Cervical Cancer

MR guided Focused Ultrasound Surgery

Cervical cancer, or cancer of the cervix, begins on the surface of your cervix. It happens when the cells on your cervix begin to change to precancerous cells. Not all precancerous cells will turn to cancer, but finding these problematic cells and treating them before they can change is critical to preventing cervical cancer.

Types of cervical cancer
There are two main types of cancer of the cervix: squamous cell carcinomas and adenocarcinomas. About 80% to 90% of cervical cancers are squamous cell carcinomas, while 10% to 20% are adenocarcinomas.

Symptoms of Cervical Cancer

Early stages of cervical cancer don’t usually involve symptoms and are hard to detect. The first signs of cervical cancer may take several years to develop. Finding abnormal cells during cervical cancer screenings is the best way to avoid cervical cancer.

Signs and symptoms of stage 1 cervical cancer can include:

  • Watery or bloody vaginal discharge that may be heavy and can have a foul odor.
  • Vaginal bleeding after intercourse, between menstrual periods or after menopause.
  • Menstrual periods may be heavier and last longer than normal.

If cancer has spread to nearby tissues or organs, symptoms may include:

  • Difficult or painful urination, sometimes with blood in urine.
  • Diarrhea, or pain or bleeding from your rectum when pooping.
  • Fatigue, loss of weight and appetite.
  • A general feeling of illness.
  • Dull backache or swelling in your legs.
  • Pelvic/abdominal pain.

If you experience abnormal bleeding, vaginal discharge or any other unexplained symptoms, you should have a complete gynecological examination that includes a Pap test.

Causes of Cervical Cancer

Most cervical cancers are caused by the virus HPV, a sexually transmitted infection. HPV spreads through sexual contact (anal, oral or vaginal) and can lead to cancer. Most people will get HPV at some point in their lives and not realize it because their bodies fight the infection. However, if your body doesn’t fight the infection, it can cause the cells of your cervix to change to cancerous cells.

Diagnostics of Cervical Cancer

Cervical cancer develops slowly and over many years. Before turning to cancer, the cells in your cervix go through a lot of changes. The once normal cells in your cervix start to appear irregular or abnormal. These abnormal cells may go away, stay the same or turn into cancer cells.

Regular gynecological screenings with a Pap test can detect most cases of cervical cancer. A Pap test, or Pap smear, is a test that collects cells from your cervix. These cells are examined for signs of precancers or other irregularities.

If your Pap comes back as abnormal, further testing is necessary. This could include an HPV test, which is a specific test that checks the cells of your cervix for HPV infection. Certain types of HPV infection are linked to cervical cancer.

Your healthcare provider may also examine your cervix and take a sample of tissue for a biopsy if they suspect you have cancer. There are many techniques that can be used to obtain the tissue, like punch biopsy or endocervical curettage. In other cases, a wire loop or conization are used to gather tissues from the cervix for biopsy.

If the biopsy confirms cancer, further tests will determine whether the disease has spread (metastasized). These tests might include:

  • Liver and kidney function studies.
  • Blood and urine tests.
  • X-rays of your bladder, rectum, bowels and abdominal cavity.

Treatment of Cervical Cancer

The cervical cancer treatment team includes a gynecologic oncologist (a doctor who specializes in cancers of female reproductive organs). Recommended treatment for cervical cancer is based on many factors including the stage of the disease, your age and general health, and if you want children in the future.

The treatments for cervical cancer are radiation, chemotherapy, surgery, targeted therapy and immunotherapy.

Radiation
Radiation therapy uses energy beams to kill cancer cells on your cervix. There are two types of radiation therapy:

  • External beam radiation (EBRT): Aims high-powered radiation at cancer from a machine outside your body.
  • Brachytherapy: Puts the radiation in or just near cancer.

Chemotherapy
Chemotherapy (chemo) uses drugs that are injected through your veins or taken by mouth to kill cancer cells. It enters your blood and is effective for killing cells anywhere in your body. There are several drugs used for chemo and they can be combined. Chemo is often given in cycles. The length of the cycle and the schedule or frequency of chemotherapy varies depending on the drug used and where cancer is located.

Surgery
Different kinds of surgery are used to treat cervical cancer. Some of the most common kinds of surgery for cervical cancer include:

  • Laser surgery: This surgery uses a laser beam to burn off cancer cells.
  • Cryosurgery: This surgery freezes cancer cells.
  • Cone biopsy: A surgery in which a cone-shaped piece of tissue is removed from your cervix.
  • Simple hysterectomy: This surgery involves the removal of your uterus but not the tissue next to your uterus. Your vagina and pelvic lymph nodes aren’t removed.
  • Radical hysterectomy with pelvic lymph node dissection: With this surgery, your uterus, surrounding tissue called the parametrium, your cervix, a small portion of the upper part of your vagina and lymph nodes from your pelvis are removed.
  • Trachelectomy: This procedure removes your cervix and the upper part of your vagina but not your uterus.
  • Pelvic exenteration: This is the same as a radical hysterectomy but includes your bladder, vagina, rectum and part of your colon, depending on where cancer has spread.

In its earliest stages, the disease is curable by removing the cancerous tissue. In other cases, your provider may perform a simple hysterectomy or a radical hysterectomy.

Some people may have a combination of treatments. Your provider may use radiation or chemotherapy to treat cancer that has spread or come back (recurred). Sometimes your provider will use radiation and chemotherapy before or after surgery.

Targeted therapy
Targeted drug treatment destroys specific cancer cells without damaging healthy cells. It works by targeting proteins that control how cancer cells grow and spread.

Immunotherapy
Immunotherapy uses medicine to stimulate your immune system to recognize and destroy cancer cells. Cancer cells can also avoid being attacked by your immune system by sending off a signal. Immunotherapy helps to target these signals so the cancer cells can’t trick your body into thinking it’s a healthy cell.