Scientists are studying cervical cancer to find out more about how it develops. And they are looking at better ways to detect and treat it.

The NCI provides information about cancer, including the publications mentioned in this booklet. You can order these materials by telephone or on the Internet. You can also read them on the Internet and print your own copy.

The Cervix

The cervix is part of a woman's reproductive system. It is the lower, narrow part of the uterus (womb). The uterus is a hollow, pear-shaped organ in the lower abdomen. The cervix connects the uterus to the vagina. The vagina leads to the outside of the body.

The cervical canal is a passageway. Blood flows from the uterus through the canal into the vagina during a woman's menstrual period. The cervix also produces mucus. The mucus helps sperm move from the vagina into the uterus. During pregnancy, the cervix is tightly closed to help keep the baby inside the uterus. During childbirth, the cervix dilates (opens) to allow the baby to pass through the vagina.

Understanding Cancer

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.

Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.

Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.

Tumors can be benign or malignant:

• Benign tumors are not cancer:
  • Benign tumors are rarely life-threatening.
  • Generally, benign tumors can be removed, and they usually do not grow back.
  • Cells from benign tumors do not invade the tissues around them.
  • Cells from benign tumors do not spread to other parts of the body.
  • Polyps, cysts and genital warts are types of benign growths on the cervix.

• Malignant tumors are cancer:
  • Malignant tumors are generally more serious than benign tumors. They may be life-threatening.
  • Malignant tumors often can be removed. But sometimes they grow back.
  • Cells from malignant tumors can invade and damage nearby tissues and organs.
  • Cells from malignant tumors can spread (metastasize) to other parts of the body. Cancer cells spread by breaking away from the original (primary) tumor and entering the bloodstream or lymphatic system. The cells invade other organs and form new tumors that damage these organs. The spread of cancer is called metastasis.

Risk Factors

Doctors cannot always explain why one woman develops cervical cancer and another does not. However, we do know that a woman with certain risk factors may be more likely than others to develop cervical cancer. A risk factor is something that may increase the chance of developing a disease.

Studies have found a number of factors that may increase the risk of cervical cancer. These factors may act together to increase the risk even more:

Human papillomaviruses (HPVs): HPV infection is the main risk factor for cervical cancer. HPV is a group of viruses that can infect the cervix. HPV infections are very common. These viruses can be passed from person to person through sexual contact. Most adults have been infected with HPV at some time in their lives. Some types of HPV can cause changes to cells in the cervix. These changes can lead to genital warts, cancer and other problems. Doctors may check for HPV even if there are no warts or other symptoms.

If a woman has an HPV infection, her doctor can discuss ways to avoid infecting other people. The Pap test can detect cell changes in the cervix caused by HPV. (See the "Screening" section to learn more about the Pap test.) Treatment of these cell changes can prevent cervical cancer. There are several treatment methods, including freezing or burning the infected tissue. Sometimes medicine also helps.

The NCI offers a fact sheet called "Human Papillomaviruses and Cancer: Questions and Answers."

• Lack of regular Pap tests: Cervical cancer is more common among women who do not have regular Pap tests. The Pap test helps doctors find precancerous cells. Treating precancerous cervical changes often prevents cancer.

• Weakened immune system (the body's natural defense system): Women with HIV (the virus that causes AIDS) infection or who take drugs that suppress the immune system have a higher-than-average risk of developing cervical cancer. For these women, doctors suggest regular screening for cervical cancer.

• Age: Cancer of the cervix occurs most often in women over the age of 40.

• Sexual history: Women who have had many sexual partners have a higher-than-average risk of developing cervical cancer. Also, a woman who has had sexual intercourse with a man who has had many sexual partners may be at higher risk of developing cervical cancer. In both cases, the risk of developing cervical cancer is higher because these women have a higher-than-average risk of HPV infection.

• Smoking cigarettes: Women with an HPV infection who smoke cigarettes have a higher risk of cervical cancer than women with HPV infection who do not smoke.

• Using birth control pills for a long time: Using birth control pills for a long time (five or more years) may increase the risk of cervical cancer among women with HPV infection.

• Having many children: Studies suggest that giving birth to many children may increase the risk of cervical cancer among women with HPV infection.

Women who think they may be at risk for cancer of the cervix should discuss this concern with their doctor. They may want to ask about a schedule for checkups. For more information about risk factors, see the NCI booklet "Understanding Cervical Changes."

Screening

Screening to check for cervical changes before there are symptoms is very important. Screening can help the doctor find abnormal cells before cancer develops. Finding and treating abnormal cells can prevent most cervical cancer. Also, screening can help find cancer early, when treatment is more likely to be effective.

For the past several decades, the number of women diagnosed each year with cervical cancer has been falling. Doctors believe this is mainly because of the success of screening.

Doctors recommend that women help reduce their risk of cervical cancer by having regular Pap tests. A Pap test (sometimes called Pap smear or cervical smear) is a simple test used to look at cervical cells. For most women, the test is not painful. A Pap test is done in a doctor's office or clinic during a pelvic exam. The doctor or nurse scrapes a sample of cells from the cervix, and then smears the cells on a glass slide. In a new type of Pap test (liquid-based Pap test), the cells are rinsed into a small container of liquid. A special machine puts the cells onto slides. For both types of Pap test, a lab checks the cells on the slides under a microscope for abnormalities.

Pap tests can find cervical cancer or abnormal cells that can lead to cervical cancer.
Doctors generally recommend that:

• Women should begin having Pap tests the years after they begin having sexual intercourse, or when they reach age 21 (whichever comes first).

• Most women should have a Pap test at least once every three years.

• Women aged 65 to 70 who have had at least three normal Pap tests and no abnormal Pap tests in the past 10 years may decide, after speaking with their doctor, to stop cervical cancer screening.

• Women who have had a hysterectomy (surgery) to remove the uterus and cervix, also called a total hysterectomy, do not need to have cervical cancer screening. However, if the surgery was treatment for precancerous cells or cancer, the woman should continue with screening.

Some activities can hide abnormal cells and affect Pap test results. Doctors suggest the following tips:

• Do not douche for 48 hours before the test.
• Do not have sexual intercourse for 48 hours before the test.
• Do not use vaginal medicines (except as directed by a doctor) or birth control foams, creams or jellies for 48 hours before the test.

Most often, abnormal cells found by a Pap test are not cancerous. However, some abnormal conditions may become cancer over time:

• LSIL (low-grade squamous intraepithelial lesion): LSILs are mild cell changes on the surface of the cervix. Such changes often are caused by HPV infections. LSILs are common, especially in young women. LSILs are not cancer. Even without treatment, most LSILs stay the same or go away. However, some turn into high-grade lesions, which may lead to cancer.

• HSIL (high-grade squamous intraepithelial lesion): HSILs are not cancer, but without treatment they may lead to cancer. The precancerous cells are only on the surface of the cervix. They look very different from normal cells.

You may want to ask the doctor the following questions about screening:

• How soon after the test will I learn the results?
• Do you recommend that I get tested for HPV?
• How much do the tests cost? Will my health insurance help pay for screening tests?

Precancerous changes and early cancers of the cervix generally do not cause pain or other symptoms. It is important not to wait to feel pain before seeing a doctor.

When the disease gets worse, women may notice one or more of these symptoms:

• Abnormal vaginal bleeding
• Bleeding that occurs between regular menstrual periods
• Bleeding after sexual intercourse, douching or a pelvic exam
• Menstrual periods that last longer and are heavier than before
• Bleeding after menopause
• Increased vaginal discharge
• Pelvic pain
• Pain during sexual intercourse

Diagnosis

If a woman has a symptom or Pap test results that suggest precancerous cells or cancer of the cervix, her doctor will suggest other procedures to make a diagnosis.

These may include:

• Colposcopy: The doctor uses a colposcope to look at the cervix. The colposcope combines a bright light with a magnifying lens to make tissue easier to see. It is not inserted into the vagina. A colposcopy is usually done in the doctor's office or clinic.

• Biopsy : The doctor removes tissue to look for precancerous cells or cancer cells. Most women have their biopsy in the doctor's office with local anesthesia. A pathologist checks the tissue with a microscope.
  • Punch biopsy: The doctor uses a sharp, hollow device to pinch off small samples of cervical tissue.

  • LEEP: The doctor uses an electric wire loop to slice off a thin, round piece of tissue.

  • Endocervical curettage: The doctor uses a curette (a small, spoon-shaped instrument) to scrape a small sample of tissue from the cervical canal. Some doctors may use a thin, soft brush instead of a curette.

  • Conization: The doctor removes a cone-shaped sample of tissue. A conization, or cone biopsy, lets the pathologist see if abnormal cells are in the tissue beneath the surface of the cervix. The doctor may do this test in the hospital under general anesthesia. Conization also may be used to remove a precancerous area.

For more information about tests, cell changes, and treatment for these changes, you may want to read "Understanding Cervical Changes."

You may want to ask the doctor these questions before having a procedure:

• Which test(s) do you recommend?
• How will the test be done?
• Will I have to go to the hospital?
• How long will it take? Will I be awake? Will it hurt?
• Are there any risks? What are the chances of infection or bleeding after the procedure?
• Can the test affect my ability to get pregnant and have children?
• How soon will I know the results? Who will explain them to me?
• If I do have cancer, who will talk to me about the next steps? When?

If the biopsy shows that you have cancer, your doctor will do a thorough pelvic exam and may remove additional tissue to learn the extent (stage) of your disease. The stage tells whether the tumor has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body.

These are the stages of cervical cancer:

• Stage 0: The cancer is found only in the top layer of cells in the tissue that lines the cervix. Stage 0 is also called carcinoma in situ.

• Stage I: The cancer has invaded the cervix beneath the top layer of cells. It is found only in the cervix.

• Stage II: The cancer extends beyond the cervix into nearby tissues. It extends to the upper part of the vagina. The cancer does not invade the lower third of the vagina or the pelvic wall (the lining of the part of the body between the hips).

• Stage III: The cancer extends to the lower part of the vagina. It also may have spread to the pelvic wall and nearby lymph nodes.

• Stage IV: The cancer has spread to the bladder, rectum or other parts of the body.

• Recurrent cancer: The cancer was treated, but has returned after a period of time during which it could not be detected. The cancer may show up again in the cervix or in other parts of the body.

• Chest x-rays: X-rays often can show whether cancer has spread to the lungs.

• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your organs. You may receive contrast material by injection in your arm or hand, by mouth or by enema. (Some people are allergic to contrast materials that contain iodine. Tell your doctor or nurse if you have allergies.) The contrast material makes abnormal areas easier to see. A tumor in the liver, lungs or elsewhere in the body can show up on the CT scan.

• MRI: A powerful magnet linked to a computer is used to make detailed pictures of your pelvis and abdomen. The doctor can view these pictures on a monitor and can print them on film. An MRI can show whether cancer has spread. Sometimes contrast material makes abnormal areas show up more clearly on the picture.

• Ultrasound: An ultrasound device is held against the abdomen or inserted into the vagina. The device sends out sound waves that people cannot hear. The waves bounce off the cervix and nearby tissues, and a computer uses the echoes to create a picture. Tumors may produce echoes that are different from the echoes made by healthy tissues. The picture can show whether cancer has spread.

Many women with cervical cancer want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and your treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything you want to ask the doctor. It often helps to make a list of questions before an appointment.

To help remember what the doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to the doctor - to take part in the discussion, to take notes, or just to listen.

You do not need to ask all your questions at once. You will have other chances to ask your doctor to explain things that are not clear and to ask for more information.

Your doctor may refer you to a specialist, or you may ask for a referral. Gynecologists, gynecologic oncologists, medical oncologists and radiation oncologists are specialists who treat cervical cancer.

Getting a Second Opinion
Before starting treatment, you might want a second opinion about the diagnosis and treatment plan. Many insurance companies cover a second opinion if you or your doctor requests it. It may take some time and effort to gather medical records and arrange to see another doctor. Usually it is not a problem to take several weeks to get a second opinion. In most cases, the delay in starting treatment will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Some women with cervical cancer need treatment right away.

There are a number of ways to find a doctor for a second opinion:

• Your doctor may refer you to one or more specialists. At cancer centers, several specialists often work together as a team.

• NCI's Cancer Information Service, at (800) 4-CANCER, can tell you about nearby treatment centers. Information Specialists also can provide online assistance through LiveHelp at http://www.cancer.gov.

• A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists in your area.

• The American Board of Medical Specialties (ABMS) has a list of doctors who have had training and passed exams in their specialty. You can find this list in the Official ABMS Directory of Board Certified Medical Specialists. This Directory is in most public libraries. Or you can look up doctors at http://www.abms.org. (Click on "Who's Certified.")

• The NCI provides a helpful fact sheet called "How To Find a Doctor or Treatment Facility If You Have Cancer."

Your doctor can describe your treatment choices and the expected results of each. You and your doctor can work together to develop a treatment plan that meets your medical needs and personal values.

You may want to ask the doctor these questions before treatment begins:

• What is the stage of my disease? Has the cancer spread? If so, where?

• What are my treatment choices? Which do you recommend for me? Will I have more than one kind of treatment?

• What are the expected benefits of each kind of treatment?

• What are the risks and possible side effects of each treatment? What can we do to control my side effects?

• How will treatment affect my normal activities?

• What can I do to take care of myself during treatment?

• How long will treatment last?

• Will I have to stay in the hospital?

• What is the treatment likely to cost? Does my insurance cover this treatment?

• How often should I have checkups?

• Would a clinical trial (research study) be appropriate for me?

At any stage of disease, women with cervical cancer may have treatment to control pain and other symptoms, to relieve the side effects of therapy, and to ease emotional and practical problems. This kind of treatment is called supportive care, symptom management, or palliative care. Information about such treatment is available on NCI's Web site at http://www.cancer.gov/cancerinfo/coping and from NCI's Cancer Information Service at (800) 4-CANCER.

You may want to talk to your doctor about taking part in a clinical trial, a research study of new treatment methods. The section on "The Promise of Cancer Research" has more information about clinical trials.

Surgery
Surgery treats the cancer in the cervix and the area close to the tumor.

Most women with early cervical cancer have surgery to remove the cervix and uterus (total hysterectomy). However, for very early (Stage 0) cervical cancer, a hysterectomy may not be needed. Other ways to remove the cancerous tissue include conization, cryosurgery, laser surgery, or LEEP.

Some women need a radical hysterectomy. A radical hysterectomy is surgery to remove the uterus, cervix and part of the vagina.

With either total or radical hysterectomy, the surgeon may remove both fallopian tubes and ovaries. (This procedure is a salpingo-oophorectomy.)

The surgeon may also remove the lymph nodes near the tumor to see if they contain cancer. If cancer cells have reached the lymph nodes, it means the disease may have spread to other parts of the body.

You may want to ask the doctor these questions about surgery:

• What kind of operation will I have? Will my ovaries be removed?
• Do I need to have lymph nodes removed? Will other tissues be removed? Why?
• How will I feel after the operation?
• If I have pain, how will it be controlled?
• How long will I have to stay in the hospital?
• Will I have any lasting side effects? If I don't have a hysterectomy, will I be able to get pregnant and have children? Is there increased risk of miscarriage?
• When will I be able to resume normal activities?
• How will the surgery affect my sex life?

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the treated area.

Women have radiation therapy alone, with chemotherapy, or with chemotherapy and surgery. The doctor may suggest radiation therapy instead of surgery for the small number of women who cannot have surgery for medical reasons. Most women with cancer that extends beyond the cervix have radiation therapy and chemotherapy. For cancer that has spread to distant organs, radiation therapy alone may be used.

Doctors use two types of radiation therapy to treat cervical cancer. Some women receive both types:

• External radiation: The radiation comes from a large machine outside the body. The woman usually has treatment as an outpatient in a hospital or clinic. She receives external radiation five days a week for several weeks.

• Internal radiation (intracavitary radiation): Thin tubes (also called implants) containing a radioactive substance are left in the vagina for a few hours or up to three days. The woman may stay in the hospital during that time. To protect others from the radiation, the woman may not be able to have visitors or may have visitors for only a short period of time while the tubes are in place. Once the tubes are removed, no radioactivity is left in her body. Internal radiation may be repeated two or more times over several weeks.

• What is the goal of this treatment?
• How will the radiation be given?
• Will I need to stay in the hospital? If so, for how long?
• When will the treatments begin? When will they end?
• How will I feel during therapy? Are there side effects?
• How will we know if the radiation therapy is working?
• Will I be able to continue my normal activities during treatment?
• How will radiation therapy affect my sex life?
• Will I be able to get pregnant and have children after my treatment is over?

Anticancer drugs for cervical cancer are usually given through a vein. Women usually receive treatment in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, a woman needs to stay in the hospital during treatment.

You may want to ask the doctor these questions before having chemotherapy:

• Why do I need this treatment?
• Which drug or drugs will I have?
• How do the drugs work?
• What are the expected benefits of the treatment?
• What are the risks and possible side effects of treatment? What can we do about them?
• When will treatment start? When will it end?
• How will treatment affect my normal activities?

Because cancer treatment often damages healthy cells and tissues, unwanted side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each woman, and they may change from one treatment session to the next. Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them.

The NCI provides helpful booklets about cancer treatments and coping with side effects. These include Radiation Therapy and You, Chemotherapy and You, and Eating Hints for Cancer Patients.

Surgery
It takes time to heal after surgery, and the recovery time is different for each woman. You may be uncomfortable for the first few days. However, medicine can usually control the pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain relief.

If you have surgery to remove a small tumor on the surface of the cervix, you may have cramping or other pain, bleeding or a watery discharge.

If you have a hysterectomy, the length of the hospital stay may vary from several days to a week. It is common to feel tired or weak for a while. You may have problems with nausea and vomiting, and you may have bladder and bowel problems. The doctor may restrict your diet to liquids at first, with a gradual return to solid food. Most women return to their normal activities within four to eight weeks after surgery.

After a hysterectomy, women no longer have menstrual periods. They cannot become pregnant.

When the ovaries are removed, menopause occurs at once. Hot flashes and other symptoms of menopause caused by surgery may be more severe than those caused by natural menopause. You may wish to discuss this with your doctor before surgery. Some drugs have been shown to help with these symptoms, and they may be more effective if started before surgery.

After surgery, some women may be concerned about sexual intimacy. Many women find that it helps to share these concerns with their partner. A couple may want to ask a counselor to help them express their concerns.

Radiation Therapy
Side effects depend mainly on the dose of radiation and the part of your body that is treated. Radiation to the abdomen and pelvis may cause nausea, vomiting, diarrhea or urinary problems. You may lose hair in your genital area. Also, your skin in the treated area may become red, dry and tender.

You may have dryness, itching or burning in your vagina. The radiation may also make your vagina narrower. The doctor or nurse may suggest ways to relieve discomfort. There also are ways to expand the vagina, which will help make follow-up exams easier. Your doctor may advise you not to have intercourse during treatment. But most women can resume sexual activity within a few weeks after treatment ends.

You are likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.

Although the side effects of radiation therapy can be distressing, your doctor can usually find ways to relieve them.

Chemotherapy
The side effects of chemotherapy depend mainly on the specific drugs and the dose. The drugs affect cancer cells and other cells that divide rapidly:

• Blood cells: These cells fight infection, help your blood to clot, and carry oxygen to all parts of the body. When drugs affect your blood cells, you are more likely to get infections, bruise or bleed easily and feel very weak and tired.

• Cells in hair roots: Chemotherapy can cause you to lose your hair. The hair will grow back, but it may be somewhat different in color and texture.

• Cells that line the digestive tract: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea or mouth and lip sores.

Your doctor can suggest ways to control many of these side effects.

Complementary and Alternative Medicine

Some people with cancer use complementary and alternative medicine (CAM) to ease stress or to reduce side effects and symptoms:
An approach is generally called complementary medicine when it is used along with standard treatment.

An approach is called alternative medicine when it is used instead of standard treatment.
Acupuncture, massage therapy, herbal products, vitamins or special diets, visualization, meditation and spiritual healing are types of CAM. Many people say that such approaches help them feel better.

However, some types of CAM, including certain vitamins, may interfere with standard treatment. Combining CAM with standard treatment may even be harmful. Before trying any type of CAM, you should discuss its possible benefits and harmful effects with your doctor.

Some types of CAM are expensive. Health insurance may not cover the cost.

The NCI offers a fact sheet called "Complementary and Alternative Medicine in Cancer Treatment: Questions and Answers."

Nutrition

It is important to eat well during cancer treatment. Eating well means getting enough calories to maintain a good weight and enough protein to keep up your strength. Good nutrition often helps people with cancer feel better and have more energy.

But eating well can be difficult. You may not feel like eating if you are uncomfortable or tired. Also, the side effects of treatment (such as poor appetite, nausea, vomiting or mouth sores) can be a problem. Some people find that foods do not taste as good during cancer therapy.

The doctor, a dietitian, or another health care provider can suggest ways to maintain a healthy diet. The NCI booklet Eating Hints for Cancer Patients has many useful ideas and recipes.

Follow-up Care

Follow-up care after treatment for cervical cancer is important. Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment. Your doctor will monitor your recovery and check for recurrence of the cancer. Checkups help ensure that any changes in your health are noted and treated as needed. Checkups may include a physical exam as well as Pap tests and chest x-rays. Between scheduled visits, you should contact the doctor right away if you have any health problems.

To help answer questions about follow-up care and other concerns, NCI has a booklet for people who have completed their treatment. Facing Forward Series: Life After Cancer Treatment provides tips for making the best use of medical visits. It describes how to talk with the doctor about creating a plan of action for your recovery and future health.

Sources of Support

Living with a serious disease such as cervical cancer is not easy. You may worry about caring for your family, keeping your job, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or other activities. Meeting with a social worker, counselor or member of the clergy can be helpful if you want to talk about your feelings or concerns. Often, a social worker can suggest resources for financial aid, transportation, home care or emotional support.

Support groups also can help. In these groups, patients or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone or on the Internet. You may want to talk with a member of your health care team about finding a support group.

Cancer Information Specialists at (800) 4-CANCER and at LiveHelp (http://www.cancer.gov) can help you locate programs, services and publications. Also, you may want to see the NCI fact sheets called "Cancer Support Groups: Questions and Answers" and "National Organizations That Offer Services to People With Cancer and Their Families."

The Promise of Cancer Research

Doctors all over the country are conducting many types of clinical trials (research studies in which people volunteer to take part). They are studying new ways to treat cervical cancer. Some are also studying therapies that may improve the quality of life for women during or after cancer treatment.

Clinical trials are designed to answer important questions and to find out whether new approaches are safe and effective. Research already has led to many advances, and researchers continue to search for more effective methods for dealing with cancer.

Researchers are testing new approaches to treatment, including anticancer drugs and drug combinations. They also are studying different methods, doses and schedules of radiation therapy. Some trials are combining chemotherapy, surgery and radiation therapy. Other trials are researching biological therapy.

Researchers also are studying surgery to remove sentinel lymph nodes. A sentinel lymph node is the first lymph node to which the cancer is likely to spread. Today, surgeons often have to remove many lymph nodes and check each of them for cancer. But if the research shows that it is possible to identify the sentinel lymph node (the lymph node most likely to have cancer), doctors may be able to avoid more surgery to remove other lymph nodes.

People who join clinical trials may be among the first to benefit if a new approach is effective. And even if participants do not benefit directly, they still make an important contribution to medicine by helping doctors learn more about the disease and how to control it. Although clinical trials may pose some risks, researchers do all they can to protect their patients.

If you are interested in being part of a clinical trial, talk with your doctor. You may want to read the NCI booklet Taking Part in Clinical Trials: What Cancer Patients Need To Know. The NCI also offers an easy-to-read brochure called If You Have Cancer…What You Should Know About Clinical Trials. These NCI publications describe how clinical trials are carried out and explain their possible benefits and risks.

NCI's Web site includes a section on clinical trials at http://www.cancer.gov/clinical_trials. It has general information about clinical trials as well as detailed information about specific ongoing studies of cervical cancer. Information Specialists at (800) 4-CANCER or at LiveHelp at http://www.cancer.gov can answer questions and provide information about clinical trials.

National Cancer Institute Information Resources

You may want more information for yourself, your family, and your doctor. The following National Cancer Institute (NCI) services are available to help you.

Telephone
Cancer Information Service (CIS)
The CIS provides accurate, up-to-date information on cancer to patients and their families, health professionals, and the general public. Information Specialists translate the latest scientific information into understandable language and respond in English, Spanish, or on TTY equipment. Calls to the CIS are free.
Telephone: (800) 4-CANCER (800-422-6237)
TTY: (800) 332-8615

Internet
The NCI's Web site (http://www.cancer.gov) provides information from numerous NCI sources. It offers current information on cancer prevention, screening, diagnosis, treatment, genetics, supportive care, and ongoing clinical trials. It has information about NCI's research programs and funding opportunities, cancer statistics, and the Institute itself. Information Specialists provide live, online assistance through LiveHelp.

Revision Date: March 18, 2005

Source: National Cancer Institute, National Institutes of Health

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