Cervical cancer primarily affects women under 50 years old. Scripps multidisciplinary teams of affiliated surgeons, medical oncologists, gynecologic oncologists, radiation oncologists, pathologists, nurses and clinicians are focused on helping you fight cancer.
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Annual check-ups are part of a healthy lifestyle. Screening for cervical cancer has proven to be effective in the early detection of the disease. More than 90 percent of U.S. women diagnosed and treated for stage IA cervical cancer survive 5 years or more, according to national statistics.
The Pap test (also known as a Pap smear) can find abnormal cervical cells and help doctors learn if you’re at risk for cervical cancer. The test can be combined with a human papillomavirus (HPV) test.
For women 30 and older, screening with an HPV test and a Pap test is more likely to find abnormal cervical cell changes than either test performed alone, according to the National Cancer Institute. Be sure to discuss with your doctor the best approach for your individual care.
The American Cancer Society recommends the following cervical cancer screening guidelines:
- At age 21, all women should begin cervical cancer screening with a Pap test every 3 years until age 29.
- At age 30, a Pap test should be combined with a human papillomavirus (HPV) test every 5 years until age 65.
- For women between 30 and 65, an alternative screening can be a Pap test every 3 years.
- Women older than 65 who have had regular screenings the previous 10 years may stop if they haven’t had any pre-cancers such as CIN2 or CIN3 in the past 20 years.
- Women who have been diagnosed with pre-cancers CIN2 or CIN3 should continue to be screened for a minimum of 20 years after their initial diagnosis.
- Women who have had a total hysterectomy for reasons other than treatment for pre-cancer or cancer of the cervix may not need regular screenings.
- Women who have had a hysterectomy in which their cervix was not removed should continue to follow standard screening guidelines up to age 65.
- Women at high risk of cervical cancer due to a suppressed immune system or exposure in utero to Diethylstilbestrol (DES), a synthetic form of the hormone estrogen prescribed to some pregnant women between 1940 and 1971 for miscarriage prevention, should speak with their physician and healthcare team about a recommended screening schedule.
Pap tests and HPV tests can alert physicians early to a possible cervical cancer and increase chances of beating it. If you have an abnormal finding or other potential symptoms such as unexplained vaginal bleeding, vagina discharge or pain during intercourse, more tests are usually performed. They may include:
- Pelvic exam may include a physical check of the vulva, uterus, cervix, fallopian tubes, ovaries, bladder and rectum.
- Colposcopy in which a doctor examines the surface of the cervix through a special instrument with magnification called a colposcope that remains outside the body.
- Hysteroscopy is a procedure in which a small telescope (diameter of one-sixth of an inch) is inserted into the cervix for a physician to view the uterus.
- Cervical biopsies can involve taking a tissue sample or larger removal of abnormal tissue. Types of cervical biopsies include a colposcopic biopsy, endocervical curettage or cone biopsy.
- Cystoscopy or proctoscopy under anesthesia is the insertion of slender tubes with lights and/or lenses that allow doctors to see urinary organs and the rectum for possible spread of cancer in cases with large cervical cancer tumors.
- Imaging tests can include computed tomography (CT) and magnetic resonance imaging (MRI), chest X-ray or positron emission tomography (PET/CT).
- Intravenous urography and intravenous pyelography are X-rays of the urinary system, and urinary system plus kidneys that rely in part on a special dye injected into the arm.
Treatment of cervical cancer may include one or more of the following: surgery, chemotherapy or radiation therapy.
- Hysterectomy involves the removal of the uterus (and possibly the cervix). It can be performed through an abdominal incision, the vagina or through minimally-invasive procedures such as laparoscopic surgery or robotic-assisted surgery, which is aimed to reduce scarring and improve recovery times. Minimally-invasive surgeries also may provide benefits for patients receiving radiation therapy post-surgery as part of their treatment plan. Radical hysterectomy and modified radical hysterectomy are two variations of the surgery.
- Cone biopsy (also called conization) can be performed for early-stage cervical cancers in women who want to preserve the opportunity for childbirth and involves removal of a cone-shaped section of tissue from the cervix and cervical canal.
- Trachelectomy preserves the uterus (for childbirth) but removes the cervix, upper part of the vagina and nearby lymph nodes. The procedure is performed with the goal of minimizing surgical adhesions and scarring.
- Pelvic exenteration is the most extensive surgical approach and is typically for recurrent cervical cancer. It involves removal of the uterus, cervix, bladder, vagina, rectum and possibly part of the colon, based on how extensively the cancer has spread.
Chemotherapy may be given as primary treatment for metastatic or for recurrent cervical cancer — or in combination with radiation treatment, an approach known as concurrent chemoradiation.
External beam radiation therapy may be provided in combination with chemotherapy.
Another form of radiation therapy called high-dose rate brachytherapy may be given alone or in conjunction with a shortened course of external beam radiation therapy. Scripps has the most advanced radiation therapy choices.
Complementary therapies, including therapeutic nutrition and supplementation, acupuncture, yoga and massage therapy, can help manage cancer symptoms.