Cervical cancer begins in the cervix, which is the lower, narrow end of the uterus, also called the womb. The cervix connects the vagina, or birth canal, to the upper part of the uterus and is where a baby grows during pregnancy. Almost all cervical cancers are caused by human papillomavirus (HPV), a common virus that can be passed from one person to another during sex. There are more than 80 types of human papillomavirus. About 30 types can infect the cervix and about half of them have been linked to cervical cancer. Some HPV types can cause genital warts. HPV is so common that most people get it at some point in their lives and it usually causes no symptoms.
Cervical cancer may not cause signs and symptoms early on. Advanced cervical cancer, however, may cause abnormal vaginal bleeding or discharge, such as bleeding after sex. If you have either of these symptoms, please see your doctor. Though these symptoms may be caused by something other than cancer, you will only know this by seeing your doctor.
Human Papillomavirus (HPV) causes almost all cervical cancers. HPV is a common sexually transmitted virus. More than 30 types of HPV can infect the cervix, and about half of them cause cervical cancer. Some HPV types can cause genital warts. HPV is so common that most people get it at some point in their lives with no symptoms. Fortunately, there is a human papillomavirus (HPV) test that can detect HPV infection, and a vaccine is available to protect against the HPV strains that most often cause cervical, vaginal, and vulvar cancers.
You can lower your risk of cervical cancer by lowering your risk of HPV infection by:
- Avoiding sexual activity: HPV infection of the cervix is the most common cause of cervical cancer. Avoiding sexual activity decreases your risk of HPV.
- Using barrier protection or spermicidal gels: Some methods used to prevent sexually transmitted diseases (STDs) decrease your risk of HPV infection. The use of barrier methods of birth control, such as a condom or spermicide, helps protect against HPV infection.
- Getting vaccinated: The HPV vaccine can prevent infection by the two types of HPV that cause most cervical cancers. The vaccine protects against infection for six to eight years. It is unknown if protection lasts.
Two vaccines are available to protect against the types of HPV that cause most cases of cervical, vaginal, and vulvar cancers. Both vaccines are recommended for 11- and 12-year-old girls and females 13 - 26 years of age who did not get any or all of their shots when they were younger. The vaccines are also approved for girls as young as nine years of age.
Vaccinated or not, it is always important, to have regular Pap tests to screen for cervical cancer.
Other Risks of Cervical Cancer
Other conditions associated with cervical cancer, include the following:
- You have given birth to three or more children
- You have HIV/AIDS or another condition that makes it hard for your body to resist illness
- You smoke
- You use birth control pills for five or more years
- Secondhand smoke, although the risk is lower than active smoking
Cervical cancer is the only gynecologic cancer for which there is a screening test, the Pap test or smear, that can find signs of cancer early, when treatment is generally most effective. The most important measure you can take to help prevent cervical cancer is to have regular screening tests:
- The Pap test (or Pap smear) looks for pre-cancer or cell changes on the cervix that may become cervical cancer if left untreated.
- The human papillomavirus (HPV) test looks for the virus that can cause these cell changes.
Your doctor may repeat some of the tests used to diagnose cancer or determine its stage, and some will be repeated 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.
The extent of your cancer is the stage of cancer. Information about the size of the cancer or how far it has spread is often used to determine the stage. Doctors use this information to plan treatment and to monitor progress.
Treatment options for cervical cancer depend on the following:
- The stage of your cancer
- The size of your tumor
- Your desire to have children
- Your age
There are three types of standard treatment used for cervical cancer: surgery, radiation, and chemotherapy.
Mount Sinai offers the following means of surgically removing the cancer:
- Bilateral salpingo-oophorectomy: Surgery to remove both ovaries and both fallopian tubes.
- 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.
- 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.
- Modified radical hysterectomy: Surgery to remove the uterus, cervix, upper part of the vagina, and ligaments and tissues that closely surround these organs. Nearby lymph nodes may also be removed. In this type of surgery, not as many tissues and/or organs are removed as in a radical hysterectomy.
- 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.
- Radical hysterectomy: Surgery to remove the uterus, cervix, part of the vagina, and a wide area of ligaments and tissues around these organs. The ovaries, fallopian tubes, or nearby lymph nodes may also be removed.
- 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 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.
- Radical cervical trachelectomy: This fertility-conserving treatment is a laparoscopic procedure for early cervical cancer. Certain patients with early cervical cancer are candidates for, a minimally-invasive removal of the cervix, in which the uterus and ovaries are retained for childbearing. Studies have shown that cervical trachelectomy has a similar cancer-treatment outcome to radical hysterectomy. Patients studied were able to conceive at a rate similar to the general population, with only a slightly increased risk of pregnancy loss.
- Minimally-Invasive Radical Hysterectomy and Lymphadenectomy: A very advanced, minimally-invasive treatment. In this robotically-assisted laparoscopic radical hysterectomy and lymphadenectomy, the robot enables our surgeons to do more complex operations without a major incision than would otherwise be possible. In this procedure, the Da Vinci Robot is used to augment the laparoscopic removal of the lymph nodes, uterus, parametrium, and cervix.
Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. The type of radiation therapy you receive depends on the stage of your cervical cancer. There are two types of radiation therapy:
- External radiation therapy: A machine outside the body is used to send radiation toward the cancer.
- Internal radiation therapy: A radioactive substance is sealed inside needles, seeds, wires, or catheters that are placed directly into or near the cancer.
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.