The cervix is the portion of the uterus that joins to the vagina. During pregnancy, the cervix remains tightly shut; during labor, the cervix dilates to accommodate the birth of a baby.
Almost all cases of cervical cancer are caused by the human papillomavirus (HPV). However, HPV, doesn’t always cause cervical cancer. More than 80 percent of American women are infected with HPV at some point in their lifetime, but very few develop cervical cancer. Many women apparently clear the virus from their systems with no apparent ill effects.
Others develop pre-cancerous changes of the cervix, which, if left untreated, may progress to 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.
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) and CIN III (severe dysplasia). Cervical dysplasia describes the presence of abnormal, precancerous cells in the canal of or on the surface of the cervix (opening of the uterus that leads into the vagina). The term “plasia” means growth. Dysplasia means “disordered growth.”
The diagnosis is made by undergoing a colposcopy — an advanced visual exam of the cervix and biopsy. Depending on the degree of dysplasia, watchful waiting may be appropriate. If the dysplasia is more advanced, cryosurgery, electrocauterization, laser ablation or the loop electrosurgical excision procedure (LEEP) can destroy the precancerous cells and prevent cervical cancer.
Early cervical cancer produces almost no symptoms. Symptoms of advanced disease may include:
Weight loss/loss of appetite
Pelvic, back or leg pain
Leaking of urine or feces from the vagina
A single swollen leg
If cervical cancer is suspected, the physician will biopsy any suspicious lesions and submit them to the lab for analysis. Other possible tests include imaging studies, such as an X-Ray, PET-CT scan and MRI to assess the extent of the disease.
The treatment of cervical cancer depends on stage at diagnosis and the patient’s general age and health. Because a variety of treatment options are available, the specialists at the Gynecologic Cancer Program at Froedtert & The Medical College of Wisconsin work together to design optimal, individualized treatment plans.
Radical hysterectomy. During a radical hysterectomy, a gynecologic oncologist removes the patient’s uterus (including the diseased cervix), top part 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. The ovaries do not need to be removed for the treatment of cervical cancer.
Brachytherapy (internal radiation therapy). Brachytherapy places small amounts of radioactivity directly into the cancerous region, increasing the amount of radiation that attacks the disease and minimizing the amount of radiation to the surrounding tissues. For cervical cancer, the uterus provides a natural holding area for the radioactive implants. At Froedtert & The Medical College, patients receive a CT scan and MRI prior to each brachytherapy insertion, allowing precisely targeted treatment that may improve treatment outcomes.
External radiation therapy. Image-guided external beam radiation can be used to treat cervical cancer. This therapy targets the primary tumor and the lymph nodes.
Chemotherapy. Often, a combination of intravenous chemotherapy and radiation is prescribed for cervical cancer. Specially trained oncology nurses administer chemotherapy and work with patients to minimize and manage side effects.