Cervical Cancer Services at UPMC in Central Pa.

The physicians and staff at the Women's Cancer Center in Central Pa. are committed to the prevention, early detection and treatment of cervical cancer. Our experts have vast experience treating this disease.

What is Cervical Cancer?

The cervix is the lower, narrow part of the uterus (womb) located between the bladder and the rectum. It forms a canal that opens into the vagina, which leads to the outside of the body.

Precancerous conditions of the cervix are identified as cells that look abnormal, but are not cancerous at the present time. However, the appearance of these abnormal cells may be the first evidence of cancer that develops years later. If abnormal cells on the surface of the cervix spread deeper into the cervix, or to other tissues or organs, the disease is then called cervical cancer, or invasive cervical cancer.

Cervical cancer occurs most often in women younger than the age of 50. It is different from cancer that begins in other parts of the uterus and requires different treatment. Most cervical cancers are squamous cell carcinomas and adenocarcinomas.

The mortality rates for cervical cancer have declined sharply as Pap screenings have become more prevalent. According to the American Cancer Society about 12,340 cases of invasive cervical cancer will be diagnosed in the U.S. during 2013.

Risk Factors for Cervical Cancer

Infection with the human papillomavirus (HPV). HPV is the cause of nearly all cervical cancers. Infection with HPV is most often the result of unprotected sex. Risk factors include:

• Not getting regular Pap tests. Cervical cancer is more common in women who don't have regular Pap tests. Pap tests help doctors find abnormal cells. These cells can then be removed, which usually prevents cervical cancer.
• Infection with HIV or other conditions that weaken the immune system. HIV is the precursor to AIDS and can increase your risk of cervical cancer. Taking certain medications that suppress the immune system also increases the risk of cervical cancer.
• Smoking. Women who smoke are nearly twice as likely as nonsmokers to have cervical cancer.
• Diet. Women with diets low in fruits and vegetables and those who are overweight are at increased risk for cervical cancer.
• Chlamydia infection. Some studies have seen a higher risk of cervical cancer in women whose blood test results show evidence of past or current chlamydia infection when compared with women who have normal test results. Chlamydia is spread by sexual contact.
• Using birth control pills for a long time. Using birth control pills for 5 or more years may slightly increase the risk of cervical cancer, but the risk decreases when women stop using birth control pills.
• Having many children. Studies suggest that giving birth to 3 or more children may slightly increase the risk of cervical cancer in women with HPV infections.
• Having sexual intercourse before the age of 18.
• Having many sexual partners, and having partners who have had many partners themselves.
• First full-term pregnancy at a young age. Women who were younger than 17 years when they had their first full-term pregnancy are almost 2 times more likely to get cervical cancer later in life than women who waited until they were 25 years or older to get pregnant.
• Poverty. Many low income women do not have access to adequate health care services, including Pap tests, so they are not screened or treated for precancerous cervical lesions.
• Family history of cervical cancer. This cancer may run in some families. A woman's chance of developing it are 2 to 3 times higher if her mother or sister had cervical cancer than if no one in her family had it.
• Diethylstilbestrol (DES). DES is a drug that was used to prevent miscarriage between 1940 and 1971. Women whose mothers took DES while pregnant with them develop this cancer more than would normally be expected. The risk seems to be highest in women whose mothers took the drug during their first 16 weeks of pregnancy. (The FDA stopped the use of DES during pregnancy in 1971.)

Prevention Of Cervical Cancer

Early detection of cervical problems is the best way to prevent cervical cancer. Routine, annual pelvic exams and Pap tests can detect precancerous conditions that often can be treated before cancer develops. Invasive cancer that does occur would likely be found at an earlier stage. Pelvic exams and Pap tests are used to determine if there are cervical problems. Women who are age 21 or older should have regular checkups, including a pelvic exam and Pap test.

HPV Vaccine

Because certain strains of HPV have been found to cause most cases of cervical cancer, two HPV vaccines have been approved:

• Gardasil protects against 4 types of the HPV virus the 2 types of viruses that cause most cervical cancers, and the 2 that cause 90% of genital warts. It protects against other cancers caused by HPV, too, such as cancers and precancers of the vagina, vulva and anus.
• Cervarix protects against the 2 types of the HPV virus that cause most cervical cancers. It protects against anal cancers, too.

These vaccines can only be used to prevent certain types of HPV infection before a person is infected. They cannot be used to treat an existing HPV infection.

Both vaccines are administered as a series of 3 injections over a 6-month period. To be most effective, one of the vaccines should be given before a person becomes sexually active.

Cervical Cancer Symptoms

Symptoms of cervical cancer usually do not appear until abnormal cervical cells become cancerous and invade nearby tissue:

The most common symptom is abnormal bleeding, which may:

• Start and stop between regular menstrual periods.
• Occur after sexual intercourse, douching, or a pelvic exam.

Other symptoms may include:

• Heavier menstrual bleeding, which may last longer than usual
• Bleeding after menopause
• Increased vaginal discharge
• Pain during intercourse

The symptoms of cervical cancer may resemble other conditions or medical problems. If you have symptoms such as these that won't go away, and cannot be explained by other reasons, report them to your doctor.

Cervical Cancer Diagnosis

When cervical problems are found during a pelvic examination, or abnormal cells are found through a Pap test, a cervical biopsy may be performed.

There are several types of cervical biopsies that may be used to diagnose cervical cancer, and some of these procedures that can completely remove areas of abnormal tissue may also be used for treatment of precancerous lesions. Some biopsy procedures only require local anesthesia, while others require a general anesthesia. Several types of cervical biopsies include:

• Loop electrosurgical excision procedure (LEEP). A procedure that uses an electric wire loop to obtain a piece of tissue so it can be examined under a microscope.
• Colposcopy. A procedure that uses an instrument with magnifying lenses called a colposcope, to examine the cervix for abnormalities. If abnormal tissue is found, a biopsy is usually performed (colposcopic biopsy).
• Endocervical curettage (ECC). A procedure that uses a narrow instrument called a curette to scrape the lining of the endocervical canal. This type of biopsy is usually completed along with the colposcopic biopsy.
• Cone biopsy (also called conization). A biopsy in which a larger cone-shaped piece of tissue is removed from the cervix by using the loop electrosurgical excision procedure or the cold knife cone biopsy procedure. The cone biopsy procedure may be used as a treatment for precancerous lesions and early cancers.
• HPV DNA test. A test that detects the presence of cervical HPV infection. The cells are collected as they are for a regular Pap test, but it is not a replacement for a Pap test. The HPV DNA test may be used as a screening test for women over 30 or for women with slightly abnormal Pap test results to determine if further testing or treatment is required.
• Cold knife cone biopsy. A procedure in which a laser or a surgical scalpel is used to remove a piece of cervical tissue for further examination. This procedure requires the use of general anesthesia.

Treatment for Cervical Cancer

Gynecologist Oncologist are sub-specialty trained experts at the surgical management of cervical cancer. Our surgeons are experts at traditional and minimally invasive/robotic radical surgery. Treatment may include:

• LEEP or conization may also be used to remove abnormal tissue.
• Hysterectomy. Surgery to remove the uterus, including the cervix. In some cases, a hysterectomy may be required, particularly if abnormal cells are found inside the opening of the cervix.
• Radical hysterectomy. Removal of the uterus, cervix, upper vagina, and parametria.
• Chemotherapy.
• Laser surgery. Use of a powerful beam of light, which can be directed to specific parts of the body without making a large incision, to destroy abnormal cells (only used for pre-invasive cancer).
• Radical trachelectomy. Removal of cervix, upper vagina, parametria, lymph nodes. Sometimes to preserve surgery.
• Radiation therapy.

Contact Us

Need more information? Our friendly staff can assist you. To get in touch, request information or call our West Shore Office at 717-221-5940 or East Shore Office at 717-230-3026 for more information or to make an appointment.