Cervical Cancer

Elizabeth Munro, M.D. with a patient
Dr. Elizabeth Munro is a gynecologic oncologist with expertise in minimally invasive surgery and robotic procedures. She is an expert in women's reproductive cancers. She works with a team of specialists to give you the best care possible.

The OHSU Knight Cancer Institute has Oregon’s first team dedicated to treating gynecologic cancers. We provide sensitive, expert care for women dealing with cervical cancer. Our services include:

  • Team-based care that includes a gynecologic oncologist (a doctor who treats women’s reproductive cancers with surgery and other therapies), other doctors and nurses. They will work with you to plan the most effective treatment.
  • The latest treatments for cervical cancer, including precision radiation therapy, targeted therapy and minimally invasive robotic surgery.
  • Comprehensive screening and treatment for precancerous changes in the cervix.
  • Care in OHSU’s welcoming Center for Women’s Health.
  • A full menu of support services including complementary medicine and fertility services.

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Understanding cervical cancer

What is cervical cancer?

Cervical cancer develops in a woman’s cervix — the lower, narrow part of the uterus that leads to the vagina. It starts when cells lining the cervix develop abnormally.

If these cells are not found during routine screening and treated, they may develop into cancer. Screening is especially important for cervical cancer because it’s effective at finding precancerous cells and cancer in early stages, when treatment works best.

What causes cervical cancer?

Certain types of the human papillomavirus, or HPV, cause practically all cervical cancers. HPV is a common infection spread by sexual contact.

More about HPV

Human papillomavirus is the most common sexually transmitted infection in the United States. It infects skin cells and cells that line body cavities.

Most people in the U.S. become infected at some point, according to the Centers for Disease Control and Prevention. Most women’s bodies clear the infection on their own, but in some people, the infection persists and can lead to cancer.

HPV has more than 200 types, classified by number. More than 40 are sexually transmitted. The strains that cause genital warts, or papillomas, are not the same as the 15 high-risk types that can cause cancers in the anus and genitals.

According to the World Health Organization, HPV-16 and HPV-18 cause 70% of precancerous cervical cell changes and cervical cancers worldwide.

Three vaccines prevent infection with HPV-16, HPV-18 and some other high-risk strains. These vaccines are recommended for males and females ages 9 to 26. They are effective against new infections but cannot treat established infections or related cancers.

Who gets cervical cancer?

An estimated 13,170 new cases of cervical cancer are expected in the United States in 2019. Anyone with a cervix, regardless of gender identity, can be at risk.

According to National Cancer Institute statistics, about 66% of patients survive at least five years after diagnosis. That number rises to 90% if cancer is caught before spreading from the cervix. These numbers are averages, though, and cannot predict individual outcomes. Five-year survival rates are also, by definition, based on treatments available five or more years ago.

Risk factors include:

  • Persistent HPV infection: Nearly all cases start with HPV infection.
  • Age: Most cases are diagnosed in women younger than 50, though cervical cancer is rare in women under 20. At the same time, more than 15% of cases are diagnosed in women older than 65.
  • Lack of screening: Women without access to regular screening, such as a Pap test, are especially vulnerable. 
  • Exposure to diethylstilbestrol, or DES: Rarely, women who were exposed to the medication DES before birth develop cervical cancer. DES, a synthetic form of the hormone estrogen, was prescribed to pregnant women in the United States until 1971 to prevent miscarriage.
  • Other: Giving birth to many children, being sexually active at a young age, having many sexual partners, long-term use of oral contraceptives.

Symptoms of cervical cancer

Early cervical cancer usually has no noticeable symptoms. In later stages, possible symptoms include:

  • Bleeding between periods, after sex or at any time after menopause
  • Pain during sexual intercourse
  • Pelvic pain
  • Unusual vaginal discharge that may smell unpleasant

All of these symptoms can be caused by other conditions, however, and don’t necessarily mean you have cancer.

Amanda Bruegl, M.D., conversing with a patient
Dr. Amanda Bruegl is a gynecologic oncologist, a doctor with expertise in diagnosing and treating women's reproductive cancers.

Cervical cancer screening

Screening tests can detect precancers and early stages of cervical cancer before you have symptoms. If you have symptoms, your care team may also do an overall physical exam and ask about your medical history.

Pelvic exam: Your doctor will examine your pelvic organs, on the outside and through the vagina, to look for signs of abnormality.

Pap test: Your doctor will gently scrape or brush some cells from your cervix so they can be examined under a microscope for abnormalities.

HPV test: Cells are collected from your cervix to check for high-risk strains of the HPV virus that can cause cell abnormalities. For women 30 and older who may have more risk of long-lasting HPV infections, a Pap test combined with an HPV test is effective at finding early-stage cervical cancers.

Diagnosing cervical cancer

If abnormal cells are detected, your doctor will conduct tests that might include:

Colposcopy: Your doctor uses a lighted magnifying glass called a colposcope to look, from outside your body, for cell changes on your cervix. Your doctor might do a biopsy, removing a small sample of tissue so the cells can be analyzed for cancer or precancer.

Endocervical curettage: Your doctor uses a small spoonlike instrument called a curet to remove a small sample of tissue from inside your cervix.

Cone biopsy: This is a small operation to remove a cone-shaped section of tissue from your cervix. This can be a diagnostic test or, if all abnormal cells are removed, a treatment.

Imaging: Your care team will use imaging such as X-ray, MRI, CT or PET scan to precisely locate the cancer and see if it has spread.

Types of cervical cancer

Cervical cancer is classified by the type of cell involved. Many cancers start in an area of the cervix called the transformation zone, where two kinds of cells meet.

Squamous cell carcinoma: The lower part of the cervix that opens to the vagina is covered by flat, skinlike squamous cells. According to the American Cancer Society, nine out of 10 cervical cancers form in these cells.

Adenocarcinoma: Glandular cells in the cervical canal close to the uterus secrete mucus and other fluids. Tumors that arise from these cells are called adenocarcinomas. They account for about 10% of cervical cancers. Evidence suggests that adenocarcinomas have become more common in recent decades.

Other types:

  • Adenosquamous or mixed carcinomas: Tumors in this relatively rare type of cervical cancer have both squamous and glandular cells.
  • Small cell carcinoma of the cervix: This is a rare, fast-growing form that can be difficult to treat.
  • Clear cell adenocarcinoma of the cervix: Women who have been exposed to DES in the womb are at risk of developing this rare type.
This diagram illustrates tumor sizes compared with everyday items - a pea, a peanut, a grape, a walnut, a lime, an egg, as well as a pencil tip, a crayon tip, and a pencil eraser.

Cervical cancer staging

Your doctors determine the tumor’s size, whether cancer has spread, and if so, how much. This helps them plan the most effective treatment.

Stage I: Cancer cells have penetrated the tissues of the cervix but have not spread beyond that.

  • Stage IA: Cancer is microscopic, no deeper than 5 millimeters and no wider than 7 millimeters.
  • Stage IB: The tumor is visible without a microscope, or it’s microscopic but bigger than in Stage 1A. In Stage IB1, the cancer is smaller than 4 centimeters at its greatest dimension. In Stage IB2, it’s bigger than 4 centimeters

Stage II: The cancer has spread but not to the pelvic wall or to the lower third of the vagina.

  • Stage IIA: The tumor has not spread to the parametrium, tissue next to the cervix. In Stage IIA1, the cancer is smaller than 4 centimeters. In Stage IIA2, the cancer is bigger than 4 centimeters.
  • Stage IIB: The tumor has spread to the parametrium.

Stage III: The cancer has spread to the lower third of the vagina and/or to the pelvic wall. It may also have blocked one or both ureters (the tubes that drain urine from the kidneys), causing kidney problems. 

Stage IV: The cancer has spread to the bladder or rectum and possibly beyond the pelvis to organs such as the liver or lungs.

Cervical cancer treatments

Treatment depends on the stage of your cancer, your age, general health and whether you want to have children. Your care team will develop recommendations tailored to your needs.

For early-stage cancer, only surgery may be needed. For cancer that has spread outside the cervix, your care team may recommend radiation therapy combined with chemotherapy instead.

Surgery

Early cancers can be treated with a cone biopsy, a small operation to remove affected tissue. For women with Stage I cancer who want to have children, it may be possible to remove only the cervix, leaving the uterus and ovaries. For later-stage cancers, it may be necessary to remove the uterus and sometimes the ovaries, fallopian tubes and surrounding tissue.

At OHSU, we offer the latest minimally invasive and robotic surgical techniques, which allow for much smaller incisions, less pain and quicker recovery.

Radiation therapy

Radiation therapy uses beams of energy to target cancer cells. In external beam radiation, a machine outside the body is used to target tissues. An internal form called brachytherapy involves placing high-energy material in a tube. The tube is inserted into the vagina so radiation can be applied directly to the tumor.

Intraoperative radiation therapy: If your cervical cancer has come back, your care team may recommend intraoperative (during surgery) radiation therapy. Our Mobetron device delivers high-energy beams directly to the tumor area. OHSU is the only hospital in Oregon and southwest Washington to offer this therapy.

Chemotherapy

Chemotherapy medications can kill cancer cells or stop them from growing nearly anywhere in your body. They are usually circulated through your bloodstream using an IV drip called an infusion. Chemotherapy can be used to:

  • Shrink a tumor before surgery.
  • Kill cancer cells circulating in your body after surgery.
  • Slow growth and control symptoms of advanced cancer.

Targeted therapy

These medications target specific molecules, such as proteins, within cancer cells. Matching a specific medication to a molecule can stop cancer cells from growing while limiting damage to normal cells. Some medications are given as pills. Others are by IV.

Additional services

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For patients

Call 503-418-4500 to:

  • Request an appointment
  • Seek a second opinion
  • Ask questions

Location

Parking is free for patients and their visitors.

Kohler Pavilion
Center for Women’s Health, seventh floor
808 S.W. Campus Drive
Portland, OR 97239
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