Learning more about Cervical Cancer

From prevention to cure

If you have been diagnosed with cervical cancer or precancerous cervical changes, it's common to feel overwhelmed and afraid. But many types of cervical cancer can be found early, or even prevented by having regular screening tests. Our mission is to help you overcome your fears and conquer cancer, by understanding how this disease is detected, diagnosed and treated.

What is cervical cancer?

The cervix is a narrow canal that connects the vagina to the uterus (the organ where a baby grows). The cervix is covered with two types of cells: squamous cells are found in the part of the cervix near the vagina, called the exocervix; glandular cells are found in the part of the cervix near the uterus, called the endocervix.

Cancer occurs when abnormal cells grow out of control. These cells can create a mass of tissue, called a tumor.

Precancerous cervical changes

Most cervical cancers start from cells that develop precancerous changes.
• These changes typically do not cause any symptoms, and are found through a Pap test.
• Precancerous changes sometimes are called dysplasia or cervical intraepithelial neoplasia (CIN).
• The changes can range from mild to severe, depending on how much of the tissue looks abnormal when viewed through a microscope.

Types of cervical cancer

Almost all cervical cancers are squamous cell carcinomas or adenocarcinomas:

Squamous cell carcinoma: Most cervical cancers form in the exocervix or the area where it meets the endocervix. These tumors usually grow slowly.

Adenocarcinoma: This type of cancer can be more difficult to detect than squamous cell carcinoma, because it begins high in the endocervix and may be missed during a Pap test.

Non-cancerous changes

It's important to know that not all cervical changes are precancerous or malignant (cancerous). Benign (non-cancerous) conditions include:
• Polyps: These localized growths can form on the lining of the cervix.
• Nabothian cyst: This is a mucus-filled lump that can form on the surface of the cervix.
• Cervicitis: This is inflammation of the cervix caused by infection.

Calculating your risk

Your risk for developing cervical cancer is higher if you:
• Have been infected with the human papilloma virus (HPV), a sexually transmitted infection that can cause precancerous changes in cervical cells
• Do not get regular Pap tests
• Have had sexual activity with multiple partners, which increases your risk of HPV
• Smoke
• Have a weak immune system due to disease or an organ transplant
• Have had chlamydia, a sexually transmitted disease
• Don't eat enough fruits and vegetables
• Have taken birth control pills for longer than five years
• Have had three or more full-term pregnancies (lasting at least 39 weeks)
• Were younger than 17 during your first full-term pregnancy
• Have a mother or sister who has been diagnosed with cervical cancer

Prevention

Get vaccinated. Because nearly all cases of cervical cancer are caused by HPV, an HPV vaccine can greatly reduce your risk. This one-time vaccination is recommended for girls and women ages 11 through 26.

Get regular Pap tests. By testing cells from the cervix, a doctor can detect HPV and precancerous changes and take steps to prevent the development of cancer.

Use protection. Using a condom or diaphragm during sexual activity can reduce the risk of being infected with HPV.

Symptoms

In its earliest stages, cervical cancer usually does not cause any symptoms, so see your doctor right away if you experience:

• Bleeding between regular menstrual periods
• Bleeding after sexual intercourse, douching or a pelvic exam
• Periods that last longer or are heavier than usual
• Bleeding after menopause
• Increased discharge from the vagina
• Ongoing pelvic pain
• Pain during sexual intercourse

Diagnosis

If a Pap test shows abnormal cells, your doctor may take a sample of the tissue (called a biopsy) to look for precancerous or cancerous changes.

Basic tests include:

Colposcopic biopsy: Using a bright light with a magnifying lens, a doctor looks closely at tissue in the cervix and removes a small sample for testing.

Endocervical curettage: If the abnormal tissue is in the endocervix and can't be seen with a colposcope, a small instrument is used to take a sample.

Cone biopsy: A cone-shaped sample of tissue is taken from the area where the endocervix meets the exocervix - where most precancerous changes and cervical cancers begin.

Staging

If cancer is found, your doctor will perform imaging tests to determine the "stage" of the disease. This is based on the size of the tumor, if it has affected nearby organs or tissue, and if the cancer has spread to other areas in the body, including the lymph nodes.

The main stages are:
• Stage 0 (carcinoma in situ): Abnormal cells are limited to the innermost lining of the cervix
• Stage I: Cancer is limited to the cervix
• Stage II: Cancer has spread beyond the uterus but not to tissue in the pelvis or the lower third of the vagina
• Stage III: Cancer has spread to pelvic tissue, the lower third of the vagina or has caused kidney problems
• Stage IV: Cancer is found in the lining of the bladder or rectum, or has spread to other parts of the body outside of the pelvis

Treatment

Treatment options for cervical cancer and precancerous changes depend on several factors, including:
• The stage of the disease
• Your overall health and age
• Your personal preferences
One or more of these treatments may be used:

Cone biopsy: This procedure, used to diagnose cervical cancer, also can treat precancerous conditions and cancer that has not spread.

Surgery: If the tumor cannot be completely removed through the cone procedure, surgery may be performed. Depending on the extent of the cancer, the cervix and uterus could be removed, in addition to the ovaries, fallopian tubes, vagina and nearby lymph nodes and tissue.

Radiation therapy: High-energy X-rays are used to kill cancer cells or keep them from growing.

Chemotherapy: Chemotherapy drugs are used to kill cancer cells or stop them from growing. They can be taken in pill form, injected directly into the abdomen or given through an IV.

Targeted therapy: Targeted therapy uses drugs that kill cancer cells or stop them from dividing. Unlike chemotherapy, this does not affect healthy cells, so there are fewer side effects.



Mercy Health — Gynecological Oncology

2409 Cherry St., Suite 307
Toledo, OH 43608
419-251-4873