Atualizado: 26 de Dez de 2020
What is Cervical Cancer?
Cervical cancer is a type of cancer that occurs in the cells of the cervix. The cervix is the lower part of the uterus that connects to the vagina and invade other tissues and organs of the body. When cervical cancer is invasive, it affects the deeper tissues of the cervix and to other parts of the body, most notably:
- the lungs
- the liver
- the bladder
- the vagina
- the rectum
What Causes Cervical Cancer?
Various strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cervical cancer. When exposed to HPV, a woman's immune system typically prevents the virus from doing harm. In a small group of women, however, the virus survives for years, contributing to the process that causes some cells on the surface of the cervix to become cancer cells. You can reduce your risk of developing cervical cancer by having screening tests and receiving a vaccine that protects against HPV infection.
Cervical Cancer Exams and Tests
As with all cancers, an early diagnosis of cervical cancer is key to successful treatment and cure. Treating precancerous changes that affect only the surface of a small part of the cervix is much more likely to be successful than treating invasive cancer that affects a large portion of the cervix and has spread to other tissues. The most important progress that has been made in early detection of cervical cancer is widespread use of the Papanicolaou test (Pap smear) and high-risk HPV testing.
A Pap smear is done as part of a regular exam. During the procedure, cells from the surface of the cervix are collected and examined for abnormalities. Diagnosis of cervical cancer requires that a sample of cervical tissue (called a biopsy) be taken and analyzed under a microscope. This would be done if the Pap smear is abnormal.
Colposcopy is a procedure similar to a pelvic exam. It is usually used for a patient who had an abnormal Pap smear result but a normal physical exam. The examination uses a type of microscope called a colposcope to inspect the cervix. The entire area of the cervix is stained with a harmless dye or acetic acid to make abnormal cells easier to see. These areas are then biopsied. The colposcope magnifies the cervix by eight to 15 (depends on the colposcope) times, allowing easier identification of any abnormal-appearing tissue that may need biopsy. This procedure can usually be done in your gynecologist's office. If a biopsy under colposcopy suggests an invasive cancer, a larger biopsy is needed to fully evaluate your condition. Treatment will depend on stage of the cancer.
Internal or implant radiation:Internal or implant radiation comes from a capsule containing radioactive material which is placed directly in the cervix. The implant puts cancer-killing rays close to the tumor while sparing most of the healthy tissue around it.
Radiation therapy:Radiation Therapy (or radiotherapy) is also used to treat cervical cancer at some stages. Radiation therapy uses high-energy rays to damage cancer cells and stop their growth. Like surgery, radiation therapy is local therapy; the radiation affects cancer cells only in the treated area. Radiation may be applied externally or internally. Some women receive both kinds. External radiation comes from a large machine, which aims a beam of radiation at your pelvis. Treatments, which take only a few minutes, usually are given five days a week for five to six weeks. At the end of that time, an extra dose of radiation called a "boost" may be applied to the tumor site. Because of safety concerns and expense of equipment, radiation therapy generally is offered only at certain large medical centers or hospitals.
Chemotherapy: Chemotherapy is the use of powerful drugs to kill cancer cells. In cervical cancer, it is used most often when the cancer is locally advanced or has spread to other parts of the body. Just one drug or a combination of drugs may be given. Anticancer drugs used to treat cervical cancer may be given via an IV line or by mouth. Either way, chemotherapy is systemic treatment, meaning that the drugs flow through the body in the bloodstream. They can kill cancer cells anywhere in the body. Chemotherapy is given in cycles: each cycle comprises a period of intensive treatment followed by a recovery period. Treatment usually consists of several cycles. Most patients have chemotherapy as an outpatient (in an outpatient clinic at the hospital, at the doctor's office, or at home). Depending on which drugs are given and your general health, however, you may need to stay in the hospital during treatment.
Cryocautery:Cryocautery may be used in some cases. In this procedure, a steel instrument is cooled to subzero temperatures by immersion in liquid nitrogen or a similar liquid. This ultracooled instrument is then applied to the surface of the cervix, freezing cells. They eventually die and are sloughed off, to be replaced by new cervical cells. Tissue may also be removed by laser ablation. In this procedure, a laser beam is applied to either specific areas of cervical tissue or a whole layer of tissue at the surface of the cervix. The laser destroys these cells, leaving healthy cells in their place.
How Fast Can Cervical Cancer Spread?
Cervical cancer is slow-growing, which provides opportunities for prevention, early detection, and treatment. Most women diagnosed with precancerous changes in the cervix are in their 20s and 30s, but the average age of women, when they are diagnosedwith cervical cancer, are in their mid 50s.
Cervical cancer begins when healthy cells acquire a genetic change (mutation) that causes them to turn into abnormal cells.
Healthy cells grow and multiply at a set rate, eventually dying at a set time. Cancer cells grow and multiply out of control, and they don't die. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can break off from a tumor to spread (metastasize) elsewhere in the body.
It isn't clear what causes cervical cancer, but it's certain that HPV plays a role. HPV is very common, and most women with the virus never develop cervical cancer. This means other factors — such as your environment or your lifestyle choices — also determine whether you'll develop cervical cancer.
Symptoms - Early-stage cervical cancer generally produces no signs or symptoms.Signs and symptoms of more-advanced cervical cancer include:
Vaginal bleeding after intercourse, between periods or after menopause. Abnormal vaginal bleeding (other than during menstruation)
Watery, bloody vaginal discharge that may be heavy and have a foul odor
Pelvic pain or pain during intercourse
Kidney failure due to a urinary tract or bowel obstruction, when the cancer is advanced
When to Seek Medical Care - The range of conditions that can cause vaginal bleeding are diverse and may not be related to cancer of the cervix. They vary based on your age, fertility, and medical history.
Vaginal bleeding after menopause is never normal. If you have gone through menopause and have vaginal bleeding, see your health care provider as soon as possible.
Very heavy bleeding during your period or frequent bleeding between periods warrants evaluation by your health care provider.
Bleeding after intercourse, especially after vigorous sex, does occur in some women. If this occurs only occasionally, it is probably nothing to worry about. Evaluation by your health care provider is advisable, especially if the bleeding happens repeatedly.
If you have vaginal bleeding that is associated with weakness, feeling faint or light-headed, or actual fainting, go to a hospital emergency department for care.
Types of cervical cancer - The type of cervical cancer that you have helps determine your prognosis and treatment. The main types of cervical cancer are:
Squamous cell carcinoma. This type of cervical cancer begins in the thin, flat cells (squamous cells) lining the outer part of the cervix, which projects into the vagina. Most cervical cancers are squamous cell carcinomas.
Adenocarcinoma. This type of cervical cancer begins in the column-shaped glandular cells that line the cervical canal.Sometimes, both types of cells are involved in cervical cancer. Very rarely, cancer occurs in other cells in the cervix.
Risk factors for cervical cancer include:
Many sexual partners. The greater your number of sexual partners — and the greater your partner's number of sexual partners — the greater your chance of acquiring HPV.
Early sexual activity. Having sex at an early age increases your risk of HPV.
Other sexually transmitted infections (STIs). Having other STIs — such as chlamydia, gonorrhea, syphilis and HIV/AIDS — increases your risk of HPV.
A weak immune system. You may be more likely to develop cervical cancer if your immune system is weakened by another health condition and you have HPV.
Smoking. Smoking is associated with squamous cell cervical cancer.
Support Groups and Counseling for Cervical Cancer - Living with cervical cancer presents many new challenges for you and for your family and friends.
You will probably have many worries about how the cancer will affect you and your ability to "live a normal life," that is, to care for your family and home, to hold your job, and to continuing the friendships and activities you enjoy.
Many people feel anxious and depressed. Some people feel angry and resentful; others feel helpless and defeated.
For most people with cancer, talking about their feelings and concerns can help.
Your friends and family members can be very supportive. They may be hesitant to offer support until they see how you are coping. Don't wait for them to bring it up. If you want to talk about your concerns, let them know.
Some people don't want to "burden" their loved ones, or they prefer talking about their concerns with a more neutral professional. A social worker, counselor, or member of the clergy can be helpful if you want to discuss your feelings and concerns about having cancer. Your gynecologist or oncologist should be able to recommend someone.
Many people with cancer are helped profoundly by talking to other people who have cancer. Sharing your concerns with others who have been through the same thing can be remarkably reassuring. Support groups of people with cancer may be available through the medical center where you are receiving your treatment. The American Cancer Society also has information about support groups all over the U.S.
Outlook for Cervical Cancer:
Regular pelvic exams and Pap smears are important for every woman. These tests are no less important for a woman who has been treated for precancerous changes or for cancer of the cervix.
Follow-up care should include a full pelvic exam, Pap smear, and other tests as indicated on a regular schedule recommended by your gynecologist. These precautions are necessary to allow early detection should the cancer return.
Cervical cancer treatment may cause side effects many years later. For this reason, you should continue to have regular checkups and should report any health problems that appear.
Maintaining good nutrition is one of the best things you can do. You may lose your appetite during treatment for cervical cancer. Common side effects of chemotherapy include nausea, vomiting, and sores inside the mouth.
However, if you take in enough calories and protein, you will maintain your strength and energy and better tolerate the side effects of treatment. Your cancer specialist (oncologist) or gynecologist may be able to recommend a nutritionist who can provide suggestions for keeping up your calorie and protein intake.
The following lifestyle changes may help keep you stronger and more comfortable during treatment:
Engage in mild physical activity to keep up your energy level. Make sure it doesn't wear you out.
Get enough rest at night, and take naps if needed.
Avoid alcohol. You may not be able to drink alcohol with some of the medications you are taking. Be sure to ask your health care provider.
For cervical cancer, the survival rate is close to 100% when precancerous or early cancerous changes are found and treated. The prognosis for invasive cervical cancer depends on the stage of the cancer when it is found.
the stage of a cancer is a measure of how far it has progressed, namely, what other organs or tissues have been invaded.
For the earliest stage of cervical cancer—stage 0 – more than 90% of women survive at least five years after diagnosis
Stage I cervical cancer patients have a five-year survival rate of 80 – 93%.
Women with stage II cervical cancer have a five-year survival rate of 58 – 63%.
The survival rate for women with stage III cervical cancer is anywhere from 32 – 35%
Sixteen percent or fewer women with stage IV cervical cancer survive five years.
Health care providers who treat cancer often use the term "remission" rather than "cure." Although many women with cervical cancer recover completely, medical professionals sometimes avoid the word "cure," because the disease can recur.
Cervical Cancer Prevention - To reduce your risk of cervical cancer:
Get vaccinated against HPV. Vaccination is available for girls and women ages 9 to 26. The vaccine is most effective if given to girls before they become sexually active.
Have routine Pap tests. Pap tests can detect precancerous conditions of the cervix, so they can be monitored or treated in order to prevent cervical cancer. Most medical organizations suggest women begin routine Pap tests at age 21 and repeat them every few years.
Practice safe sex. Using a condom, having fewer sexual partners and delaying intercourse may reduce your risk of cervical cancer.
The key to preventing invasive cervical cancer is to detect any cell changes early, before they become cancerous. Regular pelvic exams and Pap tests are the best way to do this. How often you should have a pelvic exam and Pap test depends on your individual situation, but here are guidelines:
Make sure you get a Pap test to check for cervical cancer every 3 years if you are 21 or older.
If you are 30-65, you can get both a Pap test and human papillomavirus ( HPV ) test every 5 years. Older than that, you may be able to stop testing if your doctor says you are low risk.
Women of any age who’ve had a hysterectomywith removal of the cervix and no history of cervical cancer or precancers do not need to be screened, according to the guidelines.
If you are sexually active and have a higher risk for STDs, get tests for chlamydia, gonorrhea, and syphilis yearly. Take an HIV test at least once, more frequently if you’re at risk.