The Cervix
The cervix is the lower, narrow part of the uterus
(womb). The uterus, a hollow, pear-shaped organ, is located in a woman's
lower abdomen,
between the bladder
and the rectum.
The cervix forms a canal that opens into the vagina,
which leads to the outside of the body.
What Is Cancer?
Cancer
is a group of more than 100 different diseases. They all affect the body's
basic unit, the cell. Cancer occurs when cells become abnormal and divide
without control or order.
Like all other organs of the body, the cervix is made up of many types
of cells. Normally, cells divide to produce more cells only when the body
needs them. This orderly process helps keep us healthy.
If cells keep dividing when new cells are not needed, a mass of tissue
forms. This mass of extra tissue, called a growth or tumor,
can be benign
or malignant.
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Benign tumors are not cancer. They can usually be removed and,
in most cases, they do not come back. Most important, cells from benign
tumors do not spread to other parts of the body. Benign tumors are not a
threat to life. Polyps,
cysts,
and genital warts
are types of benign growths of the cervix.
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Malignant tumors are cancer. Cancer cells can invade and
damage tissues and organs near the tumor. Cancer cells also can break
away from a malignant tumor and enter the lymphatic
system or the bloodstream. This is how cancer of the cervix can
spread to other parts of the body, such as nearby lymph
nodes, the rectum, the bladder, the bones of the spine, and the
lungs. The spread of cancer is called metastasis.
Cancer of the cervix also may be called cervical cancer. Like most
cancers, it is named for the part of the body in which it begins. Cancers
of the cervix also are named for the type of cell in which they begin.
Most cervical cancers are squamous
cell carcinomas. Squamous cells are thin, flat cells that form the
surface of the cervix.
When cancer spreads to another part of the body, the new tumor has the
same kind of abnormal cells and the same name as the original (primary)
cancer. For example, if cervical cancer spreads to the bones, the cancer
cells in the bones are cervical cancer cells. The disease is called
metastatic cervical cancer (it is not bone cancer).
NOTE:Cervical cancer is different from cancer that begins
in other parts of the uterus and requires different treatment. The most
common type of cancer of the uterus begins in the endometrium,
the lining of this organ.
Precancerous Conditions and Cervical Cancer
Cells on the surface of the cervix sometimes appear abnormal but not
cancerous. Scientists believe that some abnormal changes in cells on the
cervix are the first step in a series of slow changes that can lead to
cancer years later. That is, some abnormal changes are precancerous;
they may become cancerous with time.
Over the years, doctors have used different terms to refer to abnormal
changes in the cells on the surface of the cervix. One term now used is
squamous
intraepithelial lesion (SIL). (The word lesion
refers to an area of abnormal tissue; intraepithelial
means that the abnormal cells are present only in the surface layer of
cells.) Changes in these cells can be divided into two categories:
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Low-grade SIL refers to early changes in the size, shape, and
number of cells that form the surface of the cervix. Some low-grade
lesions go away on their own. However, with time, others may grow larger
or become more abnormal, forming a high-grade lesion. Precancerous
low-grade lesions also may be called mild dysplasia
or cervical
intraepithelial neoplasia 1 (CIN 1). Such early changes in the
cervix most often occur in women between the ages of 25 and 35 but can
appear in other age groups as well.
-
High-grade SIL means there are a large number of precancerous
cells; they look very different from normal cells. Like low-grade SIL,
these precancerous changes involve only cells on the surface of the
cervix. The cells will not become cancerous and invade deeper layers of
the cervix for many months, perhaps years. High-grade lesions also may
be called moderate or severe dysplasia,
CIN 2 or 3, or carcinoma
in situ. They develop most often in women between the ages of 30
and 40 but can occur at other ages as well.
If abnormal cells spread deeper into the cervix or to other tissues or
organs, the disease is then called cervical cancer, or invasive
cervical cancer. It occurs most often in women over the age of
40.
Early Detection of Cervical Cancer
If all women had pelvic exams and Pap
tests regularly, most precancerous conditions would be detected
and treated before cancer develops. That way, most invasive cancers could
be prevented. Any invasive cancer that does occur would likely be found at
an early, curable stage.
In a pelvic exam, the doctor checks the uterus, vagina, ovaries,
fallopian
tubes, bladder, and rectum. The doctor feels these organs for any
abnormality in their shape or size. A speculum
is used to widen the vagina so that the doctor can see the upper part of
the vagina and the cervix.
The Pap test is a simple, painless test to detect abnormal cells in and
around the cervix. A woman should have this test when she is not
menstruating; the best time is between 10 and 20 days after the first day
of her menstrual period. For about 2 days before a Pap test, she should
avoid douching
or using spermicidal foams, creams, or jellies or vaginal medicines
(except as directed by a physician), which may wash away or hide any
abnormal cells.
A Pap test can be done in a doctor's office or a health clinic. A
wooden scraper (spatula) and/or a small brush is used to collect a sample
of cells from the cervix and upper vagina. The cells are placed on a glass
slide and sent to a medical laboratory to be checked for abnormal changes.
The way of describing Pap test results is changing. The newest method
is the Bethesda System. Changes are described as low-grade or high-grade
SIL. Many doctors believe that the Bethesda System provides more useful
information than an older system, which uses numbers ranging from class 1
to class 5. (In class 1, the cells in the sample are normal, while class 5
refers to invasive cancer.) Women should ask their doctor to explain the
system used for their Pap test.
Women should have regular checkups, including a pelvic exam and a Pap
test, if they are or have been sexually active or if they are age 18 or
older. Those who are at increased risk of developing cancer of the cervix
should be especially careful to follow their doctor's advice about
checkups. (For a discussion of risk
factors for cervical cancer see the Cause and Prevention section.) Women who have had a hysterectomy
(surgery to remove the uterus, including the cervix) should ask their
doctor's advice about having pelvic exams and Pap tests.
Cervical Cancer Symptoms
Precancerous changes of the cervix usually do not cause pain. In
fact, they generally do not cause any symptoms and are not detected unless
a woman has a pelvic exam and a Pap test.
Cervical Cancer symptoms usually do not appear until abnormal cervical cells become
cancerous and invade nearby tissue. When this happens, the most common
symptom is abnormal bleeding. Bleeding may start and stop between regular
menstrual periods, or it may occur after sexual intercourse, douching, or
a pelvic exam. Menstrual bleeding may last longer and be heavier than
usual. Bleeding after menopause
also may be a symptom of cervical cancer. Increased vaginal discharge is
another symptom of cervical cancer.
These symptoms may be caused by cancer or by other health problems.
Only a doctor can tell for sure. It is important for a woman to see her
doctor if she is having any of these symptoms.
Diagnosis of Cervical Cancer
The pelvic exam and Pap test allow the doctor to detect abnormal
changes in the cervix. If these exams show that an infection is present,
the doctor treats the infection and then repeats the Pap test at a later
time. If the exam or Pap test suggests something other than an infection,
the doctor may repeat the Pap test and do other tests to find out what the
problem is.
Colposcopy
is a widely used method to check the cervix for abnormal areas. The doctor
applies a vinegar-like solution to the cervix and then uses an instrument
much like a microscope (called a colposcope) to look closely at the
cervix. The doctor may then coat the cervix with an iodine solution (a
procedure called the Schiller
test). Healthy cells turn brown; abnormal cells turn white or
yellow. These procedures may be done in the doctor's office.
The doctor may remove a small amount of cervical tissue for examination
by a pathologist.
This procedure is called a biopsy.
In one type of biopsy, the doctor uses an instrument to pinch off small
pieces of cervical tissue. Another method used to do a biopsy is called
loop electrosurgical excision procedure (LEEP). In this procedure, the
doctor uses an electric wire loop to slice off a thin, round piece of
tissue. These types of biopsies may be done in the doctor's office using
local anesthesia.
The doctor also may want to check inside the opening of the cervix, an
area that cannot be seen during colposcopy. In a procedure called endocervical
curettage (ECC), the doctor uses a curette (a small, spoon-shaped
instrument) to scrape tissue from inside the cervical opening.
These procedures for removing tissue may cause some bleeding or other
discharge. However, healing usually occurs quickly. Women also often
experience some pain similar to menstrual cramping, which can be relieved
with medicine.
These tests may not show for sure whether the abnormal cells are
present only on the surface of the cervix. In that case, the doctor will
then remove a larger, cone-shaped sample of tissue. This procedure, called
conization
or cone biopsy, allows the pathologist to see whether the abnormal cells
have invaded tissue beneath the surface of the cervix. Conization also may
be used as treatment for a precancerous lesion if the entire abnormal area
can be removed. This procedure requires either local or general anesthesia
and may be done in the doctor's office or in the hospital.
In a few cases, it may not be clear whether an abnormal Pap test or a
woman's symptoms are caused by problems in the cervix or in the
endometrium (the lining of the uterus). In this situation, the doctor may
do dilation
and curettage (D and C). The doctor stretches the cervical opening
and uses a curette to scrape tissue from the lining of the uterus as well
as from the cervical canal. Like conization, this procedure requires local
or general anesthesia and may be done in the doctor's office or in the
hospital.
Treating Precancerous Conditions
Treatment for a precancerous lesion of the cervix depends on a number
of factors. These factors include whether the lesion is low or high grade,
whether the woman wants to have children in the future, the woman's age
and general health, and the preference of the woman and her doctor. A
woman with a low-grade lesion may not need further treatment, especially
if the abnormal area was completely removed during biopsy, but she should
have a Pap test and pelvic exam regularly. When a precancerous lesion
requires treatment, the doctor may use cryosurgery
(freezing), cauterization
(burning, also called diathermy),
or laser
surgery to destroy the abnormal area without harming nearby healthy
tissue. The doctor also can remove the abnormal tissue by LEEP or
conization. Treatment for precancerous lesions may cause cramping or other
pain, bleeding, or a watery discharge.
In some cases, a woman may have a hysterectomy, particularly if
abnormal cells are found inside the opening of the cervix. This surgery is
more likely to be done when the woman does not want to have children in
the future.
Cervical Cacner Treatment
Staging
The choice of treatment for cervical cancer depends on the location and
size of the tumor, the stage (extent) of the disease, the woman's age and
general health, and other factors.
Staging
is a careful attempt to find out whether the cancer has spread and, if so,
what parts of the body are affected. Blood and urine tests usually are
done. The doctor also may do a thorough pelvic exam in the operating room
with the patient under anesthesia. During this exam, the doctor may do
procedures called cystoscopy
and proctosigmoidoscopy.
In cystoscopy, the doctor looks inside the bladder with a thin, lighted
instrument. Proctosigmoidoscopy is a procedure in which a lighted
instrument is used to check the rectum and the lower part of the large
intestine. Because cervical cancer may spread to the bladder, rectum,
lymph nodes, or lungs, the doctor also may order x-rays
or tests to check these areas. For example, the woman may have a series of
x-rays of the kidneys and bladder, called an intravenous
pyelogram. The doctor also may check the intestines and rectum
using a barium
enema. To look for lymph nodes that may be enlarged because they
contain cancer cells, the doctor may order a CT
or CAT scan, a series of x-rays put together by a computer to make
detailed pictures of areas inside the body. Other procedures that may be
used to check organs inside the body are ultrasonography
and MRI.
Getting a Second Opinion
Before starting treatment, the patient may want a second pathologist to
review the diagnosis and another specialist to review the treatment plan.
Some insurance companies require a second opinion; others may cover a
second opinion if the patient requests it. It may take a week or two to
arrange for a second opinion. This short delay will not reduce the chance
that treatment will be successful. There are a number of ways to find a
doctor who can give a second opinion:
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The woman's doctor may be able to suggest pathologists
and specialists to consult.
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The Cancer Information Service, at 1-800-4-CANCER, can tell callers
about treatment facilities, including cancer centers and other programs
supported by the National Cancer Institute.
-
Women can get the names of specialists from their local medical
society, a nearby hospital, or a medical school.
Preparing for Cervical Cancer Treatment
Most women with cervical cancer want to learn all they can about their
disease and treatment choices so they can take an active part in decisions
about their medical care. Doctors and others on the medical team can help
women learn what they need to know.
When a person is diagnosed with cancer, shock and stress are natural
reactions. These feelings may make it difficult for patients to think of
everything they want to ask the doctor. Often it helps to make a list of
questions. Also, to help remember what the doctor says, patients may take
notes or ask whether they may use a tape recorder. Some people also want
to have a family member or friend with them when they talk to the doctor
-- to take part in the discussion, to take notes, or just to listen.
Patients should not feel they need to ask all their questions or
remember all the answers at one time. They will have other chances to ask
the doctor to explain things and to get more information.
Here are some questions a woman with cervical cancer may want to ask
the doctor before her treatment begins:
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What is the stage (extent) of my disease?
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What are my treatment choices? Which do you recommend for me?
Why?
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What are the chances that the treatment will be successful?
-
Would a clinical
trial be appropriate for me?
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What are the risks and possible side
effects of each treatment?
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How long will treatment last?
-
Will it affect my normal activities?
-
What is the treatment likely to cost?
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What is likely to happen without treatment?
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How often will I need to have checkups?
Methods of Treatment for Cervical Cancer
Most often, treatment for cervical cancer involves surgery
and radiation
therapy. Sometimes, chemotherapy
or biological
therapy is used. Patients are often treated by a team of
specialists. The team may include gynecologic
oncologists and radiation
oncologists. The doctors may decide to use one treatment method or
a combination of methods. Some patients take part in a clinical trial
(research study) using new treatment methods. Such studies are designed to
improve cancer treatment. More information about clinical trials is in the
Clinical Trials of Cervical Cancer Treatments section.
Surgery is local
therapy to remove abnormal tissue in or near the cervix. If the
cancer is only on the surface of the cervix, the doctor may destroy the
cancerous cells in ways similar to the methods used to treat precancerous
lesions. If the disease has invaded deeper layers of the cervix but has
not spread beyond the cervix, the doctor may perform an operation to
remove the tumor but leave the uterus and the ovaries. In other cases,
however, a woman may need to have a hysterectomy
or may choose to have this surgery, especially if she is not planning to
have children in the future. In this procedure, the doctor removes the
entire uterus, including the cervix; sometimes the ovaries and fallopian
tubes also are removed. In addition, the doctor may remove lymph nodes
near the uterus to learn whether the cancer has spread to these
organs.
Here are some questions a woman may want to ask the doctor before
surgery:
-
What kind of operation will it be?
-
How will I feel after the operation?
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If I have pain, how will you help me?
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When can I return to my normal activities?
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How will this treatment affect my sex life?
Radiation therapy (also called radiotherapy) uses high-energy
rays to damage cancer cells and stop them from growing. Like surgery,
radiation therapy is local therapy; the radiation can affect cancer cells
only in the treated area. The radiation may come from a large machine
(external radiation) or from radioactive materials placed directly into
the cervix (implant radiation). Some patients receive both types of
radiation therapy.
A woman receiving external radiation therapy goes to the hospital or
clinic each day for treatment. Usually treatments are given 5 days a week
for 5 to 6 weeks. At the end of that time, the tumor site very often gets
an extra "boost" of radiation.
For internal or implant radiation, a capsule containing radioactive
material is placed directly in the cervix. The implant puts cancer-killing
rays close to the tumor while sparing most of the healthy tissue around
it. It is usually left in place for 1 to 3 days, and the treatment may be
repeated several times over the course of 1 to 2 weeks. The patient stays
in the hospital while the implants are in place.
Here are some questions a woman may want to ask the doctor before
radiation therapy:
-
What is the goal of this treatment?
-
How will the radiation be given?
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How long will treatment last?
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How will I feel during therapy?
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What can I do to take care of myself during therapy?
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Can I continue my normal activities?
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How will this treatment affect my sex life?
Chemotherapy is the use of drugs to kill cancer cells. It is
most often used when cervical cancer has spread to other parts of the
body. The doctor may use just one drug or a combination of drugs.
Anticancer drugs used to treat cervical cancer may be given by
injection into a vein or by mouth. Either way, chemotherapy is systemic
treatment, meaning that the drugs flow through the body in the
bloodstream.
Chemotherapy is given in cycles: a treatment period followed by a
recovery period, then another treatment period, and so on. Most patients
have chemotherapy as an outpatient (at the hospital, at the doctor's
office, or at home). Depending on which drugs are given and the woman's
general health, however, she may need to stay in the hospital during her
treatment.
Here are some questions a woman may want to ask the doctor before
chemotherapy begins:
-
What is the goal of this treatment?
-
What drugs will I be taking?
-
Do the drugs have side effects? What can I do about them?
-
How long will I need to take this treatment?
Biological therapy is treatment using substances to improve the
way the body's immune system fights disease. It may be used to treat
cancer that has spread from the cervix to other parts of the body. Interferon
is the most common form of biological therapy for this disease; it may be
used in combination with chemotherapy. Most patients who receive
interferon are treated as outpatients.
Clinical Trials of Cervical Cancer Treatments
Some women with cervical cancer are treated in clinical trials. Doctors conduct clinical trials
to find out whether a new treatment is both safe and effective and to
answer scientific questions. Patients who take part in these studies may
be the first to receive treatments that have shown promise in laboratory
research. Some patients may receive the new treatment while others receive
the standard approach. In this way, doctors can compare different
therapies. Patients who take part in a trial make an important
contribution to medical science and may have the first chance to benefit
from improved treatment methods.
Clinical trials of new treatments for cervical cancer are under way.
Doctors are studying new types and schedules of radiation therapy. They
also are looking for new drugs, drug combinations, and ways to combine
various types of treatment.
Those who are interested in
taking part in a trial should talk with their doctor.
One way to learn about clinical trials is through PDQ, a computerized resource developed
by the National Cancer Institute. This resource contains information about
cancer treatment and about clinical trials in progress all over the
country. The Cancer Information Service can provide PDQ information to
doctors, patients, and the public.
Side Effects of Cervical Cancer Treatment
It is hard to limit the effects of therapy so that only cancer cells
are removed or destroyed. Because treatment also damages healthy cells and
tissues, it often causes unpleasant side effects.
The side effects of cancer treatment depend mainly on the type and
extent of the treatment. Also, each patient reacts differently. Doctors
and nurses can explain the possible side effects of treatment, and they
can help relieve symptoms that may occur during and after treatment. It is
important to let the doctor know if any side effects occur.
Surgery
Methods for removing or destroying small cancers on the surface of the
cervix are similar to those used to treat precancerous lesions. Treatment
may cause cramping or other pain, bleeding, or a watery discharge.
Hysterectomy is major surgery. For a few days after the operation, the
woman may have pain in her lower abdomen. The doctor can order medicine to
control the pain. A woman may have difficulty emptying her bladder and may
need to have a catheter
inserted into the bladder to drain the urine for a few days after surgery.
She also may have trouble having normal bowel movements. For a period of
time after the surgery, the woman's activities should be limited to allow
healing to take place. Normal activities, including sexual intercourse,
usually can be resumed in 4 to 8 weeks.
Women who have had their uterus removed no longer have menstrual
periods. However, sexual desire and the ability to have intercourse
usually are not affected by hysterectomy. On the other hand, many women
have an emotionally difficult time after this surgery. A woman's view of
her own sexuality may change, and she may feel an emotional loss because
she is no longer able to have children. An understanding partner is
important at this time. Women may want to discuss these issues with their
doctor, nurse, medical social worker, or member of the clergy.
Radiation Therapy
Patients are likely to become very tired during radiation therapy,
especially in the later weeks of treatment. Resting is important, but
doctors usually advise patients to try to stay as active as they can.
With external radiation, it is common to lose hair in the treated area
and for the skin to become red, dry, tender, and itchy. There may be
permanent darkening or "bronzing" of the skin in the treated area. This
area should be exposed to the air when possible but protected from the
sun, and patients should avoid wearing clothes that rub the treated area.
Patients will be shown how to keep the area clean. They should not
use any lotion or cream on their skin without the doctor's advice.
Usually, women are told not to have intercourse during radiation
therapy or while an implant is in place. However, most women can have
sexual relations within a few weeks after treatment ends. Sometimes, after
radiation treatment, the vagina becomes narrower and less flexible, and
intercourse may be painful. Patients may be taught how to use a dilator
as well as a water-based lubricant
to help minimize these problems.
Patients who receive external or internal radiation therapy also may
have diarrhea and frequent, uncomfortable urination. The doctor can make
suggestions or order medicines to control these problems.
Chemotherapy
The side effects of chemotherapy depend mainly on the drugs and the
doses the patient receives. In addition, as with other types of treatment,
side effects vary from person to person. Generally, anticancer drugs
affect cells that divide rapidly. These include blood cells, which fight
infection, help the blood to clot, or carry oxygen to all parts of the
body. When blood cells are affected by anticancer drugs, patients are more
likely to get infections, may bruise or bleed easily, and may have less
energy. Cells in hair roots and cells that line the digestive tract also
divide rapidly. When chemotherapy affects these cells, patients may lose
their hair and may have other side effects, such as poor appetite, nausea,
vomiting, or mouth sores. The doctor may be able to give medicine to help
with side effects. Side effects gradually go away during the recovery
periods between treatments or after treatment is over.
Biological Therapy
The side effects caused by biological therapies vary with the type of
treatment the patient receives. These treatments may cause flu-like
symptoms such as chills, fever, muscle aches, weakness, loss of appetite,
nausea, vomiting, and diarrhea. Sometimes patients get a rash, and they
may bleed or bruise easily. These problems can be severe, but they
gradually go away after the treatment stops.
Nutrition for Cancer Patients
Some patients find it hard to eat well during cancer treatment. They
may lose their appetite. In addition to loss of appetite, the common side
effects of treatment, such as nausea, vomiting, or mouth sores, can make
eating difficult. For some patients, foods taste different. Also, people
may not feel like eating when they are uncomfortable or tired.
Eating well during cancer treatment means getting enough calories and
protein to help prevent weight loss and regain strength. Patients who eat
well often feel better and have more energy. In addition, they may be
better able to handle the side effects of treatment.
Doctors, nurses, and dietitians can offer advice for healthy eating
during cancer treatment.
Followup Care
Regular followup exams -- including a pelvic exam, a Pap test, and
other laboratory tests -- are very important for any woman who has been
treated for precancerous changes or for cancer of the cervix. The doctor
will do these tests and exams frequently for several years to check for
any sign that the condition has returned.
Cancer treatment may cause side effects many years later. For this
reason, patients should continue to have regular checkups and should
report any health problems that appear.
Support for Cervical Cancer Patients
Living with a serious disease is not easy. Cancer patients and those
who care about them face many problems and challenges. Coping with these
problems is often easier when people have helpful information and support
services.
Cancer patients may worry about holding their job, caring for their
family, keeping up with daily activities, or starting a new relationship.
Worries about tests, treatments, hospital stays, and medical bills are
common. Doctors, nurses, and other members of the health care team can
answer questions about treatment, working, or other activities. Also,
meeting with a social worker, counselor, or member of the clergy can be
helpful to patients who want to talk about their feelings or discuss their
concerns.
Friends and relatives can be very supportive. Also, it helps many
patients to discuss their concerns with others who have cancer. Cancer
patients often get together in support groups, where they can share what
they have learned about coping with cancer and the effects of treatment.
It is important to keep in mind, however, that each patient is different.
Treatments and ways of dealing with cancer that work for one person may
not be right for another -- even if they both have the same kind of
cancer. It is always a good idea to discuss the advice of friends and
family members with the doctor.
Often, a social worker at the hospital or clinic can suggest groups
that can help with rehabilitation, emotional support, financial aid,
transportation, or home care. For example, the American Cancer Society has
many services for patients and their families. They also offer many free
booklets, including one on sexuality and cancer. Local offices of the
American Cancer Society are listed in the white pages of the telephone
directory.
What the Future Holds
The outlook for women with precancerous changes of the cervix or very
early cancer of the cervix is excellent; nearly all patients with these
conditions can be cured. Researchers continue to look for new and better
ways to treat invasive cervical cancer.
Patients and their families are naturally concerned about what the
future holds. Sometimes patients use statistics to try to figure out their
chances of being cured. It is important to remember, however, that
statistics are averages based on large numbers of patients. They cannot be
used to predict what will happen to a particular woman because no two
patients are alike; treatments and responses vary greatly. The doctor who
takes care of the patient and knows her medical history is in the best
position to talk with her about her chance of recovery (prognosis).
Doctors often talk about surviving cancer, or they may use the term
remission
rather than cure. Although many women with cervical cancer recover
completely, doctors use these terms because the disease can recur.
(The return of cancer is called a recurrence.)
Cause and Prevention
By studying large numbers of women all over the world, researchers have
identified certain risk factors that increase the chance that cells in the
cervix will become abnormal or cancerous. They believe that, in many
cases, cervical cancer develops when two or more risk factors act
together.
Research has shown that women who began having sexual intercourse
before age 18 and women who have had many sexual partners have an
increased risk of developing cervical cancer. Women also are at increased
risk if their partners began having sexual intercourse at a young age,
have had many sexual partners, or were previously married to women who had
cervical cancer.
Scientists do not know exactly why the sexual practices of women and
their partners affect the risk of developing cervical cancer. However,
research suggests that some sexually transmitted viruses can cause
cells in the cervix to begin the series of changes that can lead to
cancer. Women who have had many sexual partners or whose partners have had
many sexual partners may have an increased risk for cervical cancer at
least in part because they are more likely to get a sexually transmitted
virus.
Scientists are studying the effects of sexually transmitted human
papillomaviruses (HPVs). Some sexually transmitted HPVs cause
genital warts (condylomata
acuminata). In addition, scientists believe that some of these
viruses may cause the growth of abnormal cells in the cervix and may play
a role in cancer development. They have found that women who have HPV or
whose partners have HPV have a higher-than-average risk of developing
cervical cancer. However, most women who are infected with HPV do not
develop cervical cancer, and the virus is not present in all women who
have this disease. For these reasons, scientists believe that other
factors act together with HPVs. For example, the genital herpes
virus also may play a role. Further research is needed to learn
the exact role of these viruses and how they act together with other
factors in the development of cervical cancer.
Smoking also increases the risk of cancer of the cervix, although it is
not clear exactly how or why. The risk appears to increase with the number
of cigarettes a woman smokes each day and with the number of years she has
smoked.
Women whose mothers were given the drug diethylstilbestrol
(DES) during pregnancy to prevent miscarriage also are at increased risk.
(This drug was used for this purpose from about 1940 to 1970.) A rare type
of vaginal and cervical cancer has been found in a small number of women
whose mothers used DES.
Several reports suggest that women whose immune systems are weakened
are more likely than others to develop cervical cancer. For example, women
who have the human immunodeficiency virus (HIV), which causes AIDS, are at
increased risk. Also, organ transplant patients, who receive drugs that
suppress the immune system to prevent rejection of the new organ, are more
likely than others to develop precancerous lesions.
Some researchers believe that there is an increased risk of cervical
cancer in women who use oral contraceptives (the pill). However,
scientists have not found that the pill directly causes cancer of the
cervix. This relationship is hard to prove because the two main risk
factors for cervical cancer -- intercourse at an early age and multiple
sex partners -- may be more common among women who use the pill than among
those who do not. Still, oral contraceptive labels warn of this possible
risk and advise women who use them to have yearly Pap tests.
Some research has shown that vitamin A may play a role in stopping or
preventing cancerous changes in cells like those on the surface of the
cervix. Further research with forms of vitamin A may help scientists learn
more about preventing cancer of the cervix.
At present, early detection and treatment of precancerous tissue remain
the most effective ways of preventing cervical cancer. Information about
early detection appears in the Early Detection section. Women should talk
with their doctors about an appropriate schedule of checkups. The doctor's
advice will be based on such factors as the women's age, medical history,
and risk factors.
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
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