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Table of Contents General Information About Cervical Cancer
Stages of Cervical Cancer
Recurrent Cervical Cancer
Treatment Option Overview
Treatment Options by Stage
Treatment Options for Recurrent Cervical Cancer
To Learn More About Cervical Cancer
Get More Information From NCI
Changes to This Summary (06/13/2008)
About PDQ
General Information About Cervical Cancer
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Cervical cancer is a disease in which malignant (cancer) cells
form in the tissues of the cervix.
The cervix is the lower,
narrow end of the uterus (the
hollow, pear-shaped organ where a fetus grows). The cervix leads from the uterus to
the vagina (birth canal).
Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of
the cervix go through changes known as dysplasia, in which cells that are not normal
begin to appear in the cervical tissue. Later, cancer cells start to grow and
spread more deeply into the cervix and to surrounding areas.
Cervical cancer in children is rare. For more information, see the PDQ summary on Unusual Cancers of Childhood 1.
Human papillomavirus (HPV) infection is the major risk factor
for development of cervical cancer.
Infection of the cervix with human
papillomavirus (HPV) is the most common cause of cervical
cancer. Not all women with HPV infection, however, will develop cervical
cancer. Women who do not regularly have a Pap
smear to detect HPV or abnormal cells in the cervix are at
increased risk of cervical cancer.
Other possible risk factors include the following:
- Giving birth to many children.
- Having many sexual partners.
- Having first sexual intercourse at a young age.
- Smoking cigarettes.
- Oral contraceptive use ("the Pill").
- Weakened immune
system.
There are usually no noticeable signs of early cervical cancer
but it can be detected early with yearly check-ups.
Early cervical cancer may not cause noticeable signs or symptoms. Women should have yearly
check-ups, including a Pap smear to check for abnormal cells in the cervix. The prognosis (chance of recovery) is
better when the cancer is found early.
Possible signs of cervical cancer include vaginal bleeding and
pelvic pain.
These and other symptoms may be caused by cervical cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems
occur:
- Vaginal bleeding.
- Unusual vaginal discharge.
- Pelvic pain.
- Pain during sexual intercourse.
Tests that examine the cervix are used to detect (find) and
diagnose cervical cancer.
The following procedures may be used:
- Pap smear: A procedure to collect cells from the surface of the cervix and vagina. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to find out if they are abnormal. This procedure is also called a Pap test.
- Colposcopy: A procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas. Tissue samples may be taken using a curette (spoon-shaped instrument) and checked under a microscope for signs of disease.
- Biopsy: If abnormal
cells are found in a Pap smear, the doctor may do a biopsy. A sample of tissue
is cut from the cervix and viewed under a microscope by a pathologist to check for signs of cancer. A biopsy that removes
only a small amount of tissue is usually done in the doctor’s office. A woman
may need to go to a hospital for a cervical cone
biopsy (removal of a larger, cone-shaped sample of cervical
tissue).
- Pelvic exam: An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. A speculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test of the cervix is usually done. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
- Endocervical
curettage: A procedure to collect cells or tissue from the cervical canal using a curette (spoon-shaped instrument). Tissue samples may be taken and checked under a microscope for signs of cancer. This procedure is sometimes done at the same time as a colposcopy.
Certain factors affect prognosis (chance
of recovery) and treatment options.
The prognosis (chance of recovery) depends on the following:
- The stage of the cancer (whether it
affects part of the cervix, involves the whole cervix, or has spread to the lymph nodes or other places in the
body).
- The type of cervical cancer.
- The size of the tumor.
Treatment options 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.
Treatment of cervical cancer during pregnancy depends on the stage
of the cancer and the stage of the pregnancy. For cervical cancer found early
or for cancer found during the last trimester of pregnancy, treatment may be
delayed until after the baby is born.
Stages of Cervical Cancer
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After cervical cancer has been diagnosed, tests are done to
find out if cancer cells have spread within the cervix or to other parts of the
body.
The process used to find out if cancer has spread within the cervix or to other parts of the body
is called staging. The information
gathered from the staging process determines the stage of the disease. It is important to know the
stage in order to plan treatment. The following tests and procedures
may be used in the staging process:
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- CT scan (CAT
scan): A procedure that makes a series of detailed pictures of areas inside the
body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography,
computerized tomography, or computerized axial tomography.
- Lymphangiogram:
A procedure used to x-ray the lymph
system. A dye is injected into the lymph vessels in the feet. The dye travels upward through the lymph
nodes and lymph vessels, and x-rays are taken to see if there are any blockages. This test helps find out whether cancer has spread to the lymph nodes.
- Pretreatment surgical staging: Surgery (an operation) is done to find out if the
cancer has spread within the cervix or to other parts of the body. In some
cases, the cervical cancer can be removed at the same time. Pretreatment
surgical staging is usually done only as part of a clinical trial.
- Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
- MRI (magnetic
resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
The results of these tests are viewed together with the results of
the original tumor biopsy to
determine the cervical cancer stage.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are used for cervical cancer:
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the innermost lining of the cervix. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is
also called carcinoma in
situ.
Stage I
In stage I, cancer has formed and is
found in the cervix only. Stage I is divided into stages IA and IB, based on
the amount of cancer that is found.
- Stage IA: A very small amount of cancer that can only be seen
with a microscope is found in the tissues of the cervix. Stage IA is divided into stages IA1 and IA2, based on the size of the tumor.
- Stage IB: In stage IB, cancer can only be seen with a microscope and is more than 5 millimeters deep or more than 7 millimeters wide, or can be seen without a microscope. Cancer that can be seen without a microscope is divided into stages IB1 and IB2, based on the size of the tumor.
Stage II
In stage II, 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 II is divided into stages IIA and IIB, based on
how far the cancer has spread.
Stage III
In stage III, cancer has spread to the lower third of the vagina, may have spread to the pelvic
wall, and/or has caused the kidney to stop working. Stage III is divided into stages IIIA and IIIB,
based on how far the cancer has spread.
Stage IV
In stage IV, cancer has spread to the bladder, rectum,
or other parts of the body. Stage IV is divided into stages IVA and IVB, based
on where the cancer is found.
Recurrent Cervical Cancer
Recurrent cervical cancer is cancer that has recurred
(come back) after it has been treated. The cancer may come back
in the cervix or in other parts of
the body. Treatment Option Overview
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There are different types of treatment for patients with
cervical cancer.
Different types of treatment are available for patients with cervical cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A
treatment clinical trial is a research study meant to help improve current
treatments or obtain information on new treatments for patients with cancer.
When clinical trials show that a new treatment is better than the
standard treatment, the new
treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Three types of standard treatment are used:
Surgery
Surgery (removing the
cancer in an operation) is sometimes used to treat cervical cancer. The
following surgical procedures may be used:
- Conization:
A procedure to remove a cone-shaped piece of tissue from the cervix and cervical canal. A pathologist views the tissue under a microscope to look for cancer cells. Conization may be used to diagnose or treat a cervical condition. This procedure is also called a cone biopsy.
- Total hysterectomy: Surgery to remove the uterus, including the cervix. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.
- Bilateral salpingo-oophorectomy: Surgery to remove both ovaries and both fallopian tubes.
- Radical hysterectomy:
Surgery to remove the uterus, cervix, and part of the vagina. The ovaries, fallopian tubes, or nearby lymph nodes may also be removed.
- Pelvic exenteration: Surgery to remove the lower colon, rectum, and bladder. In women, the cervix, vagina, ovaries, and nearby lymph nodes are also removed. Artificial openings (stoma) are made for urine and stool to flow from the body to a collection bag. Plastic surgery may
be needed to make an artificial vagina after this operation.
- Cryosurgery: A treatment that uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ. This type of treatment is also called cryotherapy.
- Laser surgery:
A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.
- Loop electrosurgical excision procedure (LEEP): A treatment that uses electrical current passed through a thin wire loop as a knife to remove abnormal tissue or cancer.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
New types of treatment are being tested in clinical trials.
Information about clinical trials is available from the
NCI Web site 2.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Treatment Options by Stage
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
Stage 0 (Carcinoma in Situ)
Treatment of stage 0 may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage 0 cervical cancer 3.
Stage IA Cervical Cancer
Treatment of stage IA cervical
cancer may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IA cervical cancer 4.
Stage IB Cervical Cancer
Treatment of stage IB cervical
cancer may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IB cervical cancer 5.
Stage IIA Cervical Cancer
Treatment of stage IIA cervical
cancer may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IIA cervical cancer 6.
Stage IIB Cervical Cancer
Treatment of stage IIB cervical
cancer may include internal and external radiation therapy combined with chemotherapy.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IIB cervical cancer 7.
Stage III Cervical Cancer
Treatment of stage III cervical
cancer may include internal and external radiation therapy combined with chemotherapy.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III cervical cancer 8.
Stage IVA Cervical Cancer
Treatment of stage IVA cervical
cancer may include internal and external radiation therapy combined with chemotherapy.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IVA cervical cancer 9.
Stage IVB Cervical Cancer
Treatment of stage IVB cervical
cancer may include the following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IVB cervical cancer 10.
Treatment Options for Recurrent Cervical Cancer
Treatment of recurrent cervical cancer may include the
following:
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent cervical cancer 11. To Learn More About Cervical Cancer
For more information from the National Cancer Institute about cervical cancer, see the following:
For general cancer information and other resources from the National Cancer Institute, see the following:
Get More Information From NCI
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