Risk Factors

Several factors influence the risk of developing cervical cancer:

• Human papillomavirus (HPV) infection: This is the most significant risk factor. There are more than 100 types of the virus; about two thirds of all cervical cancers are caused by HPV types 16 and 18.
• Sexual history: Behaviors that increase the risk of HPV infection include sex at an early age, many sexual partners, and a partner who has had many sexual partners.
• HIV infection: HIV is the virus that causes AIDS. Because HIV damages the body’s immune system, it increases the risk for HPV infection.
• History of sexually transmitted disease (STD): Studies suggest that women who have had an STD are at greater risk for cervical cancer.
• Multiple pregnancies: Although the reasons are unclear, having many full-term pregnancies increases cervical cancer risk.
• Cigarette smoking: Cancer-causing chemicals from smoking affect more than just the lungs. Women who smoke double their cervical cancer risk.
• Diet: Diets low in fruits and vegetables may increase cervical cancer risk. Also, overweight women are more likely to develop cervical cancer.

Steps to Reduce the Risk of Cervical Cancer

• Get vaccinated. Two HPV vaccines (Gardasil and Cervarix) have been approved to protect against the types of HPV that cause most cervical cancers. This vaccine is approved for females 9-26 years of age and includes a series of injections over a six-month period.
• Have regular pelvic exams and Pap tests. A woman’s health care provider will tell her how often she needs a Pap test based on her age, lifestyle, and the results of previous tests.
• Use condoms or abstain from intercourse and oral sex.
• Eat a healthy diet with fruits, vegetables, and whole grains. Three or more servings of each daily can help the body fight disease and stay healthy.
• Do not smoke or use tobacco.

Symptoms

Cervical precancers and early cancers usually show no symptoms. Some symptoms are common if the cancer has already invaded nearby tissue. These include the following:

• Abnormal vaginal bleeding or discharge
• Pain or bleeding during or after intercourse
• Bleeding after a pelvic exam

All of these symptoms can be caused by conditions other than cervical cancer. Therefore, regular Pap tests and pelvic exams are very important.

Screening and Diagnosis

Health care providers recommend that women help reduce their risk of cervical cancer by having regular Pap tests. During a Pap test (sometimes called Pap smear), a health care provider swabs a sample of cervical cells. These cells are examined under a microscope to look for abnormal cells that can lead to cervical cancer. Finding and treating abnormal cells can prevent most cervical cancer. Also, the Pap test can help find cancer early, when treatment is more likely to be effective.

If a woman has abnormal Pap or HPV test results, her health care provider will suggest other tests to make a diagnosis. Here are some of these tests:

• Colposcopy: The doctor uses a colposcope to look at the cervix. The colposcope combines a bright light with a magnifying lens to make tissue easier to see. The procedure is usually done in the provider's office or clinic.
• Biopsy: The doctor removes tissue to look for cancer cells. A biopsy is the only way to know for sure if cancer is present. Different types of biopsies are used to diagnose cervical cancer:
  • Punch biopsy: The doctor uses a sharp tool to pinch off small samples of cervical tissue.
  • LEEP: The doctor uses an electric wire loop to slice off a thin, round piece of cervical tissue.
  • Endocervical curettage: The doctor uses a curette (a small, spoon-shaped instrument) to scrape a small sample of tissue from the cervix. Some doctors may use a thin, soft brush instead of a curette.
  • Conization: The doctor removes a cone-shaped sample of tissue. A conization, or cone biopsy, lets the pathologist see if abnormal cells are in the tissue beneath the surface of the cervix. The doctor may do this test in the hospital under general anesthesia.

Staging

If the biopsy shows cancer, doctors need to learn the stage (extent) of the disease to help choose the best treatment. The stage is based on whether the cancer has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body.

Doctors will do a pelvic exam, feel for swollen lymph nodes, and may remove additional tissue. To learn the extent of disease, the doctor may order some of the following tests:

• CT scan: Doctors often use CT scans to take pictures of tissue inside the body. An x-ray machine linked to a computer takes several pictures. The pictures may show a tumor, abnormal fluid, swollen lymph nodes, or if the cancer has spread to other parts of the body.
• Magnetic resonance imaging (MRI): This procedure uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body.
• PET scan: Doctors use PET scans to find cancer that has spread. The patient receives a small amount of radioactive sugar by injection. A machine makes computerized pictures of the sugar being used by cells in the body. Cancer cells use sugar faster than normal cells, and areas with cancer look brighter on the pictures.
• X-ray: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

Stages of Cervical Cancer

Stage I: The tumor has invaded the cervix beneath the top layer of cells. Cancer cells are found only in the cervix.

Stage II: The tumor extends to the upper part of the vagina. It may extend beyond the cervix into nearby tissues toward the pelvic wall (the lining of the part of the body between the hips). The tumor does not invade the lower third of the vagina or the pelvic wall.

Stage III: The tumor extends to the lower part of the vagina. It may also have invaded the pelvic wall. If the tumor blocks the flow of urine, one or both kidneys may not be working well.

Stage IV: The tumor invades the bladder or rectum, or the cancer has spread to other parts of the body.

Treatment

At Huntsman Cancer Institute, cervical cancer is treated by a team of specialists, including gynecologic oncologists (doctors who specialize in cancers of the female reproductive system), surgeons, radiation oncologists, nurses, social workers, dietitians, and other professionals.

Treatment options for cervical cancer include the following:

• Surgery
• Radiation therapy
• Chemotherapy
• Clinical trials

The treatment that's right for each patient depend on the size of the tumor and whether the cancer has spread, and may also depend on whether the patient would like to become pregnant someday.

Surgery

This treatment is an option for women with stage I or II cervical cancer. The surgeon removes tissue that may contain cancer cells. Types of surgery include the following:

• Radical trachelectomy: The surgeon removes the cervix, part of the vagina, and the lymph nodes in the pelvis. This option is for a small number of women with small tumors who want to try to get pregnant later on.
• Total hysterectomy: The surgeon removes the cervix and uterus. After a hysterectomy, women no longer have menstrual periods. They cannot become pregnant.
• Radical hysterectomy: The surgeon removes the cervix, some tissue around the cervix, the uterus, and part of the vagina. After a hysterectomy, women no longer have menstrual periods and cannot become pregnant.

With either total or radical hysterectomy, the surgeon may remove other tissues.

• Fallopian tubes and ovaries: The surgeon may remove both fallopian tubes and ovaries. This surgery is called a salpingo-oophorectomy.
• Lymph nodes: The surgeon may remove the lymph nodes near the tumor to see if they contain cancer. If cancer cells have reached the lymph nodes, it means the disease may have spread to other parts of the body.

When the ovaries are removed, menopause occurs at once. Hot flashes and other symptoms of menopause caused by surgery may be more severe than those caused by natural menopause. The patient may wish to discuss this with her doctor before surgery. Some drugs have been shown to help with these symptoms, and they may be more effective if started before surgery.

Radiation therapy

This treatment is an option for women with any stage of cervical cancer. Radiation therapy uses high-energy rays to kill cancer cells. It affects cells only in the treated area. Women with early-stage cervical cancer may choose radiation therapy instead of surgery. It also may be used after surgery to destroy any cancer cells that remain in the area. Women with cancer that extends beyond the cervix may have radiation therapy and chemotherapy. Doctors use two types of radiation therapy to treat cervical cancer. Some women receive both types:

• External radiation therapy: A large machine directs radiation at the pelvis or other tissues where the cancer has spread. The treatment usually is given in a hospital or clinic.
• Internal radiation therapy: A thin tube is placed inside the vagina. A radioactive substance is loaded into the tube. The patient may need to stay in the hospital while the radioactive source is in place (up to three days). Or the treatment session may last a few minutes, and the patient can go home afterward. Once the radioactive substance is removed, no radioactivity is left in ther body. Internal radiation may be repeated two or more times over several weeks.

Chemotherapy

This treatment uses drugs that enter the bloodstream and destroy or control cancer throughout the body. Learn more about this in our introduction to chemotherapy video.

Clinical trials

These studies discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctors about participating in a clinical trial or any questions regarding research studies. For more information, also visit HCI’s clinical trials website.

Support

When you or someone you love is diagnosed with cancer, concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, employment, or how to continue normal daily activities.

Here's where you can go for support:

• Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
• The Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist. Call 801-581-6365 or toll free 1-888-424-2100, or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
• Our Patient and Family Support Services professionals offer HCI patients and their families emotional support and resources for coping with cancer and its impact on daily life.
• The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers support groups, classes, and activities aimed to increase the quality of life and well-being of HCI patients and their families.