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Cervical Cancer Screening
Cervical cancer is curable in its early stages. Regular screening can help detect this cancer. Cervical cancer screening uses two kinds of tests:
Current cervical cancer screening guidelines from the United States Preventive Services Task Force (USPSTF), the American Cancer Society (ACS), and the American College of Obstetricians and Gynecologists (ACOG) recommend:
Human papillomavirus (HPV) is the most common sexually transmitted disease. High-risk strains of HPV cause cervical cancer, as well as other types of cancer. Low-risk strains of HPV cause genital warts. Nearly all cases of cervical cancer are caused by HPV.
Two vaccines, Gardasil and Cervarix, are available to prevent (not treat) cervical cancer in girls and young women. Gardasil is also approved for boys. Both vaccines protect against HPV-16 and HPV-18, the two HPV strains that cause most cases of cervical cancer. Gardasil, but not Cervarix, also protects against HPV-6 and HPV-11, the two viruses that cause most cases of genital warts.
Current immunization guidelines recommend the HPV vaccine for all girls and boys ages 11 - 12. The vaccine is given as a 3-dose series.
The cervix is the lower third portion of the uterus (womb). It serves as a neck to connect the uterus to the vagina. The opening of the cervix, called the os, remains small and narrow, except during childbirth when it widens to allow a baby to pass from the uterus into the vagina.
Cervical cancer develops in the thin layer of cells called the epithelium, which cover the cervix. Cells found in this tissue have different shapes:
Cervical cancer usually begins slowly with precancerous abnormalities, and even if cancer develops it generally progresses very gradually. Cervical cancer usually takes about 10 - 20 years to develop.
Cervical cancer is the most preventable type of cancer and is very treatable in its early stages. Regular Pap tests and human papillomavirus (HPV) screening can help detect this disease early.
Dysplasia is a term that refers to a pre-cancerous condition. In the case of cervical cancer, dysplasia indicates that some cells on the outside of the cervix (squamous epithelial cells) are abnormal in size and shape and are beginning to grow. However, the abnormal cells are still confined to the surface (epithelial layer). These abnormal cells may eventually become cancerous, but this does not always happen.
Pap test screening can help identify abnormal cells that may be pre-cancerous, but a biopsy is necessary for confirmation. In a biopsy test result, pre-cancerous cells are classified as cervical intraepithelial neoplasia (CIN), which is another term for dysplasia. The severity of CIN is graded on a scale of 1 to 3:
(For more information on pre-cancer, see the Diagnosis and Screening section of this report.)
The cells of the epithelium rest on a very thin layer called the basement membrane. Invasive cervical cancer occurs when cancer cells in the epithelium cross this membrane and invade the stroma, the underlying supportive tissue of the cervix.
In later stages, the original cancer may spread to areas surrounding the uterus and cervix or near organs such as the bladder or rectum. It may also spread to distant sites in the body through the bloodstream or the lymph nodes.
The human papillomavirus (HPV) is the main cause and risk factor of cervical cancer. Nearly all cases of cervical cancer are caused by HPV. In general, doctors assume that a woman with cervical cancer has been infected with HPV.
HPV is a very common sexually transmitted virus. There are many different types of HPV:
At least half of sexually active women and men are infected with HPV at some point in their lives. HPV usually goes away on its own. Only 10% of women remain infected for more than 5 years. But sometimes HPV does not go away. A chronic, long-term infection with a high-risk type of HPV can cause changes in cervical cells that eventually lead to cancer.
HPV infection is spread primarily by having sex with a partner infected with HPV. It is transmitted through skin-to-skin contact with infected areas of the genitals, anus, or mouth. Using condoms and limiting the number of sexual partners can help reduce the risk of contracting HPV.
About 12,000 new cases of invasive cervical cancer are diagnosed each year in the U.S. However, the number of new cervical cancer cases has been declining steadily over the past decades.
Although it is the most preventable type of cancer, each year cervical cancer kills about 4,000 women in the U.S. and about 300,000 women worldwide. In the United States, cervical cancer mortality rates plunged by 74% from 1955 - 1992 thanks to increased screening and early detection with the Pap test.
Cervical cancer is extremely rare in women younger than age 20. The median age of diagnosis is 48 years. Half of all cervical cancer diagnoses occur in women ages 35 - 54 years. About 20% of cervical cancer diagnoses occur in women over 65 years of age, mostly in women who did not receive regular cancer screening during their younger years. .
In the United States, Hispanic women are most likely to develop cervical cancer, followed by African-American women. African-American women have the highest death rate from cervical cancer. Asians, Caucasians, and Native American women have the lowest risks for being diagnosed with and dying from cervical cancer.
These differences are probably related to socioeconomic factors. Numerous studies report that high poverty levels are linked with low screening rates. In addition, lack of health insurance, limited transportation, and language difficulties often hinder a poor woman’s access to screening services.
Human papillomavirus (HPV) is the main risk factor for cervical cancer. The most important risk factor for HPV is sexual activity with an infected person. Women most at risk for cervical cancer are those with a history of multiple sexual partners, sexual intercourse at age 17 years or younger, or both. A woman who has never been sexually active has a very low risk for developing cervical cancer.
Sexual activity with multiple partners increases the likelihood of many other sexually transmitted infections (chlamydia, gonorrhea, syphilis). Studies have found an association between chlamydia and cervical cancer risk, including the possibility that chlamydia may prolong HPV infection.
Women have a higher risk of cervical cancer if they have a first-degree relative (mother, sister) who has had cervical cancer.
Long-term use of oral contraceptives (OCs, birth control pills) may increase the risk for cervical cancer. Women who take birth control pills for more than 5 - 10 years appear to have a much higher risk HPV infection (up to four times higher) than those who do not use OCs. (Women taking OCs for fewer than 5 years do not have a significantly higher risk.)
The reasons for this risk from OC use are not entirely clear. Some research suggests that the hormones in OCs might help the virus enter the genetic material of cervical cells. Another possible reason is that women who use OCs may be less likely to use condoms. Latex condoms can help reduce the risk of HPV transmission and other STDs.
Having given birth to three or more children may increase the risk for cervical cancer.
Smoking is associated with a higher risk for pre-cancerous changes (dysplasia) in the cervix and for progression to invasive cervical cancer.
Women with weak immune systems, such as those with HIV/AIDS, are more susceptible to acquiring HPV. Immunocompromised patients are also at higher risk for having cervical pre-cancer develop rapidly into invasive cancer.
From 1938 - 1971, diethylstilbestrol (DES), an estrogen-related drug, was widely prescribed to pregnant women to help prevent miscarriages. The daughters of these women face a higher risk for cervical cancer as well as other gynecological problems. DES is no longer prescribed.
The best ways to prevent cervical cancer are:
Two vaccines are approved by the Food and Drug Administration (FDA) to prevent either HPV or cervical cancer: Gardasil and Cervarix.
Gardasil is approved for:
Cervarix is approved for:
Current immunization guidelines recommend:
The HPV vaccine can only prevent -- not treat -- HPV infection, genital warts, and cervical cancer. Because the vaccine cannot protect females who are already infected with HPV, doctors recommend that girls and boys get vaccinated before they become sexually active. Studies indicate that the vaccine is nearly 100% effective in preventing cervical cancer and genital warts (caused by the HPV types covered in the vaccine) when given prior to HPV exposure. However, young women who are sexually active may still derive some benefit from the vaccine, at least for protection against any of the four HPV strains that they have not yet acquired.
The most common side effects of the vaccine include discomfort or pain at the injection site, headache, and mild fever.
These vaccines do not protect against all types of cancer-causing HPV. Women should receive regular screening to detect any early signs of cervical cancer. For girls and women who have been sexually active before they receive the vaccine, screening still provides the best protection against cervical cancer.
Condoms provide some protection against HPV as well as other sexually transmitted diseases.
Male circumcision may possibly reduce the risk of HPV, but it does not completely prevent it. Men who are circumcised should still use condoms.
Some recent evidence suggests that the intrauterine device (IUD) may help protect against cervical cancer. The IUD is a type of birth control that is inserted into the uterus by a health professional. It is a small plastic T-shaped device that contains either the hormone progesterone or copper. Researchers are not certain exactly how the IUD reduces cervical cancer risk, but think that the process of inserting or removing the device may destroy pre-cancerous lesions. Still, there may also be some risks associated with IUDs. Discuss the risks and benefits with your doctor.
Regular Pap tests are the most effective way to diagnose cervical cancer when it is still in its earliest, most curable stages. In some cases, a HPV test may also be used. [For more information, see Diagnosis and Screening section of this report.]
A patient’s prognosis for cervical cancer depends on the stage of the cancer, the type of cervical cancer, and the size of the tumor.
Over the past 30 years, the death rate from cervical cancer has declined significantly. African-American women tend to have poorer 5-year survival rates than Caucasian women, although survival rates have significantly improved in African-American women in recent years.
The earlier that cervical cancer is detected, the better the odds for survival.
About half of cervical cancer cases are diagnosed in the early stages when the cancer is confined to the cervix (localized; Stage I). About 35% of cases are diagnosed after the cancer has spread to adjacent areas or lymph nodes (regional; Stage II/III), and about 10% of cases are diagnosed when the cancer has already spread to distant regions (metastasized; Stage IV).
Depending on the stage and spread of cancer, 5-year survival rates are:
Most women with dysplasia or pre-invasive cancer have no symptoms. Screening tests, therefore, are very important.
Symptoms of invasive cancer include:
These symptoms are not exclusive to cervical cancer. Sexually transmitted diseases, for instance, can cause similar symptoms.
The changes that lead to cervical cancer develop slowly. Screening tests performed during regular gynecologic examinations can detect early changes. The two tests used for cervical cancer screening are:
The Papanicolaou test, better known as the Pap test or Pap smear, can help detect cervical cancer when it is in its earliest stages. It can also detect pre-cancerous changes in cells. Use of the Pap test has significantly reduced the death rate from cervical cancer. Most cases of cervical cancer occur in women who have not had regular Pap tests.
Preparing for a Pap Test. To help get the most accurate results, doctors recommend scheduling a Pap test for the 10 - 20 days after menstruation begins. Those are the best days for obtaining the most accurate results. The Pap test should not be performed during menstruation.
In the 24 - 48 hours before the test:
The Procedure. A Pap test is usually painless, although some women may have some discomfort.
Reliability and Accuracy. The Pap test is not a perfectly reliable measure of a woman's risk for cervical cancer. In general, about 10% of Pap tests have abnormal results, but only about 0.1% of the women who have these results actually have cancer. In most cases, abnormal cells are low grade and not likely to progress to cancer or are due to benign conditions, including natural cell changes after menopause.
No test is 100% accurate, and it is possible for the Pap test to miss the presence of cancer. However, if abnormal cells are missed on one test, they are likely to be spotted during the next one. It is also possible for a test to indicate abnormal cells when the cells are really normal. If a test indicates possible abnormal cells, your doctor will order another Pap test or additional other tests to confirm the results.
For a HPV test, the doctor collects a sample of the cervical cells the same way (and usually at the same time) as the Pap test. This test looks for the types of human papillomavirus that cause cervical cancer by analyzing the DNA of the cervical cells. The HPV test can be used along with the Pap test to screen for cervical cancer in women ages 30 years and older. It may also be used to provide more information after an abnormal Pap test in women ages 21 years and older.
General guidelines for cervical cancer screening recommend:
The cells viewed in a cervical smear sample are classified on a scale representing the spectrum of cell changes from normal to cancerous. The Pap test is first characterized as either normal or abnormal.
Once abnormal epithelial cells are identified, the doctor must decide whether the patient needs a repeat Pap test, an HPV test, or more invasive testing with colposcopy and biopsy. (Colposcopy is a procedure used to magnify the cervix and to help find lesions for biopsy). To help the doctor make the decision, the abnormal cells are divided into categories, depending on the degree of abnormality, and whether they are squamous or glandular (adenocarcinoma).
Squamous cell carcinoma represents the large majority of all cervical cancers. The remaining cases are either a combination of squamous and glandular, or rarer types.
The Bethesda System (TBS) is used to report Pap test results. It classifies abnormal results as atypical squamous cells (ASC with subtypes of ASC-US and ASC-H), squamous intraepithelial lesions (SILs) or atypical glandular cells.
Atypical Squamous Cells. Atypical squamous cells (ASC) are mildly abnormal cells on the surface of the cervix. It is difficult to know if they are pre-cancerous. They may be normal cells with changes simply be caused by inflammation. Atypical squamous cells are further categorized as ASC-US or ASC-H:
Squamous Intraepithelial Lesions (SILs). Squamous intraepithelial lesions (SILs) are classified as either low-grade (LGSIL) or high-grade (HGSIL). High-grade SILs are more serious than low-grade SILs, and need to be treated because they can develop into invasive cancer. Pap tests can identify the presence of SILs but not their grade. All patients with SILs should undergo colposcopy. A colposcopy can determine whether SILs are high-grade or low-grade and whether treatment is required.
Atypical Glandular Cells and Adenocarcinoma. Atypical glandular cells pose a higher risk for cancerous changes than atypical squamous cells or low-grade squamous intraepithelial lesions. Patients with atypical glandular cells need colposcopy and endocervical testing. Adenocarcinoma refers to glandular cells that are cancerous.
The Pap test shows only the presence of abnormal cells. It is useful simply as a screening test that identifies women who may have pre-invasive or early cancerous changes. For a definitive diagnosis, the next step is usually colposcopy, during which the cervix is visualized under low power magnification. The surgeon takes samples of suspicious cells for biopsies. A biopsy will determine the stage of the pre-cancerous growth or whether invasive cancer is present.
The Procedure. Colposcopy can be performed in a doctor's office without anesthesia in 10 - 15 minutes. It causes about as much discomfort as mild menstrual cramps:
After the colposcopy, the woman may have a brownish discharge from an iron solution called Monsel's solution, which the doctor applies to prevent bleeding. Doctors usually advise sexual abstinence for 1 - 2 weeks.
The pre-cancerous changes from biopsy results of colposcopy are called cervical intraepithelial neoplasia. They are graded according to severity: CIN I, CIN II, and CIN III.
CIN III is considered the same as carcinoma in situ (CIS) or Stage 0 cervical cancer. In both CIN III and CIS the pre-cancerous cells still rest on the surface of the cervix and have not yet invaded deeper tissues. However, if not surgically removed, there is a high chance that CIN III or CIS can progress to invasive cancer.
Follow-Up Procedures. Women with evidence of cervical intraepithelial neoplasia (CIN) or cervical cancer need treatment. Women with biopsies that show low-grade abnormal cells, but whose cervix is otherwise normal, are generally given follow-up colposcopies.
If a biopsy detects invasive cancer, the patient will need additional tests to find out how far the cancer has spread. Tests to stage cancer may include a computed tomography (CT) scan (to check for the spread of the disease to lymph nodes and areas around the pelvic region), chest x-ray, ultrasound, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, and other imaging tests.
Treatment of cervical intraepithelial neoplasia (CIN), including pre-invasive cancer, depends on the type and extent of abnormal changes. Some of the treatments for CIN are also used for early-stage cancer.
In contrast to cervical intraepithelial neoplasia, cervical cancer represents true invasion of cells beyond the epithelium into surrounding tissue. Cervical cancer may be detected in a biopsy performed during colposcopy for an abnormal Pap smear, or it may be visible to the naked eye when the doctor performs a speculum exam.
After making a diagnosis, the doctor will classify the stage of the cancer according to how far the disease has spread into the lining of the cervix, throughout the cervix, or beyond. Doctors use these classifications to determine treatment and prognosis.
Stage 0. Stage 0 cancer is also called carcinoma in situ. It is equivalent to CIN III pre-invasive cancer. In stage 0, the cancer cells are confined to the first layer of cervical tissue (the epithelium) lining the cervix and have not yet spread further in the cervix.
Stage I. Stage I is invasive cancer, but the tumor is confined to the cervix. This stage is further categorized as IA and IB, which each have further subcategorizations based on the size of the tumor:
Stage II. Stage II invasive cancer has spread beyond the cervix, but it has not spread to the pelvic side wall. This stage is further categorized as IIA and IIB.
Stage III. In stage III, the cancer has spread to the lower third of the vagina.
Stage IV. Stage IV is advanced (metastasized) cancer. The cancer has spread to other organs or parts of the body.
Treatments for cervical cancer depend on the stage of the cancer. Clinical trials investigating new treatment approaches are available for all stages of cervical cancer.
Stage 0. Stage 0 cancer is carcinoma in situ (CIN III) and is considered a pre-invasive cancer. Treatment options include:
Stage IA1. Treatment options for stage IA1 may include:
Stage IA2. Treatment options for stage IA2 may include:
Stage IB1. Treatment options for stage IB1 may include:
Stage IB2. Treatment options for stage IB2 may include:
Stage IIA. Treatment options for stage IIA may include:
Stage IIB. Treatment options for stage IIB may include:
Stage III. Treatment options for stage IIIA and stage IIIB may include combined internal and external radiation therapy plus chemotherapy Stage IVA.
Treatment options for stage IVA may include combined internal and external radiation therapy plus chemotherapy.
Stage IVB. Stage IVB cancer is generally not considered curable. Treatment options may include:
Recurrent Cancer. Cervical cancer may recur locally in the lymph nodes near the cervix, it may spread to distant sites, such as the lung or bones, or it may appear both locally and in distant locations. Treatment options depend on where the cancer has recurred. They include:
Cervical cancer is one of the most common cancers diagnosed during pregnancy. To diagnose the condition, a cervical biopsy, in which a small amount of tissue is removed for diagnosis, can be performed anytime during the pregnancy. However, a cone biopsy (conization), which removes larger amounts of tissue, is typically delayed until after the first trimester to reduce the risk of causing a miscarriage. Conization does increase the risk for preterm delivery and may increase this risk for future pregnancies. The loop electrosurgical excision procedure (LEEP/LLETZ) may be performed in centers equipped to handle it, but should be reserved only for patients in whom invasive disease is strongly suspected.
Treatment of cervical cancer depends in part on whether a patient wishes to continue the pregnancy, and her desire for future fertility. For pregnant women who want to continue the pregnancy, and preserve fertility when possible, treatment options may include:
Women of child-bearing age should discuss with their doctors any concerns and questions they may have about how various cancer treatments could affect their fertility. They may also wish to have a consultation with a fertility specialist. Some women with cervical cancer may be candidates for surgical procedures that preserve fertility. Other women may want to consider assisted reproductive technology such as embryo or oocyte (egg) cryopreservation (“freezing”). It is very important that you have these discussions with your health care team before you begin cancer treatment.
In the early stages of cervical cancer, surgery is usually the preferred primary treatment approach. Not all women are candidates for all surgical procedures.
Surgery procedures by stage are:
Loop electrosurgical excision procedure (LEEP), also called large loop excision of the transformation zone (LLETZ), uses a high frequency electrical current to cut away diseased tissue.
The procedure is done in one office visit. Extensive and deep sections of damaged tissue can be effectively removed in this visit. Disease can be cured in one treatment. When used for dysplasia, it appears to be as effective as more invasive procedures.
Laser surgery for cervical cancer uses a laser beam, in place of a knife, to burn off abnormal cells or to remove pieces tissue for biopsy. The laser beam is directed through the vagina.
Conization is a surgical procedure that removes a cone-shaped piece of tissue from the cervix. Conization uses either a heated wire, like LEEP, or it may involve a scalpel or laser (in which case the procedure is sometimes called “cone knife cone biopsy”). The surgery is performed under general anesthesia in an operating room. With conization, the ability to become pregnant can be preserved in most cases.
A hysterectomy attempts to eliminate the cancerous tissue by removing the uterus and cervix. Hysterectomy causes infertility. After a hysterectomy, a woman no longer has menstrual periods and she can no longer become pregnant.
Depending on the stage of the cervical cancer and how far it has spread, the patient will usually have either a total (simple) hysterectomy or a radical hysterectomy.
Total Hysterectomy. A total (also called simple) hysterectomy involves the removal of the uterus and the cervix, but leaves the parametrium (tissue surrounding the uterus) and vagina intact. Lymph nodes in the pelvis are not usually removed. The uterus may be removed through an open abdominal incision or vaginally. There are various ways to perform vaginal hysterectomy, including laparoscopically. A simple hysterectomy is usually performed to treat early-stage cancer that is still confined to the cervix, such as stage IA1 cervical cancer.
Radical Hysterectomy. A radical hysterectomy removes not only the uterus and the cervix but also the parametrium, the supporting ligaments, the upper vagina, and some or all of the pelvic lymph nodes (a procedure called lymphadenectomy). The fallopian tubes and ovaries are not usually removed, (a procedure called bilateral-salpingo-oopherectomy) unless there are other medical reasons for doing so. The procedure may be performed through open abdominal surgery or through a laparoscopic vaginal hysterectomy. Radical hysterectomy is generally used to treat cervical cancers that have spread beyond the cervix such as those in stages IA2, IB1, and IB2.
Recovery. Hospital stays for simple hysterectomy range from 1 - 2 days for vaginal hysterectomy to 3 - 5 days for abdominal hysterectomy. Total recovery time is generally 2 - 3 weeks for vaginal hysterectomy and 4 - 6 weeks for abdominal hysterectomy. Radical hysterectomy generally requires a 5 - 7 hospital stay and about a 6-week recovery period.
Side Effects. Side effects after hysterectomy can include painful lower abdomen if an abdominal incision was used. About half of women develop minor and treatable urinary tract infections. There is usually mild pain and light vaginal bleeding post operation. More serious complications are uncommon but can include infection and blood clots. Normal activity, including sexual intercourse, can be resumed in about 4 - 8 weeks.
The effects of hysterectomy on sexuality vary among women. Women retain their clitoris and can still experience sexual arousal and climax. Some women note a change in their orgasmic response because they no longer experience uterine contractions. However, many women with cervical cancer have improved sexuality after hysterectomy as they no longer have symptoms such as pain or bleeding during intercourse.
Once the uterus is removed, menstruation will cease. If the ovaries are removed, the symptoms of menopause will begin. These symptoms are likely to be more severe in surgical menopause than in natural menopause. The patient should discuss the benefits and risks of hormone replacement therapy with her doctor.
Women who have had a hysterectomy with removal of the cervix no longer need to have Pap tests.
For some women with stage IA2 and stage IB1 cancer, radical trachelectomy may be a fertility-sparing alternative to hysterectomy. Radical trachelectomy involves removing the cervix, surrounding lymph nodes, and upper part of the vagina. The uterus is then reattached to the remaining vagina. Patients must meet strict criteria in terms of lesion size and lymph node involvement.
Radical trachelectomy poses a high risk for miscarriage during future pregnancy, but about half of women who have had this procedure have been able to carry a baby to term. The baby is delivered by cesarean section.
If the cancerous tumor recurs within the pelvis after primary treatment, the patient may need a more extreme procedure called a pelvic exenteration, which combines radical hysterectomy with removal of the bladder and rectum. The surgeon will perform a colostomy to create a new passage for the stool to leave the body and will similarly construct a new urinary drainage system. If the vagina is removed, a plastic surgeon may be able to reconstruct a new one. Full recovery for pelvic exenteration can take up to 6 months.
Radiation therapy is a treatment option for early stage cervical cancer (stages IA2 - IB1). Radiation given along with cisplatin-based chemotherapy is commonly used for stages IB2 - IVA cervical cancer.
There are two types of radiation therapy:
Both types of radiation therapy may be used together.
In order to be effective, radiation therapy must be powerful enough to destroy the cancer cells' capacity to grow and divide. This means that normal cells are also affected, which may cause significant side effects. Fortunately, healthy cells usually recover quickly from the damage, whereas abnormal cells do not.
Side Effects. Side effects of radiation therapy include fatigue, redness or dryness in the treated area, diarrhea, frequent or uncomfortable urination, and vaginal dryness, itching, or burning. After treatment, side effects usually disappear.
Long-Term Complications. Complications include proctitis (inflammation of the rectum) and cystitis (inflammation of the bladder). Radiation therapy may also cause vaginal scarring, sexual difficulties, and premature menopause in younger women.
Radiation itself may increase the risk for later development of cancer in the area surrounding the treated tissue. Although newer more precise radiotherapy approaches should reduce this risk, the development of secondary cancers may be of particular concern for younger patients.
Chemotherapy uses cell-killing drugs called cytotoxic drugs to destroy widespread cancer cells that have spread from the primary tumor and can no longer be treated with surgery or radiation alone. Chemotherapy is usually used along with radiation (a combination called “chemoradiation”) for treatment of stages IB1 - IVB cervical cancer. Chemotherapy can help increase the effectiveness of radiation therapy. In the most advanced cancer stage, IVB, chemotherapy is used palliatively to help relieve symptoms.
Platinum-Based Drugs. Platinum-based drugs are the main chemotherapy treatment for cervical cancer. Cisplatin is the primary drug used. Carboplatin is an alternative platinum drug that is used for treating more advanced cervical cancer.
Other drugs. Other drugs may be given alone or in combination with a platinum-based drug. They include paclitaxel, topotecan, gemcitabine, 5-FU, vinorelbine, and others.
Administration. Chemotherapy is given intravenously at a medical center or doctor's office. The drugs are given in cycles with a period of rest following a period of treatment, to allow recovery from the side effects.
Side Effects. Chemotherapy affects all fast-growing cells, including healthy ones. So, side effects are inevitable. Side effects occur with all chemotherapeutic drugs. They are more severe with higher doses and increase over the course of treatment. Side effects also tend to be more severe when chemotherapy is given along with radiation.
Common side effects may include:
Complications. Serious short- and long-term complications can also occur and may vary, depending on the specific drugs used. They include:
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