About 15,000 women in the United States are diagnosed with cervical cancer (cancer of the cervix) each year. The cervix is the narrow part at the bottom of the uterus (womb). Cervical cancer is different from other uterine cancers.
What Is Cervical Cancer?
Cancer is a group of many related diseases that begin in cells, the body's basic unit of life. The body is made up of many types of cells, and normally, cells grow and divide to produce more cells only when the body needs them. Sometimes, however, cells keep dividing when new cells are not needed. These extra cells form a mass of tissue, called a growth or tumor. There are two types or tumor, benign and malignant.
Benign tumors are not cancer. They can usually be removed and, in most cases, they do not come back. Cells from benign tumors do not spread to other parts of the body and are not a threat to life. Polyps, cysts and genital warts are all types of benign growths of the cervix.
Malignant tumors are cancer. Cancer cells can invade and damage tissues and organs near the tumor, and can break away from a malignant tumor and enter the lymphatic system or the bloodstream. Cancer of the cervix can spread to other parts of the body, such as nearby lymph nodes, the rectum, the bladder, the bones of the spine, and the lungs. The spread of cancer is called metastasis.
Cancers of the cervix are named for the type of cell in which they begin. Most cervical cancers are squamous cell carcinomas. Squamous cells are thin, flat cells that form the surface of the cervix. When cancer spreads from its original location to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if cervical cancer spreads to the bones, the cancer cells in the bones are actually cervical cancer cells. The disease is called metastatic cervical cancer.
Sometimes cells on the surface of the cervix can appear abnormal but not cancerous, but may however, become cancerous over time. The abnormal cells are known as precancerous lesions or squamous intraepithelial lesions (SIL).
Changes in these cells can be divided into two categories:
- Low-grade SIL refers to early changes in the size, shape, and number of cells that form the surface of the cervix. Some low-grade lesions may disappear altogether, others can grow larger or become more abnormal, forming a high-grade lesion. Precancerous low-grade lesions may also be called mild dysplasia or cervical intraepithelial neoplasia 1 (CIN 1). These early changes in the cervix most often occur in women between the ages of 25 and 35 but can appear in other age groups as well.
- High-grade SIL means there are a large number of precancerous cells. Like low-grade SIL, these precancerous changes involve only cells on the surface of the cervix. The cells do not become cancerous and invade deeper layers of the cervix for many months, perhaps years. High-grade lesions may also be called moderate or severe dysplasia, CIN 2 or 3, or carcinoma in situ. These changes in the cervix most often occur in women between the ages of 30 and 40 but can occur in other age groups as well.
If abnormal cells spread deeper into the cervix or to other tissues or organs, the disease is then called cervical cancer, or invasive cervical cancer. This occurs most often in women over the age of 40.
The Pap test is a simple, painless test used to detect abnormal cells in and around the cervix. Precancerous conditions can be detected are treated early before cancer develops.
Precancerous changes of the cervix generally do not cause any symptoms and can only be detected by a Pap test. If the cervical cells become cancerous and invade nearby tissue, symptoms will appear, usually in the forms of abnormal vaginal bleeding or increased vaginal discharge.
Bleeding after menopause may also be a symptom of cervical cancer. It is important to see a doctor when suffering from any abnormal vaginal bleeding, so that the cause may be established.
The following procedures may be used in the diagnosis of cervical cancer:
- Colposcopy is a widely used method to check the cervix for abnormal areas. A vinegar-like solution is applied to the cervix and viewed with an instrument called a colposcope, which is like a microscope.
- Schiller test is a procedure where the cervix is coated with an iodine solution, and turns healthy cells brown and abnormal cells white or yellow.
- Biopsy involves removing a small amount of cervical tissue for examination by a pathologist. A biopsy can be performed using an instrument to pinch off the tissue, or by loop electrosurgical excision procedure (LEEP) where an electric wire loop is used to slice off a thin, round piece of tissue. Both of these biopsies can be performed using a local anesthetic.
- Endocervical Curettage (ECC) is used to check inside the opening of the cervix, an area that cannot be seen during colposcopy. In this procedure a curette (a small, spoon-shaped instrument) is used to scrape tissue from the cervical opening.
- Cone Biopsy or Conization involves the removal of a larger, cone-shaped sample of tissue, and is used to determine whether the abnormal cells have invaded the tissue beneath the surface of the cervix. This procedure may also be used as a treatment for a precancerous lesion if the entire abnormal area can be removed.
- Dilation and Curettage (D and C) is a procedure where the cervical opening is stretched and tissue is scraped from the lining of the uterus as well as from the cervical canal. It is used in situations where it is unclear if the problems are in the cervix or the endometrium (lining of the uterus)
Treating Precancerous Conditions
Treatment of precancerous lesions include Cryosurgery (freezing), cauterization (burning, also called diathermy), and laser surgery, which are all procedures used to remove the abnormal tissue without harming surrounding healthy tissue. Conization and LEEP procedures (used for biopsies) can also be used in the removal of precancerous lesions.
Hysterectomy may be performed if abnormal cells are found inside the opening of the cervix. It is more likely in women who do not intend having children in the future.
Methods of Treatment and Side Effects
Most often, treatment for cervical cancer involves surgery and radiation therapy. Sometimes, chemotherapy or biological therapy is used.
Surgery is local therapy to remove abnormal tissue near the cervix. If the cancer is on the surface of the cervix, the doctor may destroy the cancerous cells in ways similar to the methods used to treat precancerous lesions. Patients may suffer cramping or other pain, bleeding, or a watery discharge after treatment.
If the disease has invaded deeper layers of the cervix but has not spread beyond the cervix, an operation may be performed to remove the tumor but leave the uterus and the ovaries intact. In other cases, a woman may need to, or elect to have a hysterectomy. In this procedure, the entire uterus, including the cervix, and sometimes the ovaries and fallopian tubes, are removed. Lymph nodes near the uterus may also be removed to determine if the cancer has spread. For a few days after a hysterectomy, pain and discomfort will usually need to be controlled with pain relievers and a catheter is inserted into the bladder to drain the urine.
Radiation therapy (radiotherapy) uses high-energy rays to damage cancer cells and stop them from growing. Radiation therapy is local therapy and only affects cancer cells in the treated area. The radiation may come from a large machine (external radiation) or from radioactive materials placed directly into the cervix (implant radiation). Some patients receive both types of radiation therapy.
Patients are likely to become very tired during radiation therapy, especially in the later weeks of treatment. With external radiation, it is common to lose hair in the treated area and for the skin to become red, dry, tender, and itchy. There may be permanent darkening or "bronzing" of the skin in the treated area. This area should be exposed to the air when possible but protected from the sun. Patients who receive external or internal radiation therapy also may have diarrhea and frequent, uncomfortable urination. The doctor can make suggestions or order medicines to control these problems.
Chemotherapy is the use of oral or injected drugs to kill cancer cells. A single drug, or a combination of drugs may be used. It is most often used when cervical cancer has spread to other parts of the body.
Chemotherapy is given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on.
The side effects of chemotherapy depend mainly on the specific drugs and the dose. In general, anticancer drugs affect rapidly dividing cells. These include blood cells, which fight infection, help the blood to clot, and carry oxygen to all parts of the body. When blood cells are affected, patients are more likely to get infections, may bruise or bleed easily, and may feel unusually weak and very tired. Rapidly dividing cells in hair roots and cells that line the digestive tract may also be affected. As a result, side effects may include loss of hair, poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores.
Many of these side effects can now be controlled, thanks to new or improved drugs. Side effects generally are short-term and gradually go away. Hair grows back, but it may be different in color and texture.
Biological therapy is a treatment using substances to improve the way the body's immune system fights disease. It may be used to treat cancer that has spread from the cervix to other parts of the body. Interferon is the most common form of biological therapy for this disease; it may be used in combination with chemotherapy.
The side effects caused by biological therapies vary with the type of treatment the patient receives. These treatments may cause flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Sometimes patients get a rash, and they may bleed or bruise easily. These problems can be severe, but they gradually go away after the treatment stops.
Developments in Treatment of Cervical Cancer
At present, early detection and treatment of precancerous tissue remain the most effective ways of preventing cervical cancer.
The outlook for women with precancerous changes of the cervix or very early cancer of the cervix is excellent, and nearly all patients with these conditions can be cured. Researchers still continue to look for new and better ways to treat invasive cervical cancer.