Cervical Cancer

Search Knowledgebase

Topic Contents

Cervical Cancer

Topic Overview

Is this topic for you?

This topic talks about the testing, diagnosis, and treatment of cervical cancer. For general information about abnormal Pap test results, see the topic Abnormal Pap Test.

What is cervical cancer?

Cervical cancer occurs when abnormal cells on the cervix grow out of control. The cervix is the lower part of the uterus that opens into the vagina. Cervical cancer can often be cured when it's found early. It is usually found at a very early stage through a Pap test.

What causes cervical cancer?

Most cervical cancer is caused by a virus called human papillomavirus, or HPV. You can get HPV by having sexual contact with someone who has it. There are many types of the HPV virus. Not all types of HPV cause cervical cancer. Some of them cause genital warts, but other types may not cause any symptoms.

You can have HPV for years and not know it. It stays in your body and can lead to cervical cancer years after you were infected. This is why it is important for you to have regular Pap tests. A Pap test can find changes in cervical cells before they turn into cancer. If you treat these cell changes, you may prevent cervical cancer.

What are the symptoms?

Abnormal cervical cell changes rarely cause symptoms. But you may have symptoms if those cell changes grow into cervical cancer. Symptoms of cervical cancer may include:

  • Bleeding from the vagina that is not normal, or a change in your menstrual cycle that you can't explain.
  • Bleeding when something comes in contact with your cervix, such as during sex or when you put in a diaphragm.
  • Pain during sex.
  • Vaginal discharge that is tinged with blood.

How is cervical cancer diagnosed?

As part of your regular pelvic examination, you should have a Pap test. During a Pap test the doctor scrapes a small sample of cells from the surface of the cervix to look for cell changes. If a Pap test shows abnormal cell changes, your doctor may do other tests to look for precancerous or cancer cells on your cervix.

Your doctor may also do a Pap test and take a sample of tissue (biopsy) if you have symptoms of cervical cancer, such as bleeding after sex.

How is it treated?

Cervical cancer that is caught early can usually be cured. If the cancer is caught very early, you still may be able to have children after treatment.

The treatment for most stages of cervical cancer removes the cancer and makes you unable to have children. These treatments include:

Depending on how much the cancer has grown, you may have one or more treatments. And you may have a combination of treatments.

It's common to feel scared, sad, or angry after finding out that you have cervical cancer. Talking to others who have had the disease may help you feel better. Ask your doctor about support groups in your area. You can also find people online who will share their experiences with you.

Can cervical cancer be prevented?

The Pap test is the best way to find cervical cell changes that can lead to cervical cancer. Regular Pap tests almost always show these cell changes before they turn into cancer. It is important to follow up with your doctor after any abnormal Pap test result to treat abnormal cell changes. This may help prevent cervical cancer.

If you are age 26 or younger, you can get the HPV shot. The vaccines Cervarix and Gardasil protect against two types of HPV that cause cervical cancer. Gardasil also protects against two types of HPV that cause genital warts. Three shots are given over 6 months. The series of shots is recommended for girls ages 9 to 13 and can be given to females ages 14 to 26.

The virus that causes cervical cancer is spread through sexual contact. The best way to avoid getting a sexually transmitted infection is to not have sex. If you do have sex, practice safer sex, such as using condoms and limiting the number of sex partners you have.

Frequently Asked Questions

Learning about cervical cancer:

Being diagnosed:

Getting treatment:

Living with cervical cancer:

End-of-life issues:

Health Tools Health Tools help you make wise health decisions or take action to improve your health.

Health Tools help you make wise health decisions or take action to improve your health.


Decision Points focus on key medical care decisions that are important to many health problems. Decision Points focus on key medical care decisions that are important to many health problems.
  HPV: Should My Daughter Get the Vaccine?

Actionsets help people take an active role in managing a health condition. Actionsets are designed to help people take an active role in managing a health condition.
  Cancer: Controlling cancer pain
  Cancer: Controlling nausea and vomiting from chemotherapy
  Stress Management: Breathing Exercises for Relaxation

Cause

Cervical cancer is caused by severe abnormal changes in the cells of the cervix. Most precancerous or cancerous cell changes occur in the cervix at the transformation zone, because these cells normally undergo constant change. During this natural process of change, some cervical cells can become abnormal if you are infected with high-risk types of HPV.

Other factors that may play a role in causing cervical cancer include:

Regular Pap test screening is the single most important tool to identify cervical cell changes early before they progress to cancer.

Symptoms

Since abnormal cervical cell changes rarely cause symptoms, it is important to have regular Pap test screening. If cervical cell changes progress to cervical cancer, symptoms may develop. Symptoms of cervical cancer may include:

  • Abnormal vaginal bleeding or a significant unexplained change in your menstrual cycle.
  • Bleeding when something comes in contact with the cervix, such as during sexual intercourse or when you insert a diaphragm.
  • Pain during sexual intercourse.
  • Abnormal vaginal discharge containing mucus that may be tinged with blood.

Symptoms that may occur when your cervical cancer has progressed include:

  • Anemia because of abnormal vaginal bleeding.
  • Ongoing pelvic, leg, or back pain.
  • Urinary problems because of blockage of a kidney or ureter.
  • Leakage of urine or fecal content into the vagina because an abnormal opening (fistula) has developed between the vagina and the bladder or rectum.
  • Weight loss.

What Happens

If cervical cancer is not treated, it may spread from the cervix to the vagina, then into deeper tissue layers of connective tissue around the uterus. As it progresses, it may spread to the pelvic lymph nodes and other pelvic organs. Advanced-stage cancer may spread to lymph nodes, to other organs in the pelvis, causing problems with kidney and bowel function, or to other organs in the body, such as the liver and lungs.

Cervical cancer is classified in stages that are determined by the size of the cancer and how far it has spread to nearby tissues and other organs, such as the lungs, the liver, or bones. Your doctor will determine the stage of your cervical cancer by gathering information from a variety of tests, including X-rays. The stage of your cancer is one of the most important factors in selecting the treatment option that is right for you. The long-term outcome (prognosis) depends on the stage of your cervical cancer.

What Increases Your Risk

The most common cause of cervical cancer is a persistent infection with a high-risk type of human papillomavirus (HPV). HPV infection of the cervix is a sexually transmitted infection (STI). A past HPV infection in you or your partner can cause abnormal cervical cell changes years later because the virus may remain in the body for life. HPV infection usually does not cause symptoms and often goes away without causing any problems, so you or your partner may not be aware of a current or past HPV infection.

Other risk factors that may increase your risk for cervical cancer include:

  • High-risk sexual behaviours, such as having more than one sex partner, or having a sex partner who has more than one partner. Safer sex can reduce your risk.
  • Having an impaired immune system. For example, women with human immunodeficiency virus (HIV) seem to:1
    • Have higher rates of HPV infection.
    • Be more likely to develop cervical cell changes from HPV.
    • Be more likely to quickly develop cervical cancer from those cell changes.
  • Using birth control pills for more than 5 years.
  • Exposure to diethylstilbestrol (DES) before birth (prenatal exposure), though this is rare.
  • Smoking cigarettes or breathing in second-hand smoke.

Pregnant women have the same risk of developing cervical cancer as non-pregnant women.

When To Call a Doctor

If you have been diagnosed with cervical cancer, be sure to follow your doctor's instructions about calling when you have problems, new symptoms, or symptoms that get worse.

If you are concerned about your symptoms or if you think you have an increased risk for cervical cancer, call your doctor if you have:

  • Unexpected bleeding between menstrual periods.
  • Menstrual periods that are irregular or 1½ to 2 times longer than normal for 3 months in a row. For example, if your menstrual periods usually last 6 days and then they last between 9 and 12 days for 3 months in a row, call your doctor.
  • Severe menstrual bleeding that causes you to change a maxi-pad or super tampon every hour for longer than 8 hours.
  • Unexpected bleeding after douching or sexual intercourse.
  • Pain during sexual intercourse.
  • Abnormal vaginal discharge containing mucus that may be tinged with blood.

Watchful Waiting

Regular Pap test screening is the most important tool in identifying and treating cervical cell changes before they progress to cervical cancer. After cervical cancer has been diagnosed, it should be treated. Watchful waiting is not appropriate.

Who To See

Health professionals who can evaluate your symptoms and your risk factors, and who can diagnose cervical cancer include:

Doctors who can manage your cancer treatment include:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Examinations and Tests

The Pap test is a routine screening test used to identify abnormal cell changes of the cervix and to screen for cervical cancer. Regular Pap test screening is the single most important tool in identifying and treating cervical cell changes before they progress to cervical cancer. If cervical cancer is suspected, your doctor will take a medical history and perform a physical examination, including a pelvic examination and a Pap test. Several follow-up tests may be needed for evaluation and treatment.

Tests to confirm a diagnosis of cervical cancer include:

If you are pregnant, a colposcopy and cervical biopsy can be done to confirm cervical cancer.

Tests to determine the extent (stage) of cervical cancer include:

  • A cone biopsy or loop electrosurgical excision procedure (LEEP). These tests are sometimes recommended to determine the spread of cancer in cervical tissue.
  • A cystoscopy, to look at the interior lining of the bladder and the urethra to determine whether the cancer has spread to the urinary system.
  • A proctoscopy, to look at the lower part of the large intestine (colon) to determine whether the cancer has metastasized.
  • An intravenous pyelogram, to see whether there is any blockage of a kidney.
  • A chest X-ray, to check for cancer cells that have spread from the cervix.

Other surgeries may be done to determine the extent of cervical cancer. For more information, see the Surgery section of this topic.

Tests to guide treatment decisions include:

Early Detection

The recommended Pap test schedule is based on your age and things that increase your risk. For most women, it is best to have a Pap test every 1 to 3 years. Talk to your doctor about when to have your first Pap test and how often to have this test.

Treatment Overview

Cervical cancer detected in its early stages can be cured with treatment and close follow-up. Treatment choices for cervical cancer may include one or more of the following therapies:

  • Surgery to remove the cancer
  • Radiation therapy to treat the cancer itself or other organs affected by the cancer
  • Chemotherapy to help make the cancer more sensitive to radiation therapy and to treat cancer that has spread (metastasized)

Your quality of life becomes a critical issue when considering treatment options. Be sure to discuss your personal preferences with your oncologist when he or she recommends treatment.

Initial treatment

The choice of treatment and the long-term outcome (prognosis) of cervical cancer depends on the type and stage of cancer. Your age, overall health, quality of life, and desire to be able to have children must also be considered. Treatment choices for cervical cancer may be a single therapy or a combination of therapies, such as:

  • Surgery to remove the cancer.
    • Cone biopsy to remove the cancer
    • Radical trachelectomy to remove the cervix, part of the vagina, and the pelvic lymph nodes (lymph node dissection) but not the uterus
    • Simple hysterectomy to remove the uterus and cervix
    • Modified radical hysterectomy and lymph node dissection to remove the cancer
  • Radiation therapy, which uses high-dose X-rays or implants in the vaginal cavity to kill cancer cells.
  • Chemotherapy, which uses medicines to kill cancer cells.

When you have a hysterectomy, your doctor may also remove your fallopian tubes and your ovaries. This is called a salpingo-oophorectomy (say "sal-PING-oh oh-uh-fuh-REK-tuh-mee").

Surgery to remove the uterus and cervix (hysterectomy) may be done through an incision in the belly. For early-stage cervical cancer, laparoscopic surgery may be possible. This is done with several small incisions in the belly for a tiny camera and special instruments.

Robotic-assisted laparoscopic surgery uses robotic arms that translate the surgeon's hand motions into finer and more precise movements. This surgery requires specially trained doctors.

Chemotherapy may be given at the same time as radiation therapy (chemoradiation). Compared with radiation alone, chemoradiation improves survival. It is usually used as the primary therapy or after a hysterectomy.

Most treatments for cervical cancer cause side effects. Side effects may differ, depending on the type of treatment used and your age and overall health. Your doctor can talk to you about your treatment choices and the side effects associated with each treatment.

Home treatment measures may help relieve some common side effects of cancer treatment. For more information, see the Home Treatment section of this topic.

If you have recently been diagnosed with cervical cancer, you may experience a wide variety of emotions in reaction to your diagnosis. Most women will feel some denial, anger, and grief. There is no "normal" or "right" way to react to a diagnosis of cancer. You can take steps, though, to manage your emotional reactions to learning that you have cervical cancer. Some women find that talking with family and friends is comforting, while others may need to spend time alone to understand their feelings about their disease.

If your emotions are interfering with your ability to make decisions about your health and to move forward with your life, it is important to talk with your doctor. Your cancer treatment centre may offer counselling services. You may also contact your local chapter of the Canadian Cancer Society to help you find a support group. Talking with other women who have had similar feelings after a diagnosis such as yours can help you accept and deal with your disease.

Treatment for pregnant women

Recommended treatments are the same for pregnant women as for non-pregnant women. Treatment for early-stage cervical cancer may be delayed until after delivery if the pregnancy is in the third trimester. A vaginal delivery may be possible.

For all stages of cervical cancer, treatment will be managed by a team of doctors specializing in cancer and high-risk pregnancies. Treatment for cervical cancer may cause problems such as an early delivery or even the loss of the baby. Treatment will consider the recommendations for the specific stage of cancer, the development of the baby, and the mother's preferences.

What to think about during initial treatment

Depending on the extent (stage) of your cancer, surgery may be combined with radiation therapy and chemotherapy. Radiation or chemotherapy given after a surgery is called adjuvant therapy.

Some women with cervical cancer may be interested in participating in research studies called clinical trials. Clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Women who do not want standard treatments or are not cured using standard treatments may want to participate in clinical trials. These are ongoing in many Canadian provinces and in some other countries for all stages of cervical cancer.

For more information about specific cervical cancer treatments, see the topics:

Ongoing treatment

After initial treatment for cervical cancer, it is important to receive follow-up care. Your emotional reactions may continue throughout the course of your treatment depending on your prognosis, the treatment methods used, and your quality-of-life decisions.

Your oncologist or gynecologic oncologist will schedule regular checkups that will include:2

  • A pelvic examination and Pap test every 3 to 6 months for the first 2 years.
  • After the first 2 years, a pelvic examination and Pap test every 6 months for another 3 to 5 years.
  • After 5 years, a pelvic examination and Pap test every year.

Follow-up tests that may be recommended by your oncologist include an abdominal and pelvic computed tomography (CT) scan to monitor whether cancer has spread to other organs in the abdomen or pelvis.

If respiratory symptoms are present, a chest X-ray may be done to determine whether cancer has spread to the lungs.

Treatment if the condition gets worse

Cervical cancer can return after treatment. About 35% of women with cervical cancer will have persistent or recurrent disease.3 The chance that your cancer will return depends on the stage of the initial cancer: cancer found early is less likely to come back than cancer found at a later stage.

Your long-term outcome (prognosis) for recurrent cervical cancer depends greatly on how much the cancer has spread when the recurrence is diagnosed.

The goal of treatment of advanced-stage cervical cancer that has spread outside the pelvis is to control symptoms, reduce complications, and increase comfort (hospice palliative care). It is not intended to cure the disease. Hospice palliative care may include:

Complementary therapies

People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the therapies that may be helpful include:

These types of therapies also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.

Complementary therapies are not a substitute for the standard treatment recommended for cervical cancer. Before you try any of these therapies, discuss their possible benefits and side effects with your doctor. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.

End-of-life issues

Some women with advanced-stage disease that is not curable may choose not to have cancer treatment because the time, costs, and side effects of treatment may be greater than the benefits. Making the decision about when to stop cancer treatment aimed at prolonging life and shift the focus to best supportive care can be difficult. For more information, see the topics:

Talk to your doctor about an advance directive, which includes a living will and names a substitute decision maker. In a living will, you describe the kind of care you want if something happens to you and you cannot speak for yourself. A substitute decision maker is a person you choose to make medical decisions for you if you cannot speak for yourself. Be sure to share your wishes with your family or close friends.

Prevention

You can treat early cervical cell changes (dysplasia), which can reduce your risk for cervical cancer. You can also reduce your risk factors for abnormal cell changes.

Have regular Pap test screening

The recommended Pap test schedule is based on your age and things that increase your risk. For most women, it is best to have a Pap test every 1 to 3 years. Talk to your doctor about when to have your first Pap test and how often to have this test.

Quit smoking

Women who smoke cigarettes or who breathe in second-hand smoke have a higher risk of developing cervical cell changes that can lead to cervical cancer.4 Quitting smoking may decrease this risk.

Vaccine

If you are age 26 or younger, you can get the HPV shot. The vaccines Cervarix and Gardasil protect against two types of human papillomavirus (HPV) that cause cervical cancer. Gardasil also protects against two types of HPV that cause genital warts. Three shots are given over 6 months. The series of shots is recommended for girls ages 9 to 13 and can be given to females ages 14 to 26. You can get either vaccine. For more information, see the topic Immunizations.

Click here to view a Decision Point. HPV: Should My Daughter Get the Vaccine?

Reduce your risk of a sexually transmitted infection (STI)

Sexually transmitted infections (STIs) often cause abnormal Pap tests and can lead to other serious health problems. Preventing an STI is easier than treating an infection after it occurs. The most common cause of cervical cancer is infection with a high-risk type of the HPV. Since the HPV virus may remain in body cells for life, abnormal cervical cell changes that cause cervical cancer can be the result of either you or your partner having had an HPV infection years earlier. HPV infection usually does not cause symptoms, so you or your partner may not be aware of a current or past HPV infection.

To reduce your risk:

  • Talk with your partner about STIs before beginning a sexual relationship. Find out if he or she is at risk for an STI. Remember that it is quite possible to be infected with an STI without knowing it. Some STIs, such as HIV, can take up to 6 months before they are detected in the blood.
  • Be responsible.
    • Avoid sexual contact if you have symptoms of an STI or are being treated for an STI.
    • Avoid all intimate sexual contact with anyone who has symptoms of an STI or who may have been exposed to an STI.
  • The fewer sex partners you have in your lifetime, the better it is for your health. Your risk for an STI increases if you have several sex partners, or if your sex partner has more than one partner.
  • Use male or female condoms to reduce the risk of getting an STI. Using male condoms when you have sex has been shown to reduce your risk of getting HPV.5 Female condoms may help also, although there has been less study of this type of protection.

Not having sexual contact is the only certain way to prevent exposure to STIs. Sexually transmitted infections such as human papillomavirus (HPV) can be spread to or from the genitals, anus, mouth, or throat during sexual activities.

Home Treatment

During medical treatment for any stage of cervical cancer, you can use home treatment to help manage the side effects of cervical cancer or cancer treatment. Home treatment may be all that is needed to manage the following common problems. If your doctor has given you instructions or medicines to treat these symptoms, be sure to follow them. In general, healthy habits such as eating a balanced diet and getting enough sleep and exercise can help control your symptoms.

Home treatment for:

  • Nausea or vomiting includes watching for and treating early signs of dehydration, such as a dry mouth, sticky saliva, and reduced urine output with dark yellow urine. Older adults can quickly become dehydrated from vomiting. Nausea and vomiting caused by chemotherapy usually require medical treatment. Your doctor may also prescribe medicines to control nausea and vomiting. For more information on how to deal with these side effects, see:
    Click here to view an Actionset. Cancer: Controlling Nausea and Vomiting From Chemotherapy.
  • Diarrhea includes resting your stomach and being alert for signs of dehydration. Check with your doctor before using any non-prescription medicines for your diarrhea.
  • Constipation includes making sure that you drink enough fluids and include fruits, vegetables, and fibre in your diet each day. Do not use a laxative without consulting your doctor.

Other issues that may arise include:

  • Sleep problems. If you find you have trouble sleeping, some tips for managing sleep problems may be helpful, such as having a regular bedtime, getting some exercise during the day, and avoiding caffeine late in the day.
  • Fatigue. If you feel as though you do not have any energy and tire easily, try some measures to manage fatigue, such as getting extra rest, eating a balanced diet, and reducing your stress.
  • Urinary problems, which can be caused by both cervical cancer and its treatment. It may help to eliminate caffeinated drinks from your diet and to establish a schedule of urinating every 3 to 4 hours, regardless of whether you feel the need.
  • Hair loss. Hair loss may be unavoidable, but using mild shampoos and avoiding damaging hair products will reduce irritation of your scalp.

Many women with cervical cancer face emotional issues as a result of their disease or its treatment.

  • Finding out that you have cancer and going through treatment is stressful. Managing stress may include expressing your feelings to others. Learning relaxation techniques may also be helpful. Relaxation techniques, such as meditation, and support groups may be helpful.
  • Your feelings about your body and your sexuality may change following treatment for cancer. It may help to talk openly with your partner about your feelings and to discuss your concerns with your doctor. Your doctor may be able to refer you to organizations that can offer additional support and information.

Not all forms of cancer or cancer treatment cause pain. If pain occurs, many options are available to relieve it. If your doctor has given you instructions or medicines to treat pain, be sure to follow them. Home treatment for pain such as a non-steroidal anti-inflammatory drug (NSAID) or an alternative therapy like biofeedback may improve your physical and mental well-being. Be sure to discuss with your doctor any home treatment you use for pain. For more information on how to deal with pain from cancer or cancer treatment, see:

Click here to view an Actionset. Cancer: Controlling Cancer Pain.

Some women with advanced-stage disease may choose not to have treatment because the time, costs, and side effects of treatment may be greater than the benefits. Making the decision about when to stop medical treatment aimed at prolonging life and shift the focus to end-of-life care can be difficult. For more information, see the topics:

Medications

Chemotherapy is used to shrink cervical cancer and decrease tumour growth. Chemotherapy may be used to treat later stages (stages II, III, and IV) of cervical cancer. It may be used alone or in combination with radiation (chemoradiation). Compared with radiation alone, chemoradiation improves survival.6 It is usually used as the primary therapy or after a hysterectomy.

Chemotherapy medicines may be taken by mouth (orally) or injected into a vein (intravenous, or IV). Chemotherapy is called a systemic treatment because the medicines enter the bloodstream and travel through the body to kill cancer cells.

Extensive research and clinical trials have studied the different chemotherapy medicines used to treat cervical cancer. Some medicines are used routinely, and some are used in combination with others for greater effectiveness. Your oncologist will discuss and recommend chemotherapy treatment specific to your condition.

Medication Choices

Common chemotherapy medicines used to treat cervical cancer include:

What To Think About

Most chemotherapy will cause some side effects.

Chemotherapy may be given after surgery to try to kill any cancer cells that may remain, which is called adjuvant therapy.

Chemotherapy may be given at the same time as radiation treatment (chemoradiation) to improve survival rates. Chemoradiation may be used as primary therapy or after a hysterectomy.

Cisplatin is the medicine most often used in chemoradiation for cervical cancer.

Surgery

Surgery to remove cervical cancer may be an option when the cancer is confined to the cervix or uterus. The type of surgery performed depends on the location and extent of cervical cancer and your desire to be able to have children.

Surgery Choices

Surgery for very early stages of cervical cancer that preserves your ability to have children includes:

Surgery for most stages of cervical cancer does not preserve your ability to have children. Surgeries include:

  • Hysterectomy with or without removal of the ovaries, to remove the cervix and related organs where recurrence would be most likely to occur.
  • Modified radical hysterectomy with pelvic lymph node dissection. A radical hysterectomy usually includes removal of part of the vagina, the uterus, the ovaries, and the fallopian tubes. This removes the most likely sites of cancer and may reduce the risk of recurrence.

Surgery to remove the uterus and cervix (hysterectomy) may be done through an incision in the belly. For early-stage cervical cancer, laparoscopic surgery may be possible. This is done with several small incisions in the belly for a tiny camera and special instruments.

Robotic-assisted laparoscopic surgery uses robotic arms that translate the surgeon's hand motions into finer and more precise movements. This surgery requires specially trained doctors.

What To Think About

If surgery is part of your treatment, you also may be given radiation therapy, chemotherapy, or combination chemoradiation. These treatments may be given before or after surgery to try to destroy any cancer cells that may remain. Radiation, chemotherapy, or chemoradiation given before a surgery to help control or reduce the size of the tumour is called neoadjuvant therapy. Using these therapies after a surgery when only microscopic areas of cancer may still be present is called adjuvant therapy.

Compared with radiation alone, chemoradiation improves survival if it is used either before or after a hysterectomy.6

Side effects from surgery can include difficulty with urination or problems with bowel habits, such as constipation or diarrhea. Your ability to have or enjoy sexual intercourse may also be affected.

Other Treatment

Radiation therapy is the standard treatment for certain stages of cervical cancer and often is used in combination with surgery.

Radiation therapy is the use of high-energy X-rays to kill cancer cells and shrink tumours. Radiation may come from a machine outside the body (external radiation therapy) or from radiation material (radioisotopes) in thin plastic tubes inserted through the vagina into the cervical area where the cancer cells are found (intracavitary brachytherapy).

The two forms of brachytherapy used to treat cervical cancer include low-dose-rate (LDR) brachytherapy and high-dose-rate (HDR) brachytherapy. LDR brachytherapy has been used the most in the past, but HDR brachytherapy takes less time and can be done on an outpatient basis. Both LDR and HDR appear to work about the same.7

Chemotherapy may be given at the same time as radiation treatment (chemoradiation) to improve survival rates. Chemoradiation may be used as primary therapy or after a hysterectomy.

What to think about

Radiation may cause many side effects, including diarrhea and irritation of the bladder (radiation cystitis). Your ability to have or enjoy sexual intercourse may also be affected, because radiation may cause changes to the cells lining the vagina (mucosa), making intercourse difficult or painful. A series of vaginal dilators, starting with a small one and progressing to a larger size, may be used after radiation therapy. Using the dilators can make the vaginal opening larger and help make sex less difficult or painful.

Radiation to treat cervical cancer may thin the bone and increase the risk of fractures in the pelvic area, including hip fractures. You can take steps to prevent thinning of the bone (osteoporosis), such as getting enough calcium and vitamin D. Also, try to prevent falls, which can lead to fractures. For more information, see the topic Osteoporosis.

Radiation therapy may also be used to manage the symptoms that occur with incurable cervical cancer. This is called hospice palliative care.

Other Treatment Choices

People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the therapies that may be helpful include:

These types of therapies also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.

Complementary therapies are not a substitute for the standard treatment recommended for cervical cancer. Before you try any of these therapies, discuss their possible benefits and side effects with your doctor. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.

Other Places To Get Help

Organizations

Society of Obstetricians and Gynaecologists of Canada (SOGC)
780 Echo Drive
Ottawa, ON  K1S 5R7
Phone: 1-800-561-2416
(613) 730-4192
Fax: (613) 730-4314
Email: helpdesk@sogc.com
Web Address: www.sogc.org
 

The mission of SOGC is to promote optimal women's health through leadership, collaboration, education, research, and advocacy in the practice of obstetrics and gynaecology.


Canadian Cancer Society
10 Alcorn Avenue
Suite 200
Toronto, ON  M4V 3B1
Phone: (416) 961-7223
Fax: (416) 961-4189
Email: ccs@cancer.ca
Web Address: http://cancer.ca
 

The Canadian Cancer Society (CCS) is a national, community-based organization that provides information about cancer prevention, care, and treatment. The CCS also provides funding for cancer research.


Canadian Women's Health Network
419 Graham Avenue
Suite 203
Winnipeg, MB  R3C 0M3
Phone: 1-888-818-9172
(204) 942-5500
Fax: (204) 989-2355
Email: cwhn@cwhn.ca
Web Address: www.cwhn.ca
 

The Canadian Women's Health Network (CWHN) is a network of individuals, groups, organizations, and institutions. CWHN promotes information sharing, education, and advocacy for women's health and equality, and provides resources and information on women's health issues. In addition, it runs a clearinghouse of women-centred, health-related resources. The Web site also includes new research articles, information sheets, and press releases.


References

Citations

  1. Chirenje ZM (2005). HIV and cancer of the cervix. Best Practice and Research Clinical Obstetrics and Gynaecology, 19(2): 269–276.
  2. National Comprehensive Cancer Network (2010). Cervical Cancer, version 1. Available online: http://www.nccn.org/professionals/physician_gls/PDF/cervical.pdf.
  3. American College of Obstetricians and Gynecologists (2002, reaffirmed 2008). Diagnosis and treatment of cervical carcinomas. ACOG Practice Bulletin No. 35. Obstetrics and Gynecology, 99(5): 855–867.
  4. National Cancer Institute (2010). Cervical Cancer (PDQ): Prevention—Health Professional Version. Available online: http://www.nci.nih.gov/cancertopics/pdq/prevention/cervical/healthprofessional.
  5. Winer RL, et al. (2006). Condom use and the risk of genital human papillomavirus infection in young women. New England Journal of Medicine, 354(25): 2645–2654.
  6. Sundar S, et al. (2008). Cervical cancer, search date November 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
  7. Lertsanguansinchai P, et al. (2004). Phase III randomized trial comparing LDR and HDR brachytherapy in treatment of cervical carcinoma. International Journal of Radiation Oncology Biology Physics, 59(5): 1424–1431.

Other Works Consulted

  • American Cancer Society (2009). Cancer Facts and Figures for African Americans 2009–2010. Atlanta: American Cancer Society. Available online: http://www.cancer.org/downloads/STT/cffaa_2009-2010.pdf.
  • Balasubramanian A, et al. (2008). Cervical neoplasia and other STD-related genital tract neoplasias. In KK Holmes et al., eds., Sexually Transmitted Diseases, 4th ed., pp. 1051–1074. New York: McGraw-Hill.
  • Eifel PJ, et al. (2008). Cancer of the cervix, vagina, and vulva. In VT DeVita Jr et al., eds., DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology, 8th ed., vol. 2, pp. 1496–1543. Philadelphia: Lippincott Williams and Wilkins.
  • Eifel PJ, et al. (2008). Cancer of the cervix, vagina, and vulva. In VT DeVita Jr et al., eds., Cancer: Principles and Practice of Oncology, 8th ed., vol. 1, pp. 1496–1540. Philadelphia: Lippincott Williams and Wilkins.
  • National Cancer Institute (2009). Cervical Cancer (PDQ): Treatment—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/cervical/healthprofessional.
  • U.S. Preventive Services Task Force (2003). Screening for cervical cancer: Summary of recommendations. Available online: http://www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.pdf.

Credits

By Healthwise Staff
Primary Medical Reviewer Adam Husney, MD, MD - Family Medicine
Primary Medical Reviewer Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine
Specialist Medical Reviewer Ross Berkowitz, MD - Obstetrics and Gynecology
Last Revised October 25, 2010

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.