Precancerous changes can be separated into several categories based on how the cells of the cervix look under a microscope. There are several systems for naming and describing these categories of potentially cancerous or precancerous changes. These systems are also discussed in the section on "Can Cancer of the Cervix Be Prevented?"
There are two main types of cervical cancers: squamous cell carcinoma and adenocarcinoma. These, as well as rarer types of cervical cancer and cervical precancers, are classified according to how they look under a microscope. About 85%-90% of cervical cancers are squamous cells carcinomas. They begin in the ectocervix, most often at its border with the endocervix. The remaining 10%-15% of cervical cancers are adenocarcinomas. Cervical adenocarcinoma develops from the mucus-producing gland cells of the endocervix. Less commonly, cervical cancers have features of both squamous cell carcinomas and adenocarcinomas. These are called adenosquamous carcinomas or mixed carcinomas.
Precancerous and cancerous changes of the cervix can usually be found by the Pap test (also called a Pap smear). This test involves scraping some cells from the surface of the cervix and looking at them under a microscope. Since precancers and very early cervical cancers are nearly 100% curable, this test can prevent nearly all deaths from cervical cancer. The Pap test is explained more completely in the section called " Can Cancer of the Cervix Be Prevented?".
WHAT ARE THE KEY STATISTICS ABOUT CANCER OF THE CERVIX?
In the United States, cervical cancer accounts for 6% of all cancers in women.
The American Cancer Society estimates that during 1998, about 13,700 cases of invasive cervical cancer will be diagnosed in the United States. This will represent about 20% of the new cases of the disease, with the remaining 80% or about 65,000 being cases of pre-invasive cancer (carcinoma in situ).
Cervical cancer was once one of the most common causes of cancer death for American women. It is now the ninth most deadly cancer. About 4,900 women will die from cervical cancer in the United States during 1998. Between 1955 and 1992, the number of cervical cancer deaths in the United States declined by 74%. The main reason for this change is the increased use of the Pap test, a screening procedure that permits diagnosis of pre-invasive and early invasive cancer.
The 5-year relative survival rate for early invasive cervical cancer is 91%. The overall (all stages combined) 5-year survival rate for cervical cancer is 69%. For pre-invasive cervical cancer the 5-year survival rate is nearly 100%.
CAN CANCER OF THE CERVIX BE PREVENTED?
The vast majority of cervical cancers can be prevented. Since the most common form of cervical cancer starts with preventable and easily detectable precancerous changes, there are two ways to prevent this disease.
The first way is to prevent precancers. Most precancers of the cervix can be prevented by avoiding risk factors. Delaying onset of sexual intercourse if you are young, and using condoms for sexual activity at any age can help to avoid infections with human papillomavirus (HPV). Not smoking is another way to reduce the risk of cervical cancer and precancer.
The second way is to have a Pap test to detect HPV infection and precancers. Treatment of these disorders can stop cervical cancer before it is fully developed. Most invasive cervical cancers are found in women who have not had regular Pap tests.
The ACS recommends that all women begin yearly Pap tests at age 18 or when they become sexually active, whichever occurs earlier. If a woman has had three negative annual Pap tests in a row, this test may be done less often at the judgment of a woman's health care provider.
This recommendation also applies to most women who have had a hysterectomy (surgical removal of the uterus) and to women who are past menopause (no longer having periods) and past childbearing. If a hysterectomy was done for cancer, more frequent Pap tests may be recommended.
It is important to remember that while the Pap test has been more successful than any other screening test in preventing a cancer, it is not perfect. Because some abnormalities may be missed (even when samples are examined in the best laboratories), it is not a good idea to have this test less often than ACS guidelines recommend. Some women believe they do not have to be examined by a health care provider once they have stopped having children. This is not correct. They should continue to follow ACS guidelines.
How a Pap test and pelvic examination are done
The healthcare provider first inserts a speculum, a metal instrument that keeps the vagina open so that the cervix can be seen clearly. Next, a sample of cells and mucus is lightly scraped from the ectocervix using a spatula. A small brush or a cotton tipped swab is used to sample the endocervix. These samples are then smeared on to glass slides. The slides are sent to the lab where specially trained technologists and physicians examine the samples under a microscope.
The most widely used system for describing Pap test results is the Bethesda System ( TBS). This system was developed during a conference of experts in cervical cancer that was held at the National Cancer Institute in Bethesda, Maryland.
The first category of TBS is within normal limits, which means that no signs of cancer or precancerous changes or other significant abnormalities were found.
The category of reactive cellular changes indicates that some squamous cells from the ectocervix or glandular cells from the endocervix are not completely normal but still show no evidence of being precancerous or cancerous. Reactive cellular changes are often due to infections (such as yeast, herpes, chlamydia, or trichomonas).
The type of cells that cover the ectocervix (outer part of the cervix) are called squamous cells and cancers of the ectocervix are classified as squamous cell carcinomas. Precancerous changes involving the ectocervix are placed in the category of squamous intraepithelial lesions. This category is often given the abbreviation of SIL. The SIL category is subdivided into low grade SIL and high grade SIL. The high grade SILs are less likely than low grade SILs to go away without treatment and are more likely to eventually develop into cancer if they are not treated. However, treatment can cure all SILs and prevent true cancer from developing. A Pap smear is not used to say for sure whether or a woman has a high or low-grade SIL. It merely flags the smear as fitting into one of these abnormal categories. However, the need for treatment is based on further testing and examination (see below).
The most confusing TBS category for cells of the ectocervix is atypical squamous cells of undetermined significance, often abbreviated as ASCUS and pronounced "ask-us". This category is used when it is not possible to tell from the Pap test whether the abnormal cells are due to inflammation or to a precancer. In these situations, a repeat Pap test in 4 months or other tests such as colposcopy and biopsy may be recommended, depending on the patient's history and previous Pap tests.
The Bethesda System also describes abnormalities of the glandular cells of the endocervix. Cancers of the endocervix are reported as adenocarcinoma. When endocervical glandular cells have features that do not permit a confidant decision as to whether they are cancerous or not, the term atypical glandular cells of undetermined significance, abbreviated as AGUS, is used. The patient will usually have further testing if a Pap test shows AGUS.
This is not the only classification for reporting Pap test results. Sometimes, squamous cell abnormalities are classified as mild, moderate, or severe dysplasia or cervical intraepithelial neoplasia, CIN1, CIN2, or CIN3. Squamous intraepithelial lesion, dysplasia, and cervical intraepithelial lesion are all names for potentially precancerous changes of the cervix.
Additional tests for patients with abnormal Pap test results.
Because the Pap test is a screening test rather than a diagnostic test, patients with abnormal Pap test results have additional tests (colposcopy and biopsy) to find out whether or not a precancerous change or cancer is present. If the biopsy shows SIL or dysplasia, steps will be taken to prevent progression to an actual cancer.
How Pap Tests are Reported
If certain symptoms suggest cancer or if the Pap test shows abnormal cells, your healthcare provider may perform an additional test called a colposcopy. In this procedure, an instrument with magnifying lenses (very much like binoculars) is used to view the cervix through the vaginal speculum. The lens makes it possible to see the surface of the cervix closely and clearly. The exam is not painful and has no side effects. It can be performed safely throughout pregnancy. If abnormal areas are seen on the cervix, a biopsy (removal of a small tissue sample) is done for study under the microscope by a pathologist in the laboratory. If an abnormal area is present, a biopsy is the only way to tell for certain whether you have a precancer, a true cancer, or neither.
Types of cervical biopsies
There are several types of biopsies used to diagnose cervical precancers and cancers. For precancers and early cancers, some types of biopsies can completely remove the abnormal tissue and may be the only treatment needed. In some situations, additional treatment of precancers or cancers are needed.
- Colposcopic biopsy: For this type of biopsy, a doctor or other healthcare provider first examines the cervix with a colposcope. This instrument uses magnifying binoculars to help find abnormal areas. A biopsy forceps is used to remove a small (about 1/8 inch) section of the abnormal area on the surface of the cervix. The biopsy procedure may cause mild cramping or brief pain and there may be light bleeding afterwards. A local anesthetic may be used to numb the cervix.
- Endocervical curettage (endocervical scraping): This procedure is usually done during the same session as the colposcopic biopsy. A narrow instrument (the curette) is inserted into the endocervical canal (the passage between the outer part of the cervix and the inner part of the uterus). Some of the tissue lining the endocervical canal is removed by scraping with the curette and sent to the laboratory. Because the colposcope views only the outer part of the cervix and cannot see into the endocervix , healthcare providers use the endocervical scrape to find out if this area is affected by precancer or cancer. A local anesthetic may be used to numb the cervix. Patients may have a temporary cramping sensation, similar to a severe menstrual cramp. There may be light bleeding after the procedure.
- Cone biopsy: This procedure removes a cone-shaped piece of tissue from the cervix. The base of the cone is formed by the ectocervix (outer part of the cervix), and the point or apex of the cone is from the endocervical canal. The transformation zone (the border between the ectocervix and endocervix) is contained within the cone. This is important, because this transformation zone is the area of the cervix where precancers and cancers are most likely to develop. The cone biopsy is also a treatment, and can completely remove many precancers and very early cancers. There are two methods commonly used for cone biopsies, the loop electrosurgical excision procedure (LEEP or LLETZ) and the cold knife cone biopsy.
The LEEP (LLETZ) removes tissue using a wire that is heated by electrical current. This procedure uses a local anesthetic, and can be done in your doctor's office. It takes only about ten minutes. There may be mild cramping during and after the procedure, and mild to moderate bleeding may persist for several weeks.
The cold knife cone uses a surgical scalpel or a laser as a scalpel, rather than a heated wire to remove tissue. It requires general anesthesia (you are asleep during the operation). It is done in a hospital, but no overnight stay is needed. After the procedure, cramping and some bleeding may persist for a few weeks.
How are patients with abnormal Pap test results treated to prevent cancers from developing?
If an area of SIL can be seen using colposcopy, your doctor will be able to remove the abnormal area by using the biopsy techniques discussed earlier in this section such as the LEEP (LLETZ) technique or a cold knife cone biopsy or by destroying the abnormal cells with cryosurgery or laser surgery. Cryosurgery uses a metal probe cooled with liquid nitrogen to kill the abnormal cells by freezing. Laser surgery uses a focused beam of high energy light to vaporize the abnormal tissue. Both of these treatments can be done in a doctor's office or clinic without staying overnight in the hospital. After treatment, women may have a watery brown discharge for a few weeks.
These treatments are almost always effective in destroying precancers and preventing them from developing into true cancers. Follow-up examinations will be needed to make sure that the abnormality does not come back. If they do, treatments can be repeated.
|HOW IS CANCER OF THE CERVIX TREATED?
Options for treating each patient with cervical cancer depend on the stage of her disease. The stage of a cancer describes its size, depth of invasion and how far it has spread.
After the stage of your cervical cancer has been established, your cancer care team will recommend a treatment strategy. Consider the options without feeling rushed. If there is anything you do not understand, ask for explanations. While the choice of treatment depends largely on the stage of the disease at the time of diagnosis, other factors are your age, your general health, your individual circumstances, and your preferences. Be sure you understand all the risks and side effects of the various therapies before making a decision about treatment.
You may want to seek a second opinion for personal or practical reasons. On the personal level, seeking a second medical perspective can deepen your understanding of your treatment options and help you decide whether to work with your initial medical team or with those proposing a second view. On the practical side, some insurance companies require a second opinion before authorizing payment for your cancer care expenses.
The three main types of treatment used for patients with cervical cancer are surgery, radiation therapy and, less commonly, chemotherapy.
Types of surgery for cancer of the cervix
- Laser surgery: A focused laser beam is used to vaporize (burn off) abnormal cells or to remove a small piece of tissue for study. Laser surgery is used as treatment for preinvasive cervical cancer. It is not used in the treatment of invasive cancer.
- Simple Hysterectomy: This is surgical removal of the uterus (the body of the uterus and the cervix). The tissue next to the uterus (parametria and uterosacral ligaments) are not removed. The vagina remains entirely intact, and pelvic lymph nodes are not removed. The ovaries and fallopian tubes are left in place unless they are affected by some other disease.
- Cone biopsy: A cone shaped piece of tissue is removed from the cervix using a surgical or laser knife (cold knife cone) or using the LEEP (LEETZ) procedure. The LEEP (LEETZ) procedure uses a thin wire heated by electricity to remove tissue. See the section on " Can Cancer of the Cervix be Prevented? " for more information. A cone biopsy is rarely used as the sole treatment, except in those women with early (Stage IA) cancer who might want to have children. It may be used to establish the diagnosis of cancer, prior to treatment with additional surgery or radiation. The uterus is removed through a surgical incision in the front of the abdomen or through the vagina. General or epidural (regional) anesthesia is used. A hospital stay of 3 to 5 days is usual. Complete recovery takes about 3-6 weeks. The surgery results in infertility (inability to have children). Complications are unusual, but could include excessive bleeding, wound infection, or damage to the urinary or intestinal systems. A simple hysterectomy is done to treat some Stage IA cervical cancer. The operation is used for some stage 0 cancers (carcinoma in situ), such as some cases where the abnormal cells involve the surgical margins (edges) of the cone biopsy. The same operation is also used to treat some noncancerous conditions such as large leiomyomas (a benign tumor of the muscle of the uterus, also known as fibroids), severe cases of adenomyosis (monthly bleeding in the muscle of the uterus that can cause severe pain), and some cases of prolapse of the uterus (weakening of the ligaments that hold the uterus in place causing the uterus to extend into the vagina or even outside the body).
- Radical hysterectomy and pelvic lymph node dissection: Like a simple hysterectomy, this operation removes the entire uterus. However, the tissues next to the uterus (parametria and uterosacral ligaments), the upper part (about 1 inch) of the vagina next to the cervix, and lymph nodes (bean-shaped collections of immune system tissue) from the pelvis are also removed. The ovaries and fallopian tubes are not removed unless there is some other medical reason to do so. Although this procedure is usually performed with an abdominal surgical incision, it is possible to perform this procedure using a vaginal approach, in combination with a laparoscopic pelvic node dissection. Laparoscopy is a relatively new method for viewing the inside of the abdomen and pelvis through a tube inserted into a very small surgical incision. Small surgical instruments can be controlled through the tube, allowing the surgeon to remove lymph nodes through the tube without a large incision in the abdomen. Since more tissue is removed than for a simple hysterectomy, the hospital stay is longer -- about 7 days. The surgery results in infertility. Complications are unusual, but could include excessive bleeding, wound infection, or damage to the urinary and intestinal systems. A radical hysterectomy and pelvic lymph node dissection are the usual treatment for stages IB and IIA cervical cancer, especially in young patients.
- Pelvic exenteration: In addition to removing all of the organs and tissues as in a radical hysterectomy and pelvic lymph node dissection, this operation may also remove the bladder, vagina, rectum, and part of the colon. This operation is used to treat recurrent cervical cancer. If the bladder is removed, it will be necessary to create a way to store and eliminate urine. This usually involves using a short segment of intestine to function as a new bladder. This may be connected to the abdominal wall so that urine is drained periodically when the patient places a catheter into a urostomy (a small opening). Or, urine may drain continuously into small plastic bag attached to the front of the abdomen. If the rectum and part of the colon is removed, a new way to eliminate solid waste is needed. This is done by attaching the remaining intestine to the abdominal wall so that fecal material can pass through a colostomy (a small opening)into a small plastic bag worn on the front of the abdomen. It may be possible to remove the involved colon (next to the cervix) and reconnect the colon, so no bags or external appliances are needed. If the vagina is removed, a new vagina can be surgically created out of skin, intestinal tissue, or by myocutaneous (muscle and skin) grafts.
- Radiation therapy for cervical cancer: Radiation therapy uses high energy x-rays to kill cancer cells. These x-rays may be given externally in a procedure that is much like having a diagnostic x-ray. This is called external beam radiation therapy. It also may be given as an implant of radioactive materials near the tumor. This is called brachytherapy.
The skin in the treated area may look and feel sunburned, but this gradually fades into a tanned look, returning to a normal appearance in six to 12 months. Many women also notice tiredness, upset stomach, or loose bowels. Pelvic radiation therapy may cause vaginal stenosis (narrowing of the vagina by scar tissue), which might make intercourse painful. Premature menopause and problems with urination may also occur. If you are having side effects from radiation, discuss them with your cancer care team. There are treatments to obtain relief from these symptoms, and restore normal vaginal length.
- Chemotherapy for cervical cancer: Chemotherapy uses anticancer drugs that are given into a vein or by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment potentially useful for cancer that has spread beyond the cervix. If this treatment is chosen, you may receive a combination of drugs. Combination chemotherapy is sometimes more effective in treating cancer than one drug alone. Drugs used in treating cervical cancer include cisplatin, hydroxyurea, ifosfamide, and paclitaxel. These drugs kill cancer cells but can also damage some normal cells. Therefore, careful attention is given to avoiding or minimizing side effects.
Side effects of chemotherapy depend on the type of drugs, the amount taken, and the length of time you are treated. They include:
- Upset stomach and vomiting (new medications given together with the chemotherapy can prevent these unpleasant side effects)
- Loss or increase of appetite
- Temporary loss of hair
- Mouth or vaginal sores
- Increased chance of infections, bleeding, or anemia (low red blood cells)
- Changes in the menstrual cycle
- Premature menopause
- Infertility (inability to become pregnant) - Note: most women with cervical cancer are already infertile before chemotherapy as a result of surgery or radiation therapy.
Most of these side effects of chemotherapy (except premature menopause and infertility) stop when the treatment is over. Premature menopause can be treated with hormones. You will need to discuss this with your cancer care team. If you are taking chemotherapy and have side effects, there are remedies for many of them. Be sure to talk with your cancer care team about any side effects you are experiencing.
- Clinical Trials: Clinical trials are scientific studies of promising new treatments. Ask your cancer care team about clinical trials for which you may qualify. You can obtain a current list of these trials from the National Cancer Institute's Cancer Information Service by calling 1-800-4-CANCER.
Treatment options for cervical cancer by stage
The stage of a cervical cancer is the most important factor in choosing treatment. However, other factors that affect this decision include the exact location of the cancer within the cervix, the type of cancer (squamous cell versus adenocarcinoma), your age, your overall condition, and your desire to have children.
- Stage 0 (carcinoma in situ): Treatment options are the same as for precancerous changes (squamous intraepithelial lesions, dysplasia or CIN). Options include cryosurgery, laser surgery, loop electrosurgical excision procedure (LEEP/LEETZ), and cold knife conization. A simple hysterectomy is occasionally done if the cancer returns after conization or if other diseases of the uterus are also present and the woman does not want to have additional children. All of these cancers can be cured with appropriate treatment. However, the precancerous changes or the stage 0 cancer can recur (come back) in the cervix or vagina, so close follow-up is very important.
- Stage IA: The treatment for some stage IA cervical cancer is simple hysterectomy. However, if the cancer has invaded more than 3 mm or invaded the lymph-vascular channels, a radical hysterectomy will be needed. In patients whose tumor invasion is very superficial, treatment by cold knife conization is another option. This approach requires careful medical follow-up so that additional treatment can be given if the cancer recurs (comes back). A consultation with a gynecologic oncologist may be advisable to see if you qualify for this treatment. The advantage of conization is that having more children is still possible. The five year survival rate is over 95%.
- Stage IB: Either of two treatments may be used. The first option is radical hysterectomy with pelvic lymph node dissection. If cancer cells are found to extend to the edge of the organs removed, or if lymph node involvement is detected in this operation, postoperative (after surgery) radiation therapy may be used. Some women with stage IB cancers with certain patterns of growth and invasion may receive radiation therapy before a hysterectomy. The second treatment option is high-dose internal and external radiation therapy. The choice of high-dose radiation therapy or radical hysterectomy with pelvic lymph node dissection has no effect on cure rates (about 85%-90%). The basis for this decision is a woman's feelings about the side effects of the two treatments and the presence of any other medical conditions that might make surgery dangerous.
- Stage IIA: Either of two treatments may be used. The first is high dose internal and external radiation therapy. The second is radical hysterectomy with pelvic lymph node dissection. The choice of radiation therapy or radical hysterectomy with pelvic lymph node dissection has no effect on cure rates (about 75%-80%). The basis for this decision is dependent on the size and other characteristics of the tumor, a woman's feelings about the side effects of the two treatments and the presence of any other medical conditions that might make surgery dangerous.
- Stage IIB: Combined internal and external radiation therapy is the recommended treatment. The 5 year survival rate is about 65%. Clinical trials are in progress to test new ways to deliver radiation therapy and to see if addition of chemotherapy is useful.
- Stage III: Combined internal and external radiation therapy is the recommended treatment. The 5 year survival rate is about 40%. Clinical trials are in progress to test new ways to deliver radiation therapy and to see if addition of chemotherapy is useful.
- Stage IVA: Combined internal and external radiation therapy is the recommended treatment. The 5 year survival rate is less than 20%. Clinical trials are in progress to test new ways to deliver radiation therapy and to see if addition of chemotherapy is useful.
- Stage IVB: Cancer at this stage is not considered curable. Treatment options include radiation therapy to relieve the symptoms of local (near the cervix) spread or of distant metastases. Clinical trials are in progress to test new combinations of one or more chemotherapy drugs, as well as some other experimental treatments.
Recurrent cervical cancer: This means that the disease has recurred (or come back) after treatment. Recurrence can be local (in the pelvic organs near the cervix) or distant (spread through the bloodstream to organs such as the lungs or bone).
If the cancer has recurred in the pelvis only, treatment by palliative treatment exenteration (extensive surgery) is an option for some patients. This treatment may cure from 40%-50% of patients. Or, (treatment to relieve symptoms) by radiation or by chemotherapy may be chosen. Enrollment in a clinical trial may help these patients.
If distant recurrence is present, palliation of specific symptoms using chemotherapy or radiation therapy is an option. If chemotherapy is used, the goals and limitations of this therapy should be clearly understood. From 15%-25% of patients may respond, at least temporarily, to chemotherapy. Clinical trials are in progress to evaluate new treatments that may benefit patients with distant recurrence of cervical cancer.
WHAT WILL HAPPEN AFTER TREATMENT FOR CERVICAL CANCER?
Each type of treatment for cervical cancer could have side effects that may last from a few months to many years. A woman may be able to hasten her recovery by being aware of those side effects before treatment and by taking steps to minimize them and shorten their duration where possible after treatment.
From the start, keep in mind that you must deal with your own individual physical and emotional factors. In the process of deciding what kind of treatment to have, for instance, you will find it helpful to discuss options with your family and friends, as well as with your primary care physician and nurse. At every step of the way in pre-treatment, treatment, and recovery, you should talk with your cancer care team about side effects, ways to make them easier to endure, and the general outlook, or prognosis, for your case. They want to answer your questions, so ask them!
Your body is as unique as your personality and your fingerprints. Scientists can determine certain facts about tumors and drugs, and doctors can use a variety of treatments to eliminate the cancer. But no one can say precisely how you will respond to cancer or its treatment.
You may have special strengths such as a healthy immune system, a history of excellent nutrition, a strong family support system, a deep faith. All of these can make a difference in how you respond to cancer. In fact, behavioral scientists have recently found that women who took advantage of a social support system, such as a cancer support group, survived with a better quality of life.
An important part of your treatment plan is a specific schedule of follow-up visits after surgery, chemotherapy, or radiation therapy to be sure what, if any, additional treatment is necessary.
Follow-up may involve procedures such as x-rays, CT scans, ultrasound studies, or magnetic resonance imaging. There also may be biopsies to get tissue samples for laboratory microscopic evaluation, blood tests, and other examinations.
You can help in your own recovery from cancer by making healthy lifestyle choices.
If you use tobacco, stop now. Quitting will improve your overall health and the full return of the sense of smell may help you enjoy a healthy diet during recovery.
If you use alcohol, limit how much you drink. Have no more than one or two drinks per day.
Good nutrition can help you get better after treatment. Eat a nutritious diet. Researchers are also finding increasing evidence of the importance of nutrition in the prevention of cancer. Eat less fat, especially animal fat. Most patients should eat more fruits, vegetables, whole grains, and high-fiber foods. However, if you developed diarrhea or cramping pain after radiation therapy, your healthcare team may recommend a low-fiber diet.
Exercise once you are well.
If you are in treatment for cancer, be aware of the battle that is going on in your body. Radiation therapy and chemotherapy add to the fatigue caused by the disease itself. Give your body all the rest it needs so that you will feel better as time goes on.
A cancer diagnosis and its treatment is a major life challenge, with an impact on you and everyone who cares for you. Before you get to the point where you feel overwhelmed, consider attending a meeting of a local support group. If you need individual assistance in other ways, contact your hospital's social service department or your local Division of the American Cancer Society for help in contacting counselors or other services.
Finally, your cancer care team is always ready to help you understand your disease and treatment to answer your questions about what you can do to improve your outlook for the future.
WHAT SHOULD YOU ASK YOUR PHYSICIAN ABOUT CERVICAL CANCER?
It is important for you to have frank, open discussions with your cancer care team. They want to answer all of your questions, no matter how trivial you might think they are. Here are some questions to consider:
- What type of cervical cancer do I have?
- Has my cancer spread beyond the cervix?
- What is the stage of my cancer and what does that mean in my case?
- What treatments are appropriate for me? What do you recommend? Why?
- What should I do to be ready for treatment?
- What are the risks or side effects that I should expect?
- Will I be able to have children after my treatment?
- What are the chances my cancer will recur (come back) with the treatment programs we have discussed?
- Should I follow a special diet?
- What is my expected prognosis, based on my cancer as you view it?
- Where can I get a wig?
- What do I tell my children, husband, parents, and other family members?
In addition to these sample questions, be sure to write down some of your own. For instance, you might want specific information about anticipated recovery times so you can plan your work schedule. Or, you may want to ask about second opinions or about clinical trials for which you may qualify.