Cervical cancer starts in a woman's cervix, which is the lower, narrow part of the uterus. The uterus holds the growing fetus during pregnancy. The cervix connects the lower part of the uterus to the vagina and, with the vagina, forms the birth canal.
Cervical cancer develops when normal cells on the surface of the cervix begin to change, grow uncontrollably, and eventually form a mass of cells called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous).
At first, the changes in a cell are simply abnormal, not cancerous. Researchers believe, however, that some of these abnormal changes mark the first step in a series of slow changes that can lead to cancer. Some of the abnormal cells go away without treatment, but others begin to become cancerous. This phase of the disease is called dysplasia (an abnormal growth of cells). The precancerous tissue needs to be removed to keep cancer from developing. Often, the precancerous tissue can be removed or destroyed without harming healthy tissue, but in some cases, a hysterectomy (removal of the uterus and cervix) is needed to prevent cervical cancer. Treatment of a lesion (a precancerous area) depends on the following factors:
How big the lesion is, and what type of changes have occurred in the cells
If the woman wants to have children in the future
The woman's age
The woman's general health
The preference of the woman and her doctor
If the precancerous cells change into true cancer cells and spread deeper into the cervix or to other tissues and organs, the disease is then called cervical cancer.
There are two main types of cervical cancer, named for the type of cell where the cancer started.
Squamous cell carcinoma, which makes up about 80% to 90% of all cervical cancers
Adenocarcinoma, which makes up 10% to 20% of all cervical cancers
In addition, there are a few other rare types of cervical cancer.
Statistics
In 2008, an estimated 11,070 women will be diagnosed with cervical cancer in the United States. It is estimated that 3,870 deaths from the disease will occur this year. The number of new cases of cervical cancer is decreasing as screening with the Pap test (see Prevention) becomes more prevalent. The number of cervical cancer deaths continues to decrease each year.
The one-year relative survival rate (percentage of patients who survive at least one year after the cancer is detected, excluding those who die from other diseases) of women with cervical cancer is 88%. The five-year relative survival rate (percentage of patients who survive at least five years after the cancer is detected, excluding those who die from other diseases) for all stages of cervical cancer is 72%. When detected at an early stage, invasive cervical cancer has a five-year relative survival rate of 92%.
Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a woman how long she will live with cervical cancer. Because the survival statistics are measured in five-year (or sometimes one-year) intervals, they may not represent advances made in the treatment or diagnosis of this cancer.
Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2008.
A risk factor is anything that increases a person's chance of developing cancer. There are risk factors that can be controlled, such as smoking, and risk factors that cannot be controlled, such as age and family history. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and communicating them to your doctor may help you make more informed lifestyle and health-care choices.
The following factors can raise a woman's risk of developing cervical cancer:
Human papillomavirus (HPV) infection. The most important risk factor for cervical cancer is infection with HPV. HPV is passed from one person to another during sexual intercourse. Factors that raise the risk of being infected with HPV include becoming sexually active at an early age, having many sexual partners (or having sex with a man who has had many partners), and/or having sex with a man who has penile warts.
Human immunodeficiency virus (HIV) infection. Infection with HIV, the virus that causes acquired immune deficiency syndrome (AIDS), is a risk factor for cervical cancer. When a woman is infected with HIV, her immune system is less able to fight off early cancers. Women whose immune systems have been suppressed by corticosteroid medications, kidney transplantations, or treatments for other types of cancers or AIDS are also at greater risk.
Herpes. Women who have genital herpes are at greater risk of developing cervical cancer.
Smoking. Women who smoke are about twice as likely to develop cervical cancer as women who do not smoke.
Age. Girls younger than 15 rarely develop cervical cancer. The risk goes up between the late teens and mid-30s. Women over 40 remain at risk and need to continue having regular Pap test screenings.
Ethnicity. Cervical cancer is more common among black women, Hispanic women, and American Indian women.
Exposure to diethylstilbestrol (DES). Women whose mothers were given this drug during pregnancy to prevent miscarriage are at increased risk for cervical cancer. DES was given for this purpose from about 1940 to 1970.
Most cervical cancers can be prevented by preventing precancers and having regular Pap tests. Preventing precancers means controlling these risk factors.
Delaying first sexual intercourse until the late teens or older
Limiting the number of sex partners
Avoiding sexual intercourse with people who have had many partners
Avoiding sexual intercourse with people who are obviously infected with genital warts or show other symptoms
Having safe sex by using condoms will reduce the risk of HPV infection. Condoms also protect against HIV and AIDS.
Quitting smoking
The Pap test is the most common test for cervical cancer. Researchers have found that combining it with a test to detect HPV provides the most accurate results. In 2003, a U.S. Food and Drug Administration (FDA) panel recommended that Pap tests and HPV tests be used together when screening for cervical cancer in women over the age of 29. The HPV test is already being used as a secondary test in people with Pap test results that indicate abnormal cells are present.
In 2006, a vaccine to prevent cervical cancer was approved by the FDA for girls and women between ages 9 and 26. It prevents infection by the four most common strains (types) of the HPV. The vaccine does not protect people who are already infected with HPV. Doctors still recommend regular Pap tests using the guidelines below for all women. For more information on the HPV vaccine, read the ASCO Expert Corner: HPV Vaccination for Cervical Cancer.
In 2003, the American Cancer Society, American College of Obstetricians and Gynecologists, Association of Reproductive Health Professionals, Society of Gynecologic Oncologists, and the U.S. Preventive Task Force developed screening guidelines with the Pap test for cervical cancer.
All women should begin having yearly Pap tests within three years of beginning vaginal sexual intercourse, but no later than age 21.
Women should be screened annually with a conventional Pap test or every two years with liquid-based tests. Women with three consecutive normal test results can lengthen their screening intervals to every two to three years. Women with specific medical conditions, such as infection with HIV, should be screened more often.
Women over the age of 70 can discontinue screening if their previous three Pap tests were normal and there were no abnormal test results within the previous 10 years. Certain medical conditions, such as HIV infection, are cause for the continuation of routine screening.
Screening after a hysterectomy (removal of the uterus and cervix) is not necessary unless the surgery was done to treat cervical cancer or precancer. Women who have had a hysterectomy without removal of the cervix should continue screening until age 70.
Women with cervical cancer often experience the following symptoms. Sometimes, women with cervical cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor.
Most women do not have any signs or symptoms of a precancer or early stage cervical cancer. Symptoms usually do not appear until the cancer has spread to other tissues and organs.
Any of the following could be signs or symptoms of cervical dysplasia or cancer:
Blood spots or light bleeding between or following periods
Menstrual bleeding that is longer and heavier than usual
Bleeding after intercourse, douching, or a pelvic examination
Pain during sexual intercourse
Bleeding after menopause
Increased vaginal discharge
Any of these six symptoms should be reported to the doctor. If these symptoms appear, it is important to talk with your doctor about them even if they appear to be symptoms of other, less serious conditions. The earlier cancer or precancerous cells are found and treated, the better the chance that the cancer can be cured.
Doctors use many tests to diagnose cancer and determine if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
Age and medical condition
The type of cancer
Severity of symptoms
Previous test results
In addition to a physical examination, the following tests may be used to diagnose cervical cancer:
Pap test. The doctor gently scrapes the outside of the cervix and vagina and takes samples of the cells for testing.
Pelvic examination. In this examination, the doctor feels a woman's uterus, vagina, ovaries, fallopian tubes, cervix, bladder, and rectum to check for any unusual changes. A Pap test is often done at the same time.
If the doctor finds abnormal changes to the cervix during a pelvic examination and a Pap test, the doctor may repeat the Pap test. The doctor may also test for HPV at the same time. Certain strains (kinds) of HPV, such as HPV 16, are seen more often in women with cervical cancer and may help confirm a diagnosis. Many women carry HPV, so HPV testing alone is not an accurate test for cervical cancer. But if the Pap tests show some cellular abnormality, and the HPV test is also positive, the doctor may suggest one or more of the following diagnostic tests:
Colposcopy. The doctor may do a colposcopy to check the cervix for abnormal areas. A special instrument called a colposcope (an instrument that magnifies the cells of the cervix and vagina, similar to a microscope) is used. The colposcope gives the doctor a lighted, magnified view of the tissues of the vagina and the cervix. The colposcope is not inserted into the woman's body and the examination is not painful, can be done in the doctor's office, and has no side effects. It can be done on pregnant women.
Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis.
During a biopsy, the doctor removes a small sample of tissue and sends it to the laboratory. At the laboratory, a pathologist (a doctor who specializes in interpreting laboratory tests and diagnosing disease) will look at the tissue under a microscope to determine whether the cells are cancerous. If the lesion (suspicious area) is small, the doctor may remove all of it during the biopsy. There are several types of biopsies:
One common method uses an instrument to pinch off small pieces of cervical tissue.
Sometimes, the doctor wants to check an area inside the opening of the cervix that cannot be seen during a colposcopy. To do this, the doctor uses a procedure called endocervical curettage (ECC). Using a small, spoon-shaped instrument called a curette, the doctor scrapes a small amount of tissue from inside the cervical opening.
A loop electrosurgical excision procedure (LEEP) uses an electrical current passed through a thin wire hook. The hook removes tissue for examination in the laboratory. A LEEP may also be used to remove a precancer or an early stage cancer.
Conization (a cone biopsy) removes a cone-shaped piece of tissue from the cervix. Conization may be done as treatment to remove precancers or early stage cancers.
The first three procedures are usually done in the doctor's office using a local anesthetic to numb the area. There may be some bleeding and other discharge and, for some women, discomfort similar to menstrual cramps. Conization is done under a general or local anesthetic and may be done in the doctor's office or the hospital.
If the biopsy indicates that cervical cancer is present, the doctor will refer the woman to a gynecologic oncologist, who specializes in treating this type of cancer. The specialist may suggest additional tests to see if the cancer has spread beyond the cervix:
Pelvic examination. The specialist may re-examine the pelvic area while the patient is under anesthetic to see if the cancer has spread to organs near the cervix, including the uterus, vagina, bladder, and rectum.
Cystoscopy. This procedure allows the doctor to view the inside of the bladder and urethra (canal that carries urine from the bladder) with a cystoscope (a thin, flexible tube with a camera). A cystoscopy is used to determine whether cancer has spread to the bladder.
Proctoscopy (also called a sigmoidoscopy). This procedure allows the doctor to view the colon and rectum using a sigmoidoscope (a thin, flexible tube with a camera). A proctoscopy is used to see if the cancer has spread to the rectum.
Laparoscopy. This procedure allows the doctor to view the abdominal area with a laparoscope (a thin, flexible tub with a camera).
X-ray. An x-ray is a picture of the inside of the body. For instance, a chest x-ray can help doctors determine if the cancer has spread to the lungs. An intravenous urography is a type of x-ray that is used to view the kidneys and bladder.
Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient's vein to provide better detail.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body.
Positron emission tomography (PET) scan. In a PET scan, radioactive sugar molecules are injected into the body. Cancer cells absorb sugar more quickly than normal cells, so they light up on the PET scan. PET scans are often used to complement information gathered from the CT scan, MRI, and physical examination.
Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer.
One tool that doctors use to describe the stage is the TNM system. This system uses three criteria to judge the stage of the cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to the rest of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.
TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cervical cancer:
How large is the primary tumor and where is it located? (Tumor, T)
Has the tumor spread to the lymph nodes? (Node, N)
Has the cancer metastasized to other parts of the body? (Metastasis, M)
Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are divided into smaller groups that help describe a patient's condition in more detail. (Roman numerals given are stages used in another widely used staging system from the Federation Internationale de Gynecologie et d' Obstetrique, or FIGO).
TX: The primary tumor cannot be evaluated due to lack of information. More tests may be needed.
T0 (T plus zero): There does not seem to be a primary tumor in the cervix.
Tis: This stage is called carcinoma (cancer) in situ, which means that the cancer is found only in the layer of cells lining the cervix and has not invaded deeper tissues of the cervix.
T1/FIGO I: The carcinoma is found only in the cervix.
T1a/FIGO IA: Invasive carcinoma was diagnosed only by microscopy (viewing cervical tissue/cells under a microscope). Note: Any tumor found macroscopically (large enough to be recognized by imaging tests or to be seen/felt by the doctor) is referred to as stage T1b or FIGO IB.
T1a1/FIGO IA1: There is a cancerous area of 3.0 millimeters (mm) or smaller in depth, and 7.0 mm or smaller in terms of how far it has spread horizontally.
T1a2/FIGO IA2: There is a cancerous area larger than 3.0 mm but not larger than 5.0 mm, and a horizontal spread of 7.0 mm or smaller.
T1b/FIGO IB: In this stage, there is a lesion visible to the doctor, and the cancer is just found in the cervix, or there is a microscopic lesion (one able to be seen using a microscope) that is greater in size than a stage T1a2/FIGO IA2 tumor. The cancer may have been found because of a physical examination, laparoscopy, or other imaging methods.
T1b1/FIGO IB1: The tumor is 4.0 centimeters (cm) or smaller.
T1b2/FIGO IB2: The tumor is larger than 4.0 cm.
T2/FIGO II: The cervical carcinoma has grown beyond the uterus but not to the pelvic wall or to the lower third of the vagina.
T2a/FIGO IIA: The tumor has not invaded the tissue next to the cervix, also called the parametrial area.
T2b/FIGO IIB: The tumor has invaded the tissue next to the cervix, also called the parametrial area.
T3/FIGO III: The tumor extends to the pelvic wall, and/or involves the lower third of the vagina, and/or causes hydronephrosis (swelling of the kidney), nonfunctioning kidney, or blockage of the ureters (tubes that connect the kidneys to the bladder).
T3a/FIGO IIIA: The tumor involves the lower third of the vagina, but it has not grown into the pelvic wall.
T3b/FIGO IIIB: The tumor has grown into the pelvic wall and/or causes hydronephrosis or nonfunctioning kidneys.
T4/FIGO IVA: The tumor has invaded the mucosa (lining) of the bladder or rectum and grown beyond the true pelvis.
Node. The "N" in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the site of the cancer are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.
NX: The regional lymph nodes (lymph nodes near the cervix) cannot be assessed.
N0 (N plus zero): There is no regional lymph node metastasis.
N1: The tumor has invaded the regional lymph node(s).
Distant metastasis. The "M" in the TNM system indicates whether the cancer has spread to other parts of the body (to areas such as the lungs or the bones).
MX: Distant metastasis cannot be evaluated.
M0 (M plus zero): There is no distant metastasis.
M1: There is distant metastasis.
Cancer stage grouping
Doctors assign the stage of the cancer by combining the T, N, and M classifications.
Stage 0: The tumor is called carcinoma in situ. In other words, the cancer is found only in the first layer of cells lining the cervix, not in the deeper tissues (Tis, N0, M0).
Stage I: The cancer has spread from the cervix lining into the deeper tissue but is still just found in the uterus. It has not spread to lymph nodes or other parts of the body (T1, N0, M0). This stage may be described in more detail.
Stage IA: T1a, N0, M0
Stage IA1: T1a1, N0, M0
Stage IA2: T1a2, N0, M0
Stage IB: T1b, N0, M0
Stage IB1: T1b1, N0, M0
Stage IB2: T1b2, N0, M0
Stage II: The cancer has spread beyond the cervix to nearby areas, such as the vagina or tissue near the cervix, but it is still inside the pelvic area. It has not spread to lymph nodes or other parts of the body (T2, N0, M0). This stage may be described in more detail.
Stage IIA: T2a, N0, M0
Stage IIB: T2b, N0, M0
Stage III: The cancer has spread outside of the cervix and vagina but not to the lymph nodes or other parts of the body (T3, N0, M0).
Stage IIIa: The cancer has spread to the lower part of the vagina but not to other parts of the body (T3a, N0, M0).
Stage IIIb: The cancer may have spread as far as the pelvic wall and to lymph nodes but not to other parts of the body (T1, T2, or T3a; N1, M0). If it has spread to the pelvic wall, it is called stage IIIb regardless of whether there is cancer in the lymph nodes (T3b, any N, M0).
Stage IVa: The cancer has spread to the bladder or rectum and may or may not have spread to the lymph nodes, but it has not spread to other parts of the body (T4, any N, M0).
Stage IVb: The cancer has spread to other parts of the body (any T, any N, M1).
Recurrent cervical cancer
Recurrent disease means that the cancer has recurred (come back) after it has been treated. It may come back in the cervix or in another place.
Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Sixth Edition (2002) published by Springer-Verlag New York, www.springer-ny.com.
The treatment of cervical cancer depends on the size and location of the tumor, whether the cancer has spread, and the woman's overall health. In many cases, a team of doctors will work with the woman to determine the best treatment plan.
The most common treatments for cervical cancer are surgery, radiation therapy, and chemotherapy. The type of treatment used depends on the stage of the disease, the size of the tumor, the woman's age, her health, and her desire to have children. A woman who is pregnant should talk with her doctor about how treatments could affect both her and the unborn child, and whether treatment can be delayed until after the baby is born.
Radiation therapy alone or surgery is generally used for a small tumor. Chemoradiation (a combination of chemotherapy and radiation therapy) is generally used for women with invasive cervical cancer. Surgery and radiation therapy are both called local therapies because they affect only the area around the cancer site. Chemotherapy is a systemic therapy because it affects the entire body.
Surgery
In surgery, the doctor operates on the patient to remove the cancerous tissue. For cervical cancer that has not spread beyond the cervix, these procedures are often used:
Conization uses the same procedure as a cone biopsy (see Diagnosis) to remove all of the abnormal tissue. It can be used to remove microinvasive cervical cancer.
LEEP uses an electrical current passed through a thin wire hook. The hook removes the tissue. It can be used to remove microinvasive cervical cancer.
A hysterectomy removes the uterus and cervix. Hysterectomy can be either a simple hysterectomy, which involves removal of the uterus and cervix, or a radical hysterectomy which involves a removal of the uterus, cervix, upper vagina, and the tissue around the cervix. In addition, a radical hysterectomy includes an extensive pelvic lymph node dissection (removal of the lymph nodes). If needed, bilateral salpingo-oophorectomy (the removal of both fallopian tubes and both ovaries) is done at the same time as the hysterectomy.
Radical trachelectomy (surgery to remove the cervix that leaves the uterus intact) with pelvic lymph node dissection may be used for young patients who desire fertility preservation (to have children in the future). This procedure has gained acceptance as an alternative to a hysterectomy.
For cervical cancer that has spread beyond the cervix, one of these procedures may be used:
Radical hysterectomy removes the cervix, uterus, part of the vagina, and the nearby lymph nodes.
Exenteration removes the uterus, vagina, lower colon, rectum, or bladder if cervical cancer has spread to these organs following radiation therapy.
Complications or side effects from surgery vary depending on the extent of the procedure. Occasionally, patients experience significant bleeding, infection, or damage to the urinary and intestinal systems.
If extensive surgical procedures have affected sexual function, other surgical procedures can construct an artificial vagina. Because these surgical procedures can affect a woman's sexual health, women should talk with their doctor about their symptoms in detail. The doctor may be able to help reduce the side effects of surgery.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy travels through the bloodstream to tumor cells throughout the body. The goal of chemotherapy can be to destroy cancer remaining after surgery, slow the tumor's growth, or reduce side effects.
Although chemotherapy can be given orally (by mouth), most drugs used to treat cervical cancer are given intravenously (IV). IV chemotherapy is either injected directly into a vein or through a thin tube called a catheter, a tube temporarily put into a large vein to make injections easier.
Because chemotherapy affects normal cells as well as cancer cells, many people experience side effects from treatment. Side effects depend on the drug used and the dosage amount. Common side effects include nausea and vomiting, loss of appetite, diarrhea, fatigue, low blood cell count, bleeding or bruising after minor cuts or injuries, numbness and tingling in the hands or feet, headaches, hair loss, and darkening of the skin and fingernails. Side effects usually go away when treatment is completed.
Other potential longer-term side effects include the inability to become pregnant and premature menopause. Rarely, specific drugs may cause some hearing loss. Others may cause kidney damage. Patients may be given extra fluid intravenously for kidney protection.
The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications you've been prescribed, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions through Cancer.Net's Drug Information Resources, which provides links to searchable drug databases.
Radiation therapy
Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. Radiation therapy may be given alone or before surgery to shrink the tumor. Some women may be treated with a combination of radiation therapy and chemotherapy.
The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy.
Side effects from radiation therapy depend on the dosage and the area of the body being treated. Common side effects include tiredness, mild skin reactions (such as dry or reddened skin at the site of radiation treatment), loss of appetite, nausea, vomiting, urinary discomfort, and diarrhea. Side effects of internal radiation therapy may include abdominal pain and bowel obstruction. Most side effects usually go away soon after treatment is finished.
Sometimes, doctors advise their patients not to have sexual intercourse during radiation therapy. Women may resume normal sexual activity within a few weeks after treatment if they feel ready.
For more information about radiation therapy, see the American Society for Therapeutic Radiology and Oncology's pamphlet, Radiation Therapy for Gynecologic Cancers.
Advanced cervical cancer
Cancer has spread beyond the cervix may be called advanced cervical cancer. Palliative treatment with radiation therapy may be given to relieve pain. Chemotherapy and surgery may be used to treat or remove newly affected areas both within the pelvic area and in other parts of the body. The doctor may also suggest entering a clinical trial, which is a research study to test new treatments.
Doctors and scientists are always looking for better ways to treat women with cervical cancer. A clinical trial is a way to test a new treatment in order to prove that it is safe, effective, and possibly better than a standard treatment. Women who participate in clinical trials are among the first to receive new treatments, such as new chemotherapy, before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.
Women decide to participate in clinical trials for many reasons. For some women, a clinical trial is the best treatment option available. Because standard treatments are not perfect, women are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other women volunteer for clinical trials because they know that finding new drugs and other therapies is the only way to make progress in treating cervical cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with cervical cancer.
To join a clinical trial, women must complete a learning process known as informed consent. During informed consent, the doctor should list all of the woman's options, so she understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials.
Cancer and cancer treatment can cause a variety of side effects; some are easily controlled and others require specialized care. Below are some of the side effects that are more common to cervical cancer and its treatments. For more detailed information on managing these and other side effects of cancer and cancer treatment, visit the Cancer.Net Managing Side Effects section.
Anemia. Anemia is common in people with cancer, especially those receiving chemotherapy. Anemia is an abnormally low level of red blood cells (RBCs). RBCs contain hemoglobin (an iron protein) that carries oxygen to all parts of the body. If the level of RBCs is too low, parts of the body do not get enough oxygen and cannot work properly. Most people with anemia feel tired or weak. The fatigue (tiredness) associated with anemia can seriously affect quality of life and make it more difficult for patients to cope with cancer and treatment side effects.
Appetite loss. Appetite changes are common with cancer and cancer treatment, including chemotherapy. Individuals with a poor appetite or appetite loss may eat less than usual, not feel hungry at all, or feel full after eating only a small amount. Ongoing appetite loss can lead to weight loss, malnutrition, and loss of muscle mass and strength. The combination of weight loss and loss of muscle mass, also called wasting, is referred to as cachexia.
Blocked intestine (gastrointestinal [GI] obstruction). In some types of cancer (such as bile duct, cervical, colorectal, and ovarian cancers), the tumor can grow so it blocks the path that food and fluids take when they travel through the stomach, intestines, or GI tract (bowels). Normally, the intestines move food and fluids through the GI tract, and enzymes, fluid, and electrolytes help the body to absorb nutrients. In a GI obstruction, the food and fluids can't move through the system, and the normal contractions the intestines make to move the food (called peristalsis) can cause intense pain. If left untreated, a GI obstruction is a very serious and even life-threatening problem. Patients with a GI obstruction may experience nausea and/or vomiting, pain from the obstruction, and cramping from the movement of the intestine as it tries to move food along.
Diarrhea. Diarrhea is frequent, loose, or watery bowel movements. It is a common side effect of some chemotherapy or of radiation therapy to the pelvis, such as in women with uterine, cervical, or ovarian cancers. It can also be caused by certain types of cancer, such as pancreatic cancer.
Fluid in the arms or legs (lymphedema). Lymphedema is the abnormal buildup of fluid in the lymphatic system, the series of channels and nodes (small sacs that hold fluid) that carries lymph (fluid) through the body and helps fight infection and disease. When cancer metastasizes, cancer cells first move to the lymph nodes and then to other parts of the body. Lymphedema can develop immediately after cancer surgery or radiation therapy, or it can develop months or years later. The most common causes of lymphedema includes surgery to remove the lymph nodes; radiation therapy to the lymph nodes; metastatic cancer; bacterial or fungal infection; injury to the lymph nodes; and other diseases involving the lymph system.
Fatigue. Fatigue is extreme exhaustion or tiredness and is the most common problem that people with cancer experience. More than half of patients experience fatigue during chemotherapy or radiation therapy, and up to 70% of patients with advanced cancer experience fatigue. Patients who feel fatigue often say that even a small effort, such as walking across a room, can seem like too much. Fatigue can seriously impact family and other daily activities, can make patients avoid or skip cancer treatments, and may even impact the will to live.
Hair loss (alopecia). A potential side effect of radiation therapy and chemotherapy is hair loss. Radiation therapy and chemotherapy cause hair loss by damaging the hair follicles responsible for hair growth. Hair loss may occur throughout the body, including the head, face, arms, legs, underarms, and pubic area. The hair may fall out entirely, gradually, or in sections. In some cases, the hair will simply thin-sometimes unnoticeably-and may become duller and dryer. Losing one's hair can be a psychologically and emotionally challenging experience and can affect a patient's self-image and quality of life. However, the hair loss is usually temporary, and the hair often grows back.
Infection. An infection occurs when harmful bacteria, viruses, or fungi (such as yeast) invade the body and the immune system is not able to destroy them quickly enough. Patients with cancer are more likely to develop infections because both cancer and cancer treatments (particularly chemotherapy and radiation therapy to the bones or extensive areas of the body) can weaken the immune system. Symptoms of infection include fever (temperature of 100.5°F or higher); chills or sweating; sore throat or sores in the mouth; abdominal pain; pain or burning when urinating or frequent urination; diarrhea or sores around the anus; cough or breathlessness; redness, swelling, or pain, particularly around a cut or wound; and unusual vaginal discharge or itching.
Menopausal symptoms in women. Menopausal symptoms depend on the type of therapy and may include hot flashes; night sweats; vaginal dryness, itching, irritation, or discharge; painful sexual intercourse; difficulties with bladder control; depressed feelings; and insomnia.
Mouth sores (mucositis). Mucositis is an inflammation of the inside of the mouth and throat, leading to painful ulcers and mouth sores. It occurs in up to 40% of patients receiving chemotherapy. Mucositis can be caused by chemotherapy directly, the reduced immunity brought on by chemotherapy, or radiation treatment to the head and neck area.
Nausea and vomiting. Vomiting, also called emesis or throwing up, is the act of expelling the contents of the stomach through the mouth. It is a natural way for the body to rid itself of harmful substances. Nausea is the urge to vomit. Nausea and vomiting are common in patients receiving chemotherapy for cancer and in some patients receiving radiation therapy. Many patients with cancer say they fear nausea and vomiting more than any other side effects of treatment, but nausea and vomiting are preventable. When it is minor and treated quickly, nausea and vomiting can be quite uncomfortable but cause no serious problems. Persistent vomiting can cause dehydration, electrolyte imbalance, weight loss, depression, and avoidance of chemotherapy.
Pain. Depending on the stage of disease, 30% to 75% of all patients experience pain from cancer. About 85% to 95% of cancer pain can be treated successfully. Pain can make other aspects of cancer seem worse, such as fatigue, weakness, sleep disturbance, and confusion. Pain can come from the tumor itself or may be a result of cancer treatment. Pain from a tumor can be a result of the tumor growing and spreading to the bones or other organs and putting pressure on and damaging nerves. Pain from surgery is normal and may persist for months or years. It can also develop months or years after treatment, especially after radiation therapy to the chest, breast, or spinal cord. Some chemotherapy can cause pain and numbness in the fingers and toes. Usually this pain goes away when treatment is finished, but sometimes the damage can be permanent.
Sexual dysfunction. Sexual dysfunction is common in all people, affecting up to 43% of women and 31% of men. It may be even more common in patients with cancer, as a result of treatments, the tumor, or stress. Many people, with or without cancer, find it intimidating to discuss sexual problems with their doctors. Sexual problems are most commonly caused by body changes from cancer surgery, chemotherapy or radiation therapy, hormone changes, fatigue, pain, nausea and/or vomiting, medications that reduce libido (desire for sex), fear of recurrence, stress, depression, and anxiety. Symptoms of sexual dysfunction generally fall into four categories: desire disorders, arousal disorders, orgasmic disorders, and pain disorders.
Skin problems. Skin contains many nerves, making skin problems painful. Skin protects the inside of the body from infection, and skin problems can often lead to other serious problems. Because the skin is on the outside of the body and visible to others, many patients have difficulty coping with skin problems. As with other side effects, prevention or early treatment is best. In other cases, treatment and wound care can often improve pain and quality of life. Skin problems can have many different causes, including chemotherapy leaking out of the intravenous (IV) tube or burned skin caused by radiation therapy.
After treatment for cervical cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests, such as a pelvic examination and Pap test, to monitor your recovery in the coming months and years.
Women recovering from cervical cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. For women who smoke, quitting smoking can help recovery and reduce the risk of cancer recurrence. Learn more about Quitting Smoking. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about Healthy Living After Cancer.
Research for cervical cancer is ongoing. The following advances may still be under investigation in clinical trials and may not be approved or available at this time. Always discuss all diagnostic and treatment options with your doctor.
Improved detection and screening methods. Because cervical cancer is highly treatable when detected early, researchers are developing better ways to detect cervical cancer. For instances, fluorescent spectroscopy uses fluorescent light to detect changes in precancerous cervix cells.
Improved Pap test methods. These improvements have made it easier for doctors to find cancerous cells. Traditional Pap tests can be hard to read, because cells can be dried out, be covered with mucus or blood, or clump together on the slide.
The liquid-based cytology test (often referred to as ThinPrep or SurePath) transfers a thin layer of cells onto a slide after removing blood or mucus from the sample. Because the sample is preserved, other tests (such as the HPV test mentioned in the Prevention section) can be done at the same time.
Computer screening (often called AutoPap or Focal Point) uses a computer to scan the sample for abnormal cells.
New HPV vaccines. For women who already have cervical cancer, a therapeutic vaccine is being developed. These vaccines help "train" the immune system to recognize cervical cancer cells and destroy them. This type of vaccine is an example of a biologic therapy (also called immunotherapy).
Fertility preserving surgery. There is continued interest in refining the surgical techniques and finding out which patients with cervical cancer can be treated successfully without loss of fertility potential.
Anti-angiogenesis inhibitors. Drugs that block the action of a protein called vascular endothelial growth factor (VEGF) are being tested in women with cervical cancer. VEGF promotes angiogenesis (the formation of new blood vessels), which is necessary for tumor growth and metastasis.
Combination therapy. Some clinical trials are exploring various combinations of biologic therapy, radiation therapy, and chemotherapy.
Regular communication with your doctor is important in making informed decisions about your health care. Consider asking the following questions of your doctor:
Prevention/Before a diagnosis of cervical cancer
Should I receive the HPV vaccine?
Should I be tested for an HPV infection? What does this mean?
How often should I have Pap tests?
Is cervical cancer a sexually transmitted disease?
After a diagnosis of cervical cancer or precancer
What is my diagnosis, and what does it mean?
What are my options for treatment?
What are the side effects of this treatment, both in the short term and in the long term?
Will this treatment affect my ability to become pregnant in the future? Should I consult a fertility expert before starting treatment?
Should I stop having sex during treatment?
What can I do to stay as healthy as possible during and after treatment?
What follow-up tests will I need, and how often will I need them?
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