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CERVICAL CANCER
What Is Cervical Cancer? The cervix is the lower part of the womb (uterus). The uterus has two parts. The upper part, called the body of the uterus, is where the baby grows. The cervix, in the lower part, connects the body of the uterus to the vagina, or birth canal. What Are the Risk Factors for Cervical Cancer? A risk factor is anything that increases your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for cancers of the lung, mouth, larynx, bladder, kidney, and several other organs. But having a risk factor, or even several, does not mean that a person will get the disease. Several risk factors increase your chance of developing cervical cancer. Women without any of these risk factors rarely develop cervical cancer. Although these risk factors increase the odds of developing cervical cancer, many women with these risks do not develop this disease. When a woman develops cervical cancer or precancerous changes, it is not possible to say with certainty that a particular risk factor was the cause. In considering these risk factors, it helps to focus on those that you can change or avoid (such as smoking and sexual behaviors that can lead to human papillomavirus infection), rather than those that you cannot (such as differences in age and family history). However, understanding risk factors that cannot be changed is still important because it can convince women with these factors to get a Pap test for early detection of cervical cancer. Cervical cancer risk factors include: Human papillomavirus infection: The most important risk factor for cervical cancer is infection by the human papillomavirus (HPV). Doctors feel that a woman must be infected with this virus before they develop cervical cancer. HPVs are a group of more than 100 types of viruses called papillomaviruses because they can cause warts, or papillomas. Certain types, however, cause cancer of the cervix. These are called "high-risk" HPV types and include HPV 16, HPV 18, HPV 31, HPV 33, and HPV 45, as well as some others. About half of all cervical cancers are caused by HPV 16 and 18. Other HPV types cause different types of warts in different parts of your body. Some types cause common warts on the hands and feet. Other types tend to cause warts on the lips or tongue. Certain HPV types can infect the female and male genital organs and the anal area. These HPV types are passed from one person to another during sexual contact. When HPV infects the skin of the external (outer) genital organs and anal area, it often causes raised bumpy warts. These may be barely visible or they may be several inches across. The medical term for genital warts is condyloma accuminatum. Most genital warts are caused by two HPV types: HPV 6 and HPV 11. These seldom are associated with cervical cancer and are called "low-risk" viruses. However, other sexually transmitted HPVs have been linked with genital or anal cancers in both men and women. HPVs can also cause flat warts on the cervix or vagina that are not visible and cause no symptoms. Flat warts caused by low-risk HPV types have little or no effect on cancer risk. Flat warts caused by high-risk HPV types can develop into cervical or vaginal cancers. Most health care professionals do not determine the HPV type because these warts are usually treated. There is currently no cure for papillomavirus infection. However, the warts and abnormal cell growth caused by these viruses can be treated effectively. These treatments can destroy flat warts on the cervix and vagina and prevent them from developing into cancers. Most women with HPV infection do not develop cervical cancer. Usually the infection disappears without any treatment, because the woman’s immune system has been successful in fighting the virus. Precancerous changes are diagnosed when abnormal cells are found in specimens (samples) taken from a Pap test or biopsy (these are discussed further in "Can Cervical Cancer Be Prevented?"). HPV infection can cause changes in cells of the cervix that can be detected by the Pap test. New tests can directly identify HPVs by finding their DNA in the cells. Many doctors are now testing for HPV if the Pap smear result is mildly abnormal (doctors refer to these findings as atypical squamous cells, or ASC). If a high-risk type of HPV is present, they will perform a colposcopy and consider further treatment. Certain types of sexual behavior increase a woman's risk of getting HPV infection: sex at an early age Although condoms do not protect against HPV, it is still important, though, to use condoms to protect against AIDS and other sexually transmitted diseases that are passed on through some body fluids. Although it is necessary to be infected with HPV for cervical cancer to develop, most women with this infection do not develop cancer. Doctors feel that other factors must come into play for cancer to develop. Some of the known factors are listed below. Smoking: Women who smoke are about twice as likely as nonsmokers to get cervical cancer. Smoking exposes the body to many cancer-causing chemicals that affect more than the lungs. These harmful substances are absorbed by the lungs and carried in the bloodstream throughout the body. Tobacco by-products have been found in the cervical mucus of women who smoke. Researchers believe that these substances damage the DNA of cells in the cervix and may contribute to the development of cervical cancer. Human immunodeficiency virus (HIV) infection: HIV is the virus that causes the acquired immunodeficiency syndrome (AIDS). Because this virus damages the body's immune system, it makes women more susceptible to HPV infections, which may increase the risk of cervical cancer. Scientists believe that the immune system is important in destroying cancer cells and slowing their growth and spread. In women infected with HIV, a cervical precancer might develop into an invasive cancer faster than it normally would. Chlamydia infection: Chlamydia is a relatively common kind of bacteria that can infect the female reproductive system. It is spread by sexual contact. Although infection may cause symptoms, many women do not know they are infected unless samples taken at the time of their Pap test are analyzed for this type of bacteria. Some recent studies suggest that women whose blood test results indicate past or current chlamydia infection are at greater risk for cervical cancer than are women with a negative blood test. Although further studies are needed to confirm this finding, there is already good reason to avoid this infection and to have it treated with antibiotics promptly after diagnosis. Long-term chlamydia infection is well known as a cause of pelvic inflammation that can lead to infertility. Diet: Women with diets low in fruits and vegetables may be at increased risk for cervical cancer. Also overweight women are more likely to develop this cancer. Oral contraceptives: There is evidence that long-term oral contraceptive (OC) use increases the risk of cancer of the cervix. Some research suggests a relationship between using OCs for 5 or more years and an increase in the risk of cervical cancer. In one study the risk was increased four fold in women who used OCs longer than 10 years. In the meantime, the American Cancer Society believes that a woman and her doctor should discuss whether the benefits of using OCs outweigh this very slight potential risk. A woman with multiple sexual partners should use condoms to lower her risk of sexually transmitted diseases no matter what form of contraception she uses. Multiple pregnancies: Women who have had many full-term pregnancies have an increased risk of developing cervical cancer. Low socioeconomic status: Low socioeconomic status is also a risk factor for cervical cancer. Many women with low incomes do not have ready access to adequate health care services, including Pap tests and treatment of precancerous cervical disease. Such women may also be undernourished, which may play a role in increasing their risk. Diethylstilbestrol (DES): DES is a hormonal drug that was prescribed between 1940 and 1971 for some women thought to be at increased risk for miscarriages. Of every 1,000 women whose mother took DES when pregnant with them, about 1 develops clear-cell adenocarcinoma of the vagina or cervix. Stated another way, about 99.9% of "DES daughters" do not develop these cancers. Clear cell adenocarcinomas are more common in the vagina than the cervix. The risk appears to be greatest in those whose mothers took the drug during their first 16 weeks of pregnancy. The average age at diagnosis of DES-related clear-cell adenocarcinoma is 19 years. Most DES daughters are now between 30 and 60, so the number of new cases of DES-related cervical and vaginal clear-cell adenocarcinoma has been decreasing during the past 2 decades. However, this type of cancer has recently been found in a woman in her early 40s, and doctors still do not know exactly how long women remain at risk for DES-related cancers. Although DES daughters have an increased risk of developing clear cell carcinomas, about 40% of women with this cancer have not been exposed to DES or related medications. Some of these patients’ mothers might have taken DES but did not recall the name of the drug. It is certain, however, that women don’t have to be exposed to DES for clear cell carcinoma to develop since some cases of the disease were diagnosed before DES was invented. Some studies suggest that DES daughters are also at somewhat increased risk of developing squamous cell cancer of the cervix and precancerous changes of cervical squamous cells. Family history of cervical cancer: Recent studies suggest that women whose mother or sisters have had cervical cancer are more likely to develop the disease themselves. Some researchers suspect this familial tendency is caused by an inherited condition that makes some women less able to fight off HPV infection than others. Do We Know What Causes Cervical Cancer? In recent years, scientists have made much progress toward understanding the steps that take place in cells of the cervix when cancer develops. In addition, they have identified several risk factors that increase the odds that a woman might develop cervical cancer. Human papillomavirus (HPV): HPV infection is the most important risk factor. This disease is passed from one person to another by sexual contact. (Please see "What Are the Risk Factors for Cervical Cancer?" for more details about HPV.) Research has shown that normal cells produce substances called tumor suppressor gene products to prevent themselves from growing too rapidly and becoming cancers. Two proteins (E6 and E7) produced by high-risk HPV types can interfere with the functioning of known tumor suppressor gene products. But HPV infection does not completely explain what causes cervical cancer. Most women with HPV don’t get cervical cancer, and some women get cervical cancer without having HPV infection. Smoking: Smoking produces cancer-causing chemicals that damage the DNA of cervical cells and contribute to the development of cancer. Immune system deficiency: Another possible cause is immune system deficiency. Our immune system helps keep us free of cancer. HIV (the AIDS virus) infection makes a woman's immune system less able to fight HPV and early cervical cancers. Poor nutrition: Poor nutrition with diets low in fruits and vegetables also increases risk. Can Cervical Cancer Be Prevented? Avoiding Risk Factors You can prevent most precancers of the cervix by avoiding risk factors, notably the human papillomavirus (HPV). Delaying having sexual intercourse if you are young can help you avoid HPV infection. Limiting your number of sexual partners and avoiding sex with people who have had many other sexual partners decrease your risk of exposure to HPV. HPV infection does not always produce warts or other symptoms, so a person may be infected with, and pass on, HPV without knowing it. Be aware that condoms ("rubbers") cannot protect against infection with HPV. This is because HPV can be passed from person to person through any skin-to-skin contact with any HPV-infected area of the body, such as skin of the genital or anal area not covered by the condom. Even if there are no visible warts or other symptoms, a person with HPV can still pass on the virus to another person. HPV can be present for years with no symptoms. It is still important to use condoms to protect against AIDS and other sexually transmitted diseases that are passed on through some body fluids. Not smoking is another way to reduce the risk of cervical cancer and precancer. Detecting Precancerous Changes The second way to prevent invasive cancer is to have testing (including a Pap test) to detect HPV infection and precancers. Treatment of these disorders can stop cervical cancer before it is fully developed. Most invasive cervical cancers are found in women who have not had regular Pap tests. The American Cancer Society recommends the following guidelines for early detection: All women should begin cervical cancer screening about 3 years after they begin having vaginal intercourse, but no later than when they are 21 years old. Screening should be done every year with the regular Pap test or every 2 years using the newer liquid-based Pap test. Beginning at age 30, women who have had 3 normal Pap test results in a row may get screened every 2 to 3 years with either the conventional (regular) or liquid-based Pap test. Women who have certain risk factors such as diethylstilbestrol (DES) exposure before birth, HIV infection, or a weakened immune system due to organ transplant, chemotherapy, or chronic steroid use should continue to be screened annually. Another reasonable option for women over 30 is to get screened every 3 years (but not more frequently) with either the conventional or liquid-based Pap test, plus the HPV DNA test (see below for more information on this test). Women 70 years of age or older who have had 3 or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer screening. Women with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune system should continue to have screening as long as they are in good health. Women who have had a total hysterectomy (removal of
the uterus and cervix) may also choose to stop having cervical cancer
screening, unless the surgery was done as a treatment for cervical
cancer or precancer. Women who have had a hysterectomy without removal
of the cervix should continue to follow the guidelines above. Although the Pap test has been more successful than any other screening test in preventing a cancer, it is not perfect. One of its limitations is that Pap tests are examined by humans, so an accurate analysis of the hundreds of thousands of cells in each sample is not always possible. Engineers, scientists, and doctors are working together to improve this test. Because some abnormalities may be missed (even when samples are examined in the best laboratories), it is not a good idea to have this test less often than ACS guidelines recommend. Increasing the Accuracy of Your Pap Tests There are several things you can do to make your Pap test as accurate as possible: Try not to schedule an appointment for a time during
your menstrual period. Many people confuse pelvic examinations with Pap tests. The pelvic exam is part of a woman's routine health care. During a pelvic exam, the doctor looks at and feels the reproductive organs, including the uterus and the ovaries, and may screen for sexually transmitted diseases. But the pelvic exam will not find cervical cancer at an early stage, and cannot find abnormal cells of the cervix. The Pap test is usually done just before the pelvic exam, when the doctor removes cells from the cervix by gently scraping or brushing with a special instrument. Pelvic exams may help find other types of cancers and reproductive problems, but only Pap tests will provide information on early cervical cancer or precancers. How Cervical Cytology (Pap Test) Is Done Cytology is the branch of science that deals with the structure and function of cells. It also refers to tests to diagnose cancer by examination of cells under the microscope. The Pap test (or Pap smear) is a procedure used to obtain cells from the cervix for cervical cytology screening. The health care professional first inserts a speculum, a metal or plastic instrument that keeps the vagina open so that the cervix can be seen clearly. Next, a sample of cells and mucus is lightly scraped from the ectocervix (part next to the vagina) using a small spatula. A small brush or a cotton-tipped swab is used to take a sample from the endocervix (part closest to the body of the uterus). These are 2 main options for preparing the cell samples for testing in the laboratory, where specially trained technologists (cytotechnologists) and doctors (pathologists) examine the samples under a microscope. The sample can be smeared directly onto a glass microscope slide, which is then sent to the laboratory. For about 50 years, all cervical cytology samples were handled this way. This method works quite well and is relatively inexpensive. However, cells smeared onto the slide are sometimes piled up on each other, so cells at the bottom of the pile cannot be clearly seen. Also, infections of the cervix or vagina may cause inflammatory (pus) cells, increased mucus, yeast cells, or bacteria that hide the cervical cells. Another problem with direct smears is that the cells may become distorted by drying out. Cells can be difficult to examine accurately if they are not treated with alcohol to preserve them immediately after they are spread on the slide. A newer method called liquid-based cytology, or liquid-based Pap test, can remove some of the mucus, bacteria, yeast, and pus cells in a sample and can spread the cervical cells more evenly on the slide. Instead of being directly placed on a slide, the sample is placed into a special preservative solution. This new method, also known by brand names ThinPrep or AutoCyte, also prevents cells from drying out and becoming distorted. Recent studies show that liquid-based testing can slightly improve detection of cancers, greatly improve detection of precancers (SILs -- described below), and reduce the number of tests that need to be repeated. This method is more expensive than a usual Pap smear. Another approach to improving the Pap test is the use of computerized instruments that can recognize abnormal cells in Pap smears. The AutoPap instrument has been approved by the U.S. Food and Drug Administration (FDA) for retesting Pap test samples that were interpreted as normal by technologists. It is also approved by the FDA for initial screening of Pap smears, instead of screening by a technologist. However, a technologist would still examine all smears identified as abnormal by the AutoPap. These computerized instruments can detect abnormal cells that are sometimes missed by technologists. Most of the abnormal cells found in this way are in rather early stages, such as atypical squamous cells (ASCs), but high-grade abnormalities missed by human screening are sometimes found by the computerized instrument. Scientists do not yet know whether the instrument can find enough high-grade abnormalities missed by human screening to have a significant impact on preventing invasive cervical cancers. Automated screening also increases the cost of the cervical cytology testing. For now, the most important way to improve early detection of cervical cancer is to make certain that all women are tested according to ACS guidelines. Unfortunately, many of the women most at risk for cervical cancer are not being tested often enough or at all. How Pap Test Results Are Reported The most widely used system for describing Pap test results is The Bethesda System (TBS). This system was revised twice since it was developed in 1988 -- first in 1991 and, most recently, in 2001. The information that follows is based on the 2001 version. The general categories are: negative for intraepithelial lesion or malignancy
Epithelial cell abnormalities: The second TBS category, epithelial cell abnormalities, means that the cells of the lining layer of the cervix show changes that might indicate cancer or a precancerous condition. This category is divided into several groups for squamous cells and glandular cells. The epithelial cell abnormalities for squamous cells are called atypical squamous cells (ASCs), low-grade squamous intraepithelial lesion (SIL), high-grade SIL, and squamous cell carcinoma: Atypical squamous cells: This term is used when It is not possible to tell (from how the cells look under a microscope) whether the abnormal cells are caused by an infection or another cause of irritation or by a precancer. The Pap test is usually repeated after several months, or other tests, such as colposcopy (explained below) and biopsy may be recommended, depending on the patient's history and the results of previous Pap tests. Some doctors recommend having an HPV test in this situation. If this shows no HPV infection, then only usual follow-up is needed. If it does show HPV infection, colposcopy is recommended. Squamous intraepithelial lesions (SILs) are subdivided into low-grade SIL and high-grade SIL. All patients should have colposcopy. High-grade SILs are less likely than low-grade SILs to go away without treatment and are more likely to eventually develop into cancer if they are not treated. However, treatment can cure all SILs and prevent true cancer from developing. A Pap test cannot determine for certain whether or a woman has a high- or low-grade SIL. It merely flags the result as fitting into one of these abnormal categories. The need for treatment is based on further testing and examination (see below). Squamous cell carcinoma: This cytology result indicates that the woman is likely to have an invasive squamous cell cancer. Further testing will be done to be sure of that diagnosis before doctors recommend treatments such as radiation therapy, chemotherapy, or radical surgery. The Bethesda System also describes epithelial cell abnormalities for glandular cells. Cancers of the glandular cells are reported as adenocarcinomas. In some cases, the pathologist examining the cells can suggest whether the adenocarcinoma started in the endocervix, in the endometrium (the upper part of the uterus), or elsewhere in the body. When the glandular cells have features that do not permit a clear decision as to whether or not they are cancerous, the term used is atypical glandular cells. The patient will usually undergo further testing if her cervical cytology result shows atypical glandular cells. Other malignant neoplasms: This third TBS category refers to forms of cancer such as malignant melanoma, sarcomas, and lymphoma. Compared with squamous cell carcinoma and adenocarcinoma, these cancers affect the cervix very rarely. The HPV DNA Test As mentioned earlier, the most important risk factor for the development of cervical cancer is infection with the human papillomavirus (HPV). Doctors can now test for the types of HPV that are most likely to cause cervical cancer ("high-risk" types) by looking for pieces of their DNA in cervical cells. The test is done in a similar way to the Pap test in terms of how the sample is collected, and in some cases can even be done on the same sample. The HPV DNA test can be used in two situations: The FDA recently approved it for use as a screening test in combination with the Pap test in women over 30 (see ACS screening guidelines above). It is not recommended as a screening test in women under 30 because the test is not as useful in this population--women in their 20s who are sexually active are much more likely to have an HPV infection (most of which will go away on their own), so the results of the test are not as significant and may be more confusing. For more information, see our document "HPV Testing and Cervical Health." The HPV DNA test is also used in women with slightly abnormal Pap test results to determine if more testing or treatment might be needed (see next section). Additional Tests for Women with Abnormal Cervical Cytology Results Because cervical cytology is a screening test rather than a diagnostic test, if you have an abnormal result, you will need to have additional tests (colposcopy and biopsy, and sometimes an endocervical scraping) to find out whether a precancerous change or cancer is present. Nearly all doctors recommend one or more of these tests for women with a Pap result of SIL or atypical glandular cells. Doctors are less certain about what to do when the result is atypical squamous cells. Some recommend colposcopy and biopsy, and others recommend a repeat Pap test after several months. In making decisions about follow-up, some doctors will consider your previous Pap test results, whether you have any cervical cancer risk factors, and whether you have remembered to have Pap tests done in the past. Recently, some doctors have started using an intermediate step, testing for HPV. If a high-risk type of HPV is found in women with atypical squamous cells, particularly if they are middle aged or older, doctors are more inclined to perform a colposcopy. Generally, if you have SIL, a colposcopy will be done. If the biopsy shows SIL, or dysplasia, steps will be taken to prevent progression to an actual cancer. Colposcopy: If certain symptoms suggest cancer or if the Pap test shows abnormal cells, you will need to have an additional test called a colposcopy. In this procedure the doctor views the cervix through a colposcope, an instrument with magnifying lenses very much like binoculars. With the colposcope, doctors can see the surface of the cervix closely and clearly. The exam is not painful, has no side effects, and can be performed safely even if you are pregnant. If abnormal areas are seen on the cervix, a biopsy (removal of a small tissue sample) is done. The sample is sent to a pathologist to examine under a microscope. A biopsy is the only way to tell for certain whether an abnormal area is a precancer, a true cancer, or neither. Cervical biopsies: Several types of biopsies are used to diagnose cervical precancers and cancers. For precancers and early cancers, some types of biopsies can completely remove the abnormal tissue and may be the only treatment needed. In some situations, additional treatment of precancers or cancers is needed. Colposcopic biopsy: For this type of biopsy, a doctor or other health care professional first examines the cervix with a colposcope to find the abnormal areas. Using a biopsy forceps, he or she will remove a small (about 1/8 inch) section of the abnormal area on the surface of the cervix. The biopsy procedure may cause mild cramping or brief pain, and you may have light bleeding afterward. A local anesthetic may be used to numb the cervix. Endocervical curettage (endocervical scraping): This procedure is usually done during the same session as the colposcopic biopsy. A narrow instrument (the curette) is inserted into the endocervical canal (the passage between the outer part of the cervix and the inner part of the uterus). Some of the tissue lining the endocervical canal is removed by scraping with the curette, and this tissue sample is sent to the laboratory for examination. Because the colposcope allows a view only of the outer part of the cervix and not into the endocervix, health care professionals use endocervical scraping to find out if this area is affected by precancer or cancer. A local anesthetic may be used to numb the cervix. Patients may have a temporary sensation, similar to a severe menstrual cramp, and they may have light bleeding after the procedure. Cone biopsy: In this procedure, also known as conization, the doctor removes a cone-shaped piece of tissue from the cervix. The base of the cone is formed by the ectocervix (outer part of the cervix), and the point or apex of the cone is from the endocervical canal. The transformation zone (the border between the ectocervix and endocervix) is contained within the cone. This is the area of the cervix where precancers and cancers are most likely to develop. The cone biopsy is also a treatment and can be used to completely remove many precancers and very early cancers. There are 2 methods commonly used for cone biopsies: the loop electrosurgical excision procedure (LEEP; also called large loop excision of the transformation zone [LLETZ]) and the cold knife cone biopsy. LEEP (LLETZ): The tissue is removed with a wire that is heated by electrical current. For this procedure, a local anesthetic is used, and it can be done in your doctor's office. It takes only about 10 minutes. You may have mild cramping during and after the procedure, and mild to moderate bleeding may persist for several weeks. Cold knife cone biopsy: A surgical scalpel or a laser as a scalpel is used rather than a heated wire to remove tissue. It requires general anesthesia (you are asleep during the operation) and is done in a hospital, but no overnight stay is needed. After the procedure, cramping and some bleeding may persist for a few weeks. How biopsy results are reported: The terms for reporting biopsy results are slightly different from The Bethesda System for reporting Pap test results. Instead of The Bethesda System term squamous intraepithelial lesion (SIL), biopsy reports use 2 other terms, cervical intraepithelial neoplasia (CIN) and dysplasia, to refer to precancerous changes. The terms for reporting cancers (squamous cell carcinoma and adenocarcinoma) are the same. How Patients with Abnormal Pap Test Results Are Treated to Prevent Cervical Cancers from Developing If an area of SIL is seen during the colposcopy, your doctor will be able to remove the abnormal area by using such biopsy techniques as the LEEP (LLETZ procedure) or a cold knife cone biopsy or by destroying the abnormal cells with cryosurgery or laser surgery. During cryosurgery, the doctor uses a metal probe cooled with liquid nitrogen to kill the abnormal cells by freezing them. In laser surgery, the doctor uses a focused beam of high-energy light to vaporize (burn off) the abnormal tissue. Both of these outpatient treatments can be done in a doctor's office or clinic. After treatment, you may have a watery brown discharge for a few weeks. These treatments are almost always effective in destroying precancers and preventing them from developing into true cancers. You will need follow-up examinations to make sure that the abnormality does not come back. If it does, treatments can be repeated. Vaccines: Vaccines are being developed to immunize young women against HPV infection. So far, one vaccine that protects against HPV 16 has been shown to be effective. Trials of vaccines against other HPV types are in progress. It is hoped that in the future, a vaccine that protects against the major cancer-causing HPV types will be available for all young women. For now, this is still in the developmental stage. This information represents the views of the doctors
and nurses serving on the American Cancer Society's Cancer Information
Database Editorial Board. These views are based on their interpretation
of cervical cancer treatment studies published in medical journals,
as well as their own professional experience. Of course, your cancer care team may have reasons for suggesting a treatment plan different from these general guidelines. Don't hesitate to ask them questions about your treatment options. In addition to the information in this document, we encourage interested patients to seek out treatment information from other reliable sources. The options for treating each patient with cervical cancer depend on the stage of disease. The stage of a cancer describes its size, depth of invasion, and how far it has spread. After establishing the stage of your cervical cancer, your cancer care team will recommend one or more treatment options. Consider your options without feeling rushed. If there is anything you do not understand, ask for explanations. Although the choice of treatment depends largely on the stage of the disease at the time of diagnosis, other factors that may influence your options are your age, your general health, your individual circumstances, and your preferences. Be sure that you understand all the risks and side effects of the various treatments before making a decision. It is often a good idea to seek a second opinion, especially with doctors experienced in treating cervical cancer. A second opinion can provide more information and help you feel more confident about the treatment plan that is being considered. Some insurance companies require a second opinion before they will agree to pay for certain treatments. Almost all will pay for a second opinion. The 3 main methods of cancer treatment are surgery, radiation therapy, and chemotherapy. Sometimes the best treatment approach uses 2 or more of these methods. Your recovery is the goal of your cancer care team. If a cure is not possible, the goal may be to remove or destroy as much of the cancer as possible to prevent the tumor from growing, spreading, or returning for as long as possible. Sometimes treatment is aimed at relieving symptoms. This is called palliative treatment.
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