Cervical cancer can be diagnosed by an abnormal Pap smear or during a pelvic exam. On exam, the cervix is enlarged and bleeds easily on contact. When the cervical cancer is small and confined to the cervix, it can be treated surgically by radical hysterectomy with pelvic lymph node dissection via laparotomy. In more advanced cases, cervical cancer is treated with a combination of radiation therapy and chemotherapy.

Is it true that cervical cancer is caused by a virus?

Yes. Most cervical cancers occur as the result of long-term exposure to the human papillomavirus, also known as HPV. Men and women are exposed to this virus through intimate sexual contact. Most individuals develop immunity to the virus, but about 10 percent of the population fails to develop immunity, allowing it to remain in the genital tract. As a result, precancerous and cancerous tissue changes can occur in the cervix and other genital tissues. These changes can be detected by Pap smears, pelvic exams and viral testing.

Can the virus be prevented?

In most cases, yes. A vaccine against the most common types of HPV has been developed. This vaccine prevents the development of many precancerous and cancerous cervical changes. The vaccine works best when a woman is vaccinated prior to sexual contact. The vaccine has been targeted for use in girls and women ages 11 to 25 years.

Can invasive cervical cancer be cured?

Yes. If detected early, most cervical cancer can be cured with surgery or radiation therapy.

Treatment for cervical cancer

Gynecologic cancer surgery

Gynecologic patients have surgery performed through the abdomen, vagina or both. Abdominal surgery is done under general anesthesia. Abdominal surgery can be performed through a vertical incision that extends from the pubic bone upward toward the breast bone or though a horizontal incision located above the pubic bone. If a telescope or laparoscope is used, the incision can be limited to multiple small incisions in the abdominal wall.

Vaginal surgery is performed through the vagina under general or spinal surgery. This approach allows the vulva, vagina and cervix to be carefully examined. Patients are placed on their back with their feet in stirrups during surgery. Common vaginal procedures include uterine dilation and curettage (D&C), a procedure to remove tissue from inside the uterus, hysteroscopy, vaginal hysterectomy and some pelvic support procedures.

In general, it takes four to six weeks to resume normal activities after major abdominal surgery. Recovery time from vaginal surgery is typically shorter than that of abdominal surgery.

Radiation therapy

Radiation therapy consists of a high energy invisible field of electromagnetic waves that are created by a machine called a linear accelerator and directed at a certain part of the body in a treatment field called a port. Treatments are usually given in an outpatient setting five days a week for approximately six weeks.

During this time, patients may experience fatigue and an increase in stool and urinary frequency. Occasionally, skin irritation and redness may result from radiation.

Intracavitary or brachytherapy involves insertion of a device into the vagina and uterus and then placement of radiation sources into these devices. Patients are given general anesthesia in an operating room setting for insertion of the radiation applicator. The radiation sources are subsequently placed into the applicator later when the patient is returned to her private room. The radiation sources and applicator are removed in the patient 's room within 24 to 48 hours. Normally, two intracavitary radiation treatments are planned for cervical or vaginal cancers. Once an area of the body has been treated with radiation therapy, this area cannot be treated again without the risk of serious tissue damage.

After radiation is complete, the effects of treatment on tissues may continue for as long six months. Long-term side effects of radiation may include vaginal narrowing, chronic diarrhea or constipation and an increase in urinary frequency. Some patients have no long-term side effects, and some have only a few.

Chemotherapy

Chemotherapy involves the administration of chemical agents that poison cancer cells and, to a lesser degree, normal cells. There are many different chemotherapy agents. These can be administered intravenously, intramuscularly, intraperitoneally or orally. Most IV and intraperitoneal regimens are given at three- to four-week intervals. Most oral regimens consist of daily medication for two to four weeks each month.

Chemotherapy agents may cause nausea, vomiting, hair loss, skin reaction or low blood counts. These side effects can often be controlled with additional medication. The side effects stop when treatment has ended. Some of the drugs used for chemotherapy in gynecologic oncology include Taxol, Carboplatin, Cisplatin, Doxal, Topotecan, cytoxan and methotrexate.