Topic Overview
Is this topic for you?
This topic talks about the
testing, diagnosis, and treatment of cervical cancer. For general information
about abnormal Pap test results, see the topic
Abnormal Pap Test.
What is cervical cancer?
Cervical cancer occurs
when abnormal cells on the
cervix grow out of control. The cervix is the lower
part of the uterus that opens into the vagina. Cervical cancer can often be
cured when it's found early. It is usually found at a very early stage through
a
Pap test.
What causes cervical cancer?
Most cervical cancer
is caused by a virus called
human papillomavirus, or HPV. You can get HPV by
having
sexual contact with someone who has it. There are many
types of the HPV virus. Not all types of HPV cause cervical cancer. Some of
them cause
genital warts, but other types may not cause any
symptoms.
You can have HPV for years and not know it. It stays in
your body and can lead to cervical cancer years after you were infected. This
is why it is important for you to have regular Pap tests. A Pap test can find
changes in cervical cells before they turn into cancer. If you treat these cell
changes, you may prevent cervical cancer.
What are the symptoms?
Abnormal cervical cell
changes rarely cause symptoms. But you may have symptoms if those cell changes
grow into cervical cancer. Symptoms of cervical cancer may include:
- Bleeding from the vagina that is not normal,
or a change in your
menstrual cycle that you can't explain.
- Bleeding when something comes in contact with your cervix, such as
during sex or when you put in a diaphragm.
- Pain during
sex.
- Vaginal discharge that is tinged with blood.
How is cervical cancer diagnosed?
As part of your
regular pelvic exam, you should have a Pap test. During a Pap test the doctor
scrapes a small sample of cells from the surface of the cervix to look for cell
changes. If a Pap test shows abnormal cell changes, your doctor may do other
tests to look for precancerous or cancer cells on your cervix.
Your doctor may also do a Pap test and take a sample of tissue (biopsy) if you have symptoms of cervical cancer, such
as bleeding after sex.
How is it treated?
Cervical cancer that is caught
early can usually be cured. If the cancer is caught very early, you still may
be able to have children after treatment.
The treatment for most
stages of cervical cancer removes the cancer and makes you unable to have
children. These treatments include:
Depending on how much the cancer has grown, you may have
one or more treatments. And you may have a combination of treatments.
It's common to feel scared, sad, or angry after finding out that you have
cervical cancer. Talking to others who have had the disease may help you feel
better. Ask your doctor about support groups in your area. You can also find
people online who will share their experiences with you.
Can cervical cancer be prevented?
The Pap test is
the best way to find cervical cell changes that can lead to cervical cancer.
Regular Pap tests almost always show these cell changes before they turn into
cancer. It is important to follow up with your doctor after any abnormal Pap
test result to treat abnormal cell changes. This may help prevent cervical
cancer.
If you are age 26 or younger, you can get the HPV shot. The vaccines Cervarix and Gardasil protect against two types of HPV that cause cervical cancer. Gardasil also protects against two types of HPV that cause genital warts. Three shots are given over 6 months. The series of shots is recommended for girls age 11 or 12 and can be given to females ages 9 to 26.
The virus that causes
cervical cancer is spread through sexual contact. The best way to avoid getting
a
sexually transmitted disease is to not have
sex. If you do have sex, practice safer sex, such as
using condoms and limiting the number of sex partners you have.
Frequently Asked Questions
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Learning about cervical cancer:
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Being diagnosed:
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Getting treatment:
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Living with cervical cancer:
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End-of-life issues:
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Cause
Cervical cancer is caused by severe
abnormal changes in the cells of the
cervix. Most precancerous or cancerous cell changes
occur in the cervix at the
transformation zone, because these cells normally
undergo constant change. During this natural process of change, some cervical
cells can become abnormal if you are infected with
high-risk types of HPV.
Other factors
that may play a role in causing cervical cancer include:
Regular
Pap test screening is the single most important tool
to identify cervical cell changes early before they progress to cancer.
Symptoms
Since abnormal cervical cell changes rarely
cause symptoms, it is important to have regular
Pap test screening. If cervical cell changes progress
to
cervical cancer, symptoms may develop. Symptoms of
cervical cancer may include:
- Abnormal vaginal bleeding or a significant
unexplained change in your
menstrual cycle.
- Bleeding when something
comes in contact with the cervix, such as during sexual intercourse or when you
insert a diaphragm.
- Pain during sexual
intercourse.
- Abnormal vaginal discharge containing mucus that may
be tinged with blood.
Symptoms that may occur when your cervical cancer has
progressed include:
-
Anemia
because
of abnormal vaginal bleeding.
- Ongoing pelvic, leg, or back
pain.
- Urinary problems because of blockage of a kidney or
ureter.
- Leakage of urine or fecal content
into the
vagina because an abnormal opening (fistula) has developed between the vagina and the
bladder or rectum.
- Weight loss.
What Happens
If
cervical cancer is not treated, it may spread from the
cervix to the vagina, then into deeper tissue layers
of connective tissue around the uterus. As it progresses, it may spread to the
pelvic
lymph nodes and other pelvic organs.
Advanced-stage cancer may spread to lymph nodes, to
other organs in the pelvis, causing problems with kidney and bowel function, or
to other organs in the body, such as the liver and lungs.
Cervical
cancer is classified in
stages that are determined by the size of the cancer
and how far it has spread to nearby tissues and other organs, such as the
lungs, the liver, or bones. Your doctor will determine the stage of your
cervical cancer by gathering information from a variety of tests, including
X-rays. The stage of your cancer is one of the most important factors in
selecting the treatment option that is right for you. The
long-term outcome (prognosis) depends on the stage of
your cervical cancer.
What Increases Your Risk
The most common cause of
cervical cancer is a persistent infection with a high-risk type of
human papillomavirus (HPV). HPV infection of the
cervix is a
sexually transmitted disease (STD). A past HPV
infection in you or your partner can cause abnormal cervical cell changes years
later because the virus may remain in the body for life. HPV infection usually
does not cause symptoms and often goes away without causing any problems, so
you or your partner may not be aware of a current or past HPV infection.
Other risk factors that may increase your risk for
cervical cancer include:
Pregnant women have the same risk of developing
cervical cancer as nonpregnant women.
When To Call a Doctor
If you have been diagnosed with
cervical cancer, be sure to follow your doctor's
instructions about calling when you have problems, new symptoms, or symptoms
that get worse.
If you are concerned about your symptoms or if you
think you have an increased risk for cervical cancer, call your doctor if you have:
- Unexpected bleeding between menstrual
periods.
- Menstrual periods that are irregular or 1½ to 2 times
longer than normal for 3 months in a row. For example, if your menstrual
periods usually last 6 days and then they last between 9 and 12 days for 3
months in a row, call your doctor.
-
Severe menstrual bleeding
that causes you to change a maxi-pad or super tampon every hour
for longer than 8 hours.
- Unexpected bleeding after douching or
sexual intercourse.
- Pain during sexual
intercourse.
- Abnormal vaginal discharge containing mucus that may
be tinged with blood.
Watchful Waiting
Regular
Pap test screening is the most important tool in
identifying and treating cervical cell changes before they progress to cervical
cancer. After cervical cancer has been diagnosed, it should be treated.
Watchful waiting is not appropriate.
Who To See
Health professionals who can evaluate your symptoms
and your risk factors, and who can diagnose cervical cancer include:
Doctors who can manage your cancer treatment
include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
The
Pap test is a routine screening test used to identify
abnormal cell changes of the
cervix and to screen for
cervical cancer. Regular Pap test screening is the
single most important tool in identifying and treating cervical cell changes
before they progress to cervical cancer. If cervical cancer is suspected, your
doctor will take a
medical history and perform a physical exam, including
a
pelvic exam and a Pap test. Several follow-up tests
may be needed for evaluation and treatment.
Tests to confirm a diagnosis of cervical cancer include:
If you are pregnant, a
colposcopy and
cervical biopsy can be done to confirm cervical
cancer.
Tests to determine the extent (stage) of cervical cancer include:
- A
cone biopsy or
loop electrosurgical excision procedure (LEEP). These
tests are sometimes recommended to determine the spread of cancer in cervical
tissue.
- A
cystoscopy, to look at the interior lining of the
bladder and the
urethra to determine whether the cancer has spread to
the urinary system.
- A
proctoscopy, to look at the lower part of the large
intestine (colon) to determine whether the cancer has
metastasized.
- An
intravenous pyelogram, to see whether there is any
blockage of a kidney.
- A
chest X-ray, to check for cancer cells that have
spread from the cervix.
Other surgeries may be done to determine the extent of
cervical cancer. For more information, see the Surgery section of this
topic.
Tests to guide treatment decisions
include:
Early Detection
The recommended Pap test schedule is based on your age and things that increase your risk. For most women, it is best to have a Pap test every 1 to 3 years. Talk to your doctor about when to have your first Pap test and how often to have this test.
Treatment Overview
Cervical cancer
detected in its early stages can be cured with treatment and close follow-up.
Treatment choices for cervical cancer may include one or more of the following
therapies:
- Surgery to remove the cancer
-
Radiation therapy
to treat the cancer itself or other organs affected by the
cancer
-
Chemotherapy
to help make the cancer
more sensitive to radiation therapy and to treat cancer that has spread
(metastasized)
Your quality of life becomes a critical issue when
considering treatment options. Be sure to discuss your personal preferences
with your
oncologist when he or she recommends treatment.
Initial treatment
The choice of treatment and the
long-term outcome (prognosis) of
cervical cancer depends on the type and
stage of cancer. Your age, overall health, quality of
life, and desire to be able to have children must also be considered.
Treatment choices for cervical cancer may be a single
therapy or a combination of therapies, such as:
- Surgery to remove the cancer.
- Cone biopsy to remove the
cancer
- Radical trachelectomy to remove the cervix, part of the vagina, and the pelvic
lymph nodes (lymph node dissection) but not the uterus
- Simple hysterectomy to remove the uterus and
cervix
- Modified radical
hysterectomy and
lymph node dissection to remove the
cancer
- Radiation therapy, which uses high-dose X-rays or implants
in the vaginal cavity to kill cancer cells.
- Chemotherapy, which
uses medicines to kill cancer cells.
When you have a hysterectomy, your doctor may also remove your fallopian tubes and your ovaries. This is called a salpingo-oophorectomy (say "sal-PING-oh oh-uh-fuh-REK-tuh-mee").
Surgery to remove the uterus and cervix (hysterectomy) may be done through an incision in the belly. For early-stage cervical cancer, laparoscopic surgery may be possible. This is done with several small incisions in the belly for a tiny camera and special instruments.
Robotic-assisted laparoscopic surgery uses robotic arms that translate the surgeon's hand motions into finer and more precise movements. This surgery requires specially trained doctors.
Chemotherapy may be given at the same time as radiation
therapy (chemoradiation). Compared
with radiation alone, chemoradiation improves survival. It is usually used as the primary therapy or after a
hysterectomy.
Most treatments for cervical cancer cause side effects. Side effects may
differ, depending on the type of treatment used and your age and overall
health. Your doctor can talk to you about your treatment choices and the side
effects associated with each treatment.
Home treatment measures may help relieve some common side
effects of cancer treatment. For more information, see the Home Treatment
section of this topic.
If you have recently been diagnosed with
cervical cancer, you may experience a wide variety of emotions in reaction to
your diagnosis. Most women will feel some denial, anger, and grief. There is no
"normal" or "right" way to react to a diagnosis of cancer. You can take steps,
though, to manage your
emotional reactions to learning that you have cervical
cancer. Some women find that talking with family and friends is comforting,
while others may need to spend time alone to understand their feelings about
their disease.
If your emotions are interfering with your ability
to make decisions about your health and to move forward with your life, it is
important to talk with your doctor. Your cancer treatment center may offer
counseling services. You may also contact your local chapter of the American
Cancer Society to help you find a support group. Talking with other women who
have had similar feelings after a diagnosis such as yours can help you accept
and deal with your disease.
Treatment for pregnant women
Recommended
treatments are the same for pregnant women as for nonpregnant women. Treatment
for early-stage cervical cancer may be delayed until after delivery if the
pregnancy is in the
third trimester. A vaginal delivery may be
possible.
For all stages of cervical
cancer, treatment will be managed by a team of doctors specializing in cancer
and high-risk pregnancies. Treatment for cervical cancer may cause problems such as an early
delivery or even the loss of the baby. Treatment will
consider the recommendations for the specific stage of cancer, the development
of the baby, and the mother's preferences.
What to think about during initial treatment
Depending on the extent (stage) of your cancer, surgery may be combined
with radiation therapy and chemotherapy. Radiation or chemotherapy given after
a surgery is called
adjuvant therapy.
Some women with
cervical cancer may be interested in participating in research studies called
clinical trials. Clinical trials are designed to find
better ways to treat cancer patients and are based on the most up-to-date
information. Women who do not want standard treatments or are not cured using
standard treatments may want to participate in clinical trials. These are
ongoing in most parts of the United States and in some other countries for all
stages of cervical cancer.
For
more information about specific cervical cancer treatments, see the
topics:
Ongoing treatment
After initial treatment for
cervical cancer, it is important to receive follow-up
care. Your
emotional reactions may continue throughout the course
of your treatment depending on your prognosis, the treatment methods used, and
your quality-of-life decisions.
Your oncologist or
gynecologic oncologist will schedule regular checkups
that will include:2
- A pelvic exam and
Pap test every 3 to 6 months for the first 2 years.
- After the first 2 years, a pelvic exam and Pap test every 6 months for another 3 to 5 years.
- After 5 years, a pelvic exam and Pap test every year.
Follow-up tests that may be recommended by your
oncologist include an
abdominal and pelvic computed tomography (CT) scan to
monitor whether cancer has spread to other organs in the abdomen or
pelvis.
If respiratory symptoms are present, a
chest X-ray may be done to determine whether cancer
has spread to the lungs.
Treatment if the condition gets worse
Cervical cancer
can return after treatment. About 35% of women with cervical cancer will have
persistent or recurrent disease.3 The chance that your
cancer will return depends on the stage of the initial cancer: cancer found
early is less likely to come back than cancer found at a later stage.
Your long-term outcome (prognosis) for
recurrent cervical cancer depends greatly on how much
the cancer has spread when the recurrence is diagnosed.
The goal of treatment of advanced-stage cervical cancer
that has spread outside the pelvis is to control symptoms, reduce
complications, and increase comfort (palliative care). It is not intended to cure the disease. Palliative care may
include:
Complementary therapies
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the therapies that may be helpful include:
These types of therapies also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Complementary therapies are not a substitute for the
standard treatment recommended for cervical cancer. Before you try any of these
therapies, discuss their possible benefits and side effects with your doctor.
Let him or her know if you are already using any such therapies. For more
information, see the topic
Complementary Medicine.
End-of-life issues
Some women with
advanced-stage disease that is not curable may choose not to have cancer
treatment because the time, costs, and side effects of treatment may be greater
than the benefits. Making the decision about when to stop cancer treatment
aimed at prolonging life and shift the focus to best supportive care can be
difficult. For more information, see the topics:
Talk to your doctor about an advance directive, which includes a living will and a medical power of attorney. In a living will, you describe the kind of care you want if something happens to you and you cannot speak for yourself. In a medical power of attorney, you choose a person to make medical decisions for you if you cannot speak for yourself. Be sure to share your wishes with your family or close friends.
You can get forms from Caring Connections (www.caringinfo.org or 1-800-658-8898) or Aging With Dignity (www.agingwithdignity.org or 1-888-594-7437).
Prevention
You can treat early cervical cell changes
(dysplasia), which can reduce your risk for
cervical cancer. You can also reduce your risk factors
for abnormal cell changes.
Have regular Pap test screening
The recommended Pap test schedule is based on your age and things that increase your risk. For most women, it is best to have a Pap test every 1 to 3 years. Talk to your doctor about when to have your first Pap test and how often to have this test.
Quit smoking
Women who smoke cigarettes or who breathe in secondhand smoke have a higher risk of developing cervical cell changes that can lead to cervical cancer.4Quitting smoking may decrease this risk.
Vaccine
If you are age 26 or younger, you can get the HPV shot. The vaccines Cervarix(What is a PDF document?)
and Gardasil(What is a PDF document?)
protect against two types of human papillomavirus (HPV) that cause cervical cancer. Gardasil also protects against two types of HPV that cause genital warts. Three shots are given over 6 months. The series of shots is recommended for girls age 11 or 12 and can be given to females ages 9 to 26. You can get either vaccine. For more information,
see the topic
Immunizations.
-
HPV: Should My Daughter Get the Vaccine?
Reduce your risk of a sexually transmitted disease (STD)
Sexually transmitted diseases (STDs)
often cause
abnormal Pap tests and can lead to other serious health problems. Preventing an
STD is easier than treating an infection after it occurs. The most common cause
of cervical cancer is infection with a high-risk type of the
HPV. Since the HPV virus may
remain in body cells for life, abnormal cervical cell changes that cause
cervical cancer can be the result of either you or your partner having had an
HPV infection years earlier. HPV infection usually does not cause symptoms, so
you or your partner may not be aware of a current or past HPV infection.
To reduce your risk:
- Talk with your partner about STDs before
beginning a sexual relationship. Find out if he or she is at risk for an STD.
Remember that it is quite possible to be infected with an STD without knowing
it. Some STDs, such as
HIV, can take up to 6 months before they are detected
in the blood.
- Be responsible.
- Avoid
sexual contact if you have symptoms of an STD or are
being treated for an STD.
- Avoid all intimate sexual contact with
anyone who has symptoms of an STD or who may have been exposed to an
STD.
- The fewer sex partners you have in your lifetime, the better it
is for your health. Your risk for an STD increases if you have several sex
partners, or if your sex partner has more than one partner.
- Use
male or
female condoms to reduce the risk of getting an STD.
Using male condoms when you have sex has been shown to reduce your risk of
getting HPV.5 Female condoms may help also, although
there has been less study of this type of protection.
Not having sexual contact is the only certain way to
prevent exposure to STDs. Sexually transmitted diseases such as human
papillomavirus (HPV) can be spread to or from the genitals, anus, mouth, or
throat during sexual activities.
Home Treatment
During medical treatment for any stage
of
cervical cancer, you can use home treatment to help
manage the side effects of cervical cancer or cancer treatment. Home treatment
may be all that is needed to manage the following common problems. If your
doctor has given you instructions or medicines to treat these symptoms, be sure
to follow them. In general, healthy habits such as eating a balanced diet and
getting enough sleep and exercise can help control your symptoms.
Home treatment for:
-
Nausea or vomiting includes watching
for and treating early signs of
dehydration, such as a dry mouth, sticky saliva, and
reduced urine output with dark yellow urine. Older adults can quickly become
dehydrated from vomiting. Nausea and vomiting caused by chemotherapy usually
require medical treatment. Your doctor may also prescribe
medicines to control nausea and vomiting. For more
information on how to deal with these side effects, see:
Cancer: Controlling Nausea and Vomiting From Chemotherapy.
-
Diarrhea includes resting your stomach
and being alert for signs of dehydration. Check with your doctor before using
any nonprescription medicines for your diarrhea.
-
Constipation includes making sure that you drink
enough fluids and include fruits, vegetables, and fiber in your diet each day.
Do not use a laxative without consulting your doctor.
Other issues that may arise include:
- Sleep problems. If you find you have trouble sleeping, some tips
for
managing sleep problems may be helpful, such as having
a regular bedtime, getting some exercise during the day, and avoiding caffeine
late in the day.
- Fatigue. If you feel as though you do not have any
energy and tire easily, try some
measures to manage fatigue, such as getting extra
rest, eating a balanced diet, and reducing your stress.
- Urinary
problems, which can be caused by both cervical cancer and its treatment. It may
help to eliminate caffeinated drinks from your diet and to establish a schedule
of urinating every 3 to 4 hours, regardless of whether you feel the
need.
-
Hair loss. Hair loss may be unavoidable, but using
mild shampoos and avoiding damaging hair products will reduce irritation of
your scalp.
Many women with cervical cancer face emotional issues as a
result of their disease or its treatment.
- Finding out that you have cancer and going
through treatment is stressful.
Managing stress may include expressing your feelings
to others. Learning relaxation techniques may also be helpful. Relaxation
techniques, such as meditation, and support groups may be
helpful.
- Your feelings about your body and your sexuality may
change following treatment for cancer. It may help to talk openly with your
partner about your feelings and to discuss your concerns with your doctor. Your
doctor may be able to refer you to organizations that can offer additional
support and information.
Not all forms of cancer or cancer treatment cause pain. If
pain occurs, many options are available to relieve it. If your doctor has given
you instructions or medicines to treat pain, be sure to follow them.
Home treatment for pain such as a
nonsteroidal anti-inflammatory drug (NSAID) or an
alternative therapy like
biofeedback may improve your physical and mental
well-being. Be sure to discuss with your
doctor any home treatment you use for pain. For more information on how to deal with pain from cancer or cancer
treatment, see:
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Cancer: Controlling Cancer Pain.
Some women with advanced-stage disease may choose not to
have treatment because the time, costs, and side effects of treatment may be
greater than the benefits. Making the decision about when to stop medical
treatment aimed at prolonging life and shift the focus to end-of-life care can
be difficult. For more information, see the topics:
Medications
Chemotherapy
is
used to shrink
cervical cancer and decrease tumor growth.
Chemotherapy may be used to treat later stages (stages II, III, and IV) of
cervical cancer. It may be used alone or in combination with radiation
(chemoradiation). Compared with radiation alone, chemoradiation improves
survival.6 It is usually used as the primary therapy
or after a hysterectomy.
Chemotherapy medicines may be taken by
mouth (orally) or injected into a vein (intravenous, or IV). Chemotherapy is
called a systemic treatment because the medicines enter the bloodstream and
travel through the body to kill cancer cells.
Extensive research
and
clinical trials have studied the different
chemotherapy medicines used to treat cervical cancer. Some medicines are used
routinely, and some are used in combination with others for greater
effectiveness. Your
oncologist will discuss and recommend chemotherapy
treatment specific to your condition.
Medication Choices
Common chemotherapy medicines used to treat cervical cancer include:
What To Think About
Most chemotherapy will cause some
side effects.
Chemotherapy may be given after surgery to try to
kill any cancer cells that may remain, which is called
adjuvant therapy.
Chemotherapy may be given at the same time as radiation treatment (chemoradiation) to improve survival rates. Chemoradiation may be used as primary therapy or after a hysterectomy.
Cisplatin is the medicine most often used in
chemoradiation for cervical cancer.
Surgery
Surgery to remove
cervical cancer may be an option when the cancer is
confined to the cervix or
uterus. The type of surgery performed depends on the
location and extent of cervical cancer and your desire to be able to have
children.
Surgery Choices
Surgery for very early stages of cervical cancer that
preserves your ability to have children includes:
Surgery for most stages of cervical cancer does not
preserve your ability to have children. Surgeries include:
-
Hysterectomy with or without removal of
the
ovaries, to remove the cervix and related organs where
recurrence would be most likely to occur.
- Modified radical
hysterectomy with pelvic lymph node dissection. A radical hysterectomy usually
includes removal of part of the vagina, the uterus, the ovaries, and the
fallopian tubes. This removes the most likely sites of
cancer and may reduce the risk of recurrence.
Surgery to remove the uterus and cervix (hysterectomy) may be done through an incision in the belly. For early-stage cervical cancer, laparoscopic surgery may be possible. This is done with several small incisions in the belly for a tiny camera and special instruments.
Robotic-assisted laparoscopic surgery uses robotic arms that translate the surgeon's hand motions into finer and more precise movements. This surgery requires specially trained doctors.
What To Think About
If surgery is part of your
treatment, you also may be given
radiation therapy,
chemotherapy, or combination chemoradiation. These
treatments may be given before or after surgery to try to destroy any cancer
cells that may remain. Radiation, chemotherapy, or chemoradiation given before
a surgery to help control or reduce the size of the tumor is called
neoadjuvant therapy. Using these therapies after a
surgery when only microscopic areas of cancer may still be present is called
adjuvant therapy.
Compared with
radiation alone, chemoradiation improves survival if it is used either before
or after a hysterectomy.6
Side effects
from surgery can include difficulty with urination or problems with bowel
habits, such as constipation or diarrhea. Your ability to have or enjoy sexual
intercourse may also be affected.
Other Treatment
Radiation therapy
is the standard treatment for certain stages of
cervical cancer and often is used in combination with
surgery.
Radiation therapy is the use of high-energy X-rays to
kill cancer cells and shrink tumors. Radiation may come from a machine outside
the body (external radiation therapy) or from radiation material
(radioisotopes) in thin plastic tubes inserted through the vagina into the
cervical area where the cancer cells are found (intracavitary
brachytherapy).
The two forms of brachytherapy used to treat
cervical cancer include low-dose-rate (LDR) brachytherapy and high-dose-rate
(HDR) brachytherapy. LDR brachytherapy has been used the most in the past, but
HDR brachytherapy takes less time and can be done on an outpatient basis. Both
LDR and HDR appear to work about the same.7
Chemotherapy may be given at the same time as radiation treatment (chemoradiation) to improve survival rates. Chemoradiation may be used as primary therapy or after a hysterectomy.
What to think about
Radiation may cause many
side effects, including diarrhea and irritation of the bladder (radiation
cystitis). Your ability to have or enjoy sexual intercourse may also be
affected, because radiation may cause changes to the cells lining the vagina
(mucosa), making intercourse difficult or painful. A series of vaginal
dilators, starting with a small one and progressing to a larger size, may be
used after radiation therapy. Using the dilators can make the vaginal opening
larger and help make sex less difficult or painful.
Radiation to
treat cervical cancer may thin the bone and increase the risk of fractures in
the pelvic area, including hip fractures. You can take steps to prevent
thinning of the bone (osteoporosis), such as getting enough
calcium and vitamin D. Also, try to
prevent falls, which can lead to fractures. For more information, see the topic
Osteoporosis.
Radiation therapy may also
be used to manage the symptoms that occur with incurable cervical cancer. This
is called
palliative care.
Other Treatment Choices
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the therapies that may be helpful include:
These types of therapies also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Complementary therapies are not a substitute for the
standard treatment recommended for cervical cancer. Before you try any of these
therapies, discuss their possible benefits and side effects with your doctor.
Let him or her know if you are already using any such therapies. For more
information, see the topic
Complementary Medicine.
Other Places To Get Help
Organizations
|
American Cancer Society (ACS)
|
| Phone: |
1-800-ACS-2345 (1-800-227-2345) |
| TDD: |
1-866-228-4327 toll-free |
| Web Address: |
www.cancer.org |
| |
|
The American Cancer Society (ACS) conducts educational
programs and offers many services to people with cancer and to their families.
Staff at the toll-free numbers have information about services and activities
in local areas and can provide referrals to local ACS divisions.
|
|
|
American Congress of Obstetricians and Gynecologists
(ACOG)
|
| 409 12th Street SW |
| P.O. Box 96920 |
| Washington, DC 20090-6920 |
| Phone: |
(202) 638-5577 |
| Email: |
resources@acog.org |
| Web Address: |
www.acog.org |
| |
|
American Congress of Obstetricians and Gynecologists
(ACOG) is a nonprofit organization of professionals who provide health care for
women, including teens. The ACOG Resource Center publishes manuals and patient
education materials. The Web publications section of the site has patient
education pamphlets on many women's health topics, including reproductive
health, breast-feeding, violence, and quitting smoking.
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|
|
Centers for Disease Control and Prevention
(CDC)
|
| 1600 Clifton Road |
| Atlanta, GA 30333 |
| Phone: |
1-800-CDC-INFO (1-800-232-4636) |
| TDD: |
1-888-232-6348 |
| Email: |
cdcinfo@cdc.gov |
| Web Address: |
www.cdc.gov |
| |
|
The Centers for Disease Control and Prevention (CDC) is
an agency of the U.S. Department of Health and Human Services. The CDC works
with state and local health officials and the public to achieve better health
for all people. The CDC creates the expertise, information, and tools that
people and communities need to protect their health—by promoting health,
preventing disease, injury, and disability, and being prepared for new health
threats.
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|
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National Cancer Institute (NCI)
|
| NCI Publications Office |
| 6116 Executive Boulevard |
| Suite 3036A |
| Bethesda, MD 20892-8322 |
| Phone: |
1-800-4-CANCER (1-800-422-6237) 9:00 a.m. to 4:30 p.m. EST, Monday through Friday |
| TDD: |
1-800-332-8615 |
| Email: |
cancergovstaff@mail.nih.gov |
| Web Address: |
www.cancer.gov (or
https://cissecure.nci.nih.gov/livehelp/welcome.asp# for live help
online) |
| |
|
The National Cancer Institute (NCI) is a U.S. government agency
that provides up-to-date information about the prevention, detection, and
treatment of cancer. NCI also offers supportive care to people with cancer and
to their families. NCI information is also available to doctors, nurses, and
other health professionals. NCI provides the latest information about clinical
trials. The Cancer Information Service, a service of NCI, has trained staff
members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
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National Women's Health Information
Center
|
| 8270 Willow Oaks Corporate Drive |
| Fairfax, VA 22031 |
| Phone: |
1-800-994-9662
(202) 690-7650 |
| Fax: |
(202) 205-2631 |
| TDD: |
1-888-220-5446 |
| Web Address: |
www.womenshealth.gov |
| |
|
The National Women's Health Information Center (NWHIC)
is a service of the U.S. Department of Health and Human Services Office on
Women's Health. NWHIC provides women's health information to a variety of
audiences, including consumers, health professionals, and researchers.
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Women's Cancer Network
|
| 230 West Monroe |
| Suite Suite 2528 |
| Chicago, IL 60606 |
| Phone: |
312-578-1439 |
| Email: |
info@thegcf.org |
| Web Address: |
www.wcn.org |
| |
|
The Women's Cancer Network provides information about
cancers of the female reproductive tract (ovary, endometrium, cervix, vulva,
and vagina) for women and their families. Their goal is to help women
understand more about the disease, learn about treatment options, and have
access to new or experimental therapies.
This Web site was
developed by The Gynecologic Cancer Foundation, a non-profit organization with
a mission to help people learn how to prevent, diagnose, and treat cancers of
the female reproductive tract.
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|
References
Citations
-
Chirenje ZM (2005). HIV and cancer of the cervix. Best Practice and Research Clinical Obstetrics and Gynaecology, 19(2): 269–276.
-
National Comprehensive Cancer Network (2010). Cervical Cancer, version 1. Available online: http://www.nccn.org/professionals/physician_gls/PDF/cervical.pdf.
-
American College of Obstetricians and Gynecologists
(2002, reaffirmed 2008). Diagnosis and treatment of cervical carcinomas. ACOG
Practice Bulletin No. 35. Obstetrics and Gynecology,
99(5): 855–867.
-
National Cancer Institute (2010). Cervical Cancer (PDQ): Prevention—Health Professional Version.
Available online:
http://www.nci.nih.gov/cancertopics/pdq/prevention/cervical/healthprofessional.
-
Winer RL, et al. (2006). Condom use and the risk of genital human papillomavirus infection in young women. New England Journal of Medicine, 354(25): 2645–2654.
-
Sundar S, et al. (2008). Cervical cancer, search date
November 2006. Online version of BMJ Clinical Evidence.
Also available online: http://www.clinicalevidence.com.
-
Lertsanguansinchai P, et al. (2004). Phase III
randomized trial comparing LDR and HDR brachytherapy in treatment of cervical
carcinoma. International Journal of Radiation Oncology Biology Physics, 59(5): 1424–1431.
Other Works Consulted
- American Cancer Society (2009). Cancer Facts and Figures for African Americans 2009–2010. Atlanta: American
Cancer Society. Available online:
http://www.cancer.org/downloads/STT/cffaa_2009-2010.pdf.
- Balasubramanian A, et al. (2008). Cervical neoplasia and other STD-related genital tract neoplasias. In KK Holmes et al., eds., Sexually Transmitted Diseases, 4th ed., pp. 1051–1074. New York: McGraw-Hill.
- Eifel PJ, et al. (2008). Cancer of the cervix, vagina, and vulva. In VT DeVita Jr et al., eds., DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology, 8th ed., vol. 2, pp. 1496–1543. Philadelphia: Lippincott Williams and Wilkins.
- Eifel PJ, et al. (2008). Cancer of the cervix, vagina,
and vulva. In VT DeVita Jr et al., eds., Cancer: Principles and Practice of Oncology, 8th ed., vol. 1, pp. 1496–1540. Philadelphia:
Lippincott Williams and Wilkins.
- National Cancer Institute (2009). Cervical Cancer (PDQ): Treatment—Health Professional Version.
Available online:
http://www.cancer.gov/cancertopics/pdq/treatment/cervical/healthprofessional.
-
U.S. Preventive Services Task Force (2003). Screening for cervical cancer: Summary of recommendations. Available online: http://www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.pdf.
Credits
|
By
|
Healthwise Staff |
|
Primary Medical Reviewer
|
Adam Husney, MD - Family Medicine |
|
Specialist Medical Reviewer
|
Ross Berkowitz, MD - Obstetrics and Gynecology |
|
Last Revised
|
August 30, 2010 |