Treatment Options and Outlook
Cervical cancer is almost always curable with min-
imally invasive treatment when doctors detect it
as CIN or stage 1. Stage 2 and stage 3 cervical can-
cers require more invasive treatments and have
lower potential for cure. The primary treatment of
choice for most stage 1 cervical cancers is surgery
to remove the tumor, the entire cervix, or, in
more advanced stages, the cervix and adjacent tis-
sues such as the upper vagina and often the uterus
(total or modified radical HYSTERECTOMY). Adjuvant
(follow-up) treatment may include CHEMOTHERAPY
or RADIATION THERAPY. High-dose radiation therapy
(external beam and internal seeding) in combina-
tion with chemotherapy, is the primary treatment
of choice for most stage 2 and stage 3 cervical can-
cers as these have usually spread beyond the
scope of surgery, though surgery may be an option
for stage 2 cervical cancer that remains confined
to the upper vagina. The treatment of choice for
stage 4 cervical cancer is combination chemother-
apy with palliative radiation therapy to relieve
symptoms of obstructive tumors.
CHEMOTHERAPY AGENTS TO TREAT CERVICAL CANCER
carboplatin cisplatin
gemcitabine paclitaxel
topotecan vinorelbine
Risk Factors and Preventive Measures
The key risk factors for cervical cancer are HPV
infection with one of the few strains of HPV linked
to cervical cancer, multiple sexual partners, and
cigarette smoking. The HPV vaccine prevents
infection with HPV types 6, 11, 16, and 18, the
strains of HPV associated with genital warts and
cervical cancer. Health experts recommend HPV
vaccination for girls beginning at age 12, though
women to age 26 can receive the vaccine. Because
HPV accounts for nearly all cervical cancer, meas-
ures to reduce exposure to HPV infection (such
as condom use and mutual monogamy) are also
crucial. Routine pelvic examination with Pap test
can detect cervical cancer in its earliest, curable
stages.
See also BREAST CANCER; CONTRACEPTION; ENDOME-
TRIAL CANCER; HIV/AIDS; SEXUAL HEALTH; SEXUALLY
TRANSMITTED DISEASE(STD) PREVENTION; SURGERY BENE-
FIT AND RISK ASSESSMENT.
cervical intraepithelial neoplasia (CIN) The
growth of abnormal cells within the tissue of the
CERVIX. Because without treatment CIN often pro-
gresses in severity and is the foundation of CERVI-
CAL CANCER, doctors consider CIN a precancerous
condition and grade it according to the extent to
which it infiltrates the cervix. The four grades, or
levels of severity, of CIN are- grade 1, or CIN1, in which the abnormal cells
infiltrate only the first layer of tissue; CIN1
often goes away on its own though merits care-
ful observation until it is clear that it has done
so - grade 2, or CIN2, in which the abnormal cells
penetrate to the second or third layer of tissue;
standard treatment is surgical removal of the
affected tissue using the loop electrosurgical
excision procedure (LEEP) - grade 3, or CIN3, in which the abnormal cells
penetrate through the third layer of tissue and
involve a fairly substantial area of cervical tis-
sue; standard treatment is surgical removal of
the affected tissue, usually using LEEP and
sometimes using conization - grade 4, or carcinoma in situ, in which the
abnormal cells completely penetrate all epithe-
lial layers using conization
Though CIN often follows an orderly progres-
sion from grade 2 to grade 4, culminating with
cervical cancer, it does not always do so. About a
third of CIN2 and CIN3 progresses to the next
level and three fourths of women who have CIN4
or carcinoma in situ eventually develop cervical
cancer. However, CIN1 progresses to cervical can-
cer in only 1 percent of women.Symptoms and Diagnostic Path
Often a woman has no symptoms of CIN; the doc-
tor detects the condition during routine PELVIC
EXAMINATIONand PAP TEST. COLPOSCOPY(examina-
tion of the cervix with a lighted surgical micro-
scope) can sometimes confirm the diagnosis.
However, excisional biopsy (removal of the abnor-
mal area and laboratory examination of the tissue)
is the definitive diagnostic procedure.258 The Reproductive System