Cervical Cancer

Basic Information

Fortunately, because of early detection with Pap smears, cervical cancer is no longer the most common cause of cancer deaths among women. It is still a common cancer with 60,000 new cases diagnosed in the U.S. annually but because most are diagnosed in the early stages, it is extremely treatable. The mortality rate is only 26 cases per 100,000. But it is a leading cause of death among women in developing countries.

In the U.S. Hispanics are at greatest risk, followed by African-Americans, then whites. Other risk factors include:

• smoking
• early age of sexual intercourse (under 18)
• multiple sexual partners
• HPV (human papilloma virus)
• use of oral contraceptives
• early pregnancy
• recurring bacterial infections, including sexually transmitted diseases
• nutritional deficiencies

The average age for invasive cancer is 50 years.

Symptoms

In its early stages cervical cancer usually has no symptoms. But when the cancer has invaded nearby tissue, the most common symptoms are bleeding after intercourse or between periods, or heavy menstrual flow.

Other symptoms may include:

• abdominal pain
• unexplained weight loss
• anorexia or loss of appetite
• increased vaginal discharge

Late symptoms, after the cancer has spread, include leg and back pain, urinary frequency with blood in the urine and bowel changes.

Diagnosis/Treatment

The old saying "an ounce of prevention is worth a pound of cure" is truly applicable to this disease process since Pap smears are 95% accurate in detecting cervical cancer in its early stages.

Meticulous and ongoing GYN care is an absolute must. You should discuss with your health care provider how often pelvic and Pap smear exams should be done. It is usually recommended that sexually active women over 20 have these exams done annually, especially if you fit into a high risk group.

Initial testing is done with the Pap smear and if the Pap smear is abnormal, biopsies of the cervix are made during a colposcopy. A colposcopy is a magnification of the cervix where biopsies can be easily obtained. If the colposcopy biopsy is inconclusive, a cone biopsy may be ordered. This is where a cone-shaped sample of tissue is removed to look for cancer.

Cervical cancer can be diagnosed at various stages but early detection is important -- otherwise the cancer can spread, causing metastasis and even death.

It cannot be stressed enough that smoking is one of the major factors for risk of cervical cancer. Women who smoke are four times likelier to develop the disease than non-smokers and, amazingly, women who only smoke 100 cigarettes in their lifetime double their risk for cervical cancer.

Surgery, radiation and chemotherapy are utilized, together or separately, in the treatment of cervical cancer. The treatment decided upon usually depends on the stage of the cancer. Staging a cancer means finding out if and where a cancer has spread, i.e.:

STAGE	LOCATION
Stage 0	cancer at the site only
Stage I	cancer in cervix only
Stage II	cancer invasion, but not to the lower third of the vagina
Stage III	cancer invasion to the lower third of the vagina
Stage IV	cancer invasion of the bladder and/or rectum

Most patients diagnosed with cervical cancer are treated with surgical therapy or a combination of surgical and radiation therapy.

STAGES	TREATMENT
Stages 0 and I	hysterectomy (surgical removal of uterus) or radiation therapy
Stages II, III and IV	radiation therapy
Advanced stages	chemotherapy (not proven effective in most cases)

Your health care team (health care provider, primary care physician, gynecologist, oncologist) will follow your progress after treatment and make you aware of some of the possible side effects of the therapies listed below:

THERAPY	SIDE EFFECTS
surgical	vaginal discharge
pain	infection urinary discomfort bowel changes
radiation	dry, burning skin diarrhea vomiting
nausea	urinary frequency, burning
chemotherapy	fever vomiting nausea hair loss

If you are diagnosed with cervical cancer you must follow-up with your health care provider after initial treatment to make certain the cancer has not returned. Generally lab work, pelvic exams and repeat Pap smears are done at this stage. Stay active, get plenty of exercise. Your health care provider may recommend a support group for you and a support group for your family to help everyone deal with the strong emotions that build up. Perhaps your health care provider will recommend routine visits by a care giver who can relieve family members and help with practical necessities such as transportation and helping you get exercise. A social worker may be recommended as well to help with rehabilitation.

Remember early detection via annual Pap smear will save you a serious, debilitating illness that could lead to death should you contract cervical cancer. If you feel you are at risk for this disease or exhibit symptoms of it or would like to have prevention information, please contact your health care provider promptly.

In addition, your health care provider will want to check sexual partners of women diagnosed with cervical cancer for condyloma and HPV infection.

Additional Resource(s):

• American Cancer Society 800-ACS-2345
• Cancer Information Service 800-422-6237