What is the Cervix?

The cervix is the lowest portion of the uterus; it protrudes down into the vagina. The normal cervix has an opening to allow sperm to flow into it and menstrual blood to flow out of it. While this opening is normally very narrow, it opens to about 4 inches (10 cm.) across during labor to allow for childbirth. There are strong cervical muscles around the cervix's bottom opening to keep it closed. If the opening is too loose, the cervix is called "incompetent" and will cause miscarriages. The cells that make up the cervix lining undergo a change at the opening of the cervix, which is called the "os". The cells in the vaginal part of the cervix are called "squamous" cells, they are resistant to abrasion and heal quickly after injury. In contrast, the cells deeper in the cervix (and uterus) are called "columnar" cells which form glands. These glands produce mucous. The area of change from the squamous to columnar cells is called the "squamo-columnar junction" and is the area of the cervix where cancer most commonly arises. This is area that is scraped for the annual"Pap" smear, to look for cancerous cells, and it can be seen by a doctor performing a pelvic examination.

What is Cervical Cancer?

Normally the cervix has stopped growing by puberty, but it's cells will continue to divide to replace those that die of injury or old age. While some division of cervical cells to replace old or injured ones is normal, it is a tightly controlled process. Sometimes a abnormal cell may arise which divides out of control. This will then form a tumor . A tumor is simply a swelling, and does not necessarily mean cancer (obviously most swellings are not cancerous). If a tumor only grows in it's local area, it is called "benign" and is not cancer. If, however, it has the capability to spread to other areas of the body, then it is called "malignant" and is cancer. Cervical cancer starts in just one single cell, but this cell quickly divides to form many similar cancer cells, which each continue to grow. Eventually, if not cured, these cells push the normal cells out of the way, grow a large tumor, and spread to other body areas to ultimately kill the patient. Cervical cancer kills by anemia, infection, blockage of kidney drainage ("uremia") and general disability.

How Common is Cervical Cancer?

Each year in the U.S.A. 13,500 new patients get invasive cervical cancer and 7,000 women die of it. "Pre-cancerous" changes in the cervix are much more common; they affect 55,000 American women per year and are shown by an abnormal "Pap smear". Some, but not all, of these patients with "pre-cancerous" cervical changes will go on to develop frank cervical cancer. The average age of patients is 50 years, but the disease has been seen in patients ranging in age from 17 to 90 years. In general, cervical cancer has been on the increase in the United States, and even more in developing countries. It currently ranks as the fifth most common cancer in women, after lung, breast, colon and uterine cancer.

What Causes, or Increases the Risk, for Cervical Cancer?

Like any other cancer, the exact reason why one woman gets cervical cancer and another does not isunknown . However, several things are noted to increase the risk:

1) Being Female is obviously the biggest risk factor for cervical cancer.
2) Lots of Male Sexual Partners and having children by different men, and starting to have sex at a young age dramatically increases risk. In contrast, cervical cancer is extremely rare in women who never were pregnant and nuns.
3) Uncircumcised Sexual Partners -- cervical cancer is very rare in the wives of circumcised Jewish men.
4) Sexually Transmitted Viruses like the "Human Papilloma Virus" (HPV), especially types 16, 18, and 33. These are found in about 50% of patients.
5) Low Social and Financial Status may reflect more sexual promiscuity or inability to get proper screening and treatment for the disease.
6) Immune Deficiency Diseases like AIDS. In fact, the development of cervical cancer in a HIV positive patient is sufficient to reclassify them as full-blown AIDS. Furthermore, getting immune-system suppressing drugs (to avoid rejecting a newly transplanted organ) also increases the risk, especially in patients with HPV.
7) DES taken by the patient's mother, during pregnancy. DES is a hormone associated with developing a rare type of cervical cancer called the "clear-cell" variety.

Alcohol and Tobacco use are not linked to getting cervical cancer!

What about Screening for Cervical Cancer?

The Papaniculaou ("Pap") smear, done since 1940, is of proven value in the early detection of cervical cancer. It is also useful after treatment to help monitor the success of therapy. A Pap smear is done at the time of pelvic examination, it involves taking a brush and a small "spatula" (Ayer's) to get some cells for the squamocolumnar junction of the cervix, and also any abnormal areas. The scraping often causes slight bleeding. Too much blood in the specimen can distort the Pap smear, so it is not advised during a menstrual period. The American Cancer Society recommends a cancer "checkup" every three years for women over age 20, or starting younger if she is sexually active. This includes a pelvic exam with a Pap test every 3 years (after 2 initial "negative" tests one year apart). Those at higher risk should get more frequent (i.e. annual) screening. The cells collected from the Pap test are examined by a Pathologist (and often also checked by a computerized reading machine) to look for abnormal changes. Since many of these tests are read at once, the interpretation tricky, and the results of a wrong answer catastrophic, much publicity has surrounded misread tests. This has led pathologists to be very cautious in reading Paps, and they are likely to reject an imperfect smear (such as those mixed with blood) and request a re-scrape. Results take days to weeks to get.

The results are placed into one of 5 categories, called"classes":
Class I means "negative" (no suspicious cells)
Class II means mild and minimal changes (benign)
Class III means mild to moderate changes (suspicious)
Class IV means marked abnormal cells changes (very suspicious)
Class V means cancer cell are seen.

If a test is suspicious for cancer, it should be repeated every 3 to 6 months to 2 years. A Pap test is not completely accurate in detecting cervical cancer, the "false - negative" rate (failure to pick up an existing cancer) averages 30%. However, it remains a powerful tool to detect cancer. Unfortunately, only 15% of women get the proper screening. While a Pap test can help detect cancer, no therapy is based upon a Pap test alone.

What are the Symptoms of Cervical Cancer?

Early cervical cancer commonly has no symptoms, which is why screening is necessary to detect it. The most common actual symptoms are:

Bleeding into the vagina; the surface of the cervix is very soft and tumors bleed easily. In fact, if a woman has new vaginal bleeding after menopause, the total chance of gynecologic cancer is about 30%, with 15% having cervical cancer. In pre-menstrual women, a chance is often seen in bleeding during periods, being more bleeding, spotting between periods, or after sexual intercourse.

Vaginal Discharge, often of a yellow or green color and foul smelling. This alone is more likely an infection, but must be investigated.

Cervical Pain, noted when a tampon, finger or penis is inserted into the vagina. On physical exam, this "cervical motion tenderness" is suspicious for infection or cancer. With more advanced disease, there can be general pelvic pains.

Urinary Symptoms are seen with advancing disease, as the tumor invades into the vagina, and eventually can close off the kidney's urinary drainage. This is called "uremia" and is the most common cause of death from cervical cancer.

Signs of Spread to other areas of the body include lymph gland enlargement in the groin or collarbone area (Virchow's node) or left armpit (Irishe's node). Advanced spread may give bone, liver, lung, bowel and brain abnormalities.

How Is Cervical Cancer Detected and Evaluated?

When screening or symptoms suspicious for cervical cancer occur, the doctor must confirm the diagnosis. The only certain way to do this is to get a piece of the tumor (that is a "biopsy" ) and submit it to a pathologist for analysis. A pathologist is a physician who specializes in diagnosing disease from tissue specimens. All patients will have a Pap test, and then further work up if suspicion remains. These tests may be done:

1) Colposcopy means examining the cervix with a special lens that magnifies the surface 40 times. The outer cervix can be painted with an iodine solution which highlights abnormal areas. Biopsies are taken of these abnormal areas. Colposcopy can only see surface cells, not ones inside the cervical canal.
2) Cone Biopsy means cutting out a thin "cone" of the cervical canal for evaluation. This procedure is done with a "cold" (instead of hot) knife since heat can distort the findings. If a very thin cancer is found, this procedure can be both diagnostic and curative, since the cancer is being cut out. This is also called"conization."
3) Exam Under Anesthesia is done for any larger cervical cancer, to ascertain how large it is and if it has spread. General anesthesia relaxes the pelvic muscles so the doctor can feel deep structures. A proctoscope is inserted up the rectum and a cystoscope up the urethra to look for spread to these areas.
4) Hysterectomy ( surgical removal of the uterus and cervix) is both diagnostic and therapeutic for tumors that are too large to completely remove with a "conization." Sometimes a hysterectomy may be done for a smaller cancer if the woman has no further desire for child-bearing. Also, if the woman has symptoms from scar tissue or benign growths in the uterus ("endometriosis") hysterectomy may be appropriate. The various types of hysterectomy are discussed under "treatment".
5) Routine Blood Tests prior to any surgery include Complete Blood Count (CBC) to look for anemia and infection, and Chemistry Panel (SMA) which checks blood serum minerals, liver and kidney function. Blood tests for clotting are done (PT/PTT).
6) Radiologic Tests include regular Chest X-rays, and often a CT scan of the pelvis and abdomen.CT scan helps tell how large a mass is, and what structures it has invaded into. It can tell if lymph glands are enlarged (> 1 cm.) which suggests the cancer has spread to them. It can help tell (but not conclusively) how deeply the cancer penetrates into the cervical and uterine muscle. CT scan of the abdomen detects metastasis >1cm. to liver, lung, lymph glands, etc. CT scan is standard for any "larger" tumor of the cervix. Magnetic Resonance Imaging (MRI) is an optional test which does not use radiation, it is the best scan to tell how far the cancer has spread into the soft-tissues of the pelvis. Other elaborate tests like bone scan orliver-spleen scan are only used for symptoms in these areas.

What are the Types of Cervical Cancer?

There are several types of cervical cancer, and the treatment may differ by type:

Squamous Cell Carcinoma is the most common type, accounting for about 85% of cervical cancer. It arises on the more "outer" portion of the cervix which protrudes into the vagina. It is truly the "classic variety" cervical cancer.

Adenocarcinoma accounts for about 10% of cases and is increasing. It starts on the more "inner" portion of the cervix, from the same type of cells lining the uterus. "Clear cell" cancer is a subtype of adenocarcinoma.

Mixed types account for 4% and include "adenosquamous" (with elements of both adenocarcinoma and squamous cell carcinoma) and "Glassy cell" cancer.

Rare Types (less than 1%) include the "neuroendocrine" cancers (Carcinoid and Small cell ) which are similar to the same named cancers of the lung and digestive tract, lymphomas (arising from immune cells) and sarcomas (arising from the fat, cartilage or muscle cells). Cancer may spread to the cervix from other areas.

How does Cervical Cancer Spread?

It starts as a single abnormal cell on the cervix surface, which divides and invades down toward the muscle of the cervix. It can also form a tumor mass projecting up from the cervical surface. When it invades deeply enough, the cancer cells can come in contact with "lymphatic channels" within the cervix, and can then be carried to the local lymph glands in the pelvis. These lymph glands are in contact with ones in the groin and abdomen, so the cancer can spread there. The larger the tumor, the more chance it will spread into the lymph system. As it grows locally in the pelvis, it can invade the uterus, vagina, tissue around the uterus (called the "parametria") and all the way to the pelvic wall. It can invade the bladder and rectum, and block off the ureters which drain the kidneys. Furthermore, tumor cells can break off and get carried by the bloodstream to distant areas of the body, such as the liver, lungs, bone and brain.

How is the Extent of Cervical Cancer Gauged?

Like all cancers, the extent of cervical cancer is given by the "stage." The "FIGO" staging system is the most commonly used:

"Stage IA" means "microinvasive" cancer, (invades less than 5 mm), this is the smallest cancer that can be detected.
"Stage IB" means a larger cancer but still confined to the cervix.
"Stage IIA" means extension down into the upper or middle vagina.
"Stage IIB" indicates extension to the soft tissue around the cervix or uterus, called the "parametrium"- but not to the pelvic wall.
"Stage IIIA" means the cancer invades down into the lower vagina
"Stage IIIB" means the cancer has invaded to the pelvic side wall, or it has blocked off the kidney's drainage ("hydronephrosis").
"Stage IVA" means extension to the bladder or rectum
"Stage IVB" means distant spread, i.e. lungs, liver, bone, brain.

Note that lymph nodes are not part of the staging for cervical cancer! However, extensive lymph node involvement approximately halves long-term survival.

What is the Conventional Survival from Cervical Cancer?

This depends upon the type of cancer, the stage, and treatment selected. In general:

Absence of bulky disease (over 4 centimeters large) and no detectable lymph node involvement means better survival. Another factor is the so called "Barrel-Shaped" cervix which means that the cancer has spread out ("infiltrated") though the organ and stiffened it into a barrel-shape. These type of cancers have been shown to require more treatment to cure than the more common "non-barrel shaped" types.

What is the Conventional Treatment for Cervical Cancer?

Surgery is the conventional and current treatment for the earliest cervical cancer. In a younger woman with very early cancer, usually detected by "Pap" smear, just freezing the cancer ("cryotherapy"), burning it off ("fulgaration") or cutting it off can be curative and preserve fertility. If the cancer is inside the cervical canal, and can't be seen with a colposcope, cutting out the inner cone of cervical tissue("conization") can be curative and still preserve fertility. For the earliest "pre-invasive" cancer, this is 97% curative. If cancer cells have invaded deeper, then more drastic surgery is necessary for cure, and fertility will be lost.

Hysterectomy means cutting out the uterus and cervix surgically. This can be done either by making an incision on the lower abdomen ("abdominal hysterectomy") or by pulling the uterus out through the vagina ("vaginal hysterectomy"). While a simple, safe hysterectomy can be done by either method, vaginal hysterectomy is quicker and easier to recover from. However, a more thorough cancer operation, with removal of lymph glands and any suspicious tissues, requires an abdominal hysterectomy. Often both ovaries and fallopian tubes are also removed at hysterectomy, this is called a "Total Abdominal Hysterectomy with Bilateral Salpingo--Oophorectomy" (TAH--BSO). The removed organs are all sent to pathology for examination, and any inflammation, benign growths like endometriosis, or cancerous areas are identified and commented upon. Cervical cancer can be cured with surgery alone in many patients with stage I or II disease, but not in those with lymph node involvement or more advanced disease.

These are the various levels of hystectomy that can be done:

1) A "Type I" is a "simple hysterectomy" where the uterus and cervix are removed, and the upper vagina is sown shut to form a "vaginal cuff".
2) A "Type II" is a "modified radical hysterectomy" that removes the uterus, cervix, surrounding parametrial tissues, and the upper tip of vagina. The ovaries can be left in place in younger women to avoid instant menopause.
3) A"Type III" is a "radical hysterectomy" where a Type II is performed, but in addition the upper vagina is removed.
4) A"Type IV" is an"extended radical hysterectomy" which means besides a radical hysterectomy, the ureters are freed and thoroughly examined.
5) A"Type V" is a "pelvic exenteration", which is the most radical operation. An "anterior exenteration" a complete hysterectomy with further removal of the bladder and vagina. A "posterior exenteration" is a complete hysterectomy with removal of the rectum. A "total exenteration" is a complete hysterectomy with removal of the vagina, bladder, and rectum-- everything in the pelvis.

These drastic operations are sometimes done for recurrent cervical cancer. Studies have shown that radiation therapy should be tried first in advanced disease, since the results are better than exenteration. In a "standard" operation for early stage (I or II) cervical cancer, an abdominal incision is made, the uterus and cervix are removed, the upper vagina is sown shut, and any enlarged lymph nodes are removed. Based upon the pathology report, additional therapy with radiation and/or chemotherapy (called "adjuvant treatment") may be necessary.

Radiation Therapy is the conventional and effective treatment for many cervical cancers. It has been used since the turn of the century for treating women's cancers. It can be used alone to cure the patient, or in conjunction with surgery. It can also be used to relieve symptoms from advanced disease. Radiation is prescribed and administered by a "radiation oncologist," a physician specializing in treating cancer with radiation. Over 3 decades, tremendous advancements have been made in radiation therapy, and it is now safe and effective treatment . Radiation for cervical cancer may be given by two different methods, and often both are used for the same patient. The first is called "External Beam" therapy, where the patient lies on a hard table and gets daily treatment with a beam of photons. The second is "Intracavitary" or"Brachytherapy" treatment where the patient has radioactive seeds temporarily placed into the cervix and vagina while they lie in a hospital bed for several days. While "External Beam" treatment covers a large area to which the cancer may have spread, "Intracavitary" targets radiation to the local tumor area. To cure a cervical cancer with radiation alone, oncologists use both methods together for optimal treatment.

External Beam Treatment starts with a "simulation" during which the patient is positioned on a mock machine and the area to be treated is marked out. Often a marker is placed in the vagina, and some barium contrast in the rectum, to visualize those areas on X-Ray. The whole procedure takes less than 1 hour, and the patient then gets a CT scan or goes home. Information from the simulation and CT scans is fed into a "Treatment Planning Computer", and a "plan" is generated, and custom shielding blocks are cut. The patient returns to the department to start treatment, which takes only a few minutes each day, Monday through Friday, for 5 - 7 weeks. The total dose given by external beam is usually about 50 Gray (units of radiation). The treatment is painless, patients do not get sick, radioactive, or lose their scalp. Side effects of radiation are divided into "acute" and "late" reactions. Acute reactions occur during the course of treatment, while late reactions may occur months to years later. Expected "acute" reactions include treatment area skin redness, irritation, urinary frequency, and diarrhea. These resolve after treatment. "Late" reactions may include vaginal dryness, bowel obstruction (5%) urinary stricture (3%) and development of a second cancer from radiation (1%). In general, external beam radiation is well tolerated and effective.

Intracavitary Radiation ("Brachytherapy") means seeds of radioactive material (usually cesium-137) are placed in a special applicator which is inserted up into the vagina, cervix, and uterus. This treatment is often delayed until the cervix "opens up" with the above external-beam treatment, so that the radiation sources can be easily inserted. Different applicators are used for different treatments. The most common are the "Henshke" or "Fletcher" types, which are made up of a "tandem" (a long cylinder loaded with radioactive seeds inserted into the cervix) and "ovoids" (they are semi-spherical appendages to the tandem containing radioactive seeds and are inserted into the upper vagina). The insertion of these devices is done under anesthesia (general or spinal) in the operating room, and the patient is then taken down to the radiation therapy suite for X-rays to determine the exact position of the applicator relative to the cancer, bowel and bladder. A physicist designs a "plan" for how the applicator is to be loaded with the radioactive seeds, and what the strength of each seed will be, and how long the applicator should remain in place. The patient is taken to a hospital bed in a special room insulated for giving radiation treatments. The doctor then loads in the radioactive sources according to the "plan", this is painless. The patient rests in a hospital bed for 2 days or so while the treatment is given, and is given anti-diarrhea medicine. Then the applicator is removed (no anesthesia is needed for this) and the patient goes home. The side-effects of this kind of treatment are much like external beam, except the skin surface will not be reddened and the chance of infection is higher (5%). If an infection develops (as determined by pain and fever) the applicator must be removed right away. Sometimes several "applications" of brachytherapy are given, spaced every couple weeks, to allow the tumor time to shrink between treatments. The main advantage of brachytherapy is that the tumor and areas at highest risk get the most radiation, with normal tissues getting much less than with external beam treatment. Again, combining external beam and brachytherapy is often the optimal treatment. Radiation will be recommended if the tumor is high stage or bulky ("barrel shaped" cervix), if lymph glands are involved, if the tumor comes back after surgery, or if the patient cannot tolerate surgery. It may be alone, prior to surgery, or after it (adjuvant).

Radiation and Surgery Together: Historically, surgery or radiation gave equal cure rates (over 80%) for the common stage IB cervical cancer, and there was no advantage seen in using both together (just more side effects). However, it was seen that patients with larger tumors, "barrel shaped" cervixes, and spread to lymph nodes did worse with surgery alone, so these patients were referred for radiation. In fact, a surgeon will often remove some lymph nodes from the pelvis ("pelvic lymphadenectomy") and send them to the pathologist for immediate determination of whether cancer has spread to them before removing the uterus. If the cancer has spread to them, he will stop the operation and send the patient for radiation therapy instead. This is because surgery will cure less than 40% of these patients, while radiation can cure over 70%. Another circumstance is to have a large tumor or "barrel shaped" cervix which has been infiltrated by the cancer. This may technically still be a stage IB, since the cancer has not spread beyond the cervix, but it was found that these patients did not do as well as those with smaller tumors when treated with radiation alone. The latest treatment is to treat these patients with radiation first to shrink the tumor down, and then do a modified radical hysterectomy several weeks after radiation is completed. Radiation is very useful in locally advanced cervical cancer (stages III and IVA) and gives excellent palliation (symptom relief) as well as possible cures. Troublesome symptoms from advanced disease include bleeding and pain, which are relieved in over 80% of cases by short-course (two days to two weeks) of radiation treatments. For stage III radical radiation can cure about 35%, and 20% of stage IVA patients are cured. This is about equal to the cure rate with the drastic "exenteration" surgery, and is generally safer and less debilitating (since the bladder and rectum are kept, no collection bags on the abdomen are necessary). Thus, exenteration is rarely performed today for locally advanced disease, it's use is restricted to those who have failed radiation, and it may cure some of these patients (17% on average live 5 years).

Chemotherapy has not been widely used in cervical cancer. It is currently mostly used for patients that have recurrent disease within a previously irradiated area; that area can tolerate no further radiation. Also, it is used for patients with widespread, metastatic cancer (for lack of other effective therapy). The current most effective drugs are cisplatin (derived from platinum) and doxorubicin (a bright red liquid). Either cisplatin, doxorubicin, or even both together give a "response rate" of 40% - 60%, meaning the tumor shrinks. Only about 10% of patients get a "complete response", meaning the tumor disappears altogether. Unfortunately, even a complete response does not signal cure. This is because cancers become resistant to chemotherapy agents, much the same as bacteria become resistant to antibiotics. The average response lasts only about 6 months, then the disease progresses again. This helps explain why chemotherapy is used so little for cervical cancer. Also, it can be very toxic, causing nerve, lung, kidney, and heart damage as well as anemia and infection. It obviously must be very carefully monitored. Although many regimens of chemotherapy have been tried, the average duration of response has always been less than one year. Therefore, current chemotherapy has very little usefulness in squamous cell or adenocarcinoma of the cervix. For unusual cancers of the cervix, such as Small cell or Lymphomas, chemotherapy can be appropriate and effective. Both of these types tend to spread aggressively and are susceptible to chemotherapy, much like their counterparts in lung and skin. The most effective conventional agents for Small-Cell cancer are Cyclophosphamide, Adriamycin, Vincristine ("CAV") ; the most effective agents for Lymphomas are Cyclophosphamide, Oncovir, Prednisone and Procarbazine ("CHOP"). Chemotherapy may also be effective in relapsed cervical cancer as described below.

What is the Latest Effective Therapy for Cervical Cancer?

A large part of winning the war on cervical cancer is making more effective use of the currently available treatments, and using them in proper combination.

Surgery Advancements: Include always using a qualified "gynecologic oncologist" who attends the "Gynecology Oncology Group" ("GOG") meetings and knows their latest protocols. Previously, many patients were treated by general gynecologists who did not do complete cancer operations, so were at a higher risk for recurrence. A good gynecologic oncologist knows not only when to operate extensively, but when not to, sending the patient for other therapies.Get the patient referred to gynecologic oncologist! Radiation Therapy Advancements: All patients who have greater than stage IIA disease should get radiation. If the lymph nodes in the pelvis are involved, then giving radiation to the lymph nodes in the abdomen around the aorta (the "paraaortic" nodes) increases survival at 5 years from 55% to 65% in stages I and II disease. When patients get the intracavitary part of their treatment, about 20% less failure is seen if they get more than one application, spaced several weeks apart. For advanced disease (stages III and IVA) chemotherapy can be used to "sensitize" the tumor to radiation. A high complete response rate has been seen using 5-FU and Mitomycin C with 30 Gray of radiation; other agents that can be used with radiation are cisplatin and hydroxyurea. While the side effects of combined treatment are higher, so are the response rates. Also, newer research has shown that if appreciable tumor remains after radiation treatment (as is often the case for the "barrel-shaped" cervix), survival is higher if it is surgically removed several weeks after completion of radiation. For small recurrences, bulky parametrial or persistent disease, additional radiation can be tolerated by "interstitial" therapy. this involves placing needles with radioactive sources (Iridium-192) directly into the the tumor, using a template placed on the vulva. Using a combination of External Beam, several Intracavity applications and Interstitial radiation, a very high and possibly curative radiation dose can be delivered directly to the tumor with minimal side effects.

Chemotherapy Advancements: Includes new protocols to try to find more effective agents, usually given as "clinical trials" sponsored by the "GOG". The gynecologic oncologist not only is a surgeon, but he also prescribes this chemotherapy. Two major ideas in chemotherapy are "chemoprevention" of recurrent squamous cell cancers with vitamin A derivatives ("retinoin") can prevent new cancers in those with HPV virus, but can have side effects of liver damage. The newest protocol for advanced cancer uses Platinum and Navelbine (protocol GOG-76Z) for advanced or recurrent squamous cell cancers. In general, using a well-planned strategy of conventional treatments for manageable sized cancers and the latest effective therapy larger ones, the outlook for the woman with cervical cancer is now brighter than ever before!

This is the full transcript, offered freely in the spirit of internet sharing, of CancerAnswers' report on Cervical Cancer. Much more, including latest additional treatments for Cervical Cancer can be found on our order page. Thank you for using CancerAnswers as your information resource.