Cervical Cancer

Cervical cancer is a malignancy that occurs in the lower part of the womb where it's connected to the vagina. If left undetected, cervical cancer can spread to other organs, such as the bladder, intestines, lungs, and liver. However, the disease is often curable if caught early. Once the number-one cause of cancer death in women, cervical cancer deaths have decreased in the United States with use of the Pap test (also called a Pap smear), which finds early changes in the cervix that are most amenable to treatment.

Today, about 11,000 women are diagnosed each year after a suspicious Pap smear. Cervical cancer is most commonly seen in women between the ages of 35 and 55.

If you have identified risk factors, dysplasia (early, abnormal changes in cervix cells), or have acquired the Human Papillomavirus (HPV), UCSD’s Gynecologic Cancer Unit offers a Pre-Invasive Cancer Program with screening, counseling, and treatment to prevent cervical cancer.

Only some women with pre-cancerous changes of the cervix will actually develop cancer. For those who do, the process can take less than a year or several years. If you are diagnosed with cervical cancer, our comprehensive cancer center provides the expertise of specially trained gynecologic oncologists and a team of cancer specialists who will tailor a treatment plan specific to your individual needs.

Our patients with cervical cancer are treated at the Moores Gynecological Cancer Unit. See the Gynecological Cancer Unit for more information.

You can also review the tabs at top of this page for information on cervical cancer symptoms and risks, diagnosis, treatment, and prevention.

Symptoms

Because women usually don’t have symptoms until abnormal cells turn into cancer and invade the deepest parts of the cervix or pelvis, it is vitally important to have a regular Pap test. The following early symptoms might be noticed:

• Vaginal discharge that is heavier than normal and may be bloody or foul smelling
• Abnormal vaginal bleeding
• Odor from vaginal discharge
• Pain during sex or in the pelvic area unrelated to sex or other activities
• Bleeding after sex

In cases of more advanced cancer, symptoms may include:

• Pain in the pelvic area
• Heavy vaginal bleeding
• A single swollen leg

Risks

Most cases of cervical cancer are caused by infection with the sexually transmitted Human Papillomavirus (HPV). Additional risk factors for cervical cancer, according to data from the National Cancer Institute, can include:

• Not getting regular Pap tests
• Age - cervical cancer is most common in women over 40
• Multiple sex partners
• An impaired immune system
• Multiple full-term pregnancies may be a factor if HPV virus is present
• Long-term use of oral contraception (five years or more) may be a factor if HPV virus is present
• Cigarette smoking - women with HPV who smoke have a higher risk than women smokers without HPV

Your Pap test was a “screening” test to see if there are any cell changes.  The sample taken by your doctor is taken to the laboratory, where pathologists determine if abnormal cells are present.

If abnormalities are detected, further tests will determine if you have preinvasive disease or cervical cancer. Your doctor will obtain a tissue sample (biopsy) for further study by conducting a colposcopy. For this procedure, a speculum is inserted into the vagina and a low-power microscope called a colposcope is used to closely see the vagina and cervix. This magnified view can help determine from exactly which area the biopsy should be taken.

A procedure called endocervical curettage (or scraping) is often done at the same time as a colposcopic biopsy to remove tissue from the endocervical canal. Another procedure that may be used is called a cone biopsy, in which the doctor removes a cone-shaped piece of tissue from the cervix.  If your doctor suspects that abnormal cells might be coming from the endometrium (the lining of the uterus), an endometrial biopsy may be performed.

If cervical cancer is diagnosed, most likely it will be squamous cell carcinoma of the cervix, a cancer of cells that line the outer part of the cervix. In about 10% to 20% of cases, it will be diagnosed as adenocarcinoma, cancer of the cells lining the inner part of the cervix.

In some cases, patients may need imaging tests to determine if their cancer has spread.  These may include a chest x-ray, a computed tomography (CT) scan, magnetic resonance imaging (MRI), intravenous pyelogram (IVP), or a positron-emission tomography (PET) scan.  See Diagnostic Radiology to learn more about these procedures.

About Staging

A process called staging is used to determine how much your cancer has spread and what treatment options will be considered.

• Stage 0: The cancer is found only in the top layer of cells in the tissue that lines the cervix. 
• Stage I: The cancer has invaded the cervix beneath the top layer of cells. It is found only in the cervix.
• Stage II: The cancer extends beyond the cervix into nearby tissues. It extends to the upper part of the vagina, but does not invade the lower third of the vagina or the pelvic wall.
• Stage III: The cancer extends to the lower part of the vagina and may also have spread to the pelvic wall and nearby lymph nodes.
• Stage IV: The cancer has spread to the bladder, rectum or other parts of the body.
• Recurrent cancer: The cancer was treated but has returned after a period of time during which it could not be detected.  The cancer may show up again in the cervix or in other parts of the body.

Cervical cancer that is caught early can potentially be cured by removing or destroying the pre-cancerous or cancerous tissue.  The American Cancer Society notes that the five-year survival rate for the earliest stage of invasive cervical cancer is 92% and the overall rate for all stages of cervical cancer is about 72%.

Surgery, radiation therapy and chemotherapy are the main methods of treatment for cervical cancer.  The method chosen for you will depend upon the stage of your cancer, the size and shape of the tumor, and your general health.

Surgery

UCSD gynecologic oncologists provide a full range of surgical options to remove cancerous tissue from the cervix. These include:

• LEEP (Loop Electrosurgical Excision Procedure): Uses thin wire loop heated by electrical current to remove abnormal tissue

• Cryotherapy (also known as cryosurgery): Uses an instrument that freezes and destroys abnormal tissue
• Laser Therapy: Uses a focused beam of high-energy light to vaporize abnormal tissue.
• Hysterectomy: Removal of the uterus and cervix. In some cases, surgeons also remove pelvic lymph nodes. Ovaries and fallopian tubes may be left in place if they are not affected

Radiation Therapy

Radiation therapy is used in the treatment of a wide variety of gynecologic cancers. It may be used alone in early stage tumors or combined with chemotherapy in locally advanced disease. In addition, it may be used before or after surgery.

• High-Dose Brachytherapy is a form of internal radiation therapy where radioactive sources are placed inside the body, close to the tumor. Methods used at UCSD include cylinder, interstitial, tandem and ovoid, and tandem and ring.
• Image Guided Radiation Therapy (IGRT) is a form of external-beam radiation that uses sophisticated technologies to locate the tumor and improve treatment accuracy so that healthy tissue is not harmed.
• Intensity Modulated Radiation Therapy (IMRT) is another state-of-the-art external beam radiation therapy that improves delivery precision, thereby minimizing dosage to surrounding normal tissue.  UCSD’s Dr. Arno Mundt pioneered the use of IMRT in gynecologic cancers.

Chemotherapy

Chemotherapy is the administration of drugs by mouth, injection, or IV to kill cancer cells. One of the unique aspects of gynecologic oncology is that specialists in this field are specially trained in chemotherapy for cancers of women’s reproductive organs. With their advanced knowledge, gynecologic oncologists can select the best drug combinations for each patient, manage complications, and minimize side effects.

Most cases of cervical cancer can be prevented by avoiding exposure to the primary cause, which is infection with the Human Papilloma virus (HPV).  In addition to practicing safe sexual practices (e.g. using a condom), women should talk with their doctor about a new vaccine called Gardisil®, that protects women from HPV infection if administered before an abnormal Pap test develops.  Although the vaccine is designed for females in the 11- to 26-year-old age range, ask your doctor if you might benefit. The vaccine does not protect against all cancer-causing types of HPV, so routine Pap tests should still be done.  Additionally, the vaccine cannot be used to treat an existing infection.

Screening recommendations

The most effective method to find abnormal changes in your cervix is the Pap test, which should be done every year. Women over age 70 who have had at least three normal Pap tests in a row in the last 10 years may not need further Pap tests.

To make sure your Pap test results are as accurate as possible:

• Do not schedule an appointment during your menstrual period.
• Do not douche for 48 hours before the test.
• Do not have sexual intercourse for 48 hours before.
• Do not use tampons, birth control foams, jellies or other vaginal creams or vaginal medications for 48 hours before the test.

  A Pap test is administered during a routine pelvic exam, as the doctor places a plastic or metal speculum inside your vagina to widen it. This allows the doctor to see the vagina and cervix, and to extract a small cell sample for the Pap test.