Cervical Cancer

Cervical Cancer

cervical-diagram2Almost all cases of cervical cancer are caused by the human papillomavirus (HPV). More than 80 percent of American women are infected with HPV at some point in their lifetime, with the majority of individuals clearing the virus with no ill effects. Very few women develop cervical cancer.

What is the cervix?

The cervix is the portion of the uterus that ends in the vagina. Usually, the cervix remains closed, however during labor, the cervix dilates to accommodate birth.

What is the cervical cancer?

Cervical cancer is the is abnormal tissues of the cervix.

What are the risk factors?

  • Early age of intercourse
  • Multiple sexual partners
  • Immunosuppression
  • Cigarette or cigar smoking

What are some preventions?

  • Vaccination: Gardasil and Cervarix – protects against high risk strains of HPV which are linked to cervical cancer and protects against low risk strains which are linked to genital warts. The Centers for Disease Control offers information on HPV prevention and vaccines.
  • Condom use to protect against HPV, which is transmitted by sexual contact
  • Smoking cessation

How do you screen for abnormal cells?

Pap smear of vaginal walls

What are pre-cancerous cells?

Persistent infection of HPV can eventually cause pre-cancerous changes to cells on the surface or in the canal of the cervix. These precancerous changes are called dysplasia (or disordered growth).
The diagnosis of dysplasia is made by undergoing a colposcopy — an advanced visual exam of the cervix and biopsy. Treatment of dysplasia depends on the degree of dysplasia.
Cervical dysplasia, a precancerous condition of the cervix, is grouped into three categories:

  • CIN I (mild to moderate dysplasia)
  • CIN II (moderate to severe dysplasia)
  • CIN III (severe dysplasia)

If the dysplasia is more advanced, cryosurgery, electrocauterization, laser ablation, or a loop electrosurgical excision procedure (LEEP) can destroy the precancerous cells and prevent cervical cancer.

Janet Rader, MD, FACOG, chair of the Department of Obstetrics and Gynecology and Medical College of Wisconsin gynecologic oncologist, is currently researching why some women develop cervical cancer while others do not.

What are the symptoms?

Sometimes symptoms do not develop until the cervical cancer is advanced. Symptoms of cervical cancer include:

  • Vaginal bleeding
  • Weight loss/loss of appetite
  • Fatigue
  • Pelvic, back or leg pain
  • Leaking of urine or feces from the vagina
  • A single swollen leg

How is it diagnosed?

If cervical cancer is suspected, the physician will biopsy any suspicious lesions to be reviewed by pathology. Other possible tests include imaging studies, such as an X-Ray, PET-CT scan and MRI to assess the extent of the disease.

How is it treated?

The treatment of cervical cancer depends on the stage at diagnosis, along with the patient’s age and general health. Because a variety of treatment options are available, physicians at Froedtert & the Medical College of Wisconsin work together to design individualized treatment plans.

  • Clinical trials: As an academic medical center, Froedtert & the Medical College of Wisconsin offer its patients the opportunity to participate in many clinical trials, which offer cutting edge treatment. Patients that are eligible for clinical trials have the opportunity to be treated with novel agents or in combination with treatment that is the standard of care. Treatment on clinical trials may utilize chemotherapy, radiation, or include quality of life studies.
  • Radical hysterectomy: During a radical hysterectomy, a gynecologic oncologist removes the patient’s uterus and cervix, upper portion of the vagina, and lymph nodes in the pelvic region. A radical hysterectomy may be performed laparoscopically, with or without the assistance of the da Vinci ® Robotic Surgical System or with an open incision (by laparotomy). The ovaries may or may not be removed as well.
  • Brachytherapy (internal radiation therapy): Brachytherapy is radiation that is treated to a localized region, increasing the amount of radiation that attacks the disease and minimizing the amount of radiation to the surrounding tissue. At Froedtert & the Medical College, patients undergo a CT scan and MRI prior to each brachytherapy insertion, allowing precisely targeted treatment that may improve treatment outcomes and decrease toxicity (side effects) from treatment.
  • External radiation therapy: Image-guided external beam radiation can be used to treat cervical cancer. This therapy usually targets the primary tumor and lymph nodes.
  • Chemotherapy: Often, a combination of intravenous chemotherapy and radiation is prescribed for cervical cancer, with the chemotherapy acting as a sensitizer, to increase how well the radiation works to attack the cancerous cells. Specially trained oncology nurses administer chemotherapy and work with patients to minimize and manage side effects.