Frequently Asked Questions about Cervical Cancer

Q: What is cancer of the cervix?
A: Cervical cancer is cancer that starts in the cervix. Since the Pap test became a routine test for women in the United States, cervical cancer is no longer a major health problem here. In fact, it now makes up less than 2% of all cancers in women in the United States. However, in many developing countries where the Pap test is not a routine test, this form of cancer is very common.

Q: What is the cervix?
A: The cervix is the lower part of the uterus, which is the female reproductive organ that holds a baby during pregnancy. The cervix connects the uterus and the vagina. The vagina leads to the outside of the body. Both the uterus and the cervix are located in the pelvis. They are in close contact with other pelvic organs, such as the ovaries, upper part of the vagina, bladder, and rectum.

Q: Who gets cervical cancer?
A: Any woman can get cervical cancer, but it occurs more often in Hispanic and African-American women than in non-Hispanic white women. It also occurs most often in women between the ages of 35 and 55.

Q: Are there different types of cervical cancer?
A: Cervical cancer starts with cells that are on the surface of the cervix.

There are 2 main types of cervical cancer.

• Squamous cell carcinoma is cancer of cells that line the outer part of the cervix. These cells are squamous epithelial cells. They line the outer part of the cervix that is closest to the vagina, called the ectocervix. Squamous cell cancers have flat, thin cells. They cover the surface of the ectocervix. This type of cancer most commonly occurs where the ectocervix meets the endocervix, which is the inner part of the cervix.
• Adenocarcinoma is cancer of the cells lining the inner part of the cervix. These cells are columnar epithelial cells. They line the inner part of the cervix that is closest to the uterus, called the endocervix. They develop from gland cells in the endocervix.

Q: Who is at risk for cervical cancer?
A: Certain factors can make one woman more likely to get cervical cancer than another one. These are called risk factors. Risk factors for cervical cancer are listed below.

• Human Papillomavirus (HPV) infection. Some of the HPVs put women at higher risk for cervical cancer. These viruses can be transmitted by sexual contact. HPV infection is the major risk factor for cervical cancer.
• Smoking. A woman who smokes has a higher chance of getting cervical cancer.
• Weak immune systems. Women who have the virus HIV, which causes AIDS, have a greater risk of getting cervical cancer. This is because HIV makes the immune system weaker, so the body will not effectively clear the HPV infection.
• Family or personal history of cervical cancer. If your mother or sister has had this cancer—or you've had it before yourself—your risk is higher than a woman without this history.
• Chlamydia infection. This is a sexually-transmitted bacterial infection that may increase your risk of developing cervical cancer.
• Diet. A diet low in fruits and vegetables, as well as obesity, may increase the risk for cervical cancer.
• Oral contraceptives. A woman who has taken oral contraceptives for a long time may have a higher risk.
• Many pregnancies. A woman who has had many full-term pregnancies may be at greater risk.
• DES. If a woman's mother took the drug diethylstilbestrol (DES) when she was pregnant, she has a greater chance of getting cervical cancer.
• Socioeconomic status. Many women with low incomes don't have access to healthcare. This may prevent regular screenings and increase their risk of cervical cancer.

Q: What can a woman do to decrease her risk of getting cervical cancer?
A: Regular Pap tests are very important in detecting cervical cancer changes early, when they can be more easily treated. These are things women can do to decrease their risk.

• Talk to a doctor about when to go for checkups. It is generally recommended for women who are sexually active or 18 years and older to have a regular Pap test and a gynecologic exam each year.
• Quit smoking.
• Avoid intercourse at a young age.
• Use condoms during intercourse.
• Limit the number of sexual partners.

Q: What is the Pap test?
A: The Pap test is a very simple and important test. The doctor uses the Pap test to see if there are any changes in the cervix. The best time for a woman to have a Pap test is 10 to 20 days after her period. A Pap test can be done in a doctor's office or a health clinic. The doctor or nurse practitioner uses a tool called a speculum to hold the vagina open to see the upper part of the vagina and the cervix. Then the doctor uses a wooden scraper or a small brush to get some cells from the cervix and vagina. He or she puts these cells on a glass slide or in a solution and sends it to a laboratory to be looked at under a microscope to check for abnormal cells.

Q: Who should get Pap tests and how often?
A: Women should begin the test when they turn 18 or become sexually active, whichever comes first. The Pap test is recommended every 2-3 years until a woman has 3 or more normal exams. Then, a doctor may recommend doing the test less often. Women should talk to their doctors about how often they need the test.

Q: What are the symptoms of cervical cancer?
A: Cervical cancer and cervical pre-cancers usually have no symptoms. That is why it is important to have Pap tests. A woman usually does not have any symptoms until the cells turn into cancer and invade the deepest parts of the cervix or other pelvic organs. These are common symptoms in women with fully developed cervical cancer.

• Vaginal discharge
• Abnormal vaginal bleeding
• Vaginal odor
• Pain

These symptoms may be caused by cancer or by other health problems. It is important for a woman to see her doctor if she is having any of these symptoms.

Q: How should I prepare for my cervical cancer screening tests?

• Don't take the tests if you're having your menstrual period.
• Don't douche for 2 days before the tests.
• Don't have sexual intercourse for 2 days before the test.
• Don't use tampons or birth control foams, jellies, or other vaginal creams or vaginal medicines for 2 days before the test.

Q: How is cervical cancer diagnosed?
A: The doctor asks questions about the woman's medical history and family history. The doctor will also do a pelvic exam and Pap test. If the doctor finds something suspicious, other tests can help determine if the woman has cervical cancer. It is very important to know the extent of the cancer--how deeply it has invaded tissues. The treatment can be quite different depending upon this.

The doctor may order one or more of these tests to help make a diagnosis.

• HPV test
• Colposcopy
• Biopsy

Depending upon the extent or location of the cancer, the biopsy may be done in a variety of ways.

Q: Should everyone get a second opinion?
A: Many people with cancer get a second opinion from another doctor. There are many reasons to get a second opinion. Here are some of those reasons.

• Not feeling comfortable with the treatment decision
• Being diagnosed with a rare type of cancer
• Having several options for how to treat the cancer
• Not being able to see a cancer expert

Q: When do I need to see a specialist?
A: If you have cervical cancer, you'll likely be treated by one or more of the following specialists: a gynecologic oncologist, a radiation oncologist and a medical oncologist. An oncologist is a doctor specially trained in diagnosing and treating cancer.

If you have been diagnosed with precancerous changes, it's not essential that you see an oncologist. Depending on the degree of the change seen, your gynecologist or your primary care doctor may monitor your condition and provide treatment.

Q: How can someone get a second opinion?
A: These are some of the many ways to get a second opinion.

• Ask a primary care doctor. He or she may be able to suggest a specialist. This may be a gynecologic oncologist, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or hospitals. Never be afraid to ask for a second opinion.
• Call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237). They have information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.
• Consult The Official ABMS Directory of Board Certified Medical Specialists. This book, from the American Board of Medical Specialists, lists doctors by state. It gives their specialty, background, and training. It is available at most public libraries. You can also view it online at www.abms.org.
• Seek other options. Check with a local medical society, a nearby hospital or medical school, or support group to get names of doctors who can give you a second opinion. Or ask other people who've had cancer for their recommendations.

Q: What are the treatments for cervical cancer?
A: Treatment for cervical cancer is often surgery, especially for cancers that have not spread. Surgery is used to remove as much cancer as possible. It is called a local treatment. Local treatments fight cancer cells in one area. Another type of local treatment used for cervical cancer is high-energy X-rays, called radiation therapy. Chemotherapy is the use of drugs to kill cancer. It is called systemic treatment. It travels throughout the body. It may be combined with radiation, either before or after surgery.

Q: What check-ups should a woman have after treatment for cervical cancer?
A: In the first year after treatment, most women are advised to see their doctors every 3 months. Pap tests may be performed every 3 months. Also, women may have chest X-rays and computed tomography (CT scans) regularly. Until the fifth year, women may have check-ups regularly, at least every 6 months. After 5 years, a woman will most likely go back to yearly check ups. Women who have been treated for cervical cancer should tell their doctors about any vaginal discharge, bleeding, bone pain, weight loss, or bowel or bladder problems. They should quit smoking and use protection during intercourse to prevent further problems.

Q: What's new in cervical cancer research?
A: Researchers are working on many fronts to better prevent, diagnose, and treat cervical cancer. For example, researchers have recently developed vaccines to prevent HPV infection. They are also working on vaccines to treat cervical cancer. And they are developing surgical techniques that will cure localized cancers while preserving as much tissue as possible.

Q: What are clinical trials?
A: Clinical trials are studies of new kinds of cancer treatments. Doctors use clinical trials to learn how well new treatments work and what their side effects are. Promising treatments are ones that work better or have fewer side effects than the current treatments. People who participate in these studies have access to these treatments before the U.S. Food and Drug Administration (FDA) approves them. People who join trials also help researchers learn more about cancer and help future cancer patients.