What is Cervical Cancer?
Cervical cancer is a type of cancer that starts in the cervix. The cervix is a hollow cylinder that connects the lower part of a woman’s uterus to her vagina. Most cervical cancers begin in cells on the surface of the cervix.
Various strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cervical cancer. You can reduce your risk of developing cervical cancer by having screening tests and receiving a vaccine that protects against HPV infection.
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Before Cervical Cancer Treatment
Symptoms of cervical cancer
Many women with cervical cancer don’t realize they have the disease early on, because it usually doesn’t cause symptoms until the late stages. When symptoms do appear, they’re easily mistaken for common conditions like menstrual periods and urinary tract infections (UTIs).
Typical cervical cancer symptoms are:
. Vaginal bleeding after intercourse, between periods or after menopause
. Watery, bloody vaginal discharge that may be heavy and have a foul odor
. Pelvic pain or pain during intercourse
. Needing to urinate more often
. Pain during urination
While uncommon, advanced cervical cancer may cause the following symptoms:
. Excessive tiredness
. Leg pain or swelling
. Lower back pain.
If you notice any of these symptoms, see your doctor for an exam. Find out how your doctor will diagnose cervical cancer.
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About Iranian Surgery
Iranian surgery is an online medical tourism platform where you can find the best Surgeons to treat your cervical cancer in Iran. The price of treating a cervical cancer in Iran can vary according to each individual’s case and will be determined by the type of treatment you have and an in-person assessment with the doctor. So if you are looking for the cost of cervical cancer treatment in Iran, you can contact us and get free consultation from Iranian surgery.
Cervical Cancer Causes
Cervical cancer begins when healthy cells in the cervix develop changes (mutations) in their DNA. A cell's DNA contains the instructions that tell a cell what to do.
Healthy cells grow and multiply at a set rate, eventually dying at a set time. The mutations tell the cells to grow and multiply out of control, and they don't die. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can break off from a tumor to spread (metastasize) elsewhere in the body.
It isn't clear what causes cervical cancer, but it's certain that HPV plays a role. HPV is very common, and most people with the virus never develop cancer. This means other factors — such as your environment or your lifestyle choices — also determine whether you'll develop cervical cancer.
Risk factors for cervical cancer include:
. Many sexual partners. The greater your number of sexual partners — and the greater your partner's number of sexual partners — the greater your chance of acquiring HPV.
. Early sexual activity. Having sex at an early age increases your risk of HPV.
. Other sexually transmitted infections (STIs). Having other STIs — such as chlamydia, gonorrhea, syphilis and HIV/AIDS — increases your risk of HPV.
. A weakened immune system. You may be more likely to develop cervical cancer if your immune system is weakened by another health condition and you have HPV.
. Smoking. Smoking is associated with squamous cell cervical cancer.
. Exposure to miscarriage prevention drug. If your mother took a drug called diethylstilbestrol (DES) while pregnant in the 1950s, you may have an increased risk of a certain type of cervical cancer called clear cell adenocarcinoma.
Screening tests can help detect cervical cancer and precancerous cells that may one day develop into cervical cancer. Most guidelines suggest beginning screening for cervical cancer and precancerous changes at age 21.
Screening tests include:
. Pap test. During a Pap test, your doctor scrapes and brushes cells from your cervix, which are then examined in a lab for abnormalities.
A Pap test can detect abnormal cells in the cervix, including cancer cells and cells that show changes that increase the risk of cervical cancer.
. HPV DNA test. The HPV DNA test involves testing cells collected from the cervix for infection with any of the types of HPV that are most likely to lead to cervical cancer.
Discuss your cervical cancer screening options with your doctor.
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If cervical cancer is suspected, your doctor is likely to start with a thorough examination of your cervix. A special magnifying instrument (colposcope) is used to check for abnormal cells.
During the colposcopic examination, your doctor is likely to take a sample of cervical cells (biopsy) for laboratory testing. To obtain tissue, your doctor may use:
. Punch biopsy, which involves using a sharp tool to pinch off small samples of cervical tissue.
. Endocervical curettage, which uses a small, spoon-shaped instrument (curet) or a thin brush to scrape a tissue sample from the cervix.
If the punch biopsy or endocervical curettage is worrisome, your doctor may perform one of the following tests:
. Electrical wire loop, which uses a thin, low-voltage electrified wire to obtain a small tissue sample. Generally this is done under local anesthesia in the office.
. Cone biopsy (conization), which is a procedure that allows your doctor to obtain deeper layers of cervical cells for laboratory testing. A cone biopsy may be done in a hospital under general anesthesia.
If your doctor determines that you have cervical cancer, you'll have further tests to determine the extent (stage) of your cancer. Your cancer's stage is a key factor in deciding on your treatment.
Staging exams include:
. Imaging tests. Tests such as X-ray, CT, MRI and positron emission tomography (PET) help your doctor determine whether your cancer has spread beyond your cervix.
. Visual examination of your bladder and rectum. Your doctor may use special scopes to see inside your bladder and rectum.
To reduce your risk of cervical cancer:
. Ask your doctor about the HPV vaccine. Receiving a vaccination to prevent HPV infection may reduce your risk of cervical cancer and other HPV-related cancers. Ask your doctor whether an HPV vaccine is appropriate for you.
. Have routine Pap tests. Pap tests can detect precancerous conditions of the cervix, so they can be monitored or treated in order to prevent cervical cancer. Most medical organizations suggest beginning routine Pap tests at age 21 and repeating them every few years.
. Practice safe sex. Reduce your risk of cervical cancer by taking measures to prevent sexually transmitted infections, such as using a condom every time you have sex and limiting the number of sexual partners you have.
. Don't smoke. If you don't smoke, don't start. If you do smoke, talk to your doctor about strategies to help you quit.
During Cervical Cancer Treatment
Types of cervical cancer
Cervical cancers and cervical pre-cancers are classified by how they look in the labs with a microscope. The main types of cervical cancers are squamous cell carcinoma and adenocarcinoma.
. Squamous cell carcinomas, Most (up to 9 out of 10) cervical cancers are squamous cell carcinomas. These cancers develop from cells in the exocervix. Squamous cell carcinomas most often begin in the transformation zone (where the exocervix joins the endocervix).
. Adenocarcinomas, Most of the other cervical cancers are adenocarcinomas. Adenocarcinomas are cancers that develop from glandular cells. Cervical adenocarcinoma develops from the mucus-producing gland cells of the endocervix.
. Adenosquamous carcinomas or mixed carcinomas, less commonly, cervical cancers have features of both squamous cell carcinomas and adenocarcinomas. These are called adenosquamous carcinomas or mixed carcinomas.
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Cervical Cancer Stages
Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.
Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer. For cervical cancer, the staging system developed by the International Federation of Obstetrics and Gynecology (FIGO) is used.
FIGO stages for cervical cancer
Doctors assign the stage of the cancer by evaluating the tumor and whether the cancer has spread to other parts of the body.
Staging is based on the results of a physical exam, imaging scans, and biopsies.
Stage I: The cancer has spread from the cervix lining into the deeper tissue but is still just found in the uterus. It has not spread to other parts of the body. This stage may be divided into smaller groups to describe the cancer in more detail (see below).
. Stage IA: The cancer is diagnosed only by viewing cervical tissue or cells under a microscope. Imaging tests or evaluation of tissue samples can also be used to determine tumor size.
. Stage IA1: There is a cancerous area of less than 3 millimeters (mm) in depth.
. Stage IA2: There is a cancerous area 3 mm to less than 5 mm in depth.
. Stage IB: In this stage, the tumor is larger but still only confined to the cervix. There is no distant spread.
. Stage IB1: The tumor 5 mm or more in depth and less than 2 centimeters (cm) wide. A centimeter is roughly equal to the width of a standard pen or pencil.
. Stage IB2: The tumor is 2 cm or more in depth and less than 4 cm wide.
. Stage IB3: The tumor is 4 cm or more in width.
Stage II: The cancer has spread beyond the uterus to nearby areas, such as the vagina or tissue near the cervix, but it is still inside the pelvic area. It has not spread to other parts of the body. This stage may be divided into smaller groups to describe the cancer in more detail (see below).
. Stage IIA: The tumor is limited to the upper two-thirds of the vagina. It has not spread to the tissue next to the cervix, which is called the parametrial area.
. Stage IIA1: The tumor is less than 4 cm wide.
. Stage IIA2: The tumor is 4 cm or more in width.
. Stage IIB: The tumor has spread to the parametrial area. The tumor does not reach the pelvic wall.
Stage III: The tumor involves the lower third of the vagina, and/or has spread to the pelvic wall, and/or causes swelling of the kidney, called hydronephrosis, or stops a kidney from functioning, and/or involves regional lymph nodes. There is no distant spread.
. Stage IIIA: The tumor involves the lower third of the vagina, but it has not grown into the pelvic wall.
. Stage IIIB: The tumor has grown into the pelvic wall and/or affects a kidney.
. Stage IIIC: The tumor involves regional lymph nodes. This can be detected using imaging tests or pathology. Adding a lowercase "r" indicates imaging tests were used to confirm lymph node involvement. A lowercase "p" indicates pathology results were used to determine the stage.
. Stage IIIC1: The cancer has spread to lymph nodes in the pelvis.
. Stage IIIC2: The cancer has spread to para-aortic lymph nodes. These lymph nodes are found in the abdomen near the base of the spine and near the aorta, a major artery that runs from the heart to the abdomen.
. Stage IVA: The cancer has spread to the bladder or rectum, but it has not spread to other parts of the body.
. Stage IVB: The cancer has spread to other parts of the body.
Treatment for cervical cancer depends on several factors, such as the stage of the cancer, other health problems you may have and your preferences. Surgery, radiation, chemotherapy or a combination of the three may be used.
Early-stage cervical cancer is typically treated with surgery. Which operation is best for you will depend on the size of your cancer, its stage and whether you would like to consider becoming pregnant in the future.
Options might include:
. Surgery to cut away the cancer only. For a very small cervical cancer, it might be possible to remove the cancer entirely with a cone biopsy. This procedure involves cutting away a cone-shaped piece of cervical tissue, but leaving the rest of the cervix intact. This option may make it possible for you to consider becoming pregnant in the future.
. Surgery to remove the cervix (trachelectomy). Early-stage cervical cancer might be treated with a radical trachelectomy procedure, which removes the cervix and some surrounding tissue. The uterus remains after this procedure, so it may be possible to become pregnant, if you choose.
. Surgery to remove the cervix and uterus (hysterectomy). Most early-stage cervical cancers are treated with a radical hysterectomy operation, which involves removing the cervix, uterus, part of the vagina and nearby lymph nodes. A hysterectomy can cure early-stage cervical cancer and prevent recurrence. But removing the uterus makes it impossible to become pregnant.
Minimally invasive hysterectomy, which involves making several small incisions in the abdomen rather than one large incision, may be an option for early-stage cervical cancer. People who undergo minimally invasive surgery tend to recover more quickly and spend less time in the hospital. But some research has found minimally invasive hysterectomy may be less effective than traditional hysterectomy. If you're considering minimally invasive surgery, discuss the benefits and risks of this approach with your surgeon.
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Radiation therapy uses high-powered energy beams, such as X-rays or protons, to kill cancer cells. Radiation therapy is often combined with chemotherapy as the primary treatment for locally advanced cervical cancers. It can also be used after surgery if there's an increased risk that the cancer will come back.
Radiation therapy can be given:
. Externally, by directing a radiation beam at the affected area of the body (external beam radiation therapy)
. Internally, by placing a device filled with radioactive material inside your vagina, usually for only a few minutes (brachytherapy)
. Both externally and internally
If you haven't started menopause yet, radiation therapy might cause menopause. If you might want to consider becoming pregnant after radiation treatment, ask your doctor about ways to preserve your eggs before treatment starts.
Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. It can be given through a vein or taken in pill form. Sometimes both methods are used.
For locally advanced cervical cancer, low doses of chemotherapy are often combined with radiation therapy, since chemotherapy may enhance the effects of the radiation. Higher doses of chemotherapy might be recommended to help control symptoms of very advanced cancer.
Targeted drug treatments focus on specific weaknesses present within cancer cells. By blocking these weaknesses, targeted drug treatments can cause cancer cells to die. Targeted drug therapy is usually combined with chemotherapy. It might be an option for advanced cervical cancer.
Immunotherapy is a drug treatment that helps your immune system to fight cancer. Your body's disease-fighting immune system might not attack cancer because the cancer cells produce proteins that make them undetectable by the immune system cells. Immunotherapy works by interfering with that process. For cervical cancer, immunotherapy might be considered when the cancer is advanced and other treatments aren't working.
Supportive (palliative) care
Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care.
When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.
Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.
After Cervical Cancer Treatment
Cervical cancer prognosis
For cervical cancer that’s caught in the early stages, when it’s still confined to the cervix, the five-year survival rate is 92 percent.
Once the cancer has spread within the pelvic area, the five-year survival rate drops to 56 percent. If the cancer spreads to distant parts of the body, survival is just 17 percent.
Routine testing is important for improving the outlook of women with cervical cancer. When this cancer is caught early, it’s very treatable.
Can I lower the risk of my cancer progressing or coming back?
If you have (or have had) cervical cancer, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements. At this time, it’s not yet clear if those things will help.
It is known that smoking is linked to an increased risk of cervical cancer. While it’s not clear if smoking can affect cervical cancer growth or recurrence, it is still helpful to stop smoking to decrease your risk of getting another smoking-related cancer. Not smoking can also help you tolerate chemotherapy and radiation better and decrease further damage to the cells of the cervix or cervical area. If you need help quitting, talk to your doctor.
Adopting other healthy behaviors such as eating well, getting regular physical activity, and staying at a healthy weight might help, but no one knows for sure. However, we do know that these types of changes can have positive effects on your health that can extend beyond your risk of cervical cancer or other cancers.
Cervical cancer and pregnancy
It’s rare to get diagnosed with cervical cancer while you’re pregnant, but it can happen. Most cancers found during pregnancy are discovered at an early stage.
Treating cancer while you’re pregnant can be complicated. Your doctor can help you decide on a treatment based on the stage of your cancer and how far along you’re in your pregnancy.
If the cancer is at a very early stage, you may be able to wait to deliver before starting treatment. For a case of more advanced cancer where treatment requires a hysterectomy or radiation, you’ll need to decide whether to continue the pregnancy.
Doctors will try to deliver your baby as soon as it can survive outside the womb.
If the cancer comes back
If cancer does return at some point, your treatment options will depend on where the cancer is, what treatments you’ve had before, and your health. Surgery, radiation therapy, chemotherapy, targeted therapy, immunotherapy, or some combination of these might be options. Other types of treatment might also be used to help relieve any symptoms from the cancer.
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Can I lower my risk of getting a second cancer?
There are steps you can take to lower your risk and stay as healthy as possible. For example, women who have had cervical cancer should do their best to stay away from tobacco products. Smoking might further increase the risk of some of the second cancers that are more common after cervical cancer.
To help maintain good health, cervical cancer survivors should also:
. Get to and stay at a healthy weight
. Keep physically active and limit the time you spend sitting or lying down
. Follow a healthy eating pattern that includes plenty of fruits, vegetables, and whole grains, and limits or avoids red and processed meats, sugary drinks, and highly processed foods
. It's best not to drink alcohol. If you do drink, have no more than 1 drink per day
These steps may also lower the risk of some other health problems.