Cervical Cancer

Cervical cancer begins when healthy cells in the cervix change and become cancerous (malignant). The cervix is the lower part of the uterus, a pear-shaped organ where a fetus grows during pregnancy. It connects the uterus to the vagina. In the United States, an estimated 14,000 women will receive a cervical cancer diagnosis each year. However, cervical pre-cancers are diagnosed far more often than invasive cervical cancer.

Most frequently seen between the ages of 35 and 44, this type of cancer rarely develops in women younger than 20. Many older women don’t realize they are still at risk of developing cervical cancer as they age. More than 20% of cervical cancers are found in women over 65. However, these cancers rarely occur in women who have been getting regular tests to screen for cervical cancer before they were 65.

Cells on the cervix do not suddenly change into cancer overnight, rather they gradually develop pre-cancerous changes that have the potential to develop into cancer later. These pre-cancerous cells can usually be detected by a Pap test and treated to prevent any cancer from developing. It is advised that women begin having annual Pap tests at age 21 or when they first become sexually active.

Risk Factors & Symptoms

Infection with human papillomavirus (HPV) can cause cervical cancer, and the virus is found in over 99% of cervical cancers. HPV is the most common sexually transmitted infection (STI) in the United States, with about 43 million infections each year.

There are more than 100 different strains of HPV. HPV16 and HPV18 cause the most cervical cancers in the United States. People are exposed to the HPV virus through sexual activity. For most, the virus clears up on its own. If it doesn’t, cancer may develop years later. There is no way to predict who will develop cervical cancer after exposure.

Risk factors for cancer from HPV infections include:

Becoming sexually active at a younger age.
Having multiple sexual partners.
Having unprotected sex.
Having a weakened immune system from HIV (the virus that causes AIDS), or from medications that suppress the immune system.
Not getting the HPV vaccine.

Other risk factors can include:

Smoking cigarettes: Women who smoke are twice as likely to develop cervical cancer compared with those who don’t.
Exposure to diethylstilbestrol (DES) before birth: This medication (later found to be ineffective) was prescribed to pregnant women between 1940 and 1971 to prevent miscarriage. Daughters exposed to DES in their mother’s womb are at higher risk of developing certain cancers including cervical cancer not related to HPV.
Long-term use of oral birth control: There is an increased risk for women who take oral contraceptives over a long period of time. However, stopping birth control may help decrease your risk.

Symptoms can include:

Pain during sexual intercourse and/or vaginal bleeding afterwards.
Vaginal bleeding between periods or after menopause.
Menstrual bleeding that is heavier and lasts longer than usual.
Watery, bloody vaginal discharge that may be heavier and have a foul odor.
Persistent pelvic pain and/or back pain.

Recommended screenings for cervical cancer include:

Pap test: This test detects abnormal or irregular cells in your cervix.
HPV test: This test detects the high-risk types of HPV infection that are most likely to cause cervical cancer.
Combination: Your healthcare provider may suggest a combination Pap test/HPV test, or what is called co-testing. This may be an option for women over 30.

Many cervical cancers or precancerous cervical conditions are diagnosed following routine screening through an HPV test or pap test or after symptoms have begun to appear. If your physician suspects you may have cervical cancer or a condition that could lead to cancer, they may run a series of tests to confirm your diagnosis. This may include a colposcopy or a cervical biopsy.

While your cervical cancer may have been diagnosed by your primary care physician or gynecologist, Southern Cancer Center’s team of qualified cancer care experts will help you through the treatment process. Your cervical cancer care team may include a gynecologic oncologist, a radiation oncologist, and a medical oncologist.

A gynecologic oncologist specializes in cancers of the female reproductive Your gynecologic oncologist may perform surgery to treat your cancer but can also prescribe chemotherapy or other medicines.
A medical oncologist is a physician who specializes in treating cancer with medicine, like chemotherapy, targeted drug therapy, or immunotherapy.
A radiation oncologist specializes in treating cancer with radiation This treatment uses high-energy rays to eliminate cancer cells.

Your care team may also include other clinical professionals, such as oncology nurses, social workers, pharmacists, genetic counselors, and dietitians. These clinicians all work together to develop the treatment path that is right for you.

Treatment for cervical cancer is different for each patient. Your team will work with you to develop a plan tailored to your cancer and your goals for your health. When you meet with your cancer care team, ask any questions you feel will better help you understand your situation and your options. Writing down your questions before your appointment and bringing something to take notes with may be helpful.

Here are a few questions that may help you gain a better understanding of your options:

If I have been diagnosed with a pre-cancerous cervical condition, what does that mean? What are the chances of this condition developing into cervical cancer, and what steps can we take to prevent that?
What is the stage of my cervical cancer, and what does that mean for my treatment options?
What are the risks and side effects of my treatment options? Are these side effects treatable?
Will treatment affect my ability to become pregnant in the future?
How long will treatment last, and how will it affect my daily activities?
Is the goal of this treatment to eliminate my cancer, manage symptoms, or both?
If my cancer is eliminated, what is the chance of recurrence? If my cancer does return, what would our next steps be?

Cervical Cancer Staging

After you receive your cervical cancer diagnosis, your physician will determine the stage of your cancer to help guide your treatment plan. To do this, your physician will look at the extent of the primary tumor, any spread to nearby lymph nodes, and whether the cancer has spread to other parts of the body.

Cervical cancer is staged using the FIGO (International Federation of Gynecology and Obstetrics) staging system. This identifies the clinical stage of the cancer, which is based on a physical exam, biopsies, imaging tests, and sometimes additional testing such as cystoscopy and proctoscopy.

Stage I

Cervical cancers in stage I have grown from the surface of the cervix into the deeper tissues of the cervix but have not spread to nearby lymph nodes or other parts of the body.

Stage IA cancers are very small and can only be seen under a
Stage IB cancers range in size and have spread more than 5mm into the tissue of the cervix but have not spread outside of the cervix.

Stage II

Stage II cervical cancers have spread through the cervix and the uterus but have not spread into the walls of the pelvis or the lower part of the vagina.

Stage IIA cancers have not spread into the tissues next to the cervix (parametria).
Stage IIB cancers have spread into the

Stage III

Cervical cancers in this stage have spread to the walls of the pelvis or the lower part of the vagina. The cancer may have spread to nearby lymph nodes but has not spread to other parts of the body.

Stage IIIA cancers have spread to the lower part of the vagina but have not spread to the walls of the pelvis or nearby lymph nodes.
Stage IIIB cancers have spread into the walls of the pelvis and/or are blocking the tubes that carry urine from the kidneys to the bladder.
Stage IIIC cancers have spread to nearby lymph Tumors in this stage can be any size.

Stage IV

Cervical cancer has spread into the bladder, rectum, or distant parts of the body.

Stage IVA cancer has spread to the bladder or It may also be growing out of the pelvis.
Stage IVB cancer has spread to organs outside of the pelvic

Cervical Cancer Treatment

Your cancer care team at Southern Cancer Center will work with you to develop a treatment plan that best fits your cancer and overall needs. The treatment your physician recommends may depend on a variety of factors, including the stage of your cancer, any potential side effects, and your personal preferences. It’s important to speak to your physician about your needs, goals for your health and lifestyle, and any other concerns you may have about treatment.

Surgery

Some women with cervical cancer may have surgery to remove the tumor. The type of surgery recommended by your physician will depend on where in your body your cancer is located. Surgical procedures to treat cervical cancer include:

Conization: Your surgeon will use a scalpel to remove a cone-shaped piece of tissue from the cervix. This may be used to diagnose cervical cancer but can also be used to remove cervical cancer that can only be seen with a microscope.
Hysterectomy: If you have been diagnosed with invasive cervical cancer, a hysterectomy may be recommended. A simple hysterectomy removes the uterus, while a radical hysterectomy also removes the tissues next to the uterus, the cervix, and the upper area of the vagina next to the cervix. Your surgeon may also perform a modified radical hysterectomy, which removes less of the vagina and tissues next to the uterus.
Trachelectomy: This surgery removes the cervix and upper part of the vagina without removing the body of the Nearby lymph nodes are also removed. Some women are able to carry a pregnancy to term after this surgery.
Bilateral salpingo-oophorectomy: This surgery removes the ovaries and the fallopian tubes if the cancer has spread to those areas.
Exenteration: While not commonly recommended, this surgery may be used to treat recurrent cervical cancer. This procedure removes the uterus, vagina, lower colon, rectum, or bladder if the cancer has spread to those areas following radiation therapy.

Chemotherapy

Chemotherapy uses anti-cancer drugs that travel through the bloodstream to reach cancer cells wherever they are in the body. While chemotherapy is not always used to treat cervical cancer, it may be used in combination with radiation therapy to help the radiation work more effectively. Chemotherapy can also be used to treat cancer that has spread to other parts of the body or for cancer that has come back after treatment.

To treat cervical cancer, chemotherapy is usually given intravenously. The medicine is either directly injected into a vein or given through a tube temporarily inserted into a large vein. Chemo is typically given in cycles of one to three weeks, followed by a rest period. The schedule will vary depending on the type of drug used.

Radiation Therapy

Radiation therapy treats cancer by using high energy rays to target and eliminate cancer cells. There are two main types of radiation therapy:

External radiation therapy uses a machine to deliver radiation to the area of the body affected by cancer.
Internal radiation therapy, also called brachytherapy, places sealed radioactive substances directly into or near the cancer.

Both types of radiation therapy can be used to treat cervical cancer. Radiation therapy can also be used to treat symptoms and improve quality of life in patients with advanced cervical cancer.

Targeted Therapy

Targeted therapy uses medicine to target cancer cells and stop or slow their growth. These medicines target the proteins that cause cervical cancer cells to grow and spread. Targeted drugs for cervical cancer include:

Bevacizumab, which targets the protein that helps tumors form new blood This can be used to treat advanced cervical cancer and is often initially used alongside chemotherapy.
Tisotumab vedotin, which targets tissue-factor protein on cancer cells and is used with chemotherapy. This drug attaches to the protein and directs chemotherapy drugs directly to the cancer cell. It may be used to treat cervical cancer that has spread or come back after

Immunotherapy

Immunotherapy uses medicine to boost your immune system so it can recognize and target cancer cells. For example, the immunotherapy drug pembrolizumab (Keytruda) is used to treat cervical cancer that has spread or come back after chemotherapy. It may also be used in combination with chemotherapy and with the targeted therapy drug bevacizumab.

It is important to feel confident in your diagnosis and the physician leading your treatment. The physicians at Southern Cancer Center provide second opinions for all types of cancer diagnoses and treatment plans. To schedule a second opinion, please call our office to make an appointment with one of our medical oncologists.