Cervical Cancer

According to the National Cancer Institute, 13,800 women will be diagnosed with new cases of cervical cancer this year alone. While Cervical Cancer is most frequently diagnosed in young adult women who are 35-44, 13.8% of new cases are in women between ages 20-34.

Cervical cancer is cancer that occurs in the cells of the cervix, the lower part of the uterus. While cervical cancer starts in the cells of the cervix, as cancer progresses it can spread to deeper tissues of the cervix as well as other parts of the body including the lungs, vagina, and bladder. There are various treatment options varying depending on the stage of your cancer.

Cervical cancer can be prevented through regular screening, for Pap Smear screening can detect and lead to the removal of precancerous tissue. In addition to screening, you can take preventative measures including avoiding risk factors and getting the HPV vaccine.

What is Cervical Cancer

Written by Julia Drenga

Symptoms of Cervical Cancer: Courtesy of MD Anderson Cancer Center

Vaginal discharge tinged with blood
Vaginal bleeding after sexual intercourse
Abnormal vaginal bleeding: after menopause, between menstrual cycles or excessively heavy periods
Urinating more often
Pain during sex
Swollen leg

During the earliest stages of cervical cancer, women do not typically experience symptoms. The symptoms listed often begin to occur during the later stages. While these symptoms are symptoms of cervical cancer, they can also be symptoms of other health problems. It is important to speak to your doctor if you experience any of these symptoms or other health problems.

Diagnosis and Treatment of Cervical Cancer

Screening for cervical cancer is very important. Cervical cancer is one of the more preventable cancers, but it is important that it is caught early.

“Routine screening every three years with a Pap test or every five years with a Pap-HPV co-test ensures precancerous changes are caught early and may be followed more closely or treated.” Dr. Kathy MacLaughlin of Mayo Clinic

If you have precancerous cells and they are identified during screening, they can be treated before cancer forms. This can only be done through regular screening. Cervical cancer is the most preventable cancer of gynecological cancers due to regular screenings. The other cancers do not have a screening test and a vaccine and as a result, they are less preventable. Additionally, cervical cancer is highly curable when caught early.

The main form of screening for cervical cancer is Pap tests. Pap tests are recommended for every woman beginning at the age of 21, regardless of when you first have sex, to screen for cervical cancer and any precancerous changes. Pap tests are performed by a gynecologist and should be performed every three years after turning 21 usually until the age of 65.

During a Pap exam, the doctor will insert a lubricated instrument into the vagina to widen the opening. Then the doctor takes a sample of mucus and cells by gently scraping the cervix. The doctor will send the collected sample to a lab for analysis. A Pap test can detect abnormal cells in the cervix, which may be a result of cancer. If any irregularities are found, the doctor will discuss further tests and steps based on what is found. Pap smear exams are not usually painful, however some women feel minor discomfort.

In addition to Pap exams, there are HPV DNA tests. These tests test cells collected from the cervix for any types of HPV infection would most likely cause cervical cancer. These tests should be performed in combination with a Pap exam to accurately screen for changes in the cells that can cause cancer. The combination of Pap test and HPV DNA test should be performed every five years and is recommended for women over 30.

Pap Smear Test Screening for Cervical Cancer

Stage I (Stage IA or IB) cervical cancer, treatment may include surgeries and therapies beyond a biopsy in order to remove the cancer cells. Radiation may be recommended. Typically, surgery is recommended for younger patients, and radiation is suggested for older patients. In some cases, or when fertility is not a concern, a surgery to remove the uterus and cervix, known as a hysterectomy or radical hysterectomy, may be preferred.

Stage II (Stage IIA or IIB) cervical cancer, radiation therapy (internal and external), and chemotherapy are the usual first suggestion for treatment. Your doctor will generally review clinical trials as an option to supplement treatment. For rare

Stage II cases, they may remove the uterus, cervix, and adjacent lymph nodes.

Stage III cervical cancer, you will have a customized treatment plan or radiation (internal and external radiation) combined with chemotherapy. In advanced cases of Stage III cervical cancer, surgery to remove the cervix and/or uterus is not necessary because cancer has spread beyond that. Your doctor may recommend a clinical trial as a supplement treatment option, instead.

Stage IV (Stage IVA or IVB) cervical cancer, your treatment plan will be specialized to fit your specific needs. Generally, extensive radiation (external and internal radiation) is administered and combined with chemotherapy to control the spread of cancer, relieve any symptoms, and improve your quality of life. In advanced cases of Stage IV cervical cancer, your doctor may encourage participating in a clinical trial of new anticancer drugs or drug combinations. Surgery is only performed to relieve pain at this stage of cancer.

New treatments are being tested for all stages through clinical trials and women with cervical cancer can participate in these trials if they desire. It is important to know that both in clinical trials and the currently practiced treatments for cervical cancer that you may experience side effects from the treatment and follow-up appointments may be necessary with your doctor. Side effects can occur from cancer or cancer treatment.

Most of the side effects are short-term and go away after the treatment ends, however, the effects can be long term as well. Side effects include fatigue, bowel changes, lymphedema, menopause, and fertility issues. It is important to take care of any side effects you experience so that they do not get worse.

Follow-up appointments are very important to continue to check up to make sure everything is alright. Your doctor will discuss with you how often you need to have these follow-up appointments with them or with special divisions depending on what your treatment was. The follow-up appointments and tests are important to continue to look for signs of cancer again and help treat any side effects of the treatment.

Cervical Cancer Treatment

The overall 5-Year survival rate for cervical cancer is 66.1%, however, this can vary based on the stage of cancer.

The earlier the stage, the better the chance of surviving 5 years after diagnosis.

The stages are broken up into 4 sections: localized, regional, distant, and unknown.

If cancer has not spread and is only found in the cervix, it is localized, otherwise known as stage 1. If cancer has spread to other parts of the body, it is referred to as regional or distant. Regional staging is when cancer has spread to regional lymph nodes. Distant is when cancer has metastasized. Unknown refers to unstaged cancer.

Survival Satistics of Cervical Cancer

After surgery for cervical cancer, you may have to change some activities in your daily life for the weeks following the surgery. You will not be allowed to do any heavy lifting for six weeks. You cannot have anything in your vagina for eight weeks. This means no tampons, no douching, and no sexual intercourse for eight weeks following your surgery. Do not drive for approximately two weeks following surgery or until you stop taking narcotic pain medication.

After Surgery Care for Cervical Cancer

To help manage constipation, there are natural ways to reduce it in addition to the medications mentioned above. These ways include:

Sesame seeds: The properties of sesame seeds cause them to moisturize the intestines, which can move dry stools and provide relief from constipation. You can add sesame seeds to cereals or salads or you can grind them and add them to food like seasoning.
Molasses: Having one tablespoon of blackstrap molasses before bed can relieve your constipation by morning.
Dietary fiber: Fiber works in a way to keep the food moving in your digestive system. It is suggested that you should aim to eat 20 to 30 grams of fiber a day, however many Americans consume less than 15 grams a day. Fiber can be found in a variety of foods and can be added to your diet in a variety of ways. The best sources of fiber are ones that have been the least processed. Oftentimes processed foods do contain fiber, however, they are not the ideal source for fiber or other nutrients. Raw or steamed fruits and vegetables are an example of sources of foods that are high in fiber. Specifically, fruits and vegetables with skin have higher amounts of fiber since the skin contains more fiber than the inside of the fruit or vegetable. If you choose to increase your intake of fiber, you should drink more water than usual to keep your stool soft.
Mint or ginger tea: Mint and ginger can relieve constipation and can help with other digestive issues. Peppermint relaxes the muscles of the digestive tract. Ginger is considered a “warming” herb, which causes your body to generate more heat and speed up a sluggish digestion. Dandelion tea is also a laxative and detoxifier.
Healthy fats: Healthy fats can help lubricate your intestines and reduce constipation. Healthy fats include olive oils, nuts, and avocados.
Lemon water: Lemon juice has citric acid which stimulates your digestive system and can flush out toxins in your body. This provides constipation relief. You can add fresh lemon juice to a glass of water or you can add lemon to tea.
Coffee: Coffee can stimulate your colon, which can speed up when you have to go to the bathroom. It is important that you must drink water if you drink coffee, otherwise, your constipation will get worse.
Raisins: Raisins are high in fiber and contain tartaric acid, which acts as a laxative.
Prunes: Prunes are rich in fiber and contain a compound that triggers the contraction in your intestine that makes you want to go. Dried figs can be substituted for prunes and have a lower chance of causing bloating.
Castor Oil: Taking one to two teaspoons of castor oil on an empty stomach can allow you to see results in about eight hours. In castor oil, there is a component that breaks down into a substance that stimulates both the small and large intestines.
Exercise: Exercise can increase muscle activity in your intestines, which can relieve constipation. Even something as little as a 15-minute walk a day can help move your bowel quicker. Additionally, if you eat a heavy meal and feel sleepy after, you should keep moving instead of laying around.

Cervical Cancer and Constipation

Radiation therapy and chemotherapy are often used in the treatment of cervical cancer after Stage I. It may take time to recover from the treatment and you may experience side effects. Side effects of treatment vary depending on the person. Some women experience more side effects, while some women don’t experience side effects at all. Many of the side effects last a few weeks or months, however, some side effects can last years or permanently. No matter how long the side effect lasts luckily there are ways to reduce or manage the discomfort of them.

Radiation Therapy and Chemotherapy Effects and After Care

The most common side effects of radiation therapy according to Moffitt Cancer Center are:

Diarrhea
Skin irritation
Nausea
Fatigue
An increased need to urinate
Vaginal pain
Irregular menstruation or early menopause
An increased likelihood of bruising and infection
The most common side effects of chemotherapy according to Moffitt Cancer Center are:
Nausea
Hair loss
Fatigue
Appetite loss
Mouth sores

The most common side effects of chemotherapy according to Moffitt Cancer Center are:

Nausea
Hair loss
Fatigue
Appetite loss
Mouth sores
An increased likelihood of bruising and infection

Radiation can increase the likelihood of bruising and infection

Many of the side effects for both chemotherapy and radiation therapy can be managed with the help of medications. Some side effects can also be helped through more natural methods. Anti-nausea medication is often used to prevent vomiting during treatment as well as reducing nausea after treatment. To help with appetite loss, steroids can be used. To reduce the increased likelihood of bruising and infections, blood transfusions can be an option. To help reduce the pain from mouth sores, over-the-counter medications can help. If you experience skin irritation, you should wear loose, nonrestrictive clothing and use medicated lotions to alleviate the problem. If you experience vaginal pain during treatment, it usually ends once treatment ends. If you experience vaginal pain after treatment, you may want to use lubricants and temporarily avoid sexual intercourse until the pain subsides.

Vaginal gels and cream moisturizers can help with this dryness. One brand, in particular, that is often used is Hyalo Gyn. This gel is specifically made to hydrate the vaginal lining, reducing vaginal dryness. There are also more natural products available that women have found to be effective moisturizers, such as vitamin E oil, olive oil, coconut oil, or cocoa butter. These natural oils are safe to use on your vulva, however, you should not use them in your vagina.

Cervical Cancer and Vaginal Care

Menopause is a natural and gradual process that begins for most women around the ages of 45 and 55, however, cervical cancer treatment can cause early menopause for some women. If your ovaries have been removed or if they have been damaged by radiation therapy, your body will stop producing the hormones oestrogen and progesterone, which will stop your periods. This is menopause. Menopause has various symptoms, but they are more intense for people with sudden menopause such as a result of cervical cancer treatment.

Symptoms of menopause: Courtesy of Cancer Research UK

Hot flashes and sweating
Vaginal dryness
Low mood or depression
Loss of confidence and self-esteem
Tiredness
Thinning bones
Loss of interest in sex

Early Menopause and Cervical Cancer

After being diagnosed with cervical cancer or going through treatment, you may be nervous to have sex. If you desire, you may return to a normal sex life a few weeks after finishing radiation therapy or surgery. It is important that you rest during the weeks following your treatment so that your body can heal. After those first few weeks, it is safe to have sex again.

It is important to know that sex will not make your cancer worse or increase the likelihood of it coming back. Additionally, cervical cancer is not infectious. You cannot give your partner cervical cancer. HPV, however, is infectious and can be linked to cervical cancer and other types of cancer. If HPV is a concern for you, talk to your doctor, and practice safe sex.

If you are receiving chemotherapy as a part of your treatment, you should use a condom if you decide to have penetrative sex as a precaution. It is unknown if any drugs used for cancer treatment come through cervical or vaginal mucus therefore they recommend using a condom to be safe.

The thought of starting your sex life again after diagnosis or treatment may make you nervous. You may feel anxious or depressed or worried and this may result in you not wanting to have sex. The important thing is giving yourself the time and space to come to terms with how you are feeling.

Sex can bring back emotional intimacy with your partner. If you can, it is important to have sex again. Couples who have sex often have healthier relationships. It helps to talk to your partner about how you feel and work out what is best for both of you. If you are interested, you can also find a sex therapist to help.

For most people, it just takes some time to return to a normal sex life after the diagnosis and treatment of cervical cancer.

Sex After Cervical Cancer

Various forms of treatment are to battel Cervical Cancer. Different treatments may be used based on the stage of cancer. There are different kinds of treatment, which can be discussed with your doctors to find out which treatment is the best for you. The following information about different treatments by stage is based on information provided by Dana- Farber Cancer Institute.

Stage 0 cervical cancer, generally only surgery is needed to remove the precancerous cells. Often a biopsy to remove areas of your cervix is the only treatment needed. A minor surgery, which preserves fertility, may be performed or a simple hysterectomy if you are no longer interested in having children. Close observation may be an option for younger patients with moderate dysplasia.

Women also often experience constipation after having surgery for cervical cancer, especially if you are taking pain medication. Many pain medications slow down your bowels, which results in constipation. It is recommended that you take Colace and Senna daily to soften your stool. You should take these until you stop taking your pain medication or if your stool becomes unusually loose. If you don’t have a bowel movement for two to three days, try to take a laxative to help.

In addition to constipation, some women experience pain, cramping, and difficulty urinating. To help with the pain and cramping, medication can be provided. To manage urinating, a catheter may be used to drain the bladder for a few days after surgery.

In addition to the symptoms of menopause, it can cause other changes in the body. Over time, your bones may become weak and brittle and can break more easily. This is referred to as osteoporosis. There are several things you can do to help manage osteoporosis. You should eat 3-5 servings of calcium-rich foods daily. You should also increase your vitamin D. Vitamin D helps to absorb calcium. The sun is a good source of vitamin D. You may also ask your doctor whether vitamin D or calcium supplements are right for you.

Lastly, you can do weight-bearing exercises. Weight-bearing exercises come in many forms such as walking, team sports, or dancing. You should talk to your doctor about what is right for you. Menopause can also increase your cholesterol levels, which can increase your risk of heart disease. To help manage this, there are several things you can do. Exercising regularly can help, but it is important to talk to your doctor about what exercises are right for you.

Eating lots of fruits, vegetables, and fiber. You can ask your doctor to check your cholesterol levels and if they are high, ask about medications and/or changes to the diet that can be made. You should also reduce your saturated fat intake. You can do this by limiting the amount of processed meats you eat and takeout food. Lastly, if you smoke, you should talk to your doctor about quitting.

Chemotherapy and radiation therapy treatment for cervical cancer can result in a change in vaginal health for women. Chemotherapy can cause a change in the production of estrogen in the ovaries. As a result of this, women can experience vaginal dryness. Vaginal gels and cream moisturizers can help with this dryness. One brand, in particular, that is often used is Hyalo Gyn. This gel is specifically made to hydrate the vaginal lining, reducing vaginal dryness. There are also more natural products available that women have found to be effective moisturizers, such as vitamin E oil, olive oil, coconut oil, or cocoa butter. These natural oils are safe to use on your vulva, however, you should not use them in your vagina.

Having cervical cancer can affect your sexuality in various ways. Often people think that cancer can change your sexuality in physical ways, but often neglect the emotional ways as well. Your cancer and treatment can affect your sex life due to these physical and emotional changes.

You may experience low libido during or after treatment. A lack of interest or desire in sex is common during and after treatment due to the physical and emotional effects. This is totally okay and normal. You should talk to your partner about what you are feeling. It is normal to take time for sex to be comfortable again and you may experiment to find new ways to be intimate.

In addition to vaginal dryness, you may notice vaginal discharge. This may occur about 2 weeks after treatment started and may last 2 to 4 weeks after treatment ends. If you are experiencing discomfort from this, taking a warm bath and using panty liners can help to relieve some of this discomfort. You can also discuss this with your doctor for some other suggestions.

Lubricants versus Moisturizers for Vaginal Care

Vaginal dryness may make penetration during sex painful. To make it more comfortable, you may use lubricants.

Lubricants are different from moisturizers in that they can be used in your vagina rather than just the vulva. There are water-based lubricants and silicone-based lubricants. The one that you choose is a personal preference. Beware of lubricants or moisturizers that claim to have warming or cooling effects or intensify. These products should be avoided especially for women who have received radiation therapy in the pelvic area.

It is important to be aware of the different risk factors associated with Cervical Cancer. Talk to your gynecologist about your risks.

Human papillomavirus (HPV): HPV is a sexually transmitted disease that can increase your risk of developing cervical cancer and other types of cancer. According to the National Cancer Institute, research showed that HPV caused changes in the cervical cells slowly and often go away on their own, especially in younger women. There are various types and degrees of HPV and the high-risk types have been strongly linked to cancers, including cervical cancer.

Other sexually transmitted infections (STIs): Having other sexually transmitted infections, such as chlamydia, HIV or AIDS, syphilis, and gonorrhea, increases your chances of getting HPV and cervical cancer.

Many sexual partners: The more sexual partners you have, the greater chance you have of developing sexually transmitted infections and as a result, cervical cancer. This risk becomes higher with not only the more sexual partners you have, but also the greater the number of sexual partners that your sexual partner has.

Early sexual activity: Having sexual intercourse at an early age increases your risk of cervical cancer and HPV.
Smoking: Women who smoke are about twice as likely to get cervical cancer than those who don’t smoke. Smoking weakens the immune system, which makes it harder to fight off infections and cancer. Smoking has been linked with squamous cell cervical cancer. Cigarettes contain chemicals that can damage cervical cells.

Weakened immune system: You may be more likely to develop cervical cancer if your immune system is weakened by another health condition. Women on chronic immunosuppressive medications for inflammatory diseases after a transplant are also at a higher risk.

Giving birth to 3 or more children: Women who have had 3 or more full-term pregnancies have an increased chance of getting cervical cancer.

Diet: Diets that do not contain enough fruits and vegetables result in an increased risk of developing cervical cancer. Women who are overweight are more likely to develop adenocarcinoma of the cervix.

Oral contraceptives: Long term use of birth control pills increases your chances of developing cervical cancer.

Family history of cervical cancer: If your mother or sister had cervical cancer, your chance of developing cervical cancer are 2 to 3 times higher than someone who doesn’t have anyone in their family with cervical cancer.
Prevention

Avoiding risk factors and increasing protective factors can help reduce the risk of developing cervical cancer. The protective factors that decrease the risk of cervical cancer are getting the HPV vaccine, practicing safe sex, and having regular Pap tests. Getting the vaccine for HPV can decrease your risk of cervical cancer and other cancers related to HPV.

If you are interested in learning more about the HPV vaccine, have a discussion with your doctor to discuss if it is right for you. Practicing safe sex can reduce your chances of getting cervical cancer by reducing your chances of getting a sexually transmitted infection. Using a condom every time you have sex can prevent sexually transmitted infections as well as limiting the number of sexual partners you have.

Lastly, having regular Pap tests are very important in preventing cervical cancer. Pap tests can detect any precancerous conditions and changes in the cells of the cervix. Any changes and conditions that are detected can be monitored or treated in order to prevent cervical cancer.

Chemotherapy, Radiation, surgery can affect your fertility. In the early stages of cervical cancer, a surgery that preserves fertility may be an option if you are interested in having children in the future. Oftentimes with these forms of procedures, you can get pregnant after your treatment and carry the baby until delivery by cesarean section (also known as a C-section). In the later stages of cervical cancer, this is not usually an option. Radiation and chemotherapy can damage the ovaries and eggs.

Fertility and Cancer

If you would like to preserve your fertility, freezing your eggs might be the best option. If you decide to freeze your eggs, it may delay your treatment for a couple of weeks, while the fertility drugs increase egg production. You will have to discuss with your doctor whether a delay in treatment is safe for you. If you have your uterus removed, you will not be able to get pregnant. Despite this, if you freeze your eggs, you can have your own biological child through the use of a surrogate.
Loss of fertility can affect women emotionally. Even for women who were not planning on having more children, you may feel distressed from no longer being able to have children. Women often feel a sense of loss when they find out and feel devastated about the news. Before treatment starts you should talk to your doctor about your options. It is also recommended that you talk to your partner about your feelings.

Risk Factors and Prevention Tips of Cervical Cancer

Cervical cancer affects thousands of women in the United States every year. Cervical cancer is preventable with the correct screening. Getting regular Pap tests can save your life. “Between the HPV vaccine and improved screening options, which allow us to detect abnormalities before they turn into cancer, we have the tools to eradicate cervical cancer. It is crucially important that we use these tools properly,” said Dr. Stephanie Blank, director of the Division of Gynecologic Oncology for the Mount Sinai Health System.

In addition to screening, there are preventative factors that can help decrease your risk of developing cervical cancer and may want to be something you think about. While a diagnosis of cervical cancer at any stage can be scary, there are various treatment options to find what is best for you. Fertility may be a concern for some women and it is important to know that you have options. You should talk to your doctor about fertility options before starting treatment. Overall, cervical cancer can be intimidating, however, with regular screening and early treatment, cervical cancer can be beaten and even eradicated.