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National Cancer Institute

PDQ® bullet Treatment  bullet Patients

Cervical cancer


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is cancer of the cervix?
STAGE EXPLANATION
Stages of cancer of the cervix
Stage 0 or carcinoma in situ
Stage I
Stage II
Stage III
Stage IV
Recurrent
TREATMENT OPTION OVERVIEW
How cancer of the cervix is treated
Treatment by stage
STAGE 0 CERVICAL CANCER
STAGE I CERVICAL CANCER
STAGE II CERVICAL CANCER
STAGE III CERVICAL CANCER
STAGE IV CERVICAL CANCER
RECURRENT CERVICAL CANCER
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.

Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.

To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


What is cancer of the cervix?

Cancer of the cervix, a common kind of cancer in women, is a disease in which cancer (malignant) cells are found in the tissues of the cervix. The cervix is the opening of the uterus (womb). The uterus is the hollow, pear-shaped organ where a baby develops. The cervix connects the uterus to the vagina (birth canal).

Cancer of the cervix usually grows slowly over a period of time. Before cancer cells are found on the cervix, the tissues of the cervix go through changes in which cells that are not normal begin to appear (known as dysplasia). A Pap smear will usually find these cells. Later, cancer cells start to grow and spread more deeply into the cervix and to surrounding areas.

Since there are usually no symptoms associated with cancer of the cervix, a doctor should do a series of tests to look for it. The first of these is a Pap smear, which is done by using a piece of cotton, a brush, or a small wooden stick to gently scrape the outside of the cervix in order to pick up cells. Pressure is sometimes felt and it is usually not accompanied by pain.

If cells that are not normal are found, the doctor will need to cut a sample of tissue (this procedure is called a biopsy) from the cervix and look at it under a microscope to see if there are any cancer cells. A biopsy that needs only a small amount of tissue may be done in the doctor's office. A person may need to go to the hospital if the doctor needs to remove a larger, cone-shaped biopsy specimen (conization).

The prognosis (chance of recovery) and choice of treatment depend on the stage of the cancer (whether it is just in the cervix or has spread to other places) and the patient's general health.


STAGE EXPLANATION


Stages of cancer of the cervix

Once cancer of the cervix is found (diagnosed), more tests will be done to find out if cancer cells have spread to other parts of the body. This testing is called staging. To plan treatment, a doctor needs to know the stage of the disease. The following stages are used for cancer of the cervix.


Stage 0 or carcinoma in situ

Carcinoma in situ is very early cancer. The abnormal cells are found only in the first layer of cells of the lining of the cervix and do not invade the deeper tissues of the cervix.


Stage I

Cancer involves the cervix but has not spread nearby.

stage IA: a very small amount of cancer that is only visible under a
microscope is found deeper in the tissues of the cervix
stage IB: a larger amount of cancer is found in the tissues of the cervix


Stage II

Cancer has spread to nearby areas but is still inside the pelvic area.

stage IIA: cancer has spread beyond the cervix to the upper two thirds of
the vagina
stage IIB: cancer has spread to the tissue around the cervix


Stage III

Cancer has spread throughout the pelvic area. Cancer cells may have spread to the lower part of the vagina. The cells also may have spread to block the tubes that connect the kidneys to the bladder (the ureters).


Stage IV

Cancer has spread to other parts of the body.

stage IVA: cancer has spread to the bladder or rectum (organs close to the
cervix)
stage IVB: cancer has spread to faraway organs such as the lungs


Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the cervix or in another place.


TREATMENT OPTION OVERVIEW


How cancer of the cervix is treated

There are treatments for all patients with cancer of the cervix. Three kinds of treatment are used:

A doctor may use one of several types of surgery for carcinoma in situ to destroy the cancerous tissue:

Cryosurgery kills the cancer by freezing it.

Laser surgery is the use of a narrow beam of intense light to kill
cancerous cells.

A doctor may remove the cancer using one of these operations:

Conization is the removal of a cone-shaped piece of tissue
where the abnormality is found. Conization may be used to take out a piece
of tissue for biopsy, but it can also be used to treat early cancers of the
cervix.

Alternatively, a doctor may perform a loop electrosurgical excision
procedure (LEEP) to remove the abnormal tissue. LEEP uses an electrical
current passed through a thin wire loop to act as a knife.

A laser beam can also be used as a knife to remove the tissue.

A hysterectomy is an operation in which the uterus and cervix are taken out
along with the cancer. If the uterus is taken out through the vagina, the
operation is called a vaginal hysterectomy. If the uterus is taken out
through a cut (incision) in the abdomen, the operation is called a total
abdominal hysterectomy. Sometimes the ovaries and fallopian tubes are also
removed, which is called a bilateral salpingo-oophorectomy.

A radical hysterectomy is an operation in which the cervix, uterus, and part
of the vagina are removed. Lymph nodes in the area are also removed. This
is called lymph node dissection. (Lymph nodes are small bean-shaped
structures that are found throughout the body. They produce and store cells
that fight infection).

If the cancer has spread outside the cervix or the female organs, a
doctor may take out the lower colon, rectum, or bladder (depending on where
the cancer has spread) along with the cervix, uterus, and vagina. This is
called an exenteration and is rarely needed. Plastic surgery may be needed
to make an artificial vagina after this operation.

Radiation therapy is the use of x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes into the area where the cancer cells are found (internal radiation). Radiation may be used alone or in addition to surgery.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle inserted into a vein. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells outside the cervix.


Treatment by stage

Treatments for cancer of the cervix depend on the stage of the disease, the size of the tumor, and the patient's age, overall condition, and desire to have children.

Treatment of cervical cancer during pregnancy may be delayed depending on the stage of the cancer and how many months a patient has been pregnant.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for most stages of cancer of the cervix. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


STAGE 0 CERVICAL CANCER

Stage 0 cervical cancer is sometimes called carcinoma in situ.

Treatment may be one of the following:

1. Conization.

2. Laser surgery.

3. Loop electrosurgical excision procedure (LEEP).

4. Cryosurgery.

5. Surgery to remove the cancerous area, cervix, and uterus (total abdominal or vaginal hysterectomy) for those women who cannot or no longer want to have children.


STAGE I CERVICAL CANCER

Treatment may be one of the following depending on how deep the tumor cells have invaded into the normal tissue:

For stage IA cancer:
1. Surgery to remove the cancer, uterus, and cervix (total abdominal hysterectomy). The ovaries may also be taken out (bilateral salpingo- oophorectomy), but are usually not removed in younger women.

2. Conization.

3. For tumors with deeper invasion (3-5 millimeters): Surgery to remove the cancer, the uterus and cervix, and part of the vagina (radical hysterectomy) along with the lymph nodes in the pelvic area (lymph node dissection).

4. Internal radiation therapy.

For stage IB cancer:
1. Internal and external radiation therapy.

2. Radical hysterectomy and lymph node dissection.

3. Radical hysterectomy and lymph node dissection followed by radiation therapy plus chemotherapy.

4. Radiation therapy plus chemotherapy.


STAGE II CERVICAL CANCER

Treatment may be one of the following:

For stage IIA cancer:
1. Internal and external radiation therapy.

2. Radical hysterectomy and lymph node dissection.

3. Radical hysterectomy and lymph node dissection followed by radiation therapy plus chemotherapy.

4. Radiation therapy plus chemotherapy.

For stage IIB cancer:
1. Internal and external radiation therapy plus chemotherapy.


STAGE III CERVICAL CANCER

Treatment may be one of the following:

1. Internal and external radiation therapy plus chemotherapy.


STAGE IV CERVICAL CANCER

Treatment may be one of the following:

For stage IVA cancer:
1. Internal and external radiation therapy plus chemotherapy.

For stage IVB cancer:
1. Radiation therapy to relieve symptoms caused by the cancer.

2. Chemotherapy.


RECURRENT CERVICAL CANCER

If the cancer has come back (recurred) in the pelvis, treatment may be one of the following:

1. Radiation therapy combined with chemotherapy.

2. Chemotherapy to relieve symptoms caused by the cancer.

If the cancer has come back outside of the pelvis, a patient may choose to go into a clinical trial of systemic chemotherapy.


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about cancer of the cervix, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this toll-free number, trained information specialists can answer your questions.

The Cancer Information Service also has booklets about cancer that are available to the public and can be sent on request. The following booklet about cancer of the cervix may be helpful:

What You Need To Know About Cancer of the Cervix

The following general booklets on questions related to cancer may also be helpful:

What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again

There are many other places where people can get material and information about cancer treatment and services. The social service office at a hospital can be checked for local and national agencies that help with getting information about finances, getting to and from treatment, getting care at home, and dealing with problems.

For more information from the National Cancer Institute, please write to this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 07/1999


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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