Treatment

Symptoms, Risk and Diagnosis

Infection of the cervix with human papillomavirus (HPV) is almost always the cause of cervical cancer. Not all women with HPV infection, however, will develop cervical cancer. Women who do not regularly have pap smears to detect HPV or abnormal cells in the cervix are at increased risk of cervical cancer.

Cervical cancer usually develops slowly over time. Cells of the cervix gradually develop dysplasia (pre-cancer), abnormal cells in the cervical tissue. There is often confusion between cancer and pre-cancer and we can sort that out. Left alone, the abnormal cells may become cancer cells and start to grow and spread more deeply into the cervix and to surrounding areas. Pre-cancer is easy to treat without loss of fertility.

The main goal at the Siteman Cancer Center is to get a correct diagnosis of your condition and decide on the proper treatment. Specialists here excel in using the technology and experience to make an accurate diagnosis, often down to the genetic level so the best treatment options may be identified.

Symptoms of Cervical Cancer

There are no signs or symptoms in the early stages. Dysplasia or cancer is usually found from a swab during a pap smear or an HPV test. Later, when there are, you may experience:

  • Vaginal bleeding or bleeding after intercourse.
  • Pelvic pain.
  • Unusual vaginal discharge.
  • Pain during intercourse.

Risk Factors for Cervical Cancer

The greatest risk factor is infection with the human papilloma virus (HPV) and not being vaccinated against it. Other risk factors can include:

  • Giving birth to many children.
  • Having many sexual partners.
  • Having first sexual intercourse at a young age.
  • Smoking cigarettes.
  • Using oral contraceptives.

Making a diagnosis of cervical cancer and pre-cancer may involve different approaches. The following tests and procedures may be used:

  1. Physical exam and history: This basic exam looks at the patient’s past illnesses and treatments, and any signs of disease, or abnormalities.
  2. Pelvic exam: A speculum is inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test of the cervix is usually done. The doctor or nurse also inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
  3. Pap test: Done at the same time as a pelvic exam, this test uses a small brush or spatula to gently remove cells from the cervix so they can be checked under a microscope for cervical cancer or cell changes that may lead to cervical cancer, including infections or inflammation.
  4. Human papillomavirus (HPV) test: this laboratory test checks for certain types of HPV infection by collecting cells from the cervix taken during the Pap test. DNA or RNA from the cells is checked to find out if an infection is caused by a type of HPV that is linked to cervical cancer.
  5. Endocervical curettage and Colposcopy: A colposcope (a lighted microscope instrument) is used to check the vagina and cervix for abnormal areas. Tissue samples are collected from the cervical canal using a curette (spoon-shaped instrument) to be checked under a microscope for signs of cancer.
  6. Biopsy: If abnormal cells are found in a Pap test, the doctor may do a biopsy. A sample of tissue is cut from the cervix and viewed under a microscope by a pathologist to check for signs of cancer. It may be done in the doctor’s office, or you may need to go to a hospital for a cervical cone biopsy (removal of a larger, cone-shaped sample of cervical tissue.

Staging of Cervical Cancer

Additional tests might be used to determine extent (stage) of a cancer diagnosed by the tests above:

CT scan (CAT scan): A series of detailed pictures of areas inside the body, taken from different angles may be combined with injection or oral intake of a dye to help the organs or tissues show up more clearly.

PET scan (positron emission tomography scan): A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

MRI (magnetic resonance imaging): This procedure uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body.

Ultrasound exam: High-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes, forming a picture of body tissues.

Stages of Cervical Cancer

Stage 0: Abnormal cells that may become cancer are found in the lining of the cervix.

Stage I: Cancer is found in the cervix only.

Stage II: Cancer has spread beyond the cervix but not to the pelvic wall or to the lower third of the vagina.

Stage III: Cancer has spread to the lower third of the vagina and/or the pelvic walls or kidney

Stage IV: Cancer has spread beyond the pelvis or to other parts of the body

Recurrent Cancer: This cancer has come back in the cervix or some other part of the body after treatment.

Staging is very useful in determining the correct treatment.

Prognosis

The prognosis (chance of recovery) depends on the following:

  • The stage of the cancer (size of the tumor and whether it affects part of the cervix, the whole cervix, or has spread to the lymph nodes or other places in the body).
  • The type of cervical cancer.
  • The patient’s age and general health.
  • Whether the patient has a certain type of human papillomavirus (HPV).
  • Whether the patient has human immunodeficiency virus (HIV).
  • Whether the cancer has just been diagnosed or has recurred (come back).

Cervical cancer is best controlled before it has spread and can be removed by surgery. Clinical trials are a good option for getting the latest treatment.