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    Cervical Cancer Care in Northwest Indiana

    Cervical cancer is a type of gynecological cancer that begins in the cervix — the narrow organ that connects the body of the uterus (womb) to the vagina (birth canal). At one time, cervical cancer was one of the most common causes of cancer death for American women. However, the cervical cancer death rate has dropped significantly with the increased use of the Pap test, which can find cervical precancer before it turns into cancer.

    Cervical cancer is normally slow-growing cancer. Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia, in which abnormal cells begin to appear in the cervical tissue. Over time, the abnormal cells may become cancer cells and start to grow and spread more deeply into the cervix and to surrounding areas.

    Discussing your options with a cervical cancer specialist is important to be informed about all of your options for treatment. At Northwest Cancer Centers, our oncologists work with each patient to recommend a personalized treatment plan.

    Learn more about the cause of cervical cancer and how this type of gynecologic cancer is detected and treated.

    cancer diagnosis

    Diagnosing Cervical Cancer

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    staging cancer

    Stages of
    Cervical Cancer

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    cancer treatment options

    Treatment for Cervical Cancer

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    Causes of Cervical Cancer

    Cervical cancer is almost always caused by a human papillomavirus (HPV) infection. Most women with the virus never develop cancer. This means other factors, such as your environment or your lifestyle choices, can influence your risk of developing cervical cancer.

    cancer diagnosis

    How is Cervical Cancer Found?

    Finding and treating abnormal cells can prevent most cervical cancer. It is recommended that women get regular Pap tests to help reduce their risk of cervical cancer. Sometimes called a Pap smear or cervical smear, a Pap test is a simple test used to look at cervical cells. They can detect cervical cancer or abnormal cells that can lead to cervical cancer. Routine Pap tests can also help find cancer early when treatment is more likely to be effective.

    For most women, the Pap test is not painful. It’s done in a doctor’s office or clinic during a pelvic exam. The doctor or nurse scrapes a sample of cells from the cervix. A lab checks the cells under a microscope for cell changes. Most often, abnormal cells found by a Pap test are not cancerous. The same sample of cells may be tested for HPV infection.

    If you have abnormal Pap or HPV test results, your doctor will suggest other tests to make a diagnosis and often, at the same time, remove the abnormal cells that were found:

    • 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: Most women have tissue removed in the doctor’s office with local anesthesia. A pathologist checks the tissue under a microscope for abnormal cells.
      • Punch biopsy: The doctor uses a sharp tool to pinch off small samples of cervical tissue.
        LEEP: The doctor uses an electric wire loop to slice off a thin, round piece of cervical tissue.
      • Endocervical curettage: The doctor uses a curette (a small, spoon-shaped instrument) to scrape a small sample of tissue from the cervix. Some doctors may use a thin, soft brush instead of a curette.
      • Conization: The doctor removes a cone-shaped sample of tissue. 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.
    Removing tissue from the cervix may cause some bleeding or other discharge. The area usually heals quickly. Some women also feel some pain similar to menstrual cramps. Your doctor can suggest medicine that will help relieve your pain.

    The tissue is tested for cancer cells. If positive for cancer, there are additional tests required to determine if it’s spread beyond the cervix.

     

    staging cancer

    Stages of Cervical Cancer

    If the biopsy shows that you have cervical cancer, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. Staging is a careful attempt to find out whether the tumor has invaded nearby tissues, whether it has spread, and, if so, to what parts of the body. Cervical cancer spreads most often to nearby tissues in the pelvis, lymph nodes, or the lungs. It may also spread to the liver or bones.

    When cancer spreads from its original place to another part of the body, the new tumor has the same kind of cancer cells and the same name as the original 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’s treated as cervical cancer, not lung cancer. Doctors call the new tumor “distant” or metastatic disease.

    Your doctor will do a pelvic exam, feel for swollen lymph nodes, and may remove additional tissue. To learn the extent of cervical cancer, 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. A tumor in the liver, lungs, or elsewhere in the body can show up on the CT scan. You may receive contrast material by injection in your arm or hand, by mouth, or by enema. The contrast material makes abnormal areas easier to see.
    • 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 in the picture.
    • PET scan: You receive an injection of a small amount of radioactive sugar. A machine makes computerized pictures of the sugar being used by cells in your body. Cancer cells use sugar faster than normal cells, and areas with cancer look brighter on the pictures.
    The stage is based on where cancer is found. For cervical cancer, the staging system developed by the International Federation of Obstetrics and Gynecology (FIGO) is used. These are the stages of invasive cervical cancer:

    Stage I

    The cancer has spread from the cervix lining into the deeper tissue but is still just found in the uterus. It has not spread to other parts of the body. This stage may be divided into smaller groups to describe the cancer in more detail (see below).

    • Stage IA: The cancer is diagnosed only by viewing cervical tissue or cells under a microscope. Imaging tests or evaluation of tissue samples can also be used to determine tumor size.
      • Stage IA1: There is a cancerous area of less than 3 millimeters (mm) in depth.
      • Stage IA2: There is a cancerous area 3 mm to less than 5 mm in depth.

    • Stage IB: In this stage, the tumor is larger but still only confined to the cervix. There is no distant spread.
      • Stage IB1: The tumor is 5 mm or more in-depth and less than 2 centimeters (cm) wide. A centimeter is roughly equal to the width of a standard pen or pencil.
      • Stage IB2: The tumor is 5 mm or more in-depth and between 2 and 4 cm wide.
      • Stage IB3: The tumor is 4 cm or more in width.

    Stage II

    The cancer has spread beyond the uterus to nearby areas, such as the vagina or tissue near the cervix, but it is still inside the pelvic area. The cancer has not spread to other parts of the body. This stage may be divided into smaller groups to describe the cancer in more detail (see below).

    • Stage IIA: The tumor is limited to the upper two-thirds of the vagina. It has not spread to the tissue next to the cervix, which is called the parametrial area.
      • Stage IIA1: The tumor is less than 4 cm wide.
      • Stage IIA2: The tumor is 4 cm or more in width.

    • Stage IIB: The tumor has spread to the parametrial area. The tumor does not reach the pelvic wall.

    Stage III

    The tumor involves the lower third of the vagina and/or: has spread to the pelvic wall; causes swelling of the kidney, called hydronephrosis; stops a kidney from functioning; and/or involves regional lymph nodes. Lymph nodes are small, bean-shaped organs that help fight infection. There is no distant spread.

      • Stage IIIA: The tumor involves the lower third of the vagina, but it has not grown into the pelvic wall.

      • Stage IIIB: The tumor has grown into the pelvic wall and/or affects a kidney.

      • Stage IIIC: The tumor involves regional lymph nodes. This can be detected using imaging tests or pathology. Adding a lowercase "r" indicates imaging tests were used to confirm lymph node involvement. A lowercase "p" indicates pathology results were used to determine the stage.
        • Stage IIIC1: The cancer has spread to lymph nodes in the pelvis.
        • Stage IIIC2: The cancer has spread to para-aortic lymph nodes. These lymph nodes are found in the abdomen near the base of the spine and near the aorta, a major artery that runs from the heart to the abdomen.

    Stage IV

    • Stage IVA: The cancer has spread to the bladder or rectum, but it has not spread to other parts of the body.

    • Stage IVB: The cancer has spread to other parts of the body.

    Recurrent

    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.

    cancer treatment options

    Cervical Cancer Treatment Options

    Women with cervical cancer have many treatment options. The options include surgery, radiation therapy, chemotherapy, or a combination of methods.

    The choice of treatment depends mainly on the size of the tumor and whether the cancer has spread. The treatment options for cervical cancer may also depend on whether the patient would like to become pregnant someday.

    Surgery

    Surgery is the primary treatment for many women with Stage I or II cervical cancer. The surgeon removes tissue that may contain cancer cells:

    • Radical trachelectomy: The surgeon removes the cervix, part of the vagina, and the lymph nodes in the pelvis. This option is for a small number of women with small tumors who want to try to get pregnant later on.
    • Total hysterectomy: The surgeon removes the cervix and uterus.
    • Radical hysterectomy: The surgeon removes the cervix, some tissue around the cervix, the uterus, and part of the vagina.

    With either total or radical hysterectomy, the surgeon may remove other tissues:

    • Fallopian tubes and ovaries: The surgeon may remove both fallopian tubes and ovaries. This surgery is called a salpingo-oophorectomy.
    • Lymph nodes: The surgeon may remove the lymph nodes near the tumor to see if they contain cancer. If cancer cells have reached the lymph nodes, the disease may have spread to other body parts.

    Radiation Therapy for Cervical Cancer

    Radiation therapy (also called radiotherapy) is an option for women with any stage of cervical cancer. Radiation therapy uses high-energy rays to kill cancer cells. It affects cells only in the treated area. Women with early-stage cervical cancer may choose radiation therapy instead of surgery. It also may be used after surgery to destroy any cancer cells that remain in the area. Women with cancer that extends beyond the cervix may receive radiation therapy and chemotherapy.

     

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

    • External radiation therapy: A large machine directs radiation at your pelvis or other tissues where the cancer has spread. The treatment usually is given in a hospital or clinic. You may receive external radiation 5 days a week for several weeks. Each treatment takes only a few minutes.
    • Internal radiation therapy: A thin tube is placed inside the vagina. A radioactive substance is loaded into the tube. You may need to stay in the hospital while the radioactive source is in place (up to 3 days). Or the treatment session may last a few minutes, and you can go home afterward. Once the radioactive substance is removed, no radioactivity is left in your body. Internal radiation may be repeated two or more times over several weeks.

    Chemotherapy for Cervical Cancer

    For the treatment of cervical cancer, chemotherapy is only necessary if the cancerous cells move outside of the cervix and affect lymph nodes or other organs. It’s often used at the same time as radiation therapy. Chemotherapy alone may be used for cancer that has spread to distant organs. 

     

    The drugs for cervical cancer are usually given through a vein (intravenous). You may receive chemotherapy in a clinic, doctor’s office, or at home. Some women need to stay in the hospital during treatment.

    Targeted Therapy for Cervical Cancer

    Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming healthy cells.

     

    Monoclonal antibody therapy is a type of targeted therapy that uses antibodies made in the laboratory from a single type of immune system cell. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that may help cancer cells grow. The antibodies are able to kill the cancer cells then, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

     

    Bevacizumab is a monoclonal antibody that binds to a protein called vascular endothelial growth factor (VEGF) and may prevent the growth of new blood vessels that tumors need to grow. Bevacizumab is used to treat metastasized cervical cancer (spread to other parts of the body) and recurrent cervical cancer.

    Immunotherapy for Cervical Cancer

    Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. 

     

    Pembrolizumab, an immune checkpoint inhibitor therapy, is available to women whose cervical cancer has spread or is recurring. PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. PD-L1 is a protein found in some types of cancer cells. When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell. PD-1 and PD-L1 inhibitors keep PD-1 and PD-L1 proteins from attaching to each other.

    Find a Gynecologic Oncology Specialist in Northwest Indiana

    The medical oncologists and gynecologic oncologists at Northwest Cancer Centers ensure that the recommended treatment plan is specific to the patient’s specific needs. We have locations in the northwest Indiana area, including Crown Point, Dyer, Hobart, Michigan City, and Valparaiso. We also offer second opinions on diagnosis and treatment plans for cervical cancer. Take the time to evaluate your options and choose the cancer care team you feel most comfortable with.

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