Introduction

Cervical cancer is a very common cancer. Nearly one half million cases are diagnosed worldwide each year.

Most cases of cervical cancer can be prevented by getting regular Pap tests. The Pap test can detect abnormal cells that may develop into cancer if they are not removed.

This reference summary will help you better understand what cervical cancer is and what treatment options are available.

Cancer and Its Causes

The body is made up of very small cells. Normal cells in the body grow and die in a controlled way. Sometimes cells keep dividing and growing in an uncontrolled way, causing an abnormal growth called a tumor.

If the tumor does not invade nearby tissues and body parts, it is called a benign tumor, or non-cancerous growth. Benign tumors are usually not life threatening. It the tumor invades nearby tissues and body parts, it is called a malignant tumor or cancer.

Cancerous cells spread to different parts of the body through blood vessels and lymph channels. Lymph is a clear fluid produced by the body that drains waste from cells. It travels through special vessels and bean-shaped structures called lymph nodes.

Cancer that moves from one tissue to other body parts is known as metastatic cancer. For instance, a cervical tumor may grow through the pelvic wall and nearby tissues over time. Cancers in the body are given names, depending on where the cancer started. Cancer that begins in the cervix will always be called cervical cancer, even if it spreads to other places.

Cervical cancer begins on cells on the surface of the cervix. Over time, the cancerous cells can invade more deeply into the cervix and nearby tissues.

Causes and risk factors

It is usually impossible to specify the cause of cancer in an individual patient. However, we do know what causes cancer in general. Doctors also know factors that can increase the chances of getting cancer.

These are known as “risk factors.” Being infected with a virus called human papilloma virus is a major risk factor for cervical cancer. Nearly all cases of cervical cancer are linked to the human papilloma virus or HPV.

HPV is a virus that can cause abnormal tissue growth and other changes to cells. It is passed during skin-to-skin contact with an infected area.

An HPV infection that doesn’t go away can cause cervical cancer in some women. HPV infections are very common. Women who do not get regular Pap tests are at an increased risk of developing cervical cancer.

The Pap test helps doctors find abnormal cells. Removing or killing the abnormal cells usually prevents cervical cancer. Smoking can also increase a woman’s risk for cervical cancer if she is infected with HPV.

Having a weakened immune system, such as patients with HIV/AIDS, also raises the risk of cervical cancer. The immune system is the body’s natural defense system. Another risk factor for cervical cancer is a woman’s sexual history.

Women who have had multiple sex partners or sex with a man who has had many sex partners may be at higher risk for cervical cancer. Using birth control pills for 5 or more years may slightly increase the risk of cervical cancer for women who are infected with HPV.

This risk decreases quickly after stopping birth control pills. Women with an HPV infection are also at a slightly increased risk of cervical cancer if they have given birth to 5 or more children. DES is a synthetic hormone that used to be given to pregnant women because it was thought to prevent miscarriage.

Daughters of women who took DES during pregnancy are at an increased risk of cervical cancer. Not everybody who has risk factors for cervical cancer develops cervical cancer. Some people who have no risk factors for cervical cancer can still develop the cancer.

Symptoms

Abnormal bleeding is a common symptom of cervical cancer. It is:

    • Bleeding that happens between regular menstrual periods
    • Bleeding after sex, douching, or a pelvic exam
    • Menstrual periods that last longer and are heavier than normal
    • Bleeding after going through menopause

Other common symptoms of cervical cancer include:

    • Increased vaginal discharge
    • Pelvic pain
    • Pain during sex

These symptoms may not be caused by cervical cancer. Infections or other health problems may cause these symptoms. If you are having any of these symptoms, make sure to see a doctor to find out what is causing them.

Diagnosis

Pap tests can find cervical cancer or abnormal cells that can lead to cervical cancer. The cervical cells taken during a Pap test are checked under a microscope. Most often, abnormal cells found by a Pap test are not cancerous.

The same sample of cells may be tested for HPV infection. If you have abnormal Pap or HPV test results, your doctor may suggest other tests. A colposcopy uses a lighted magnifying instrument to examine the vagina and cervix. This makes the tissue easier to see.

A biopsy is a removal of cells or tissue for examination by a pathologist. A pathologist will examine the tissue under a microscope to look for cancer cells. There are many ways in which a cervical biopsy may be done. A biopsy is the only sure way to know if cancer cells are present.

Straging

If you have cervical cancer, your doctor will determine the stage of the cancer. Staging is an attempt to find out if the cancer has spread and, if so, to which parts of the body. Stages are usually described using the numbers 1 - 4; a lower number indicates an earlier stage.

Staging is helpful in deciding the best course of treatment. When staging cervical cancer, doctors want to find out:

    • Whether the tumor has invaded tissues outside the cervix
    • Whether the tumor has spread, and if so, to what parts of the body

If cervical cancer has spread to nearby lymph nodes, it can spread to other areas of the body. Cervical cancer most often spreads to nearby tissues in the pelvis, lymph nodes, or the lungs. It may also spread to the liver or bones.

A chest x-ray is helpful in showing if cervical cancer has spread. Tumors can show up on a CT scan. A CT scan is an x-ray machine linked to a computer. A CT scan takes a series of detailed pictures of your organs.

You may receive contrast material to make abnormal areas easier to see. An MRI is also used to make detailed pictures of areas inside your body. It uses strong magnets to create images of the inside of the body.

You may receive contrast material to make abnormal areas easier to see. A PET scan can show if the cervical cancer has spread elsewhere in the body. For this test, you are injected with a small and safe amount of radioactive sugar.

The PET scanner makes a picture of the places in your body where the sugar is being taken up. Cancer cells show up brighter because they use sugar faster than normal cells.

Treatment and Supportive Care

The type of treatment used depends on the size and location of the tumor, the stage of the disease, and the health of the patient. Treatment for cervical cancer may involve surgery, radiation therapy, chemotherapy, or some combination of these treatments.

Surgery for cervical cancer is an option for women with Stage I or II cervical cancer. The surgeon will remove the cervix. Depending on the surgery, the surgeon may also remove part of the vagina, the lymph nodes in the pelvis, the uterus, the Fallopian tubes, and the ovaries.

Radiation therapy uses high-energy rays to kill cancer cells and stop them from growing and spreading. External radiation comes from a machine that aims the rays at a specific area of the body.

Internal radiation uses radioactive liquids to treat specific areas. This is done by placing a thin tube that is loaded with the radioactive liquid into the vagina. Chemotherapy is the use of drugs to kill cancer cells.

Chemotherapy is usually given in the blood stream through an IV. Chemotherapy and radiation therapy is usually done together to treat cervical cancer. However, these treatments may be used on their own, before surgery or after surgery.

Cervical cancer and its treatment can lead to other health problems. It is important to have supportive care before, during, and after cancer treatment. Supportive care is treatment to control pain and other symptoms, to relieve the side effects of therapy, and to help you cope with emotions.

Prevention

Two kinds of vaccines can protect against the types of HPV that cause most cervical cancers:

    • Cervarix®
    • Gardasil®

Cervarix and Gardasil are effective for females ages 9 through 26 years. It is recommended that all girls who are 11 or 12 years old get 3 doses of either brand of HPV vaccine to protect against cervical cancer and pre-cancer.

Girls and young women ages 13 through 26 should get all 3 doses of an HPV vaccine if they have not received all doses yet. People who have already had sexual contact before getting all 3 doses of an HPV vaccine might still benefit, but only if they were not infected with the HPV types included in the vaccine they received.

The best way to be sure that a person gets the most benefit from HPV vaccination is to complete all three doses before sexual activity begins. Ask your healthcare provider which brand of the vaccine is best for you. The vaccine does not replace the need to wear condoms to lower your risk of getting other types of HPV and other sexually transmitted infections.

    • The best way to prevent any sexually transmitted infection is to not have vaginal, oral, or anal sex. Don't have sex

Practicing safer sex is also important:

    • Be monogamous. Having sex with just one partner can also lower your risk. Being monogamous means that you only have sex with each other and no one else.
    • Use condoms. HPV can happen in both female and male genital areas that are not covered by condoms. However, research has shown that condom use is linked to lower cervical cancer rates. Protect yourself with a condom every time you have vaginal, anal, or oral sex.

Women who have had the HPV vaccine still need to have regular Pap tests.

Proton Therapy for Cervical Cancer Treatment

"Proton therapy potentially represents the best of both worlds – delivering a high dose of radiation to tumors, while at the same time limiting side effects to patients."

Proton therapy is a non–invasive, incredibly precise cancer treatment that uses a beam of protons moving at very high speeds to destroy the DNA of cancer cells, killing them and preventing them from multiplying.

The Benefits of Proton Therapy

Unlike conventional radiation that can affect surrounding healthy tissue as it enters the body and targets the tumor, proton therapy's precise, high dose of radiation is extremely targeted. This targeted precision causes less damage to healthy, surrounding tissue.

When aimed at cancer tumors, protons pack impressive power. Protons release their energy completely once they enter a tumor, limiting the radiation dose beyond the tumor, causing less damage to the healthy surrounding tissues and resulting in fewer side effects.

Even if you've already had a course of conventional radiation and are unable to receive more, you may still be able to receive proton therapy.

More facts about proton therapy:

    • Proton therapy offers fewer reported side effects and complications
    • Normal, healthy, surrounding tissues receive 50% to 70% less radiation
    • Proton therapy offers an increased safe dose delivered to tumors
    • Cure rates may be increased with proton therapy
    • Proton therapy can re–treat tumors after recurrences

Increased Precision Close to Critical Organs

Thanks to its marvelous precision, proton therapy is perhaps the most advanced treatment for cancer tumors located close to critical organs and highly sensitive areas, such as the spinal cord, heart and brain.

Proton therapy, alone or in combination with other treatments, is a great choice for many specific types of cancers and benign conditions.

Proton therapy is also an important treatment option for cancers that cannot be completely removed by surgery.

What to expect

Each patient’s therapy is precisely tailored to their needs. Patients and clinicians collaborate closely to create a personalized treatment plan. The number and length of treatments will vary, based on the cancer. How patients respond depends on many factors, including the types of breast cancer treatments they are receiving. Many people tolerate proton therapy well and continue to perform normal activities. However, individual responses vary.

Advantages of Proton Therapy for Brain Cancer

Although proton radiation treatment is relatively new, clinical trials for cervical cancer have already shown excellent signs of disease control and minimal side effects compared with traditional forms of treatment. Proton therapy also offers a number of other compelling benefits:

    • Treatment is noninvasive and painless
    • Proton therapy is effective for treating early stage breast cancer
    • Treatment offers quicker recovery times with minimal side effects
    • It is more accurate and precise than other kinds of radiation
    • Treatment is provided in an outpatient setting
    • Proton radiation has little to no impact on patient energy level