Cervical Cancer

When a woman is diagnosed with cancer, she needs to consider her family’s history of cancer. Some cancers are inherited; however, most are spontaneous. If there is a concern with a family pattern of cancer, then a thorough family history should be taken. Sometimes this leads to formal genetic counseling with blood testing for specific gene mutations. If you have a specific gene mutation putting you at risk for breast or ovarian cancer, then surveillance testing or procedures are different from those with a spontaneous cancer. Therefore, start with telling your oncologist your family history.

The range of reported lymphedema in patient who undergo pelvic lymph node dissection is between 5-30%. However, it is important to note that the range varies widely based on several factors such as the tools to measure lymphedema or the medical comorbidities of the patient such as obesity, diabetes, hypertension, and cardiovascular disease.

The robotic system is generally recommended in the setting of early-stage cervical cancer to perform a radical hysterectomy or radical trachelectomy. It is also very commonly used to perform simple hysterectomy and lymph node removal in the setting of uterine cancer. It may also be used when performing prophylactic removal of the tubes and ovaries in patients with hereditary breast and ovarian cancer syndromes.

The robotics approach may also be used in very select cases of patients with isolated recurrent disease.

Cervical cancer is staged clinically. This means that if the tumor is very early and only detected by a biopsy, then a cold-knife cone is performed to determine the depth of tumor invasion and thus the stage. If the patient has a visible lesion, then the tumor is staged based on a pelvic examination. During that examination, the physician is trying to assess tumor size and extent within the pelvis. A chest x-ray is commonly obtained to assure that there is no evidence of spread of disease. Surgery is not routinely used to stage cervical cancer.

Good question, complex answer. I'll do my best.

In early stage cervical cancer, surgery is often possible but sometimes an organ-preserving approach is preferable and radiation can be used alone. In more advanced disease, surgery isn't possible but cure still is, so radiation is combined often with chemotherapy.

In these cases, radiation can be given partly with external x-rays, but to focus the dose some internal radiation treatment is also given. Usually, this is intracavitary brachytherapy (meaning close treatment in a cavity) by placing radioactive sources into the vagina, cervix and uterus.

Historically, radium was used. In the past 20 years, most of the brachytherapy has been with Cesium-137. Treatment required going to the operating room to place the applicator that would hold the radioactive sources, then determining how much Cesium to place internally for a period of 2-3 days while hospitalized. This is often referred to as LDR (low dose rate) brachytherapy because it's delivered slowly over time.

More recently there has been a move toward pulsed doses of HDR (high dose rate) brachytherapy with an Ir-192 source. This seems to be an equally effective approach with more radiation safety than LDR, but there are supporters for both approaches. The treatments are short but often more internal treatments are needed with HDR.

Hello there! I'm sure my surgical team did some tests, and I was told that I would get a "copy" of the study I took part in when it was done, but I never received it. I would have like to know what it said. I don't even know now where or if I could obtain it. It was at University of Alabama Birmingham. Things have changed alot medically, but I still would like to know. They even sent someone out to my house to interview me. I was counting on the information!

Since my uterus was not fully developed in the womb (the mouth, or opening), while I was in-utero, I have wondered if my mother had gene abnormalties, because she had cervical cancer at 36 (I was 12). Her's was caught in a Pap Test early and treated. She did well. But that was so long ago. If both occurrences happened today, I believe at least some of the outcomes would have been different, in a positive way.

My mother did smoke, and drink alcohol occasionally while pregnant. And while there are differences in opinion about this, some medical, some take offense to the suggestion; I believe it has to have a negative effect just by common sense. Especially with two babies at the same time are needing nutrition from the mother.

p.s. Would love to hear from you on this (if you have any thoughts)!

Most uterine malformations are just bad luck. Daughters of women who took DES when they were pregnant are at higher risk of uterine and cervical problems. Smoking in and of itself is associated with a higher risk of cervix cancer. Virtually all cervical cancer is caused by the HPV virus, which is a sexually transmitted infection. Women who smoke and are exposed to HPV may be at increased risk of developing precancerous changes on their pap smear and need to see their gynecologist yearly.