cavity, such as the abdomen, the drugs mainly affect cancer cells in that area. This is called regional chemotherapy.
How chemotherapy is given depends on the stage of the cervical cancer.
Recurrent Cervical Cancer
If cervical cancer recurs, the treatment depends on where the cancer is located and how it was treated before. If radiation has not already been given, it may be the treatment of choice for the recurrence. If radiation was already given and the cervical cancer has spread to the lower colon, rectum and bladder, a surgeon may be able to remove these organs, but this surgery is not always possible. If the cancer has spread to multiple areas, chemotherapy is usually the treatment of choice.
For the first three years after treatment, you should have follow-up visits every three to six months to ensure any changes in your health are monitored and problems are treated early. Your follow-up visits will include physical exams, pelvic exams and possibly urine tests, blood tests and X-rays. A Pap test may also be done to look for cancer cells in the vagina. If the cancer does not return within three to five years, visits can be scheduled less often.