American Medical Association Family Medical Guide - American Medical Association [592]
Symptoms
The main symptom of cervical cancer is abnormal vaginal bleeding that can occur between periods, after intercourse, or after menopause. A watery, bloody discharge, which can be heavy and foul-smelling, is another common symptom. Advanced cases of cervical cancer can cause pelvic pain and back pain.
Diagnosis
If you have an abnormal Pap smear, your doctor may want to do another Pap smear and compare the results or perform some other tests, depending on the degree of abnormality found on the Pap smear. If the doctor can see an abnormality directly, he or she will take a sample of tissue from your cervix for laboratory examination for cancer cells (biopsy).
Doctors often use a procedure called colposcopy, an examination of the cervix using a lighted viewing instrument, to check the cervix for abnormal tissue. Doctors usually take a sample of tissue for analysis under a microscope (biopsy) during a colposcopy to look for cancer cells and to evaluate the stage of the cancer. Another common biopsy procedure is called LEEP/LLETZ (see previous page). If these tests do not clearly show whether abnormal cells have spread beyond the surface of the cervix, the doctor may perform a cone biopsy, in which a cone-shaped sample of tissue is taken from the cervical canal and sent to a laboratory for analysis.
Treatment
Chances are extremely good that cervical cancer can be cured if the cancer has not spread beyond the cervix. In fact, the outlook for cervical cancer is much better than that for most other cancers. Your doctor will discuss the risks and benefits of each form of treatment with you before you choose the best course. Cervical cancer is usually treated with surgery to remove abnormal tissue in or near the cervix. If the cancer is found only on the surface of the cervix or confined to the cervix, a doctor may treat it with a cone biopsy or a hysterectomy (see page 870). Radiation therapy (see page 23) is frequently given along with chemotherapy (see page 23), which helps improve the effectiveness of the radiation.
Even if your reproductive organs are left intact, radiation therapy will probably disrupt your menstrual cycle; you may experience some symptoms of menopause. During radiation treatment and for a few months after radiation therapy, you may have diarrhea and difficulty retaining urine. Long-term radiation therapy may eventually obstruct the ureters (the tubes that connect the kidneys to the bladder), possibly leading to kidney failure. Make sure you have all the follow-up checkups that your doctor recommends to avoid these potential complications.
Cervical Polyps
A cervical polyp is a small, grapelike growth on a stalk that hangs from the lining of the cervix. Polyps usually are single and tiny but can grow to about an inch in length. The exact cause of cervical polyps is unknown, but they are linked to inflammation of the cervix and frequently accompany a chronic infection of the vagina or cervix. They are not contagious, and they rarely recur. The growths are benign (noncancerous) in 99 percent of cases but, in rare cases, can be a sign of early cervical cancer (see previous page).
Symptoms
Cervical polyps can produce a watery, bloody vaginal discharge. Sometimes they can cause bleeding after intercourse or after menopause. Cervical polyps are harmless but, because they produce symptoms similar to those of cervical cancer or cancer of the uterus (see page 869), it’s important to have these symptoms checked out by your doctor.
Diagnosis and Treatment
To determine the cause of your symptoms, your doctor will perform a pelvic examination and a Pap smear (see page 140). If the doctor finds a polyp in your cervix, he or she will probably remove it then in