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CERVICAL CANCER

Cervical cancer occurs cervical cells develop abnormally and invade other tissues and organs. It may spread to other parts of the body (metastasize) most notably the lungs, liver, bladder, vagina, and rectum. It is a slow-growing cancer, so this provides opportunities for prevention, early detection, and treatment.

Most women diagnosed with precancerous changes are those in their 20’s and 30’s and those diagnosed with cervical cancer is on average on their mid 50s.

Causes of Cervical Cancer

  • Abnormal changes in the cervical tissue usually associated with infection with human papillomavirus (HPV).
  • Early sexual contact, multiple sexual partners, and taking oral contraceptives (birth control pills) increase exposure to HPV thereby increase risk for cervical cancer.
  • Increase in the growth rate of HPV is correlated with cigarette smoking.

Signs and symptoms usually appear in the later more dangerous stages of cancer which may include:

  • Pain
  • Abnormal vaginal bleeding
  • Abnormal vaginal discharge
  • Pelvic pain
  • Kidney failure due to a urinary tract or bowel obstruction

DIAGNOSIS

Early diagnosis is key to treatment and cure. Treatment of precancerous changes is much more likely to be successful than treatment of a full blown invasive cancer.

Papanicolaou Test (Pap Smear) and high risk HPV testing

  • Widespread use is key in early detection.
  • During a Pap Smear, cells from the cervix are obtain and examined for any abnormalities. If abnormalities are found in the Pap Smear, a sample of cervical tissue will be obtained and analyzed (biopsy) to diagnose cancer.

Various diagnostic tools include:

  • Colposcopy
  • Loop electrosurgical excision procedure (LEEP) technique
  • Conization

Precancerous changes

  • Most often called squamous intraepithelial lesion (SIL)
    • Low-grade SIL (LGSIL)
      • Early, subtle changes in the size and shape of cells that form on the surface of the cervix are considered low grade
      • May disappear or develop into a High-grade SIL (HGSIL)
      • Can appear in any age but often occur in women ages 25 to 35 years
    • High-grade SIL (HGSIL)
      • A large number of precancerous cells which involve only cells on the surface of the cervix
      • Can appear in any age but often occur in women ages 30 to 40 years

Invasive cancer

  • Spread of abnormal cells deeper into the cervix and/or to other tissues or organs.
  • Occurs most often in women aged 40 years or older.

If the biopsy results show invasive cancer, a series of tests will be performed which include:

  • A chest X-ray to for lung involvement
  • Blood tests for liver involvement; a CT scan may be necessary if results are not definitive.
  • IVP or a CT scan for urinary tract involvement; the bladder and urethra are evaluated by cystoscopy.
  • Colposcopy for vaginal involvement
  • Procto signoidoscopy and barium enema for rectal involvement
  • Lymph nodes are evaluated by CT scans, MRI scans, or PET scans; the MRI is superior to the CT scan and the PET scan is superior to both.

These tests are used to “stage” the cancer:

  • Cervical cancer is staged from stage 0 (least severe) to stage IV (metastatic disease, the most severe).
  • Staging is based on size and depth of the cancerous lesion, as well as degree of spread
  • Recommended treatment will be based on the cancer staging

 

RECOMMENDED MEDICATIONS

Chemotherapy

  • Shrink cervical cancer and decrease tumor growth
  • May be a stand alone treatment or used with radiation (chemoradiation)
  • May be used to treat cervical cancer that has spread beyond the cervix

 Chemoradiation

  • Improves survival in early-stage cervical cancer

Medicine choices

Common chemotherapy medicines used to treat cervical cancer include:

  • Bevacizumab
  • Carboplatin
  • Cisplatin is the medicine most often used in chemoradiation for cervical cancer
  • Docetaxel
  • Fluorouracil (5-FU)
  • Gemcitabine
  • Ifosfamide
  • Mitomycin
  • Paclitaxel

Dealing with side effects of medicines

Most chemotherapy will cause some side effects, such as nausea, vomiting, and hair loss. Your doctor may prescribe medications to help alleviate these side effects.

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