The normal female reproductive system has two ovaries, two fallopian tubes and a uterus (womb).
- The ovaries are where human eggs are made.
- The fallopian tubes provide a path for the eggs to travel from the ovaries to the uterus.
- The uterus is where a baby grows during pregnancy. The cervix is the lower part of the uterus, where it opens into the vagina.
Cervical cancer refers to the growth of abnormal (malignant or cancerous) cells on the cervix. This type of cancer typically starts with cells that are not normal, but are not yet cancerous (dysplasia). Cervical cancer can be prevented if these abnormal cells are detected and destroyed early, before they become cancerous.
- Even when cervical cancer is present, it is highly curable if it is found in its early stages.
- Most cases of cervical cancer are found in women who have not had routine Pap smears or have not had abnormal results evaluated and treated when they are discovered.
Your healthcare provider will look to see if your cervical cancer has spread to other areas of your body. This process is called “staging.” In advanced cases, cervical cancer can involve:
- The bladder
- Other pelvic organs and tissues
- The lungs
- The liver
Your healthcare provider will need the following clinical information to decide what type of treatment is right for you.
- What does the cancer look like under the microscope?
- How large is the primary cancer in the cervix?
- Has the cancer spread to the nearby lymph glands or anywhere else in the body?
- Does the patient want to have children in the future?
An abdominal hysterectomy is the main surgery to treat cervical cancer that has spread outside the cervix. This surgery involves removal of the uterus through an incision in the lower abdomen. The incision can be in the lower abdomen along the bikini line (straight across or horizontal). It can also be in the area of the belly button (straight down or vertical). The type of incision is based on the reason for the surgery, previous surgeries and patient preference.
- The ovaries and fallopian tubes may or may not be removed at the same time as the uterus.
- You and your healthcare provider should discuss what alternative treatments might be available to you. This is especially important if you hope to have children in the future.
- If you need a hysterectomy, you and your doctor should discuss whether your ovaries and fallopian tubes should also be removed. If you have not gone through menopause and your ovaries are removed, you may need hormone supplements for a short time to avoid the symptoms of early menopause.
There are procedures that destroy abnormal cervical cells before they have spread beyond the cervix. These procedures do not usually affect a woman's ability to have children in the future. Three examples are:
- Loop Electrosurgical Excision Procedure (LEEP) – the use of an electrical current to destroy abnormal cells
- Cryotherapy – the destruction of abnormal cells by freezing them
- Laser therapy – the use of light to destroy abnormal tissue
Routine Pap smears have decreased the incidence of cervical cancer in the United States. This is because cervical cancers typically evolve slowly and Pap spears can detect pre-cancerous lesions when they are treatable. Some of the risks factors for cervical cancer include:
- HPV (human papilloma virus) – Certain strains of the HPV virus are the most common cause of cervical cancer. HPV is spread during sexual intercourse. A vaccine has been developed to prevent HPV infection and decrease the chance of cervical cancer.
- Sexual activity - You began having intercourse at an early age.
- High-risk sexual activity - You or your partner have multiple sex partners or engage in other high-risk sexual activities.
- Smoking - You are a smoker.
- DES exposure - Your mother took a synthetic estrogen called diethylstilbestrol (DES) when she was pregnant. In the past, DES was given to pregnant women to prevent miscarriage and other pregnancy complications. Daughters exposed to DES before birth have an increased risk of developing vaginal or cervical cancer.
- Weak immune system - Your immune system is weak due to medications or illness.
- Lower economic status - May be due to lack of insurance and inability to pay for routine Pap smears.
Things you can do to decrease your risk of developing cervical cancer, or catch it at a very early (curable) stage, include:
- Getting routine pap smears, as recommended by your healthcare provider.
- Getting vaccinated with the HPV vaccine, as recommended by your healthcare provider.
- Practice safe sex (use a condom).
- Limit the number of sexual partners.
- Do not have sex with people who engage in high-risk sexual activity.
There are frequently no symptoms in the early stages of cervical cancer. When present, symptoms can include:
- Constant vaginal discharge that may smell badly and vary in color from pale to brown
- Vaginal bleeding between menses or after sexual activity
- Vaginal bleeding after menopause
As the cancer advances, other symptoms can develop. These include:
- Decreased appetite and weight loss
- Feeling tired all the time
- Lower back and leg pain
- A leg that is swollen
- Inability to hold urine or stool
Contact your healthcare provider if you have any of the symptoms noted above. He or she will perform a physical examination and Pap smear to see if there are any abnormal cells on your cervix. They may also recommend one of the following tests:
- Endocervical curettage (ECC) to examine the passageway inside the cervix
- Removal of tissue for examination under a microscope (biopsy)
- A biopsy is needed to determine if an abnormality is cancer. If your cervical biopsy indicates you do have cervical cancer, additional testing may be needed.
The treatment for cervical cancer is based on many factors. These factors include:
- Your age and general health
- Your desire to have children in the future
- The size of the tumor and how fast it is growing
- Whether the cancer has spread to other parts of the body
Treatments for cervical cancer are either local (only affects the area of the cancer) or systemic (affects all areas of the body). Local treatments include:
- Surgery to remove the cancer
- Radiation to kill the cancer cells
Systemic treatments include:
- Chemotherapy to kill the cancer cells
- Targeted or biologic therapy to interfere with the changes in cells that help the cancer grow
- Targeted therapy has been approved for advanced cervical cancer
Treatment for cervical cancer can involve a combination of local and systemic treatments. You may also have more than one type of cancer treatment at a time. Depending on your situation, you may alternate between chemotherapy and radiation before or after surgery.
To get a full range of opinions and perspectives, you may want to consider input from a variety of doctors. This group may include:
- Your primary care physician
- A medical oncologist (a doctor who specializes in the treatment of cancer)
- A surgeon with experience in cervical cancer treatment
- A radiation oncologist (a doctor who specializes in treating cancer with radiation therapy)
If your healthcare provider recommends a hysterectomy, prior to the surgery tell them about any medications you are taking (including over-the-counter medications, herbal remedies and supplements). You should also ask about specific instructions to follow before and after the surgery. These include:
- Medications you should not take before the surgery, such as blood thinners
- Regular medications you should continue to take on the day of your surgery
- How many hours you should stop eating and drinking before the surgery
If you are a smoker, you should quit smoking. Smoking can interfere with your recovery from surgical procedures.
During your surgery, you will receive anesthesia to keep you comfortable and pain free. General anesthesia is the most common type of anesthesia for a hysterectomy. With this type of anesthesia, you are put into a deep sleep and are unable to see, hear, or feel anything.
- To prevent complications, it is important you get out of bed and walk as soon as possible.
- You will likely be in the hospital for a few days.
- Full recovery from a hysterectomy typically takes a couple of months.
- You will most likely need pain medication and help at home while you recover.
- Do not forget to arrange for transportation to and from the facility.
It is important to remember that the total cost of this care path does not include all possible medications, labwork or imaging studies. Those charges can add up. If your healthcare provider recommends any labwork or imaging studies you may need to search for their costs separately.
Contact your healthcare provider if you have symptoms of cervical cancer. Be prepared to discuss your symptoms and how long you have had them.
- Bring a copy of your medical history (past illnesses, surgeries, and hospitalizations).
- Make a list of your medications (including over-the-counter).
- Write down any questions, symptoms or concerns you want to talk about.
- If your healthcare provider prescribes a medication for you, ask for a generic version. If your doctor thinks that a generic version is not right for you, ask for a medication on the lowest available tier of your Prescription Drug List (PDL).
What should I ask my healthcare provider before having a hysterectomy?
- What is my diagnosis? What type of cervical cancer do I have?
- What tests are you recommending and why? Will the test results change my treatment plan? If not, then why do I need them?
- What type of hysterectomy are you recommending? Are there any alternatives? What are the benefits and risks of each?
- Are you removing all or part of my uterus? Will I need pap smears in the future?
- Do my ovaries need to be removed? Will I need to take hormone replacement?
- How will I feel after the surgery? Will I have to modify my activity? How long until I can get back to my normal activities?
- What are the possible complications for this surgery?
- What happens if I do not go through with the surgery?
- What is your experience in doing this type of surgery? What is your complication rate?
- Is there any special preparation for the surgery? (If so, get clear instructions on what you need to do.)
- Will I be receiving other treatments before or after my surgery?
Before you go home, make sure you understand all home care instructions (including medications and side effects) and follow-up plans. Your surgeon should also communicate with your primary care physician.