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Uterine Disorders

Menopausal women will have questions regarding problems that can arise with their uterus. Some of these are benign (polyps and fibroids) and some are malignant (endometrial or cervical cancer).

The following questions are addressed in this section:

I have a fibroid(s). Is this going to be a problem in menopause?

Where do polyps come from?

Can polyps turn into cancer?

How are polyps removed?

I am postmenopausal, and now I'm bleeding. Does that mean I have cancer?

What is endometrial cancer?

How did I get endometrial cancer?

How do you diagnose endometrial cancer?

Why didn't this show up on my Pap smear?

Do I need a hysterectomy to treat endometrial cancer?

I'm really scared. What will happen if I don't do anything?

I had a hysterectomy for endometrial cancer, and now my doctor says I need radiation. Is that really necessary?

Can I take hormone replacement after treatment for endometrial cancer?

How will I be followed after my treatment for endometrial cancer?

My Pap smear is abnormal. Does that mean I have cancer?

If my Pap smear is abnormal, why did the Dr. tell me to come back in three months?

How can I tell if my abnormal Pap smear is serious?

What caused my abnormal Pap smear?

How do you diagnose LGSIL and HGSIL?

How do you treat LGSIL and HGSIL?

Why is my doctor treating my SIL differently than someone I know who has the same thing?

Will SIL come back again after treatment?

If the SIL can recur, why don't you just do a hysterectomy?

What's the difference between cervical SIL and cervical cancer?

How will I know if I have cervical cancer?

How do you treat cervical cancer?

What are my chances of surviving cervical cancer?

I have a fibroid(s). Is this going to be a problem in menopause?

A fibroid is a benign (non-cancerous) smooth muscle tumor (growth) arising from the wall of your uterus. Fibroids are very common, occurring in approximately 20% of white women and 40% of African-American women. Just because you have a fibroid, doesn't mean that you need to have it removed. Occasionally fibroids will grow excessively large, or cause pain or other problems from pressing on other structures, or occasionally cause abnormal bleeding issues. These are the most common situations in which your doctor will recommend intervention, which can include any of the following:

Hysteroscopic resection: removing your fibroid through a telescope placed into the inside cavity of your uterus through the vagina and cervix (i.e. no incisions).

Laparoscopic resection: removing your fibroid under telescopic guidance (with or without a robot) through small incisions made in your abdomen.

Hysterectomy: removal of your uterus, either through an open incision in your abdomen, vaginally, or employing laparoscopic techniques.

Uterine artery embolization: threading a catheter into your uterine arteries and embolizing the vasculature of the fibroid to cut off its blood supply.

MRI guided focused ultrasound ablation of the fibroids (not readily available).

The good news is that fibroids generally regress, often shrinking somewhat after menopause. Fibroids that were previously causing pressure symptoms or bleeding issues usually become asymptomatic. If you did not have symptoms from your fibroids prior to menopause, then it is unlikely that you will have any future concerns.

 Where do polyps come from?

Uterine polyps come in two varieties, cervical and endometrial. They originate from the surface lining of the uterine cavity and cervical canal. Cervical polyps can often be detected on routine examination. They tend to be small and can usually be removed in the office. Endometrial polyps are usually hidden from view inside the uterus. Often they will cause abnormal bleeding that leads to their detection.

Can polyps turn into cancer?

The vast majority of endometrial and cervical polyps are benign (noncancerous). However, cancer can develop within polyps. All polyps that are removed should be sent to a pathologist who will examine it microscopically to rule out cancer.


How are polyps removed?

Small cervical polyps are generally removed in the office. Your doctor may administer a local anesthetic to the cervix, although most of the time this is not necessary. The polyp is attached to the cervix by a stalk. Your doctor snips the stalk with a biopsy instrument or scissors thereby removing the polyp. You may feel a pinch when this is done, but significant pain from the procedure is uncommon. Sometimes he will use a scraping instrument, called a curette in the cervical canal, where the polyp was attached. Some physicians also use chemical or electro-cautery to decrease the chances of recurrence.
Endometrial polyps aren’t quite as easy to approach. They are located inside the uterus where they cannot be seen during examination. The diagnosis may be suggested by a pelvic ultrasound study. However, most endometrial polyps are discovered when either a D & C or hysteroscopy are performed for abnormal bleeding. Abnormal bleeding is usually defined as one of the following:
• Prolonged bleeding (greater than 1 week)
• Exceptionally heavy bleeding
• Bleeding between your periods
• Post menopausal bleeding

In the past, the standard procedure for the evaluation of abnormal bleeding was a D & C, or dilatation and curettage. Your doctor performs a D & C by dilating the cervix and placing a scraping instrument (curette) into the uterus. He uses the curette to remove a sampling of the endometrium, which is then evaluated microscopically. Although this is very good at diagnosing endometrial cancer, it is mediocre at removing polyps. Another procedure done for the evaluation of abnormal bleeding is the endometrial biopsy. This is an office procedure where your doctor passes a small catheter through the cervix and obtains a specimen of endometrial tissue for analysis. However, an endometrial biopsy will not remove endometrial polyps.

 
If a pelvic scan suggests a mass inside the uterus, or if you persist with abnormal bleeding after a D & C or endometrial biopsy, hysteroscopy is indicated. During hysteroscopy, your doctor inserts a telescopic instrument through the vagina and cervix into the uterine cavity. This allows him to evaluate the inside of your uterus under direct vision. This is a distinct advantage over a D & C or endometrial biopsy, which are both “blind” procedures. Endometrial polyps can be removed through the hysteroscope using an electrocauterized loop. This procedure can be performed as an outpatient. Your recovery is usually quick. You may have varying degrees of cramping and bleeding for a short time after the procedure, but serious complications are uncommon.

I’m postmenopausal, and now I’m bleeding. Does that mean I have cancer?

Most women realize that it is not normal to have vaginal bleeding once menopause is complete. If you have not bled for years and start to bleed, it is a natural response to feel anxious. Try to remain calm. The majority of postmenopausal bleeding does not indicate cancer. Often benign growths such as polyps of the cervix or endometrium will bleed (see above). Without estrogen replacement, the lining of the vagina and uterus becomes thin, referred to as atrophic. Sometimes atrophic endometrial or vaginal tissues bleed. Another condition associated with bleeding after menopause is endometrial hyperplasia. With endometrial hyperplasia there is an excess number and crowding of the endometrial glands in the lining of your uterus. Certain types of hyperplasia are considered precancerous. When discovered, hyperplasia can be reversed medically by administering progesterone.

It is not unusual for women on hormone replacement therapy to have bleeding.  If you are taking hormone replacemnet , your doctor should indicate what to expect in terms of vaginal bleeding

Certainly postmenopausal bleeding should be investigated because it may be a sign of cancer. However, don't panic and assume you have cancer.  Your condition often turns out to be benign.


What is endometrial cancer?

Cancer of the inside lining of the uterine cavity, or endometrium, is referred to as endometrial cancer. The cancer begins inside the uterus and gradually extends into the myometrium, or muscular wall of the uterus. It is also not uncommon for it to extend downward into the cervix. In its more advanced stages, the cancer spreads elsewhere in the pelvis or into the vagina. If the cancer cells spread into the lymphatic drainage of the pelvis or the blood stream, it can disseminate to other parts of the body, particularly the lungs, liver and bones. Fortunately, most endometrial cancers cause abnormal bleeding that prompts your doctor to investigate and discover the cancer while it is still early.


How did I get endometrial cancer?

Nobody completely understands why women get endometrial cancer. Estrogen stimulates endometrial growth while progesterone decreases endometrial growth. Conditions that produce an excess of estrogen, unbalanced by progesterone, increase your risk of endometrial cancer. Conditions associated with increased estrogen include the following:
* Obesity -- Fat cells in your body convert other hormones found in your body to estrogen.
* Women with infrequent periods -- during the months that you miss your period, your ovaries are still producing estrogen. However, there is no progesterone produced during those months to oppose the effects of the estrogen on your endometrium.
* Women who have a late menopause (average age is 51).
* Women with polycystic ovarian disease -- a disease in which women infrequently ovulate and develop multiple small cysts in their ovaries.
There also may be a genetic, or familial predisposition to endometrial cancer. If you have a close family member who has had endometrial cancer, your risk is increased. Your risk is also greater if you have had cancer of the breast, ovary, or colon.


How do you diagnose endometrial cancer?

If you have abnormal bleeding past the age of 35 (some doctors use 40 as a cutoff), it must be investigated. This would include prolonged periods, bleeding between periods, and very erratic bleeding. If you are beyond menopause and have any bleeding (presuming you are not on hormone replacement), it is abnormal. Do not wait to see if it will recur. Early detection of the cancer is the mainstay of success.

Investigation of the bleeding might include pelvic ultrasound, endometrial biopsy, D & C, or hysteroscopy. These were reviewed above in our discussion of endometrial polyps. Complications from these procedures are uncommon. If you have abnormal bleeding, the need for more information outweighs the risk of any of these procedures. The least invasive of the procedures is pelvic ultrasound, but it does not provide your doctor with a tissue specimen for analysis. An endometrial biopsy can be performed in the office and is good at diagnosing or excluding cancer. D & C provides a greater amount of tissue than the endometrial biopsy, but is usually performed in the operating room under anesthesia. Hysteroscopy provides the most thorough evaluation of the uterine cavity and enables your doctor to resect other benign causes of abnormal bleeding such as fibroids and polyps. Hysteroscopy is also usually performed in the operating room under anesthesia, although some gynecologists perform this in their office.
The most important “take home message” is that you shouldn’t defer investigation of the bleeding. Your bleeding may not represent cancer. However, if cancer is discovered, you have a very good prognosis with early diagnosis.


Why didn’t this show up on my Pap smear?

There are many misconceptions regarding the Pap smear. The most prevalent misunderstanding is that Pap smears screen for all types of gynecologic malignancies. The standard Pap smear is obtained from the cervix and only screens for cervical cancer. Cancer of the endometrium begins inside the uterus and is therefore not usually detected on a Pap smear. Occasionally, malignant cells from inside the uterus “drop down” the cervical canal and are discovered on a Pap smear, but that is unusual. Abnormal bleeding must be investigated (as described above) even if your Pap smear is normal.



Do I need a hysterectomy to treat endometrial cancer?

Surgery is the mainstay of treating endometrial cancer. If it is determined that surgery would be too risky, you can be treated with radiation. If you are healthy enough to undergo surgery, your doctor will recommend an abdominal hysterectomy with removal of both tubes and ovaries. He may also want to remove lymph nodes in the pelvis or abdomen. This helps him determine if the cancer has spread beyond the uterus. Some physicians may be willing to perform a vaginal hysterectomy or laparoscopically assisted hysterectomy, particularly if it is felt that your cancer was discovered early. However, most gynecologic oncologists (doctors that specialize in gynecologic cancer) recommend an abdominal approach through a larger incision that allows them the best opportunity to assess the extent of your cancer.



I’m really scared. What will happen if I don’t do anything?

My mouth drops whenever I hear a patient ask, “What if I don’t do anything?” You will die from endometrial cancer if it is not treated. Nobody can predict how long you will live without treatment, but without treatment it is likely that you will die within several years, maybe sooner.


Generally this question stems from fear, not a genuine desire to avoid treatment. The word ‘cancer’ evokes apprehension in even the bravest of individuals. You may assume that death is inevitable if you have cancer. However, most women with endometrial cancer are diagnosed early. With appropriate treatment, the vast majority of women are cured. You may also be scared of surgery, particularly if you have never undergone an operation. Discuss these concerns with your doctor. Serious complications from the surgery are uncommon. There is no doubt that the benefit from surgery far outweighs the possibility of a complication from the surgery.



I had a hysterectomy for endometrial cancer, and now my doctor says I need radiation. Is that really necessary?

Many women will only need surgery for the treatment of their endometrial cancer. However, in the following situations, additional therapy may be required:
* Your cancer is assigned a high grade. High grade cancers are those that look particularly bizarre under the microscope. They are more likely to behave aggressively.
* Your cancer penetrates deeply into the wall of the uterus (remember it starts inside the uterus). The chance of cancer cells existing outside the uterus is increased in this situation.
* You have positive lymph nodes.
* There is evidence of cancer spreading to distant organs.
* Your uterine cancer is a variety other than the typical endometrial cancer.
In the first three instances, radiation is recommended after surgery. Radiation decreases the chances of the cancer recurring. The potential benefit of the radiation must be weighed against its side effects. The radiation may cause bowel (bleeding, spasms, colitis, constipation, or diarrhea) and bladder (increased frequency, urgency, burning, bleeding) difficulties that can persist long after the treatment. Before submitting to the radiation, ask your doctor how much additional benefit is to be obtained in your survival rate. Also consult the physician who will administer the radiation. It should be a physician that specializes in radiation therapy. Inquire as to the frequency and severity of side effects from his treatment. If your survival rate is increased by 15-20% with the addition of the radiation, it is probably in your best interest to proceed with it. If your survival is boosted by only 5%, it may not be warranted.


If there is evidence of cancer in distant organs (or a high probability that this will happen), your doctor may recommend hormonal treatment in the form of high dose progesterone. This will not cure the cancer, but may hold it in remission or slow its spread. Recently, chemotherapy has also been used with endometrial cancer that has spread beyond the uterus, especially if it is widespread.


Can I take hormone replacement after treatment for endometrial cancer?

Most doctors will not allow you to take estrogen after being treated for endometrial cancer. There is a concern that any remaining cancer cells will be stimulated by the estrogen and increase your chances of a recurrence. More recently, doctors are less strict regarding that recommendation. If your cancer was very early, then your risk of recurrence is very low (5% or less). This must be weighed against the benefits you will receive from the estrogen. You also must consider the timing of your treatment. Most endometrial cancers that recur will do so in the first five years. Recurrence after ten years is rare. Many gynecologic oncologists now feel that hormone replacement is permissible if your cancer was not advanced and you have been free of disease for ten years (some use five).

How will I be followed after my treatment for endometrial cancer?

Initially you will be seen frequently, possibly as frequently as every three to four months. Your doctor will examine your pelvic region to feel for a mass that could represent a recurrence. He also will examine and obtain Pap smears from your vagina, which is one of the more common sites for recurrence. If your cancer was more advanced, follow-up may also include periodic pelvic\abdominal scans and chest x-rays. The frequency of your visits can be decreased after two years, but most physicians will recommend that you still be seen every six months.

For more facts about endometrial cancer, contact the National Cancer Institute at:
Cancer Information Service
National Cancer Institute
Building 31
Bethesda, MD. 20892
800-422-6237
www.nci.nih.gov
OR
The American Cancer Society
19 W 56th St.
New York, N.Y. 10019
212-586-8700
www.cancer.org

My Pap smear is abnormal. Does that mean I have cancer?

You are taught that Pap smears are used to detect cervical cancer. Therefore, you might assume automatically that an abnormal Pap smear represents cancer. Actually, most abnormal Pap smears reflect cervical conditions that are not life threatening. Besides precancerous and cancerous changes, your Pap smear may become atypical from any of the following:
* Cervicitis -- infection or inflammation of the cervix. Your doctor may want you to return to the office for an examination and/or cultures if the Pap smear suggests the presence of an infection.
* Reactive changes -- irritation of the cervix from intercourse, a tampon, an IUD, or a pessary (a device placed into the vagina to treat pelvic prolapse -- see chapter 15)
* Reparative changes -- changes seen as cells repair the cervix.
* Atrophic changes -- changes seen as a result of inadequate estrogen levels (ex. menopause)

Cervicitis from an infection may require specific treatment with an antibiotic, antiviral, or antifungal medication. Often no infection can be identified when there is cervicitis. If the cervicitis persistently causes abnormal Pap smears, it can be treated with either cryotherapy (a freezing technique) or laser. Reparative and reactive changes usually reverse spontaneously without specific treatment. Atrophic changes can be reversed with estrogen therapy.



If my Pap smear is abnormal, why did the doctor tell me to come back in six months?

It doesn’t sound reasonable. After all, if the Pap is abnormal, shouldn’t you be doing something about it? Actually, minor abnormalities of the Pap smear often reverse spontaneously. If the Pap smear appears slightly atypical but doesn’t show precancerous or cancerous changes, it is considered “ASCUS”, an acronym for “atypical cells of undetermined significance”. It is saying that the cells are not quite normal enough to call negative, but not abnormal enough to put them in the category of low or high grade lesion (see below). Most of these are automatically tested for the presence of high risk strains of HPV, a sexually transmitted virus that is now known to be the cause of cervical cancer. If you test negative for HPV, some doctors will simply repeat the Pap smear (with or without another HPV) test in 6 months. At least half of the smears will have reverted to normal. If the Pap smear remains atypical, further evaluation may be undertaken, although it may not be necessary if you continue to test negative for HPV. In fact current recommendations consider an ASCUS Pap without HPV to be comparable to normal. 


How can I tell if my abnormal Pap smear is serious?

We have already addressed the ways in which your Pap smear can be abnormal but of no consequence. We have also discussed the ramifications of the Pap smear labeled ASCUS. If your Pap smear is somewhat more atypical it will then be placed in a LGSIL or HGSIL category. LGSIL, or low grade squamous intraepithelial lesion, previously was referred to as mild dysplasia or CIN 1. Low grade lesions are not uncommon when you are infected with a high risk strain of HPV. However, in many cases this degree of abnormality will reverse back to normal if your body develops in immune response that clears the HPV virus. Today, doctors rarely intervene to treat low grade lesions, presuming that they are confirmed with colposcopically directed biopsies (see below). HGSIL, or high-grade squamous intraepithelial lesions were previously referred to as moderate or severe dysplasia or CIN 2 or 3. Approximately 20% of high-grade lesions will ultimately progress to CIS (carcinoma in situ, cervical cancer that is still confined to the glands lining the cervical canal) and eventually invasive cervical cancer if left untreated. HGSIL is usually the first level of abnormality that mandates intervention, as described below.


What caused my abnormal Pap smear?

We already discussed above the fact that your Pap smear can be mildly abnormal without there being any specific cause, or clearly benign causes. If your Pap smear has reached the level of abnormality that is classified as LGSIL or HGSIL, you probably have been infected by HPV, or Human Papillomavirus. HPV is a sexually transmitted infection. Genital HPV viruses are classified as either low risk or high risk. Low risk strains are the cause for genital warts. High risk strains are those that can cause cervical abnormalities.

The only way to avoid HPV infection is to abstain from sex or engage in sex within the context of a mutually monogamous relationship in which neither partner is infected. The prevalence rate of HPV is exceedingly high in the single, sexually active population. Depending on which population is tested prevalence can reach as high as 30 to 70%. Condoms can reduce the transmission of the virus but is limited in doing so because the virus is transmitted by skin to skin contact. If you test positive for HPV, there is no way of knowing whether this was acquired recently or in the distant past. Of course, if you tested negative in the past and are now positive, then presumably you obtained the infection after your last negative test.

High risk HPV infection is exceedingly common in the young sexually active population. However, because young people have a robust immune system, most young women will clear the virus without any consequence. It is therefore not routinely recommended to screen young women for HPV. Women who do not clear their HPV infection are at risk for cervical abnormalities and it is recommended to routinely screen all women over age 30 for high risk HPV every three years. At this time it is not recommended to screen men for high risk HPV.

More recently, vaccines have been developed for the most common strains of high risk HPV and it is strongly recommended that boys and girls receive one of the two available vaccines in early adolescence. While not perfect, the vaccines would appear to have the ability of reducing cervical cancer by 80%. Currently, vaccination is approved for males and females up to age 26, and is generally covered by insurance up to that age. There are no studies to demonstrate the efficacy of the vaccines beyond age 26, although it would not be unreasonable to use the vaccines "off label" in single sexually active men and women older than 26.

How do you diagnose LGSIL and HGSIL?

LGSIL or HGSIL are initially indicated through your Pap smear. If the Pap smear suggests either of these, a colposcopy is performed. This procedure is performed in the office. Your doctor inserts a speculum into the vagina and examines the cervix through an optical instrument that magnifies images of the cervix. Dilute acetic acid (sounds bad -- it’s just vinegar) is applied to the cervix. You may feel slight burning when the acetic acid is applied, but usually this is tolerated well. SIL of the cervix has a characteristic appearance when visualized through the colposcope. The doctor will take biopsies of any suspicious areas. You will feel a pinch when a cervical biopsy is taken. The doctor may also perform endocervical curettage, in which a small scraping instrument is used in the cervical canal to obtain tissue that cannot be seen with the colposcope. This helps the doctor make sure there is no abnormality beyond the field of vision provided by the colposcope. The biopsies are sent to a laboratory for microscopic evaluation.


How do you treat LGSIL and HGSIL?


LGSIL is usually observed with serial Pap smears without intervention. Persistent LGSIL, lasting more than a year or two without reverting to normal, might be treated at the discretion of you and your doctor. HGSIL will generally be treated in one of the following ways:

* Observation -- HGSIL does not always progress, and may regress to normal in young women. A minority of physicians would continue to observe HGSIL in a patient under the age of 30, hoping for this regression. This requires an extremely compliant patient and very frequent (every 3 to 4 months) observation intervals.

* Cautery -- The SIL is destroyed by electrosurgical techniques that apply heat.

* Cryotherapy -- The SIL is treated through the application of freezing agents to the cervix.

 * LEEP procedure -- An electrosurgical loop “scoops” the SIL out of the cervix. This may be followed by application of an electrosurgical ball that cauterizes the cervix.

* Laser surgery -- a high energy beam vaporizes the SIL.

* Cervical conization -- If there is a suggestion that there may be SIL or cancer in the cervical canal, a cervical conization may be recommended. A cervical conization removes a cone of tissue from the cervix. The cone may be removed using a scalpel, laser, or LEEP loop.

The method chosen by your doctor may vary depending on the degree of your SIL, and your doctor's suspicion regarding the possibility of CIS or invasive cancer. The most common modalities used today are laser and LEEP procedures. In cases of persistent HGSIL, CIS, or early invasive cancer, hysterectomy is often recommended.

 Why is my doctor treating my SIL differently than someone I know who has the same thing?

How often have I heard, “My cousin Martha has the same thing and her doctor used .....”? From our discussion above you must reach two conclusions. First, there are varying degrees of cervical abnormalities. Some require no treatment while others are very likely to progress into cervical cancer. Try not to compare your situation to someone else’s that may not be exactly the same. Second, there are many treatment modalities used that successfully treat cervical SIL. Remember, different doesn’t mean better. Therefore, it is not uncommon for two doctors to treat the same condition using different, yet equally successful methods.

 Will SIL come back again after treatment? 

Unless a hysterectomy is performed, there is a chance of redeveloping SIL. Initial treatment eradicates the SIL but it doesn’t remove the cervix or the presence of HPV. It is important that you undergo regular Pap smears (usually every 6 months) following treatment for SIL. If a Pap smear indicates recurrent SIL, it will again be approached as outlined above. If childbearing is not a concern, one might consider hysterectomy (particularly with HGSIL).

If the SIL can recur, why don’t you just do a hysterectomy?

Treating cervical SIL via hysterectomy is like killing an insect with a sledge hammer. It’s usually more than you need. Many women will never have recurrence of SIL. Submitting a woman to a major operation when a minor procedure may solve the problem is not justifiable. If it is obvious that there will be a problem with compliance after treatment (the patient is unwilling or unable to submit to regular follow-up Pap smears), hysterectomy is indicated. It is also reasonable if you continue to persist or recur with HGSIL or CIS. Otherwise it is in your best interest to use one of the conservative modalities (e.g., laser, LEEP, cone biopsy) to treat the SIL. They are performed either in the office or as an outpatient in the operating room and have fewer complications than hysterectomy.

What’s the difference between cervical SIL and cervical cancer?

Many women assume that SIL is an early form of cervical cancer. Women tell me they have a family history of cervical cancer. Upon further questioning, it becomes apparent that their relative had SIL. SIL of the cervix is not cancer. It is potentially (as in not necessarily) precancerous (could develop into cancer). This is an important distinction. SIL can be treated with conservative approaches (as described above), while cervical cancer mandates an aggressive approach.

How will I know if I have cervical cancer?

You probably won’t know! There are no symptoms associated with early cervical cancer. That is why it is critical for you to regularly visit your doctor for Pap smears and HPV testing. There are approximately 13,000 new cases of invasive cervical cancer each year. This number is dramatically lower than prior decades because of Pap smear screening. Regular Pap smears will almost always detect cervical abnormalities prior to the development of invasive cervical cancer. Most commonly, cervical cancer is detected in women who have not been evaluated by a gynecologist for many years. Sexual activity with multiple partners increases your risk for cervical cancer by increasing your risk for HPV infection. Smoking also increases your risk. Cervical cancer may occur at any age but is most commonly seen between ages 35-50.

The earliest sign of cervical cancer is abnormal bleeding (particularly between your periods, with intercourse, or in menopause). Don’t panic! The vast majority of abnormal bleeding is not from cancer. Nevertheless, it needs to be evaluated. Advanced cervical cancer may cause difficulty with urination from obstructing the urinary tract. The tumor may also impede drainage of fluid from your legs causing them to swell. Once again, these symptoms are much more likely to be related to other causes, but should be evaluated by a physician.

How do you treat cervical cancer?

Cervical cancer is staged according to how far it has invaded. Stage I cervical cancer has invaded only minimally and is confined to the cervix. As the cancer spreads beyond the cervix, the stage increases. In stage IV, it has spread to the bladder or rectum, or other parts of the body.


 Very minimally invasive cervical cancer (microinvasion) is treated with a cervical cone biopsy (see above) in women who are trying to preserve their uterus for childbearing.Early cervical cancer is usually approached surgically with a hysterectomy. The uterus and its adjacent tissue are removed. Pelvic lymph nodes and the upper part of the vagina may also be excised. If the ovaries are normal, they do not need to be removed (although it is recommended if you are c beyond menopause). More advanced cervical cancer is often treated with radiation. Initially cervical cancer spreads locally so pelvic radiation is very effective. Complications from pelvic radiation include voiding difficulties (bladder spasms, burning with urination, frequent and urgent urination), and bowel problems (rectal spasms, diarrhea). As radiation therapy has become more sophisticated, these complications have become less frequent. Medications are available to help ease these symptoms should they occur.

Cervical cancer that has spread to distant areas of the body is treated with chemotherapy. Unfortunately successful treatment at this point is limited.

What are my chances of surviving cervical cancer?

Early cervical cancer has an excellent prognosis. With stage I disease you have an 85-90% chance of surviving. Your chances decrease as the stage of the cancer increases. Cure with advanced disease that has spread to other parts of the body is very low (5-10%).

The “take home” message here is visit your doctor regularly. A complete examination should be performed annually, and Pap smears with HPV testing should be included in women over 30 every three years (more frequently in women who have had a prior cervical abnormality). Advanced cervical cancer is exceptionally rare in women who comply with regular exams.

More information on cervical cancer can be obtained through the National Cancer Institute (www.nci.nih.gov) or the American Cancer Society (www.cancer.org)