starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body.
Cervical cancer starts in the cells lining the cervix — the lower part of the uterus (womb). This is sometimes called the uterine cervix. The fetus grows in the body of the uterus (the upper part). The cervix connects the body of the uterus to the vagina (birth canal). The part of the cervix closest to the body of the uterus is called the endocervix. The part next to the vagina is the exocervix (or ectocervix). The 2 main types of cells covering the cervix are squamous cells (on the exocervix) and glandular cells (on the endocervix). These 2 cell types meet at a place called the transformation zone. The exact location of the transformation zone changes as you age and if you give birth.
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Most Cervical Cancers begin in the cells in the transformation zone. These cells do not suddenly change into cancer. Instead, the normal cells of the cervix first gradually develop pre-cancerous changes that turn into cancer. Doctors use several terms to describe these pre-cancerous changes, including cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL), and dysplasia. These changes can be detected by the Pap test and treated to prevent cancer from developing.
Cervical cancers and cervical pre-cancers are classified by how they look under a microscope. The main types of cervical cancers are squamous cell carcinoma and adenocarcinoma.
Most (up to 9 out of 10) cervical cancers are squamous cell carcinomas. These cancers form from cells in the exocervix and the cancer cells have features of squamous cells under the microscope. Squamous cell carcinomas most often begin in the transformation zone (where the exocervix joins the endocervix).
Most of the other cervical cancers are adenocarcinomas. Adenocarcinomas are cancers that develop from gland cells. Cervical adenocarcinoma develops from the mucus-producing gland cells of the endocervix. Cervical adenocarcinomas seem to have become more common in the past 20 to 30 years.
Less commonly , cervical cancers have features of both squamous cell carcinomas and adenocarcinomas. These are called adenosquamous carcinomas or mixed carcinomas.
Although cervical cancers start from cells with pre-cancerous changes (pre-cancers), only some of the women with pre-cancers of the cervix will develop cancer. It usually takes several years for cervical pre-cancer to change to cervical cancer, but it can happen in less than a year. For most women, pre-cancerous cells will go away without any treatment. Still, in some women pre-cancers turn into true (invasive) cancers. Treating all cervical pre-cancers can prevent almost all true cervical cancers.
Although almost all cervical cancers are either squamous cell carcinomas or adenocarcinomas, other types of cancer also can develop in the cervix. These other types, such as melanoma, sarcoma, and lymphoma, occur more commonly in other parts of the body.
Treatment options for cervical cancer, by stage
Although the AJCC staging system classifies carcinoma in situ (CIS) as the earliest form of cancer, doctors often think of it as a pre-cancer. That is because the cancer cells in CIS are only in the surface layer of the cervix − they have not grown into deeper layers of cells.
Treatment options for squamous cell carcinoma in situ include cryosurgery, laser surgery, loop electrosurgical excision procedure (LEEP/LEETZ), and cold knife conization.
For adenocarcinoma in situ, hysterectomy is usually recommended. For women who wish to have children, treatment with a cone biopsy may be an option.
Treatment for this stage depends on whether or not you want to continue to be able to have children (maintain fertility) and whether or not the cancer has grown into blood or lymph vessels (called lymphovascular invasion).
Women who want to maintain fertility are often treated first with a cone biopsy to remove the cancer. If the edges of the cone don’t contain cancer cells (called negative margins), they can be watched closely without further treatment as long as the cancer doesn’t come back.
If the edges of the cone biopsy have cancer cells (called positive margins), then cancer may have been left behind. This can be treated with a repeat cone biopsy or a radical trachelectomy (removal of the cervix and upper vagina).
Women who don’t want to maintain fertility can be treated with a hysterectomy.
Treatment for this stage depends in part on whether the woman wants maintain fertility.
For women who want to maintain fertility, the main treatment is radical trachelectomy with removal of pelvic lymph nodes Another option is cone biopsy and pelvic lymph node dissection, followed by observation.
Women who don’t want to maintain fertility have 2 main options:
- Radical hysterectomy along with removal of lymph nodes in the pelvis (pelvic lymph node dissection)
- External beam radiation therapy to the pelvis plus brachytherapy
The main treatment options are surgery, radiation, or radiation given with chemo (concurrent chemoradiation).
Stage IB1 and IIA1
The standard treatment is a radical hysterectomy with removal of lymph nodes in the. Some lymph nodes from higher up in the abdomen (called para-aortic lymph nodes) may also be removed to see if the cancer has spread there. Radical trachelectomy may be recommended instead of a radical hysterectomy if the patient still wants to be able to have children.
Another option is to treat with radiation using both brachytherapy and external beam radiation therapy. Chemotherapy may be given with the radiation
Radiation therapy given with chemo (concurrent chemoradiation) is the recommended treatment. The radiation includes both external beam radiation and brachytherapy.
If cancer has spread to the lymph nodes it can be a sign that the cancer has spread to other areas in the body. Some experts recommend checking the lymph nodes for cancer before giving radiation. One way to do this is by surgery. Another way is to do an imaging study (like MRI or PET/CT) to look at the lymph nodes.
At this stage, the cancer has spread out of the pelvis to other areas of the body. Stage IVB cervical cancer is not usually considered curable. Treatment options include radiation therapy to relieve the symptoms of cancer that has spread to the areas near the cervix or to distant sites (such as the lungs or bone). Chemo is often recommended
Recurrent cervical cancer
Cancer can come back locally (in or near where it first started, such as cervix, uterus or nearby the pelvic organs) or come back in distant areas (spread through the lymphatic system and/or the bloodstream to organs such as the lungs or bone).
If the cancer has recurred in the pelvis only, extensive surgery (by pelvic exenteration) may be an option for some patients. This operation may successfully treat 40% to 50% of patients. Sometimes radiation or chemo may be used to help relieve symptoms, but they aren’t expected to cure the cancer.
If chemo is used, you should understand the goals and limitations of this therapy. Sometimes chemo can improve your quality of life, and other times it can diminish it.