Dr. M.J. Bazos, MD Patient Handout


About Your Diagnosis
The cervix is located at the end of the vaginal canal. If is a button-like structure with a narrow opening that leads into the uterus (womb). Cancer of the cervix or cervical cancer was at one time the most common cause of cancer death among women, but this risk has declined considerably over the years because of early detection with Pap smears (Papanicolaou smear). Approximately 60,000 new cases are diagnosed each year, and most are in the earliest stage, meaning the likelihood of cure is high. Risks for cervical cancer include the following: sexual intercourse before 18 years of age, many sexual partners, smoking, use of oral contraceptives (birth control pills), having a mother who took diethylstilbestrol (DES) during pregnancy to prevent miscarriage, infection with human papillomavirus (HPV), which is sexually transmitted. Pap smears are 95% accurate in the detection of early cervical cancer. They are recommended for all women older than 20 years or sooner if sexually active and should be performed annually (some organizations recommend every 3 years). If a Pap smear is abnormal, a primary care physician makes a referral to a gynecologist for colposcopy (microscopic examination of the cervix with a lighted tube). With this method, tissue can be removed and examined by a pathologist. If this does not give definitive evidence of cancer, a cone biopsy may be performed. In this procedure a cone-shaped sample of tissue is removed to detect cancer.

Living With Your Diagnosis
Patients with cervical cancer usually have no symptoms until the cancer has invaded nearby tissue. The most common symptom is vaginal bleeding or bleeding after sexual intercourse. Vaginal bleeding after menopause is cause for concern. Increased vaginal discharge may be another symptom. The cancer usually spreads locally to invade other nearby structures and can cause symptoms such as back pain, urinary frequency, and bowel changes.

Treatment usually depends on the stage of the cancer. Staging a cancer means to find out whether the cancer has spread, and if so, where has it spread? A physician performs a pelvic examination and orders blood and urine tests, radiographs (x-rays), including an intravenous pyelogram (IVP), to examine the kidneys, bladder, and ureter (the tube that connects the kidney with the bladder) to exclude any spread. Computed tomography (CT) is performed to exclude spread to lymph nodes. Cystoscopy and proctosigmoidoscopy (examinations with lighted scopes passed into the bladder and rectum, respectively) also may be performed. Staging is as follows: Stage 0, cancer only at the site; stage I, cancer confined to the cervix; stage II, cancer invasion but not to the lower third of the vagina; stage III, cancer invasion beyond the cervix to the lower third of the vagina; stage IV, cancer invasion of the bladder or rectum. Treatment includes surgical, radiation, and chemotherapy. Most patients can be treated with surgical therapy or surgical and radiation therapy. Stages 0 and I cancer can be managed by means of surgical removal of the uterus (hysterectomy). Radiation therapy can be used in place of surgical therapy for stage I disease. Radiation is the preferred therapy for stages II through IV cancer. Chemotherapy has not been effective but is are tried for
cancer in advanced stages. Side effects of surgical treatment include pain, infection, vaginal drainage, urinary discomfort, and bowel changes. Side effects of radiation therapy, because it is in the lower abdomen and pelvic area, include diarrhea; loose, bloody stools; dry, itchy, red, burning skin; nausea and vomiting; and urinary burning, pain, and frequency. Side effects of chemotherapy include easy bruising and bleeding, fever, nausea, vomiting, and hair loss.

The DOs
• Undergo yearly Pap smears.
• Educate your children (girls and boys) about early sex, multiple partners, and sexually transmitted diseases.
• Understand that early detection usually results in cure.
• Understand the importance of nutrition after surgical, radiation, or chemotherapy.
• Understand that depending on the stage of disease, you are treated by a team of physicians, including a primary care physician, gynecologist, oncologist, and radiation oncologists.

The DON’Ts
• Do not miss follow-up appointments because repeat Pap smears, pelvic examinations, and other laboratory studies are performed to make sure the cancer has not returned.
• Do not forget to stay active. Exercising daily helps you deal with the disease.
• Do not be afraid to ask about emotional support groups.
• Do not forget about social workers who can help with services such as rehabilitation, home care, finances, and transportation.

When to Call Your Doctor
• If you have any abnormal vaginal bleeding.
• If you have any pain after surgical treatment.
• If you have any bowel or urinary problems after surgical treatment or radiation therapy, such as bloody diarrhea, urinary frequency, or pain.
• If you have any excess vaginal drainage or fever after surgical treatment.
• If you are experiencing hot flashes, vaginal dryness, or vaginal pain with intercourse.