What is Cervical Cancer?

Cervical cancer begins in the cervix. The cervix is the lower part of the womb, called the uterus. It opens to the vagina. Cervical cancer was once the number-one cause of death from cancer in women. Thanks to the Pap test, which can screen for this cancer, the number of women in the United States with cervical cancer has decreased dramatically. With the Pap test, doctors can also find changes in the cervix when they are still precancerous. It is the only gynecological cancer that can be prevented with regular screening. Anatomy of the Cervix To understand where your cancer is, it may help to know more about the cervix. The cervix is one part of your reproductive system. It is the lower part of the womb, also called the uterus. The cervix connects your uterus and vagina. And your vagina leads to the outside of your body and the vulva, which is the skin area where you have pubic hair. These are the other parts of your reproductive system. They are all in your pelvis. Vagina 2 ovaries 2 fallopian tubes The cervix has 2 parts. The outer part, closest to the vagina, is called the ectocervix. The inner part, closest to the uterus, is called the endocervix. Where these 2 parts meet is where most cervical cancers start. This is also called the transformation zone. Many layers of cells make up the cervix. Two types of cells are on the surface of the cervix.

Squamous epithelial cells line the outer part of the cervix. Columnar epithelial cells line the inner part of the cervix.

Types of Cervical Cancer

A pathologist looks at the cells the doctor removed during your biopsy to tell what type of cervical cancer you have. The type of cancer partly determines your treatment plan. The cervix has 2 parts. The outer part closest to the vagina is called the ectocervix. The inner part closest to the uterus is called the endocervix. Where these 2 parts meet is where most cervical cancers start. This is called the transformation zone. There are 2 main types of cervical cancer.

Squamous cell carcinoma is cancer of cells that line the outer part of the cervix. These cancers have flat, thin cells. They cover the surface of the endocervix, which is the part closest to the uterus. About 80% of cervical cancers are this type. Adenocarcinoma is cancer of the cells lining the inner part of the cervix. They develop from gland cells in the endocervix, which is the part closest to the vagina. About 20% of cervical cancers are this type.

If the cervical cancer affects both types of cells, it is called mixed carcinoma. Statistics About Cervical Cancer Some people use numbers called statistics to figure out their chances of getting cancer. Or they use them to try to figure out their chance of being cured. Statistics show what happened with large groups of people. But statistics cant be used to know or predict what will happen to a particular person. Thats because no two people are alike. These are some 2006 statistics about cervical cancer in the United States. They came from the American Cancer Societys booklet Cancer Facts & Figures. About 9,710 women will find out they have invasive cervical cancer this year. This year, about 3,700 will die from cervical cancer. Hispanic women and African-American women are more likely to get cervical cancer than non-Hispanic white women. Half of the women who get cervical cancer are between 30 and 55 years of age.

Nearly all women with cervical cancer have human papillomavirus (HPV). Over the last 50 years, routine Pap test screening for cervical cancer has reduced deaths from the cancer by 74%. Still, cervical cancer is the second-most common cause of death from cancer in women across the world. Widespread use of HPV vaccines are expected to have a huge impact in the resource-poor countries. In those areas, cervical cancer is often the most common cause of death from cancer in women. Ive Just Been Told I Have Cervical Cancer Very few things are scarier than being told you have cancer. You may feel like youre in shock. You may not even want to believe what the doctor has told you. And there are probably so many questions you want to ask but think you cant because you dont know where to start. First of all, its okay to be overwhelmed. And its okay to feel afraid. But you shouldnt let those feelings stop you from finding out as much as you can about the cancer and about the options you have. Because the more you know, the less helpless and afraid you will feel. And the more you know, the better you will be able to work with your healthcare team to make the best choices for your treatment. To recommend the best treatment for you, your healthcare team needs to know as much as they can about you and your cancer. The biopsy that showed you have cancer give your doctor specific details about the type of cervical cancer you have. Such detailed information can help your doctor predict how fast the cancer may grow. This is called the grade. Its likely youll need other test to learn about how far the cancer has progressed, called the stage. You may need to work with more than one doctor or other healthcare professionals. Your healthcare team will include one or more doctors who specialize in cancer. You may see one or more of these specialists.

Gynecological oncologist, a doctor who specializes in treating cancer in a womans reproductive organs Medical oncologist, a doctor who specializes in using drugs to treat cancer

This team will answer any questions you may have. Theyll also help you through each of the steps youll take before, during, and after treatment. Your team will let you know what tests are being done and their results. Theyll help guide you in making decisions about treatment. Usually treatment for cervical cancer begins a few weeks after a diagnosis. This gives you time to get all the details your doctor needs by having more tests. You also have time to talk with your doctor about treatment choices, get a second opinion, decide about treatment, and prepare yourself and your loved ones. Understanding Your Stage of Cervical Cancer Stage is the word doctors use to communicate the size of a cancerous tumor and where and how far it has spread. The first place cancer is found in the body is called the primary site or primary tumor. When a cancer spreads, its said to have metastasized.

How Cervical Cancer Spreads: Cervical cancer may start growing in other parts of the body. Cervical cancer may spread in these 2 ways. It may grow larger and invade nearby structures such as the vagina, bladder, rectum, or other tissues near the uterus and vagina. It may spread through the lymph nodes in the pelvis. A third type of spread, through the bloodstream, is uncommon. When cervical cancer has spread to another part of the body, its not considered a new cancer. For example, if it spreads to the vagina, its not called vaginal cancer. Its called metastatic cervical cancer. This is because cancer is usually named for the site of the original tumor. Stage Groupings of Cervical Cancer. The most commonly used staging system for cervical cancer is a system developed by the International Federation of Gynecology and Obstetrics (FIGO). In this system, the Roman numerals from 0 to IV represent the different stages of the cancer. The higher the number, the more serious, or advanced, the cancer is.

Stage 0 --This stage is also called carcinoma in situ (CIS). The tumor is still very superficial. It has grown only in the layer of the cells lining your cervix. Stage 1--This cancer has grown into your cervix. It has not spread elsewhere. Stage 1 is further divided into these groups.

Stage IA1. The doctor cannot see this cancer without a miscroscope. It is less than 3 mm deep and less than 7 mm wide. Stage IA2. The doctor cannot see this cancer without a microscope. It is between 3 and 5 mm deep but still less than 7 mm wide. Stage IB1. A doctor can see this cancer with the naked eye. It is no bigger than 4 cm. in size. Stage IB2. A doctor can see this cancer with the naked eye. It is larger than 4 cm in size.

Stage 2--This cancer is in body parts near your cervix but not outside your pelvis. Stage II is further divided in these ways.

Stage IIA. This cancer extends to your upper vagina. It has not spread into the tissues deeper than the vagina. Stage IIB. This cancer has spread to the tissues surrounding your vagina and cervix but not yet to the wall of the pelvis.

Stage 3--This cancer has spread to your lower vagina or to the wall of the pelvis. Stage III is further divided in these ways.

Stage IIIA. The cancer has spread to the lower third of your vagina. It has not spread to the wall of your pelvis. Stage IIIB. The cancer has spread to the soft tissues surrounding your vagina and cervix all the way to the wall of the pelvis. It may cause blockage of urine from to your bladder.

Stage 4--With this stage, the cancer has spread to other parts of your body such as your bladder, rectum, or lungs. Stage IV is further divided in these ways.

Stage IVA. The cancer has spread to nearby organs, such as your bladder or rectum. Stage IVB. The cancer has spread to distant organs, such as your lungs.

Doctors consider the stage of the cancer and knowledge of a womans health and womans feelings and preferences when recommending a treatment plan. Staging information helps doctors compare an individual situation to other women with cervical cancer. Based on clinical studies done on groups of women in similar stages of the cancer, a doctor can make some predictions about how the cancer may behave, and how different kinds of treatment may work. Can I Survive Cervical Cancer? What is My Prognosis? A prognosis is a statement about the prospect of surviving and recovering from a disease. It may sound hard to ask, Can I survive this? But its a question most women have when they learn they have cervical cancer. Unfortunately, there isnt an easy answer. Your chance of recovery depends on these things.

The type and location of the cancer

The stage of the disease How quickly the cancer is likely to grow and spread Your age Your general health How you respond to treatment Before discussing your prognosis with you, your doctor will consider all the things that could affect the cancer and its treatment. Your doctor will then predict what seems likely to happen. To do that, the doctor will look at what researchers have found out over many years about thousands of people with cancer. When possible, the doctor will use statistics for groups of women whose situations are most likely yours to make a prediction. If your cancer is likely to respond well to treatment, your doctor will say you have a favorable prognosis. If the cancer is likely to be hard to control, your prognosis may be unfavorable. It is important to keep in mind, though, that a prognosis states what is

probable. It is not a prediction of what will happen. No doctor can be absolutely certain about the outcome. Some people find it easier to cope when they know their prognosis and the statistics for how well a treatment might work. Other people find statistical information confusing and frightening. Or they might think it is too general to be useful. The doctor who is most familiar with your situation is in the best position to discuss your prognosis with you and explain what the statistics may mean for you. At the same time, you should keep in mind that a persons prognosis may change. A favorable prognosis can change if treatment is successful. The decision to ask about your prognosis is a personal one. It is up to you to decide how much you want to know. What Does the 5-Year Survival Rate for Cervical Cancer Mean? Survival rates show the percentage of women who live for a specific length of time after being told they have cancer. The rates are specific to women with a certain type and stage of cancer. Often, statistics refer to the 5-year survival rate. Thats the percentage of women who are living 5 years after diagnosis. The 5-year rate includes women who are free of disease, have few or no signs or symptoms of cancer or are being treated for cancer. Most women with cervical cancer live much longer than 5 years after diagnosis. Because the statistics we have for 5-year rates are based on women diagnosed and initially treated more than 5 years ago, its possible that the outlook could be even better today. Recently diagnosed women often have a better outlook because of improvements in treatment. Survival rates are based on large groups of women. They cannot be used to predict what will happen to a particular woman. No two women are exactly alike, and treatment and responses to treatment vary greatly.

Some risk factors are out of control, such as your family history or already having HPV. However, other factors, such as getting regular screenings and doing what you can to prevent high-risk HP V, are ones you can control. In fact, when it comes to cervical cancer, you can have a good deal of influence over many of the most potent risk factors.

Experts have evidence that cervical cancer is highly preventable and curable when you work with your healthcare team. Ask your doctors and your loved ones to help you think of ways that you can succeed to lower your risk of cervical cancer.

If you agree with any of the following bolded statements, you may be at an increased risk for cervical cancer. Each time you agree with a statement below, ask yourself if you are doing all you can to control that risk factor. It may seem difficult, but your efforts can have a big payoff in terms of your health and quality of life. I have high-risk HPV. HPV is short for human papillomavirus. It is the most common cause of cervical cancer. An HPV infection is usually harmless and temporary. Anyone who has had sex, both men and women, can get an HPV infection. It is estimated that 3 out of 4 people between the ages of 15 and 49 will get an HPV infection in their lifetime. Most people with HPV never know they are infected because the virus tends to go away on its own. There are many types of this virus. Only a few high-risk types can cause cervical cancer. The only way to tell if you have a high-risk type of HPV is to be tested. These facts will help you gain a basic understanding of HPV. Both men and women can get HPV There are more than 100 different types of HPV virus. About 10 to 30 types of HPV can lead to cervical cancer. These include HPV 16, HPV 18, HPV 31, HPV 33, and HPV 45. HPV 16 and 18 cause about half of all cervical cancers. If high-risk types of HPV do not go away on their own, they may lead to cervical cancer. Infection with persistent high-risk HPV has been shown to cause virtually all cervical cancers. Ive had sexual intercourse at a young age or with multiple partners, or I dont use protection during sex. You are at an increased risk. You get high-risk HPV by having sex with someone who has the virus. Just because someone doesnt have any symptoms, doesnt mean they do not have HPV. Many people have it and dont even know it. The only sure way to protect yourself is to not have sex at all or to have sex only with a partner who you know does not have HPV. Condoms do not protect you from HPV. But condom use is still very important.

Condoms help protect against other sexually transmitted diseases, such as HIV and Chlamydia. Some research has linked Chlamydia to an increase in the risk of cervical cancer.

I smoke. If you smoke, you have a higher risk of getting cervical cancer. You are twice as likely to get cervical cancer as women who dont smoke. Chemicals in cigarettes end up in your bloodstream and in the mucus of your cervix. Other Risk Factors: A few other factors have been linked to cervical cancer. If you agree with any of the statements below, ask yourself if you are doing all you can to control that risk factor.

I have had cervical cancer before. If youve had cervical cancer before, you have a higher chance getting cervical cancer again. My mother or sister has had cervical cancer. Some studies show that if you have a mother or sister who has had cervical cancer, this increases your risk for the disease. I have had a recent or past Chlamydia infection. You can become infected with these bacteria during sex. Some studies show a link between Chlamydia and cervical cancer. More studies are needed to confirm this. I dont eat many fruits and vegetables, especially foods with carotene and vitamins A, C, and E. These foods can help lower your risk of cervical cancer. I am overweight. Some studies have shown that women who are overweight have a greater chance of getting cervical cancer. I use oral contraceptives, also called the pill. Some research has shown that if you take the pill for more than 5 years, you may have an increased risk of cervical cancer. The increased risk is small, however. Also, some women reap benefits from taking oral contraceptives. Therefore, its best to discuss your personal risks and benefits with your doctor or nurse when deciding about oral contraceptives.

I have given birth to several children. If you have had many full-term pregnancies, you may have a greater chance of getting cervical cancer.

10

I cant afford healthcare. Poor women tend to be at higher risk for cervical cancer. Health experts believe that this is because they often do not have access to good healthcare and screenings and also may not be able to afford a well-balanced diet. Ask someone at your local healthcare clinic how to get low-cost or free screenings.