Cervical Cancer
Cervical cancer occurs in approximately 10,000 women and results in nearly 4,000 deaths in the U.S. each year.
The most common type of cervical cancer is squamous cell carcinoma. Cervical cancer is caused by human papilloma virus (HPV) that is most commonly transmitted by sexual contact. With appropriate screening, cervical cancer is usually detected in its earliest stages and more commonly in its precancerous stages, when it's known as dysplasia. Prevention
There are HPV vaccines available to selected young women. These vaccines target specific strains of the HPV that cause the majority of cervical cancers. Women who undergo regular PAP smear testing are unlikely to develop advanced cervical cancer.
Screening
PAP smears have been an excellent screening test since the 1950s. In developed countries where PAP smear screening programs are utilized routinely, advanced cervical cancer is rare. In underdeveloped countries where PAP smear screening is not readily available, cervical cancer remains one of the most common causes of cancer related deaths in women.
Symptoms
As cervical cancers progress they are more likely to produce symptoms such as:
- abnormal vaginal bleeding
- bleeding after sexual intercourse
- vaginal discharge
- heavy vaginal bleeding
- flank or leg pain
- weight loss
Diagnosis
A cervical biopsy is needed to diagnose cervical cancer. An abnormal PAP smear may prompt a more thorough examination of the cervix known as a colposcopy. This is accomplished by a careful pelvic examination with a magnifying scope called a colposcope. If abnormalities are detected then biopsies are taken. In more advanced cervical cancers the patient may have a visible abnormality on the cervix that doesn't require the assistance of a colposcope for the biopsy. Depending on the result of the biopsy, a larger biopsy of the cervix, known as a cone biopsy, may be recommended for definitive diagnosis of cervical cancer.
Staging Procedures
Cervical cancer is staged using a series of radiologic tests and an examination under anesthesia. The tests include an evaluation of the chest by x-ray or CT scan; an evaluation of the ureters by intravenous pyelogram or CT scan; an evaluation of the rectum by barium enema or by proctoscopy under anesthesia; an evaluation of the bladder by cystoscopy at the time of examination under anesthesia.
At the time of the pelvic exam under anesthesia, the cervical tumor is measured. Surgical staging evaluation of the periaortic lymph nodes is an additional procedure that is considered in selected patients with locally advanced disease. This surgical procedure may help to direct further treatment recommendations.
Stages of Disease
Stage I: Confined to the cervix
Stage II: Local spread of disease to the upper portion of the vagina or to the parametria
Stage III: Local/regional spread of disease to the lower portion of the vagina, the pelvic side wall, or obstruction of the ureters
Stage IV: Spread to other organs such as the bladder, rectum, or other organs outside of the pelvis
Treatment
Women with Stage I disease can be effectively treated with a surgical procedure called a radical hysterectomy. An alternative for women wishing to maintain future fertility is known as a radical trachelectomy.
With cervical cancer that has extended to other pelvic structures or to the lymph nodes the recommended treatment is a combination of chemotherapy and radiation, called chemoradiation. If cervical cancer spreads to distant sites outside of the pelvis then chemotherapy is recommended.
Patients with Stage I cervical cancer have a better than 85% chance of long-term survival after appropriate treatment. For women with more advanced disease long-term survivals are more difficult to achieve.
Unanswered questions and controversies about cervical cancer.
Other Gynecological Cancers
Other uncommon malignancies of the female pelvic organs include sarcomas of the uterus or ovaries, germ cell and sex cord-stromal tumors, and trophoblastic tumors.
