The Cervix

Understanding Cancer

Risk Factors

Screening

Symptoms

Diagnosis

Staging

Treatment

Getting a Second Opinion Preparing for Treatment Methods of Treatment Surgery Radiation Therapy Chemotherapy

Side Effects of Treatment

Surgery Radiation Therapy Chemotherapy

Complementary and Alternative Medicine

Nutrition

Follow-up Care

Sources of Support

The Promise of Cancer Research

National Cancer Institute Information Resources

National Cancer Institute Publications

Introduction

This National Cancer Institute (NCI) booklet (NIH Publication No. 05-2047) has important information about cancer* of the cervix. Cancer of the cervix is also called cervical cancer. You will read about causes, screening, symptoms, diagnosis, and treatment. You will also find ideas about how to cope with the disease.

Scientists are studying cervical cancer to find out more about how it develops. And they are looking at better ways to detect and treat it.

The NCI provides information about cancer, including the publications mentioned in this booklet. You can order these materials by telephone or on the Internet. You can also read them on the Internet and print your own copy.

• Telephone (1-800-4-CANCER): Information Specialists at NCI's Cancer Information Service can answer your questions about cancer. They also can send NCI booklets, fact sheets, and other materials.
• Internet (http://www.cancer.gov): You can use NCI's Web site to find a wide range of up-to-date information. For example, you can find many NCI booklets and fact sheets at http://www.cancer.gov/publications. People in the United States and its territories may use this Web site to order printed copies. This Web site also explains how people outside the United States can mail or fax their requests for NCI booklets.

You can ask questions online and get help right away from Information Specialists through LiveHelp ¹. (Click on "Need Help?" at http://www.cancer.gov. Then click on "Connect to LiveHelp.")

The cervix is part of a woman's reproductive system. It is the lower, narrow part of the uterus (womb). The uterus is a hollow, pear-shaped organ in the lower abdomen. The cervix connects the uterus to the vagina. The vagina leads to the outside of the body.

The cervical canal is a passageway. Blood flows from the uterus through the canal into the vagina during a woman's menstrual period. The cervix also produces mucus. The mucus helps sperm move from the vagina into the uterus. During pregnancy, the cervix is tightly closed to help keep the baby inside the uterus. During childbirth, the cervix dilates (opens) to allow the baby to pass through the vagina.

This picture shows the cervix and nearby organs.

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.

Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.

Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.

Tumors can be benign or malignant:

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if cervical cancer spreads to the lungs, the cancer cells in the lungs are actually cervical cancer cells. The disease is metastatic cervical cancer, not lung cancer. For that reason, it is treated as cervical cancer, not lung cancer. Doctors call the new tumor "distant" or metastatic disease.

Doctors cannot always explain why one woman develops cervical cancer and another does not. However, we do know that a woman with certain risk factors may be more likely than others to develop cervical cancer. A risk factor is something that may increase the chance of developing a disease.

Studies have found a number of factors that may increase the risk of cervical cancer. These factors may act together to increase the risk even more:

• Human papillomaviruses (HPVs): HPV infection is the main risk factor for cervical cancer. HPV is a group of viruses that can infect the cervix. HPV infections are very common. These viruses can be passed from person to person through sexual contact. Most adults have been infected with HPV at some time in their lives. Some types of HPV can cause changes to cells in the cervix. These changes can lead to genital warts, cancer, and other problems. Doctors may check for HPV even if there are no warts or other symptoms.

If a woman has an HPV infection, her doctor can discuss ways to avoid infecting other people. The Pap test can detect cell changes in the cervix caused by HPV. (See the "Screening" ³ section to learn more about the Pap test.) Treatment of these cell changes can prevent cervical cancer. There are several treatment methods, including freezing or burning the infected tissue. Sometimes medicine also helps.

The NCI offers a fact sheet called "Human Papillomaviruses and Cancer: Questions and Answers." ⁴

• Lack of regular Pap tests: Cervical cancer is more common among women who do not have regular Pap tests. The Pap test helps doctors find precancerous cells. Treating precancerous cervical changes often prevents cancer.
• Weakened immune system (the body's natural defense system): Women with HIV (the virus that causes AIDS) infection or who take drugs that suppress the immune system have a higher-than-average risk of developing cervical cancer. For these women, doctors suggest regular screening for cervical cancer.
• Age: Cancer of the cervix occurs most often in women over the age of 40.
• Sexual history: Women who have had many sexual partners have a higher-than-average risk of developing cervical cancer. Also, a woman who has had sexual intercourse with a man who has had many sexual partners may be at higher risk of developing cervical cancer. In both cases, the risk of developing cervical cancer is higher because these women have a higher-than-average risk of HPV infection.
• Smoking cigarettes: Women with an HPV infection who smoke cigarettes have a higher risk of cervical cancer than women with HPV infection who do not smoke.
• Using birth control pills for a long time: Using birth control pills for a long time (5 or more years) may increase the risk of cervical cancer among women with HPV infection.
• Having many children: Studies suggest that giving birth to many children may increase the risk of cervical cancer among women with HPV infection.

Diethylstilbestrol (DES) may increase the risk of a rare form of cervical cancer and certain other cancers of the reproductive system in daughters exposed to this drug before birth. DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.)

Women who think they may be at risk for cancer of the cervix should discuss this concern with their doctor. They may want to ask about a schedule for checkups. For more information about risk factors, see the NCI booklet Understanding Cervical Changes ⁵.

Screening to check for cervical changes before there are symptoms is very important. Screening can help the doctor find abnormal cells before cancer develops. Finding and treating abnormal cells can prevent most cervical cancer. Also, screening can help find cancer early, when treatment is more likely to be effective.

For the past several decades, the number of women diagnosed each year with cervical cancer has been falling. Doctors believe this is mainly because of the success of screening.

Doctors recommend that women help reduce their risk of cervical cancer by having regular Pap tests. A Pap test (sometimes called Pap smear or cervical smear) is a simple test used to look at cervical cells. For most women, the test is not painful. A Pap test is done in a doctor's office or clinic during a pelvic exam. The doctor or nurse scrapes a sample of cells from the cervix, and then smears the cells on a glass slide. In a new type of Pap test (liquid-based Pap test), the cells are rinsed into a small container of liquid. A special machine puts the cells onto slides. For both types of Pap test, a lab checks the cells on the slides under a microscope for abnormalities.

Pap tests can find cervical cancer or abnormal cells that can lead to cervical cancer. Doctors generally recommend that:

• Women should begin having Pap tests 3 years after they begin having sexual intercourse, or when they reach age 21 (whichever comes first).
• Most women should have a Pap test at least once every 3 years.
• Women aged 65 to 70 who have had at least three normal Pap tests and no abnormal Pap tests in the past 10 years may decide, after speaking with their doctor, to stop cervical cancer screening.
• Women who have had a hysterectomy (surgery) to remove the uterus and cervix, also called a total hysterectomy, do not need to have cervical cancer screening. However, if the surgery was treatment for precancerous cells or cancer, the woman should continue with screening.

Women should talk with their doctor about when they should begin having Pap tests, how often to have them, and when they can stop having them. This is especially important for women at higher-than-average risk of cervical cancer.

Some activities can hide abnormal cells and affect Pap test results. Doctors suggest the following tips:

• Do not douche for 48 hours before the test.
• Do not have sexual intercourse for 48 hours before the test.
• Do not use vaginal medicines (except as directed by a doctor) or birth control foams, creams, or jellies for 48 hours before the test.

Doctors also suggest that a woman schedule her Pap test for a time that is 10 to 20 days after the first day of her menstrual period.

Most often, abnormal cells found by a Pap test are not cancerous. However, some abnormal conditions may become cancer over time:

• LSIL (low-grade squamous intraepithelial lesion): LSILs are mild cell changes on the surface of the cervix. Such changes often are caused by HPV infections. LSILs are common, especially in young women. LSILs are not cancer. Even without treatment, most LSILs stay the same or go away. However, some turn into high-grade lesions, which may lead to cancer.
• HSIL (high-grade squamous intraepithelial lesion): HSILs are not cancer, but without treatment they may lead to cancer. The precancerous cells are only on the surface of the cervix. They look very different from normal cells.

The NCI booklet Understanding Cervical Changes ⁵ has more information about abnormal Pap test results. You also may want to read the brochure Having a Pelvic Exam and Pap Test and the NCI fact sheet "The Pap Test: Questions and Answers." ⁶

Precancerous changes and early cancers of the cervix generally do not cause pain or other symptoms. It is important not to wait to feel pain before seeing a doctor.

When the disease gets worse, women may notice one or more of these symptoms:

• Abnormal vaginal bleeding
  • Bleeding that occurs between regular menstrual periods
  • Bleeding after sexual intercourse, douching, or a pelvic exam
  • Menstrual periods that last longer and are heavier than before
  • Bleeding after menopause
• Increased vaginal discharge
• Pelvic pain
• Pain during sexual intercourse

Infections or other health problems may also cause these symptoms. Only a doctor can tell for sure. A woman with any of these symptoms should tell her doctor so that problems can be diagnosed and treated as early as possible.

If a woman has a symptom or Pap test results that suggest precancerous cells or cancer of the cervix, her doctor will suggest other procedures to make a diagnosis.

These may include:

• Colposcopy: The doctor uses a colposcope to look at the cervix. The colposcope combines a bright light with a magnifying lens to make tissue easier to see. It is not inserted into the vagina. A colposcopy is usually done in the doctor's office or clinic.
• Biopsy : The doctor removes tissue to look for precancerous cells or cancer cells. Most women have their biopsy in the doctor's office with local anesthesia. A pathologist checks the tissue with a microscope.
  • Punch biopsy: The doctor uses a sharp, hollow device to pinch off small samples of cervical tissue.
  • LEEP: The doctor uses an electric wire loop to slice off a thin, round piece of tissue.
  • Endocervical curettage: The doctor uses a curette (a small, spoon-shaped instrument) to scrape a small sample of tissue from the cervical canal. Some doctors may use a thin, soft brush instead of a curette.
  • Conization: The doctor removes a cone-shaped sample of tissue. A conization, or cone biopsy, lets the pathologist see if abnormal cells are in the tissue beneath the surface of the cervix. The doctor may do this test in the hospital under general anesthesia. Conization also may be used to remove a precancerous area.

Removing tissue from the cervix may cause some bleeding or other discharge. The area usually heals quickly. Women may also feel some pain similar to menstrual cramps. Medicine can relieve this discomfort.

For more information about tests, cell changes, and treatment for these changes, you may want to read Understanding Cervical Changes ⁵.

If the biopsy shows that you have cancer, your doctor will do a thorough pelvic exam and may remove additional tissue to learn the extent (stage) of your disease. The stage tells whether the tumor has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body.

These are the stages of cervical cancer:

• Stage 0: The cancer is found only in the top layer of cells in the tissue that lines the cervix. Stage 0 is also called carcinoma in situ.
• Stage I: The cancer has invaded the cervix beneath the top layer of cells. It is found only in the cervix.
• Stage II: The cancer extends beyond the cervix into nearby tissues. It extends to the upper part of the vagina. The cancer does not invade the lower third of the vagina or the pelvic wall (the lining of the part of the body between the hips).
• Stage III: The cancer extends to the lower part of the vagina. It also may have spread to the pelvic wall and nearby lymph nodes.
• Stage IV: The cancer has spread to the bladder, rectum, or other parts of the body.
• Recurrent cancer: The cancer was treated, but has returned after a period of time during which it could not be detected. The cancer may show up again in the cervix or in other parts of the body.

To learn the extent of disease and suggest a course of treatment, the doctor may order some of the following tests:

• Chest x-rays: X-rays often can show whether cancer has spread to the lungs.
• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your organs. You may receive contrast material by injection in your arm or hand, by mouth, or by enema. (Some people are allergic to contrast materials that contain iodine. Tell your doctor or nurse if you have allergies.) The contrast material makes abnormal areas easier to see. A tumor in the liver, lungs, or elsewhere in the body can show up on the CT scan.
• MRI: A powerful magnet linked to a computer is used to make detailed pictures of your pelvis and abdomen. The doctor can view these pictures on a monitor and can print them on film. An MRI can show whether cancer has spread. Sometimes contrast material makes abnormal areas show up more clearly on the picture.
• Ultrasound: An ultrasound device is held against the abdomen or inserted into the vagina. The device sends out sound waves that people cannot hear. The waves bounce off the cervix and nearby tissues, and a computer uses the echoes to create a picture. Tumors may produce echoes that are different from the echoes made by healthy tissues. The picture can show whether cancer has spread.

Many women with cervical cancer want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and your treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything you want to ask the doctor. It often helps to make a list of questions before an appointment.

You do not need to ask all your questions at once. You will have other chances to ask your doctor to explain things that are not clear and to ask for more information.

Your doctor may refer you to a specialist, or you may ask for a referral. Gynecologists, gynecologic oncologists, medical oncologists, and radiation oncologists are specialists who treat cervical cancer.

Getting a Second Opinion

Before starting treatment, you might want a second opinion about the diagnosis and treatment plan. Many insurance companies cover a second opinion if you or your doctor requests it. It may take some time and effort to gather medical records and arrange to see another doctor. Usually it is not a problem to take several weeks to get a second opinion. In most cases, the delay in starting treatment will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Some women with cervical cancer need treatment right away.

There are a number of ways to find a doctor for a second opinion:

• Your doctor may refer you to one or more specialists. At cancer centers, several specialists often work together as a team.
• NCI's Cancer Information Service, at 1-800-4-CANCER, can tell you about nearby treatment centers. Information Specialists also can provide online assistance through LiveHelp ¹ at http://www.cancer.gov.
• A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists in your area.
• The American Board of Medical Specialties (ABMS) has a list of doctors who have had training and passed exams in their specialty. You can find this list in the Official ABMS Directory of Board Certified Medical Specialists. This Directory is in most public libraries. Or you can look up doctors at http://www.abms.org ⁷. (Click on "Who's Certified.")
• The NCI provides a helpful fact sheet called "How To Find a Doctor or Treatment Facility If You Have Cancer." ⁸

Preparing for Treatment

The choice of treatment depends mainly on the size of the tumor and whether the cancer has spread. If a woman is of childbearing age, the treatment choice may also depend on whether she wants to become pregnant someday.

Your doctor can describe your treatment choices and the expected results of each. You and your doctor can work together to develop a treatment plan that meets your medical needs and personal values.

Methods of Treatment

Women with cervical cancer may be treated with surgery, radiation therapy, chemotherapy, radiation therapy and chemotherapy, or a combination of all three methods.

At any stage of disease, women with cervical cancer may have treatment to control pain and other symptoms, to relieve the side effects of therapy, and to ease emotional and practical problems. This kind of treatment is called supportive care, symptom management, or palliative care. Information about such treatment is available on NCI's Web site at http://www.cancer.gov/cancertopics/coping and from NCI's Cancer Information Service at 1-800-4-CANCER.

You may want to talk to your doctor about taking part in a clinical trial, a research study of new treatment methods. The section on "The Promise of Cancer Research" ⁹ has more information about clinical trials.

Surgery

Surgery treats the cancer in the cervix and the area close to the tumor.

Most women with early cervical cancer have surgery to remove the cervix and uterus (total hysterectomy). However, for very early (Stage 0) cervical cancer, a hysterectomy may not be needed. Other ways to remove the cancerous tissue include conization, cryosurgery, laser surgery, or LEEP.

Some women need a radical hysterectomy. A radical hysterectomy is surgery to remove the uterus, cervix, and part of the vagina.

With either total or radical hysterectomy, the surgeon may remove both fallopian tubes and ovaries. (This procedure is a salpingo-oophorectomy.)

The surgeon may also remove the lymph nodes near the tumor to see if they contain cancer. If cancer cells have reached the lymph nodes, it means the disease may have spread to other parts of the body.

Radiation Therapy

Women have radiation therapy alone, with chemotherapy, or with chemotherapy and surgery. The doctor may suggest radiation therapy instead of surgery for the small number of women who cannot have surgery for medical reasons. Most women with cancer that extends beyond the cervix have radiation therapy and chemotherapy. For cancer that has spread to distant organs, radiation therapy alone may be used.

Doctors use two types of radiation therapy to treat cervical cancer. Some women receive both types:

• External radiation: The radiation comes from a large machine outside the body. The woman usually has treatment as an outpatient in a hospital or clinic. She receives external radiation 5 days a week for several weeks.
• Internal radiation (intracavitary radiation): Thin tubes (also called implants) containing a radioactive substance are left in the vagina for a few hours or up to 3 days. The woman may stay in the hospital during that time. To protect others from the radiation, the woman may not be able to have visitors or may have visitors for only a short period of time while the tubes are in place. Once the tubes are removed, no radioactivity is left in her body. Internal radiation may be repeated two or more times over several weeks.

Chemotherapy

Chemotherapy uses anticancer drugs to kill cancer cells. It is called systemic therapy because the drugs enter the bloodstream and can affect cells all over the body. For treatment of cervical cancer, chemotherapy is generally combined with radiation therapy. For cancer that has spread to distant organs, chemotherapy alone may be used.

Anticancer drugs for cervical cancer are usually given through a vein. Women usually receive treatment in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, a woman needs to stay in the hospital during treatment.

Because cancer treatment often damages healthy cells and tissues, unwanted side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each woman, and they may change from one treatment session to the next. Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them.

The NCI provides helpful booklets about cancer treatments and coping with side effects. These include Radiation Therapy and You ¹⁰, Chemotherapy and You ¹¹, and Eating Hints for Cancer Patients ¹².

Surgery

If you have surgery to remove a small tumor on the surface of the cervix, you may have cramping or other pain, bleeding, or a watery discharge.

If you have a hysterectomy, the length of the hospital stay may vary from several days to a week. It is common to feel tired or weak for a while. You may have problems with nausea and vomiting, and you may have bladder and bowel problems. The doctor may restrict your diet to liquids at first, with a gradual return to solid food. Most women return to their normal activities within 4 to 8 weeks after surgery.

After a hysterectomy, women no longer have menstrual periods. They cannot become pregnant.

When the ovaries are removed, menopause occurs at once. Hot flashes and other symptoms of menopause caused by surgery may be more severe than those caused by natural menopause. You may wish to discuss this with your doctor before surgery. Some drugs have been shown to help with these symptoms, and they may be more effective if started before surgery.

After surgery, some women may be concerned about sexual intimacy. Many women find that it helps to share these concerns with their partner. A couple may want to ask a counselor to help them express their concerns.

Radiation Therapy

You may have dryness, itching, or burning in your vagina. The radiation may also make your vagina narrower. The doctor or nurse may suggest ways to relieve discomfort. There also are ways to expand the vagina, which will help make follow-up exams easier. Your doctor may advise you not to have intercourse during treatment. But most women can resume sexual activity within a few weeks after treatment ends.

You are likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.

Although the side effects of radiation therapy can be distressing, your doctor can usually find ways to relieve them.

Chemotherapy

The side effects of chemotherapy depend mainly on the specific drugs and the dose. The drugs affect cancer cells and other cells that divide rapidly:

• Blood cells: These cells fight infection, help your blood to clot, and carry oxygen to all parts of the body. When drugs affect your blood cells, you are more likely to get infections, bruise or bleed easily, and feel very weak and tired.
• Cells in hair roots: Chemotherapy can cause you to lose your hair. The hair will grow back, but it may be somewhat different in color and texture.
• Cells that line the digestive tract: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores.

The drugs used for cervical cancer also may cause skin rash, hearing problems, loss of balance, joint pain, or swollen legs and feet.

Your doctor can suggest ways to control many of these side effects.

Some people with cancer use complementary and alternative medicine (CAM) to ease stress or to reduce side effects and symptoms:

• An approach is generally called complementary medicine when it is used along with standard treatment.
• An approach is called alternative medicine when it is used instead of standard treatment.

Acupuncture, massage therapy, herbal products, vitamins or special diets, visualization, meditation, and spiritual healing are types of CAM. Many people say that such approaches help them feel better.

However, some types of CAM, including certain vitamins, may interfere with standard treatment. Combining CAM with standard treatment may even be harmful. Before trying any type of CAM, you should discuss its possible benefits and harmful effects with your doctor.

Some types of CAM are expensive. Health insurance may not cover the cost.

The NCI offers a fact sheet called "Complementary and Alternative Medicine in Cancer Treatment: Questions and Answers." ¹³

It is important to eat well during cancer treatment. Eating well means getting enough calories to maintain a good weight and enough protein to keep up your strength. Good nutrition often helps people with cancer feel better and have more energy.

But eating well can be difficult. You may not feel like eating if you are uncomfortable or tired. Also, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth sores) can be a problem. Some people find that foods do not taste as good during cancer therapy.

The doctor, a dietitian, or another health care provider can suggest ways to maintain a healthy diet. The NCI booklet Eating Hints for Cancer Patients ¹² has many useful ideas and recipes.

Follow-up care after treatment for cervical cancer is important. Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment. Your doctor will monitor your recovery and check for recurrence of the cancer. Checkups help ensure that any changes in your health are noted and treated as needed. Checkups may include a physical exam as well as Pap tests and chest x-rays. Between scheduled visits, you should contact the doctor right away if you have any health problems.

To help answer questions about follow-up care and other concerns, NCI has a booklet for people who have completed their treatment. Facing Forward Series: Life After Cancer Treatment ¹⁴ provides tips for making the best use of medical visits. It describes how to talk with the doctor about creating a plan of action for your recovery and future health.

Living with a serious disease such as cervical cancer is not easy. You may worry about caring for your family, keeping your job, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy can be helpful if you want to talk about your feelings or concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, or emotional support.

Support groups also can help. In these groups, patients or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. You may want to talk with a member of your health care team about finding a support group.

Cancer Information Specialists at 1-800-4-CANCER and at LiveHelp ¹ (http://www.cancer.gov) can help you locate programs, services, and publications. Also, you may want to see the NCI fact sheets called "Cancer Support Groups: Questions and Answers" ¹⁵ and "National Organizations That Offer Services to People With Cancer and Their Families." ¹⁶

Doctors all over the country are conducting many types of clinical trials (research studies in which people volunteer to take part). They are studying new ways to treat cervical cancer. Some are also studying therapies that may improve the quality of life for women during or after cancer treatment.

Clinical trials are designed to answer important questions and to find out whether new approaches are safe and effective. Research already has led to many advances, and researchers continue to search for more effective methods for dealing with cancer.

Researchers are testing new approaches to treatment, including anticancer drugs and drug combinations. They also are studying different methods, doses, and schedules of radiation therapy. Some trials are combining chemotherapy, surgery, and radiation therapy. Other trials are researching biological therapy.

Researchers also are studying surgery to remove sentinel lymph nodes. A sentinel lymph node is the first lymph node to which the cancer is likely to spread. Today, surgeons often have to remove many lymph nodes and check each of them for cancer. But if the research shows that it is possible to identify the sentinel lymph node (the lymph node most likely to have cancer), doctors may be able to avoid more surgery to remove other lymph nodes.

People who join clinical trials may be among the first to benefit if a new approach is effective. And even if participants do not benefit directly, they still make an important contribution to medicine by helping doctors learn more about the disease and how to control it. Although clinical trials may pose some risks, researchers do all they can to protect their patients.

If you are interested in being part of a clinical trial, talk with your doctor. You may want to read the NCI booklet Taking Part in Cancer Treatment Research Studies ¹⁷. It explains how clinical trials are carried out and explains their possible benefits and risks.

NCI's Web site includes a section on clinical trials at http://www.cancer.gov/clinicaltrials. It has general information about clinical trials as well as detailed information about specific ongoing studies of cervical cancer. Information Specialists at 1-800-4-CANCER or at LiveHelp ¹ at http://www.cancer.gov can answer questions and provide information about clinical trials.

You may want more information for yourself, your family, and your doctor. The following National Cancer Institute (NCI) services are available to help you.

Telephone

Cancer Information Service (CIS)
The CIS provides accurate, up-to-date information on cancer to patients and their families, health professionals, and the general public. Information Specialists translate the latest scientific information into understandable language and respond in English, Spanish, or on TTY equipment. Calls to the CIS are free.

Telephone: 1-800-4-CANCER (1-800-422-6237)
TTY: 1-800-332-8615

Internet

National Cancer Institute (NCI) publications can be ordered by writing to the address below:

Publications Ordering Service
National Cancer Institute
Suite 3035
6116 Executive Boulevard, MSC 8322
Bethesda, MD 20892-8322

Many NCI publications can be viewed, downloaded, and ordered from http://www.cancer.gov/publications on the Internet. In addition, people in the United States and its territories may order these and other NCI publications by calling the Cancer Information Service at 1-800-4-CANCER.

Booklets and Fact Sheets About Cervical Changes, Their Causes, and Screening

• What You Need To Know About™ Cancer of the Cervix ¹⁸ (also available in Spanish: Lo que usted necesita saber sobre™ el cáncer de cervix ¹⁹)
• Understanding Cervical Changes ⁵
• Having a Pelvic Exam and Pap Test
• Pap Test for Older Women: A Healthy Habit for Life
• The Pap Test: It Can Save Your Life ... For You and Your Family (also available in Spanish: Hágase la prueba Pap: hágalo hoy...por su salud y su familia)
• "The Pap Test: Questions and Answers" ⁶ (also available in Spanish: "La prueba de Papanicolau: preguntas y respuestas" ²⁰)
• "Human Papillomaviruses and Cancer" ⁴ (also available in Spanish: "Los virus del papiloma humano y el cáncer" ²¹)
• "Oral Contraceptives and Cancer Risk" ²² (also available in Spanish: "Las píldoras anticonceptivas y el riesgo de cáncer" ²³)
• "DES: Questions and Answers" ²⁴

Booklets and Fact Sheets About Cancer Treatment

• Radiation Therapy and You: A Guide to Self-Help During Treatment ¹⁰ (also available in Spanish: La radioterapia y usted: una guía de autoayuda durante el tratamiento del cancer)
• Chemotherapy and You: A Guide to Self-Help During Treatment ¹¹ (also available in Spanish: La quimioterapia y usted: una guía de autoayuda durante el tratamiento del cancer)
• Helping Yourself During Chemotherapy: 4 Steps for Patients ²⁵
• Biological Therapy: Treatments That Use Your Immune System to Fight Cancer ²⁶
• Eating Hints for Cancer Patients: Before, During & After Treatment ¹² (also available in Spanish: Consejos de alimentación para pacientes con cáncer: antes, durante y después del tratamiento)
• Understanding Cancer Pain ²⁷ (also available in Spanish: El dolor relacionado con el cáncer)
• Pain Control: A Guide for People with Cancer and Their Families ²⁸ (also available in Spanish: Control del dolor: guía para las personas con cáncer y sus familias)
• Get Relief From Cancer Pain
• Taking Part in Cancer Treatment Research Studies ¹⁷
• "Cryosurgery in Cancer Treatment: Questions and Answers" ²⁹
• "Complementary and Alternative Medicine in Cancer Treatment: Questions and Answers" ¹³ (also available in Spanish: "La medicina complementaria y alternativa en el tratamiento del cáncer: preguntas y respuestas" ³⁰)
• "Biological Therapies for Cancer: Questions and Answers" ³¹ (also available in Spanish: "Terapias biológicas: preguntas y respuestas" ³²)

Booklets and Fact Sheets About Living With Cancer

• Advanced Cancer: Living Each Day ³³
• Facing Forward Series: Life After Cancer Treatment ¹⁴ (also available in Spanish: Siga adelante: la vida después del tratamiento del cancer ³⁴)
• Facing Forward Series: Ways You Can Make a Difference in Cancer ³⁵
• Taking Time: Support for People With Cancer and the People Who Care About Them ³⁶
• When Cancer Recurs: Meeting the Challenge ³⁷
• "How To Find a Doctor or Treatment Facility If You Have Cancer" ⁸ (also available in Spanish: "Cómo encontrar a un doctor o un establecimiento de tratamiento si usted tiene cáncer" ³⁸)
• "Followup Care: Questions and Answers"
• "Understanding Prognosis and Cancer Statistics" ³⁹ (also available in Spanish: "La interpretación de los pronósticos y las estadísticas del cáncer" ⁴⁰)
• "Cancer Support Groups: Questions and Answers" ¹⁵
• "National Organizations That Offer Services to People With Cancer and Their Families" ¹⁶ (also available in Spanish: "Organizaciones nacionales que brindan servicios a las personas con cáncer y sus familias" ⁴¹)
• "How To Find Resources in Your Own Community If You Have Cancer" ⁴² (also available in Spanish: "Cómo encontrar recursos en su comunidad si usted tiene cáncer" ⁴³)

Glossary Terms

The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

Acquired immunodeficiency syndrome. A disease caused by the human immunodeficiency virus (HIV). People with AIDS are at an increased risk for developing certain cancers and for infections that usually occur only in individuals with a weak immune system. Also called acquired immunodeficiency syndrome.

Not cancerous. Benign tumors may grow larger but do not spread to other parts of the body.

Treatment to boost or restore the ability of the immune system to fight cancer, infections, and other diseases. Also used to lessen certain side effects that may be caused by some cancer treatments. Agents used in biological therapy include monoclonal antibodies, growth factors, and vaccines. These agents may also have a direct antitumor effect. Also called immunotherapy, biotherapy, biological response modifier therapy, and BRM therapy.

The organ that stores urine.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

A group of abnormal cells that remain in the tissue in which they first formed. These abnormal cells may become cancer and spread into nearby normal tissue.

Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck. Cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the “neck”) of the uterus.

The lower, narrow end of the uterus that forms a canal between the uterus and vagina.

Treatment with drugs that kill cancer cells.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called a clinical study.

A lighted magnifying instrument used to examine the vagina and cervix.

CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices generally are not considered standard medical approaches. Standard treatments go through a long and careful research process to prove they are safe and effective, but less is known about most types of CAM. CAM may include dietary supplements, megadose vitamins, herbal preparations, special teas, acupuncture, massage therapy, magnet therapy, spiritual healing, and meditation. Also called CAM.

Surgery to remove a cone-shaped piece of tissue from the cervix and cervical canal. Conization may be used to diagnose or treat a cervical condition. Also called cone biopsy.

A dye or other substance that helps show abnormal areas inside the body. It is given by injection into a vein, by enema, or by mouth. Contrast material may be used with x-rays, CT scans, MRI, or other imaging tests.

A procedure in which tissue is frozen to destroy abnormal cells. This is usually done with a special instrument that contains liquid nitrogen or liquid carbon dioxide. Also called cryoablation.

Computed tomography scan. A series of detailed pictures of areas inside the body taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computed tomography scan, computerized tomography, computerized axial tomography scan, and CAT scan.

A spoon-shaped instrument with a sharp edge.

A sac or capsule in the body. It may be filled with fluid or other material.

A health professional with special training in nutrition who can help with dietary choices. Also called a nutritionist.

The organs through which food and liquids pass when they are swallowed, digested, and eliminated. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum and anus.

A procedure in which water or a medicated solution is used to clean the vagina and cervix.

The injection of a liquid through the anus into the large bowel.

A slender tube through which eggs pass from an ovary to the uterus. In the female reproductive tract, there is one ovary and one fallopian tube on each side of the uterus.

Drugs that cause loss of feeling or awareness and put the person to sleep.

A raised growth on the surface of the genitals caused by human papillomavirus (HPV) infection. The HPV in genital warts is very contagious and can be spread by skin-to-skin contact, usually during oral, anal, or genital sex with an infected partner. Also called condyloma.

A doctor who specializes in treating cancers of the female reproductive organs.

Human immunodeficiency virus. The cause of acquired immunodeficiency syndrome (AIDS). Also called human immunodeficiency virus.

High-grade squamous intraepithelial lesion. A precancerous condition in which the cells of the uterine cervix are moderately or severely abnormal. Also called high-grade squamous intraepithelial lesion.

Surgery to remove the uterus and, sometimes, the cervix. When the uterus and the cervix are removed, it is called a total hysterectomy. When only the uterus is removed, it is called a partial hysterectomy.

The complex group of organs and cells that defends the body against infections and other diseases.

Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.

Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."

A surgical procedure that uses the cutting power of a laser beam to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.

Loop electrosurgical excision procedure. A technique that uses electric current passed through a thin wire loop to remove abnormal tissue. Also called loop excision and loop electrosurgical excision procedure.

A type of Pap test. A Pap test is a procedure in which cells are scraped from the cervix for examination under a microscope. It is used to detect cancer or changes that may lead to cancer. A Pap test can also show noncancerous conditions, such as infection or inflammation. In a liquid-based Pap test, the cells are rinsed into a small container of liquid. The cells are then placed onto slides by a special machine and examined under a microscope to see if the cells are abnormal.

Drugs that cause a temporary loss of feeling in one part of the body. The patient remains awake but has no feeling in the part of the body treated with the anesthetic.

A condition in which the cells of the uterine cervix are slightly abnormal. LSIL is not cancer. Also called low-grade squamous intraepithelial lesion.

A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.

The tissues and organs that produce, store, and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes, and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body.

Cancerous. Malignant tumors can invade and destroy nearby tissue and spread to other parts of the body.

A doctor who specializes in diagnosing and treating cancer using chemotherapy, hormonal therapy, and biological therapy. A medical oncologist often is the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists.

The time of life when a woman's menstrual periods stop. A woman is in menopause when she hasn't had a period for 12 months in a row. Also called change of life.

The periodic discharge of blood and tissue from the uterus. From puberty until menopause, menstruation occurs about every 28 days, but does not occur during pregnancy.

The spread of cancer from one part of the body to another. A tumor formed by cells that have spread is called a “metastatic tumor” or a “metastasis.” The metastatic tumor contains cells that are like those in the original (primary) tumor. The plural form of metastasis is metastases (meh-TAS-tuh-SEEZ).

To spread from one part of the body to another. When cancer cells metastasize and form secondary tumors, the cells in the metastatic tumor are like those in the original (primary) tumor.

A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or x-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones. Also called magnetic resonance imaging, nuclear magnetic resonance imaging, and NMRI.

A thick, slippery fluid made by the membranes that line certain organs of the body, including the nose, mouth, throat, and vagina.

A part of the body that performs a specific function. For example, the heart is an organ.

One of a pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus.

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of palliative care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called comfort care, supportive care, and symptom management.

A procedure in which cells are scraped from the cervix for examination under a microscope. It is used to detect cancer and changes that may lead to cancer. A Pap test can also show noncancerous conditions, such as infection or inflammation. Also called a Pap smear.

A doctor who identifies diseases by studying cells and tissues under a microscope.

The muscles and ligaments that line the part of the body between the hips.

A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant.

The original tumor.

The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.

A doctor who specializes in using radiation to treat cancer.

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called radiotherapy and irradiation.

Surgery to remove the uterus, cervix, and part of the vagina. The ovaries, fallopian tubes, and nearby lymph nodes may also be removed.

Giving off radiation.

The last several inches of the large intestine closest to the anus.

Cancer that has recurred (come back), usually after a period of time during which the cancer could not be detected. The cancer may come back to the same place as the original (primary) tumor or to another place in the body. Also called recurrent cancer.

Something that may increase the chance of developing a disease. Some examples of risk factors for cancer include age, a family history of certain cancers, use of tobacco products, certain eating habits, obesity, lack of exercise, exposure to radiation or other cancer-causing agents, and certain genetic changes.

Surgical removal of the fallopian tubes and ovaries.

Checking for disease when there are no symptoms. Since screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (breast), colonoscopy (colon), Pap smear (cervix), and PSA blood level and digital rectal exam (prostate). Screening can also include checking for a person’s risk of developing an inherited disease by doing a genetic test.

The first lymph node to which cancer is likely to spread from the primary tumor. When cancer spreads, the cancer cells may appear first in the sentinel node before spreading to other lymph nodes.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

The male reproductive cell, formed in the testicle. A sperm unites with an egg to form an embryo.

SIL. A general term for the abnormal growth of squamous cells on the surface of the cervix. The changes in the cells are described as low grade or high grade, depending on how much of the cervix is affected and how abnormal the cells appear. Also called SIL.

The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of supportive care is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called palliative care, comfort care, and symptom management.

A doctor who removes or repairs a part of the body by operating on the patient.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Care given to improve the quality of life of patients who have a serious or life-threatening disease. The goal of symptom management is to prevent or treat as early as possible the symptoms of a disease, side effects caused by treatment of a disease, and psychological, social, and spiritual problems related to a disease or its treatment. Also called palliative care, supportive care, and comfort care.

Treatment using substances that travel through the bloodstream, reaching and affecting cells all over the body.

Surgery to remove the entire uterus, including the cervix. Also called complete hysterectomy.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancerous), or malignant (cancerous). Also called neoplasm.

The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a baby grows. Also called the womb.

The muscular canal extending from the uterus to the exterior of the body. Also called birth canal.

In medicine, a very simple microorganism that infects cells and may cause disease. Because viruses can multiply only inside infected cells, they are not considered to be alive.

A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.