Cervical Cancer – Gynecologic Malignancies

About Gynecologic Cancers

In this section, we provide an overview of the signs and symptoms of some of the most common types of gynecologic and urogenital tract cancers that affect women, including:

Breast Cancer Cervical Cancer Colon Cancer Endometrial Cancer (also Uterine Cancer) Endometriosis and Risk of Certain Cancers Fibroids and Risk of Certain Cancer Ovarian Cancer Uterine Carcinomas Uterine Leiomyosarcomas Uterine Sarcomas

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About Cervical Cancer

The cervix is the opening to the uterus. It is the interface between the uterus and vagina. The cells of the cervix are susceptible to many sexual transmitted infections. One type of sexual transmitted infection called Human Papilloma Virus (HPV) can lead to cervical cancer. HPV is the most common sexual transmitted infection. There are many strains of the virus. There are some strains that cause genital warts, which have not been linked to cervical cancer and there are other strains, called high risk strains that cause cervical cancer.

Signs and Symptoms of cervical cancer may include:

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Earlier stages of cervical cancer are usually without symptoms, which is why routine screening is very important. Later stages usually present with:

• abnormal vaginal bleeding
• note: any vaginal bleeding after menopause is not normal
• change in your menstrual cycle that you can’t explain
• pelvic pain or feeling of pressure
• foul smelling discharge
• vaginal discharge that is tinged with blood
• painful intercourse
• bleeding when something comes in contact with your cervix, such as during sex or when you put in a diaphragm
• weakness and/or unexplained onset of fatigue
• persistent fever
• bloating
• unusual changes in fingernails, hair, and/or skin
• Unexplained and sudden weight loss
• lump or swelling of lymph nodes (either in armpit and/or neck)
• night sweats
• loss of appetite, difficulty eating or feeling of fullness
• Urinary frequency
• Ascites – Collection of fluid in the abdomen, contributing to abdominal distension and shortness of breath
• Nausea and vomiting

Risk Factors

• early onset of sexual activity compared with age at first intercourse of 21 years or older, the risk is approximately 1.5-fold for 18 to 20 years and two-fold for younger than 18 years
• multiple sexual partners compared to one sexual partner, women who have more than 2 sexual partners have a two-fold increased risk and women who have had more than six sexual partners have a three-fold increased risk
• having intercourse with a male who has had multiple sexual partners
• having a lowered immune system
• having previous sexual transmitted infections such as gonorrhea, chlamydia, or herpes
• cigarette smoking

Cervical Cancer Screening and Diagnosis

The Pap smear is the best screening test for HPV and cervical cancer. This test is performed by your gynecologist or primary care physician by placing a speculum in the vagina and taking a sample of the cervical cells with a brush. The test is not painful. The cells are then sent to the pathologist where testing for the presence of all strains of HPV and abnormal cells are performed. If high risk HPV or any abnormal cells are detected, a colposcopy will be performed. A colposcopy is performed by a gynecologist. The cervix is visualized through a special microscope where directed biopsies can be made of any unusual looking areas. If the biopsy comes back as precancerous, then this area can be excised. Excisional procedures and your own immune system can be enough to clear HPV infections and prevent abnormal cells from developing into cervical cancer.

Prevention: Protective factors for cervical cancer include:

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There is a vaccine against high risk HPV that is protective against most forms of cervical cancer. This is given in three separate shots to women ages 13 to 26. Even after getting vaccinated, it is still recommended to get routine pap smears starting at age 21.

Treatment for Cervical cancer

Cervical cancer is treated in a variety of ways depending on the stage. Earlier stages of cervical cancer are treated by a simple hysterectomy (uterus, tubes, cervix removed) or radical hysterectomy (uterus, tubes, cervix and tissue surrounding them removed). Both of these procedures can be performed by minimally invasive surgery. Dr. Farr Nezhat, who specializes in gynecologic cancers, was the first to perform radical hysterectomies by laparoscopy. He pioneered the techniques that make this very difficult surgery safer and more successful in tumor removal than the traditional open approach. Over the past years of treating early stage cervical cancer by laparoscopic or robotic radical hysterectomy, he has proven that these methods are superior to open abdominal surgery in the hands of a surgeon experienced in minimally invasive surgery. His patients experience less postoperative complications, fewer days recovering in the hospital, and decreased pain compared to those patients who have had open abdominal radical hysterectomies.

Contrary to popular beliefs, gynecological cancers can be treated minimally invasively

The removal of gynecological cancers previously required a large incision along the entire length of the abdomen (laparotomy), often hip bone to hip bone. These painful surgical methods of yesteryear often led to serious, life-threatening complications that often caused more injury (and mortality) than the cancer itself. However, Drs. Camran and Farr Nezhat proved that such debilitating large incisions were no longer necessary when they became the first to completely remove even the largest gynecological tumors (including para aortic lymph node dissection) laparoscopically and robotically. And, because laparoscopy provides better visualization of the abdominal cavity, it actually allows surgeons to remove even more cancerous growths and perform even more complete lymph node dissections than was possible using the traditional surgical technique of laparotomy.

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