Dr. M.J. Bazos, MD
Patient Handout
CERVICAL
CANCER
About Your
Diagnosis
The cervix is located at the
end of the vaginal canal. If is a button-like structure with a narrow opening
that leads into the uterus (womb). Cancer of the cervix or cervical cancer was
at one time the most common cause of cancer death among women, but this risk has
declined considerably over the years because of early detection with Pap smears
(Papanicolaou smear). Approximately 60,000 new cases are diagnosed each year,
and most are in the earliest stage, meaning the likelihood of cure is high.
Risks for cervical cancer include the following: sexual intercourse before 18
years of age, many sexual partners, smoking, use of oral contraceptives (birth
control pills), having a mother who took diethylstilbestrol (DES) during
pregnancy to prevent miscarriage, infection with human papillomavirus (HPV),
which is sexually transmitted. Pap smears are 95% accurate in the detection of
early cervical cancer. They are recommended for all women older than 20 years or
sooner if sexually active and should be performed annually (some organizations
recommend every 3 years). If a Pap smear is abnormal, a primary care physician
makes a referral to a gynecologist for colposcopy (microscopic examination of
the cervix with a lighted tube). With this method, tissue can be removed and
examined by a pathologist. If this does not give definitive evidence of cancer,
a cone biopsy may be performed. In this procedure a cone-shaped sample of tissue
is removed to detect cancer.
Living
With Your Diagnosis
Patients with
cervical cancer usually have no symptoms until the cancer has invaded nearby
tissue. The most common symptom is vaginal bleeding or bleeding after sexual
intercourse. Vaginal bleeding after menopause is cause for concern. Increased
vaginal discharge may be another symptom. The cancer usually spreads locally to
invade other nearby structures and can cause symptoms such as back pain, urinary
frequency, and bowel
changes.
Treatment
Treatment
usually depends on the stage of the cancer. Staging a cancer means to find out
whether the cancer has spread, and if so, where has it spread? A physician
performs a pelvic examination and orders blood and urine tests, radiographs
(x-rays), including an intravenous pyelogram (IVP), to examine the kidneys,
bladder, and ureter (the tube that connects the kidney with the bladder) to
exclude any spread. Computed tomography (CT) is performed to exclude spread to
lymph nodes. Cystoscopy and proctosigmoidoscopy (examinations with lighted
scopes passed into the bladder and rectum, respectively) also may be performed.
Staging is as follows: Stage 0, cancer only at the site; stage I, cancer
confined to the cervix; stage II, cancer invasion but not to the lower third of
the vagina; stage III, cancer invasion beyond the cervix to the lower third of
the vagina; stage IV, cancer invasion of the bladder or rectum. Treatment
includes surgical, radiation, and chemotherapy. Most patients can be treated
with surgical therapy or surgical and radiation therapy. Stages 0 and I cancer
can be managed by means of surgical removal of the uterus (hysterectomy).
Radiation therapy can be used in place of surgical therapy for stage I disease.
Radiation is the preferred therapy for stages II through IV cancer. Chemotherapy
has not been effective but is are tried
for
cancer in advanced stages. Side effects
of surgical treatment include pain, infection, vaginal drainage, urinary
discomfort, and bowel changes. Side effects of radiation therapy, because it is
in the lower abdomen and pelvic area, include diarrhea; loose, bloody stools;
dry, itchy, red, burning skin; nausea and vomiting; and urinary burning, pain,
and frequency. Side effects of chemotherapy include easy bruising and bleeding,
fever, nausea, vomiting, and hair
loss.
The
DOs
• Undergo yearly Pap
smears.
• Educate your children
(girls and boys) about early sex, multiple partners, and sexually transmitted
diseases.
• Understand that early
detection usually results in cure.
•
Understand the importance of nutrition after surgical, radiation, or
chemotherapy.
• Understand that
depending on the stage of disease, you are treated by a team of physicians,
including a primary care physician, gynecologist, oncologist, and radiation
oncologists.
The
DON’Ts
• Do not miss
follow-up appointments because repeat Pap smears, pelvic examinations, and other
laboratory studies are performed to make sure the cancer has not
returned.
• Do not forget to stay
active. Exercising daily helps you deal with the
disease.
• Do not be afraid to ask
about emotional support groups.
• Do
not forget about social workers who can help with services such as
rehabilitation, home care, finances, and
transportation.
When to Call Your
Doctor
• If you have any abnormal
vaginal bleeding.
• If you have any
pain after surgical treatment.
• If
you have any bowel or urinary problems after surgical treatment or radiation
therapy, such as bloody diarrhea, urinary frequency, or
pain.
• If you have any excess
vaginal drainage or fever after surgical
treatment.
• If you are experiencing
hot flashes, vaginal dryness, or vaginal pain with
intercourse.