Cervical cancer care

Most women who develop cervical cancer are between 20 and 50 years old. It used to be one of the main causes of death from cancer in the United States, but the widespread use of the Pap test has helped doctors find cervical cancer in its early stages when treatment is most effective.

The cervix is in the bottom part of the uterus (or womb) where a baby grows. It joins the uterus to the vagina (birth canal).

Cervical cancer occurs in the cells of the cervix, the lower part of the uterus (womb) that connects to the vagina. There usually are few if any symptoms of early cervical cancer. That’s why regular Pap and HPV tests are recommended, to help screen for pre-cancerous cell changes.

Cervical cancer is the fourth most common type of cancer in women, but because it develops slowly, it is one of the easiest gynecologic/reproductive cancer to prevent, detect and treat.

Nearly all cases of cervical cancer are due to the human papilloma virus (HPV) or genital warts.

The most common types of cervical cancer are:

• Squamous cell carcinoma develops in the lining of the cervix.
• Adenocarcinoma develops in gland cells that produce cervical mucus.
• Occasionally, you may have features of both squamous cell and adeno carcinomas.

A Pap smear can find cervical cancer early, when it's most curable. You can help prevent this sexually transmitted disease by getting an HPV vaccine and practicing safe sex.

HPV is spread by sexual contact and is the cause of almost all cervical cancer, and many vaginal and vulvar cancers. HPV can cause cells in the cervix to change. If abnormal cells are not found and treated they may become cancer.

You're at higher risk of developing cervical cancer if you:

• are 40 or older
• are overweight or are not eating a healthy diet
• don’t have regular Pap tests
• have a weakened immune system
• have had a sexually transmitted disease (STD) including chlamydia
• have had Diethylstilbestrol (DES) exposure before birth: This drug was used between 1940 and 1971 to help women avoid miscarriages. Women whose mothers took DES during pregnancy have a high risk of vaginal and cervical cancers.
• have had many children
• have HIV infection
• have had human papilloma virus (HPV) or genital warts
• smoke
• used birth control pills for a long time

Notify your doctor immediately if you experience symptoms of more advanced cervical cancer which can include:

• a history of precancerous cell changes in the cervix
• a swollen leg
• abnormal or irregular vaginal bleeding
• heavy or unusual vaginal discharge
• pain during or vaginal bleeding after sex
• pain or an increased urge to urinate
• vaginal bleeding after menopause

Diagnostic tests used to detect cervical cancer include:

• biopsy
• colposcopy
• cone biopsy
• cystoscopy or proctoscopy
• endocervical curettage (ECC)
• laparoscopic retroperitoneal lymph node dissection
• LEEP (Loop electro-surgical excision procedure)
• Pap test
• punch biopsy

Imaging tests commonly used to detect cervical cancer include:

• CT
• chest X-ray
• MRI
• PET

For the earliest stages of cervical cancer, treatment may include surgery or radiation combined with chemotherapy. Later stages of cervical cancer often are treated by a combination of radiation and chemotherapy. Advanced cervical cancer is typically treated using chemotherapy alone.

Treatment:

• Fertility options to help you maintain the ability to get pregnant.
• Surgical options include:
  • laparoscopic retroperitoneal lymph node dissection
  • robotic and laparoscopic hysterectomy
  • radical hysterectomy
  • specialized advanced radiation techniques
  • trachelectomy
• Radiation options include:
  • External radiation therapy.
  • Internal radiation therapy implants (brachytherapy)
  • Intensity-modulated radiotherapy (IMRT