Cancer of the cervix, a common kind of cancer in women, is a disease in which cancer (malignant) cells are found in the tissues of the cervix. The cervix is the opening of the uterus (womb). The uterus is the hollow, pear-shaped organ where a baby develops. The cervix connects the uterus to the vagina (birth canal).
Cancer of the cervix usually grows slowly. Before cancer cells are found on the cervix, the tissues of the cervix go through changes in which cells that are not normal begin to appear. These cells are known as dysplasia, "carcinoma-in-situ," "cervical intraepithelial neoplasia," or CIN.
Since there are usually no symptoms associated with cancer of the cervix until the later stages, it is important to have a Pap smear on a regular basis.
If cells that are not normal are found, your doctor will need to do colposcopy (look at the cervix through a magnification device) and take a sample of tissue (called a biopsy) from the cervix and look at it under a microscope to see if there are any cancer cells.
It is thought that a virus called human papilloma virus (HPV) is associated with the development of abnormal cells on the cervix. It is estimated that more than 6 million women in the United States have HPV infection. Some patients with HPV infection appear to be at minimal increased risk for development of abnormal cervical cells or cervical cancer.
However, studies do suggest that the major risk factor for development of abnormal cervical cells, or invasive cancer of the cervix, is HPV infection. HPV infection far outweighs other known risk factors such as the number of children you have had, number of sexual partners, socioeconomic status, and smoking history. There are a number of types of the HPV virus. It has been shown that patients infected with types 16, 18, and 31 are more likely to have CIN, or micro-invasive cancer, on biopsy while patients with types 16 and 18 have an 11-fold risk of rapid development of high-grade dysplasia.
Cervical cancer develops slowly and in many patients (as many as 70%). Cervical dysplasia (precancer) may take 10 years to turn into an actual cancer. However, in about 10% of patients, lesions can progress from CIN to invasive cancers in under a year. There is no way to predict whose cancer will change quickly, so everyone is treated or watched closely. As the cancer progresses, it grows through the lining (skin) of the cervix into the underlying tissue and eventually outside of the cervix to neighboring structures, including muscle, bladder, and rectum.
In addition to local invasion, carcinoma of the cervix can spread to nearby lymph nodes or to distant parts of the body through the bloodstream. The spread of tumors to other areas is often a reflection of the extent of the disease in the cervix. That is, early cancers usually do not spread to other areas, while locally extensive cancers have a higher chance of being elsewhere in the body. While cancer of the cervix generally progresses in an orderly manner, occasionally a small tumor with distant metastasis is seen. For this reason, patients must be carefully evaluated for spread of the cancer elsewhere.
A variety of different types of cancers can involve the cervix. Far and away the most common is "squamous cell carcinoma" which comprises 90% of all cancers seen. About 10% will be a type called "adenocarcinoma." Treatment is the same for both. More rare cancers include adenosqaumous, small cell, sarcoma, and lymphoma. Cancers from other organs rarely spread to the cervix, but it is possible. Only a biopsy of the cancer can tell what type of cancer it is.
The stage of your cervical cancer is very important because your prognosis (chance of recovery) and choice of treatment depend on the stage of your cancer (whether it is just in the cervix or has spread to other places) and your general state of health.
The stage of the cervical cancer is defined as the extent of the tumor at the time of your diagnosis. The usual initial staging studies may include the pelvic and rectal examination. Sometimes an examination under anesthesia, with or without deeper biopsies, is needed. Other studies may include a pelvic ultrasound, CAT scan or MRI scan, a telescopic examination of the bladder, a pathology report, and a chest X-ray. The stage of the cancer is the most important deciding factor in determining which treatment will be used.
The following stages are used for cancer of the cervix:
Recurrent -- Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the cervix or in another place.
Some doctors will use a newer or more descriptive staging system for cervical cancer. It is called the TNM classification.
Primary tumor (T)
Tis: Carcinoma in situ or pre-cancerous changes seen
Nodal involvement (N)
Distant metastasis (M)
The treatment of cervical cancer is dependent on the stage of the cancer and the health of the patient. Three kinds of treatment are used:
Your doctor may use one of several types of surgery for dysplasia of the cervix:
If the cancer is confined to the superficial layers of the cervix, a standard hysterectomy is curative. For more deeply invasive cancers, radical hysterectomy is used. A radical hysterectomy is an operation in which the cervix, uterus, and part of the vagina are removed. Lymph nodes in the area may also be removed (this is called lymph node dissection). (Lymph nodes are small bean-shaped structures that are found throughout the body. They produce and store cells that fight infection.)
If the cancer has spread outside the cervix or the female organs, your doctor may take out the lower colon, rectum, or bladder (depending on where the cancer has spread), along with the cervix, uterus, and vagina. This is called an exenteration. You may need plastic surgery to make an artificial vagina after this operation.
Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in the area where the cancer cells are found (internal radiation). Radiation may be used alone or in addition to surgery.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells outside the cervix.
If the cancer has come back (recurred) in the pelvis, your treatment may be one of the following:
If the cancer has come back outside of the pelvis, the treatment is dependent on your specific situation.
The prognosis for this disease is markedly affected by the extent of disease at the time of diagnosis. Among the major factors that influence prognosis are stage, volume and grade of tumor, histologic type, lymphatic spread, and vascular invasion. In a large study of patients with clinical stage IB disease, the factors that predicted most prominently for lymph node metastases and disease-free survival were capillary-lymphatic space involvement by tumor, increasing tumor size, and increasing depth of stromal invasion, with the latter being most important and reproducible. Once your cancer has been staged and surgically removed (if that is the best treatment) your physician will be able to provide you with more information.
Thomas G. Stovall, M.D.
Dr. Stovall is a Clinical Professor of Obstetrics and Gynecology at the University of Tennessee Health Science Center in Memphis, Tennessee.
Date Published: 2004-03-04
*The recommendations and information provided by this Web site are for educational purposes only. This Web site does not contain comprehensive coverage of the topics addressed, and is not a substitute for direct consultation with your health care provider. Always consult a health care provider regarding your specific condition. Trademarks referred to are the property of their respective owners.
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