Cervical Cancer - Oncology Center Mexican American


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	Cervical Cancer Breast Cancer Lung Cancer Cancer of the Colon and Rectum Prostate Cancer Types of cancer treatment Sitemap Cervical Cancer The cervix is the lower part of the uterus (womb). The uterus has 2 parts. The upper part, called the body of the uterus, is where a baby grows. The cervix, in the lower part, connects the body of the uterus to the vagina, or birth canal. Cancer of the cervix (also called "cervical cancer") begins in the lining of the cervix. This cancer forms slowly. First, some cells begin to change from normal to pre-cancer and then to cancer. This can take many years, but sometimes it happens faster. These changes are referred to by several terms, including dysplasia. For some women, the pre-cancer changes may go away without any treatment. More often, they need to be treated to keep them from changing into true cancers. There are two main types of cancer of the cervix. About 80% to 90% are squamous cell carcinomas. The other 10%-20% are adenocarcinomas. If the cancer has features of both types it is called mixed carcinoma. If you have cervical cancer, ask your doctor to explain exactly what type of cancer you have. What Causes Cancer of the Cervix? Risk factors for cervical cancer A risk factor is anything that affects a person's chance of getting a disease. Some risk factors, such as smoking, can be controlled. Others, like a person's age or race, can't be changed. Several risk factors increase a woman's chance of getting cervical cancer. Women without any of these risk factors rarely get cervical cancer. On the other hand, while these risk factors increase the odds of getting cervical cancer, many women with these risks do not get this disease. In looking at risk factors, it helps to focus on those that can be changed. Still, those that can't be changed also serve to remind women about the importance of getting a Pap test. Risk factors for cervix cancer include: Human papilloma virus (HPV) infection For cervical cancer, the most important risk factor is infection with a virus known as HPV. HPV is really a group of more than 100 types of viruses that cause warts. Some types of HPV cause genital warts. Other types cause cancer of the cervix. The kinds that cause cancer are called "high-risk" HPVs. HPV is passed from one person to another by skin-to-skin contact during vaginal, anal, or oral sex. Having unprotected sex, especially at a young age, makes HPV infection more likely. Also, women who have many sex partners (or who have sex with men who have had many partners) have a greater chance of getting HPV. Many women may have HPV, but very few of these women will ever get cervical cancer. In most cases the body fights off the virus, and the infection goes away without any treatment. But in some women, the infection persists and can cause cervical cancer. HPV occurs mainly in young women and is less common in women over 30. We don't know why this is so. Condoms (rubbers) may protect against HPV when they are used correctly, and it is important to use them because they do protect against AIDS and other sexual diseases. The Pap test, and some newer tests, can find changes that point to HPV infection..While there is no cure for HPV, the abnormal cell growth they cause can be treated. Vaccines have been made that will prevent infection with some types of HPV. Right now, one vaccine, called Gardasil ®, has been approved for use by the FDA and more vaccines are being made and tested. Even though HPV is an important risk factor for cervical cancer, most women with this infection do not get cervical cancer. Doctors believe other factors must come into play for this cancer to develop. Some of these factors are listed below. Smoking Women who smoke are about twice as likely to get cervical cancer as those who don't. Tobacco smoke can produce chemicals that may damage the DNA in cells of the cervix and make cancer more likely to occur. HIV infection HIV (human immunodeficiency virus is the virus that causes AIDS--it is not the same as HPV). It can also be a risk factor for cancer of the cervix. Being HIV positive seems to make a woman's immune system less able to fight both HPV and early cancers. Chlamydia infection This is a common kind of bacteria that can infect women's sex organs. It is spread during sex. A woman may not know that she is infected at all unless she is tested for chlamydia when she gets her pelvic exam. Some studies suggest that women who have a past or current infection are at greater risk for cancer of the cervix. Long-term infection can cause other serious problems, too. Diet What you eat can play a part as well. Diets low in fruits and vegetables are linked to an increased risk of cervical and other cancers. Also, women who are overweight are at a higher risk. Birth control pills Long-term use of birth control pills increases the risk of this cancer. Research suggests that the risk of cervical cancer goes up the longer a woman takes "the pill," but the risk goes back down again after she stops. You should talk to your doctor about the pros and cons of birth control in your case. Having many pregnancies Woman who have had many full-term pregnancies have an increased risk of this cancer. No one really knows why this is true. Low income Poor women are at greater risk for cancer of the cervix. This may be because they cannot afford good health care, such as regular Pap tests. DES (diethylstilbestrol) This drug is a hormone that was used between 1940 and 1971 for some women who were in danger of miscarriages. The daughters of women who took this drug have a slightly higher risk of cancer of the vagina and cervix. Family history Cervical cancer may run in some families. If your mother or sister had cervical cancer, your chances of getting the disease are higher. This could be because these women are less able to fight off HPV than other women. Can Cancer of the Cervix Be Prevented? Most cervical cancer can be prevented. There are 2 ways to prevent this disease. The first way is to prevent pre-cancers. This is best done by avoiding risk factors. The second is to find and treat pre-cancers before they turn into cancer. Things to do to prevent pre-cancers Try to avoid HPV: Doing certain things can increase your chance of getting an HPV infection, for example: having sex at an early age having many sex partners having a partner who has had many sex partners having sex with men who are not circumcised Delay sex: Waiting to have sex until you are older can help you avoid HPV. It also helps to limit how many people you have sex with and to avoid having sex with someone who has had many other sex partners. Remember that someone can have HPV for years yet have no symptoms - it does not always cause warts or any other symptoms. Someone can have the virus and pass it on without knowing it. Use condoms: Condoms can help protect against HPV. Condoms cannot protect completely against HPV, but they also protect against HIV and some other sexual diseases. Don’t smoke: Not smoking is another important way to reduce the risk of cervical pre-cancer and many other cancers. Get the HPV vaccine: There are now vaccines that can protect people against certain types of HPV. Right now vaccines are only used to prevent, not treat, an HPV infection. The vaccine now in use is given as a series of 3 shots over 6 months. Side effects are mild. Because this vaccine costs so much, you may want to check first to see if it will be covered by your insurance. To be most effective, the HPV vaccine should be given before a person starts having sex. It has been approved by the FDA and should be covered by most insurance. The American Cancer Society recommends that the vaccine be given to females aged 11 to 12 (and as early as age 9 years if the doctor recommends it). The Society also recommends that "catch-up" vaccinations should be given to females aged 13 to 18 who have not yet had the vaccine. Women age 19 to 26 should talk to their doctors about whether the vaccine is right for them. It is important to know that the vaccine doesn't protect against all cancer-causing types of HPV, so Pap tests are still needed. Finding changes before they become cancer The second way to prevent cancer of the cervix is to have testing (screening) to find pre-cancers before they can turn into cancer. The Pap test (or Pap smear) is the most common way to do this. If a pre-cancer is found and treated, it can stop cervical cancer before it really starts. Most cervical cancers are found in women who have not had Pap tests when they should. The American Cancer Society recommends the following: All women should begin having the Pap test about 3 years after they start having sex (vaginal intercourse), but no later than age 21. The test should be done every year if the regular Pap test is used, or every 2 years if the newer liquid-based Pap test is used. Beginning at age 30, women who have had 3 normal test results in a row may get the test every 2 to 3 years. Another option for women over 30 is to have one of the Pap tests every 3 years plus the HPV DNA test. (See below for more information about this test.) Women who have certain risk factors (like HIV infection or weak immune systems) should have a Pap test every year. Women 70 years of age or older who have had 3 or more normal tests in a row (and no abnormal tests in the last 10 years) may choose to stop having the test. But women who have had cervical cancer or who have other risk factors (as mentioned above) should keep on having the test as long as they are in good health. Women who have had a total hysterectomy (removal of the uterus and cervix) for reasons other than having cancer or a pre-cancerous lesion may also choose to stop having the test. Women who have had a simple hysterectomy (the cervix was not removed) should continue to follow the guidelines above. Pelvic exam versus Pap test Many people confuse pelvic exams with Pap tests, perhaps because they are often done at the same time. The pelvic exam is part of a woman's regular health care. During this exam, the doctor looks at and feels the reproductive organs. Some women think that they do not need pelvic exams once they have stopped having children. This is not true. The pelvic exam may help find diseases of the female organs. But it won't find cancer of the cervix at an early stage. To do that, the Pap test is needed. The Pap test is often done just before the pelvic exam. The doctor will remove cells from the cervix by gently brushing or scraping. The cells are sent to a lab to be looked at under a microscope. How important is the Pap test? In countries where women cannot get routine Pap tests, death from cervical cancer is much more common. In fact, cervical cancer is the major cause of cancer deaths in women in many of these countries. These cancers are usually found at a late stage, rather than as pre-cancers or early cancers. Not all American women have Pap test screening. For instance, the elderly, African-Americans, and/or low-income women are less likely to have regular Pap tests. But there are ways to help all women in this country get the testing they need. A program called the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides testing to women without health insurance for free or at very little cost. Each state's Department of Health has information on this program. How is a Pap test done? The doctor uses a metal or plastic instrument to open the vagina. Then a sample of mucus and cells is lightly scraped from the cervix. This sample is sent to the lab to be looked at under a microscope. If anything unusual is found your doctor will let you know. Because the system for reporting Pap test results is complex, ask your doctor to explain your results in a way that is clear to you. If your test shows something not normal, your doctor will want to do other tests to find out what is happening. Here are some things you can do to make your Pap test more accurate: Try not to have the test during your period. Do not douche for 2 days before the test. Do not have sex for 2 days before the test. Do not use tampons, birth control foams, jellies, or other vaginal creams or medicines for 2 days before the test. Even though the Pap test is the best way to prevent cervical cancer or to find it early, it is not perfect. Because even good labs can miss some cell changes, you should have the test as often as the ACS guidelines above recommend. Women who are no longer having children still need to have pelvic exams and Pap tests. Doctors have several methods to treat women with abnormal Pap test results. These methods include cryosurgery (use of a metal probe to freeze and kill the abnormal cells) and laser surgery. If you have an abnormal Pap test, ask your doctor to explain exactly what that means in your case and what treatment options you have. The HPV DNA test As noted above, infection with HPV is the most important risk factor for cancer of the cervix. Doctors can now test for the types of HPV that are most likely to cause this cancer. They do this by looking at the DNA of cervical cells. Samples of cells are collected in much the same way as for the Pap test. This test is used in 2 ways: It can be used as a screening test (along with the Pap test) in women over 30. It does not replace the Pap test. It is not used for women under 30 because it's not as useful then. Younger women who are having sex are much more likely to have HPV, most of which will go away by itself. It can also be used in women with slightly abnormal Pap test results to see if more testing or treatment might be needed. How Is Cancer of the Cervix Treated? This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience. The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor. Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options. The treatment options for cervical cancer depend mostly on the stage of the cancer. After your cancer is staged, the doctor will tell you what choices you have. If there is anything you don't understand, ask for it to be explained. Factors other than the stage of the cancer that might have an impact on your treatment decision include your age, your overall health, and your own preferences. It is often a good idea to get a second opinion. A second opinion can give you more information and help you feel better about the treatment plan you choose. In fact, some insurance companies require you to get a second opinion. The 3 main types of treatment for cervical cancer are surgery, radiation, and chemotherapy (often called simply "chemo"). Sometimes the best approach is to use 2 or more of these methods. If a cure isn't likely, the goal may be to remove or destroy as much of the cancer as possible. This is to keep it from growing or spreading for as long as possible. Sometimes treatment is aimed at relieving symptoms. This is called palliative treatment. Surgery There are several kinds of surgery for cervical cancer. Some involve removing the uterus (hysterectomy), others do not. The list below covers the most common types of surgery for cancer of the cervix. Cryosurgery: A metal probe cooled with liquid nitrogen is placed in the vagina and on the cervix. This kills the abnormal cells by freezing them. Cryosurgery is used to treat pre-invasive cervical cancer (stage 0), but not for treating invasive cancer. Laser surgery: A laser beam is used to burn off cells or to remove a small piece of tissue for study. Laser surgery is used as a treatment for pre-invasive cervical cancer only. Conization: A cone-shaped piece of tissue is removed from the cervix. This approach can be used to find cancer or to treat early cancer. It is seldom used as the only treatment except for women with early cancer who might want to have children. Simple hysterectomy: The uterus is removed, but not the tissue next to the uterus. Neither the vagina nor the pelvic lymph nodes are removed. The uterus can be removed through either an incision in the front of the belly (abdomen) or through the vagina. After this operation, a woman cannot become pregnant. Radical hysterectomy and pelvic lymph node dissection: For this operation the surgeon removes more than just the uterus. The tissues next to the uterus, the upper part of the vagina next to the cervix, and some lymph nodes from the pelvis are also removed. This surgery is most often done through an incision in the front of the belly and less often through the vagina. After this surgery, a woman cannot become pregnant. Sexual impact of hysterectomy: After hysterectomy a woman can still feel sexual pleasure. A woman does not need a uterus to reach orgasm. But some women feel less feminine after this operation. They may see themselves as "an empty shell." If the cancer has caused pain or bleeding, though, the operation could actually improve a woman's sex life by stopping these symptoms. Trachelectomy: A newer procedure (known as a radical trachelectomy) may allow certain young women with early stage cancer to be treated and still be able to have children. This method involves removing the cervix and the upper part of the vagina and placing a "purse-string" stitch to act as an artificial opening of the cervix inside the uterus. The nearby lymph nodes are also removed. The operation is done either through the vagina or the abdomen. After this surgery, some women are able to carry a pregnancy to term and deliver a healthy baby by C-section. In one study, the pregnancy rate after 5 years was over 50%, but the risk of miscarriage is higher than is seen normal healthy women. The risk of the cancer coming back after this approach is low. Pelvic exenteration: Besides removing all the organs and tissues mentioned above, in this operation the bladder, vagina, rectum, and part of the colon may also be removed. This operation is used when the cancer has come back after earlier treatment. If the bladder is removed, a new way to store and pass urine is needed. A short piece of the intestine might be used to make a new bladder. Urine can be drained by placing a small tube (catheter) into a small opening called a urostomy. Or the urine might drain into a small plastic bag worn on the front of the stomach. If the rectum and part of the colon are removed, a new way to pass solid waste (stool) is needed. This is done with a colostomy, a small opening on the abdomen through which the stool can pass. Or the surgeon might be able to reconnect the colon so that no bags outside of the body are needed. If the vagina is removed, a new one can be made out of skin or other tissue. It can take a long time, 6 months or even more, to recover from this surgery. But women who have had this surgery can lead happy and productive lives. With practice and patience, they can also have sexual desire, pleasure, and orgasm. Ask your doctor to explain the details of the surgery he or she recommends. You'll want to know how long you will be in the hospital, how long it could take you to recover, how the surgery will change the way your body works, and what side effects you can expect to have. Radiation therapy Radiation therapy is treatment with high-energy rays (such as x-rays) to kill or shrink cancer cells. The radiation may come from outside the body (external radiation) or from radioactive materials placed directly in the tumor (internal or implant radiation). Side effects of radiation: There are quite a few side effects that could happen as a result of radiation treatment, for example: tiredness upset stomach loose bowels nausea vomiting skin changes (looks and feels like sunburn) dryness or scar tissue in the vagina causing sex to be painful early change of life (menopause) problems with urination weak bones leading to fractures low red blood cell counts (anemia) low white blood cell counts Be sure to talk with your doctor or nurse about any side effects you might have. Often there are medicines or other methods that will help. Because smoking increases the side effects from radiation, if you smoke, you should stop. Chemotherapy Chemotherapy (often called just "chemo") refers to the use of drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth. Once the drugs enter the bloodstream, they spread throughout the body. Sometimes several drugs are given at one time. Chemo can cause side effects. These side effects will depend on the type of drugs given, the amount taken, and how long treatment lasts. Side effects could include the following: upset stomach and vomiting (drugs given at the same time can prevent or reduce nausea and vomiting) loss of appetite short-term hair loss mouth sores increased chance of infection (from low white blood cell counts) bleeding or bruising after minor cuts or injuries (from low blood platelets) shortness of breath (from low red blood cell counts) tiredness early change of life (menopause) loss of ability to become pregnant (infertility) Most of the side effects (except for menopause and infertility) stop when treatment is over. If you have problems with side effects, talk with your doctor or nurse, as there are often ways to help. Giving chemo at the same time as radiation can improve the patient's outlook, but it may cause more side effects. Your health care team will watch for side effects and can give you medicines to help you feel better. Cervical cancer and pregnancy A small number of cervical cancers are found in pregnant women. Most doctors feel that if it is a very early cancer, then it is safe to continue the pregnancy to term. Several weeks after the baby is born, treatment, most likely a hysterectomy, is recommended. If the cancer is at a later stage, then the woman and her doctor must decide whether to continue the pregnancy. If they decide to continue the pregnancy, the baby should be delivered by C-section as soon as it is able to survive outside the womb. More advanced cancers should be treated right away. << Return to Types Cancer