In its early pre-cancerous stages, cervical cancer does not produce symptoms and can only be detected by an abnormal Pap smear test.
Once an invasive cancer of the cervix is present, a woman may notice abnormal vaginal bleeding, especially spotting/bleeding after sexual intercourse and bleeding between menses or in the postmenopausal period. Some women also report an abnormal vaginal discharge.
As the cancer becomes locally advanced (i.e., spreads to adjacent structures such as the pelvic wall, the bladder and/or the rectum), patients may experience pelvic pain, leg swelling, flank pain (from a blocked ureter), leg discomfort (from pressure on a nerve) and/or problems with urination and bowel movements.
When cervical cancer has metastasized, patients may develop a blood-tinged cough, bone pain and/or swelling of lymph nodes near the neck.
Most cervical cancer is caused by the human papilloma virus (HPV), which attacks cells on the surface of the cervix. In its earliest pre-cancerous stages, a Pap smear test during a routine examination can detect the presence of abnormal cells.
Once invasive cancer is present and a woman experiences bleeding abnormalities, a speculum examination of the vagina and cervix may lead to a diagnosis of cervical cancer.
In both pre-cancerous and cancerous cases, a biopsy of the cervix is needed to establish the diagnosis. This biopsy can often be performed in the outpatient setting.
Patients with more advanced cervical cancer may need to undergo a biopsy in an operating room under anesthesia to better delineate the extent of the tumor and to study whether other organs or structures are involved, such as the bladder and rectum.
Close coordination with a skilled pathologist is essential in identifying the correct type of cervical cancer that has developed.
Determining the stage of your cervical cancer is done with cervical biopsies, a detailed physical examination, a chest X-ray and other imaging studies that help us evaluate internal organs in the abdomen and pelvis.
Stages of the disease are based on the International Federation of Gynecology and Obstetrics (FIGO) clinical staging classification system for cervical cancer. This was revised most recently in 2009.
- FIGO stage I cervical cancers are those that are thought to be confined to the cervix. A FIGO stage IA designation denotes microinvasive tumors. A FIGO IB designation indicates the presence of a visible cancer on the cervix.
- FIGO stage II disease involves ligaments that surround the cervix and vagina.
- FIGO stage III disease indicates that the cancer has spread to the lower vagina and/or pelvic wall.
- FIGO stage IVA disease indicates that the cancer involves the bladder and/or rectum. In FIGO stage IVB, tumors have metastasized.
Physicians use staging information to plan treatment and to help assess a patient's prognosis.
Precancerous cervical cells are easily removed with a scalpel, a laser or wire loop that is heated with an electrical current.
A diagnosis of cervical cancer requires a multidisciplinary approach. It can involve surgery, radiation treatments and chemotherapy or combinations of these modalities.
Patients with early cervical cancers are treated by traditional open radical hysterectomy with lymph node dissection. Although this complex operation is curative in the majority of patients, it is known to be associated with significant surgical-related side effects, including abdominal scarring, blood loss requiring transfusion, loss of fertility, loss of ovarian function, leg swelling, poor bladder function and constipation.
In lieu of this approach, our UCI Health gynecologic oncologists offer the following treatment strategies for cervical cancer:
Robot-assisted surgery
Our gynecologic oncology team has spearheaded use of the da Vinci Surgical System® for radical hysterectomies with lymph node dissection.
Our patients who undergo these robot-assisted procedures:
- Are rarely transfused because they are not opened up through an incision
- Experience minimal scarring
- Experience minimal adhesion formation (the development of fibrous scar tissue on abdominal organs, causing them to stick to one another or to the wall of the abdomen)
- Have shorter hospital stays
- Have faster recoveries and return to work sooner
To address other problems associated with traditional open radical hysterectomy, our gynecologic oncologists also perform:
Novel treatment strategies
UCI Health gynecologic cancer specialists were among the first to discover that women with locally advanced cervical cancer (tumors too extensive to be removed surgically that have not yet metastasized) had better outcomes with low dose chemotherapy and radiation therapy.
Chemotherapy makes the cancer more susceptible to the effects of radiation and also sterilizes any hidden microscopic disease that may have escaped the pelvis.
This breakthrough was heralded by five pivotal clinical trials, which led to a rare clinical announcement by the National Cancer Institute. Four of these clinical trials were carried out by the Gynecologic Oncology Group (GOG), the national cooperative group that functions under the auspices of the National Institutes of Health. The chairman of the GOG is UCI Health gynecologic oncologist Dr. Philip J. DiSaia.
Metastatic relapsing cervical cancer
For patients with metastatic and relapsing cervical cancer, traditional chemotherapy does not extend patient survival by more than a few months. This is due to tumor resistance to the platinum-based chemotherapy currently in use and the phenomenon called angiogenesis, through which tumors grow blood vessels to support nourishment, continued growth and metastases.
UCI Health gynecologic oncologist Dr. Krishnansu Tewari designed and, through GOG, runs the world’s first randomized clinical trial using non-platinum chemotherapy doublets and anti-angiogenesis therapy for women with metastatic and relapsing cervical cancer.
Pelvic exenteration
Some patients with isolated, central pelvic recurrences can be successfully treated via pelvic exenteration. Most often these include patients treated initially by radiation therapy who still have their uterus and cervix. This is a complex operation that requires extremely careful patient selection based on general health status, the patient’s strong desire to undergo so extensive an operation and the clinical and radiographic absence of other sites of metastatic disease.
In this operation, the central pelvic structures, including the uterus, cervix, bladder, rectum and vagina, are removed to clear the disease completely from the abdominal area. A new bladder is created and continuity of the fecal stream is often restored. Our gynecologic oncologists are highly skilled at performing this life-saving operation.
With each of these treatment approaches, UCI Health gynecologic oncologists provide safe, personalized therapy for each woman with any of the manifestations of cervical cancer.
Questions? Please call us at 714-456-8000.
Because nearly all cervical cancers are caused by the human papilloma virus (HPV), which is spread through sexual intercourse, the risk factors for cervical cancer are primarily related to sexual behavior.
Starting intercourse at an early age, having multiple sexual partners and/or a promiscuous partner increase the risk of cervical cancer.
Women who have had a history of human papillomavirus (HPV) infection and cervical dysplasia are at highest risk.
For more information or to schedule a consultation, please call 714-456-8000.
