Cervical cancer is one of the main types of gynecological cancers. It is largely preventable, but it can also be deadly.
Nearly 13,000 new cases of cervical cancer were reported in 2018 and more than 4,000 women died of this cancer, according to the Centers for Disease Control and Prevention (CDC).
Fortunately, there is a vaccine that can help prevent cervical cancer. Cervical cancer rates have dropped in the United States since the HPV vaccine became available in 2006.
Understanding the risks, signs and symptoms of cervical cancer remains important, however. Cervical cancer usually develops over several years. Cells slowly change from normal to pre-cancerous (cervical dysplasia) to cancerous.
“Not all precancerous cervical cells will become cancerous, but some will, so it is important to detect changes and treat them if necessary,” says Jo Marie Janco, MD, a gynecologic oncologist at Scripps MD Anderson Cancer Center and Scripps Clinic.
Cervical cancer occurs when cells of the cervix become cancerous. The cervix is the lower part of the uterus and is connected to the upper part of the vaginal canal.
Yes. Most cervical cancers are related to exposure to certain strains of human papillomavirus (HPV). The HPV vaccine protects against high-risk HPV strains that can cause cervical cancer. It is most effective when given during childhood or early adolescence, but it is also approved for adults.
“No vaccine or preventive measure is perfect, but cervical cancer is one of the very few cancers for which we have a preventive option,” Dr. Janco says.
HPV is a sexually transmitted infection that spreads easily through skin-to-skin contact. Most adults who have been or are sexually active will be exposed to HPV at some point in their lives.
Many HPV infections will be cleared by the body and many more will be suppressed or become dormant. But a small number will remain or become active and lead to cervical dysplasia and potentially cancer. According to the CDC, 10 percent of women with HPV infection on their cervix will develop long-lasting HPV infections that put them at risk for cervical cancer.
“Many people are exposed to HPV, and it does not become an issue for them. But it is very important to take care of yourself and consider getting the HPV vaccine, stay up to date with screenings and be evaluated for any abnormal symptoms, so that any changes can be caught early,” says Dr. Janco.
The HPV vaccine also protects against other cancers, such as certain head and neck cancers.
“Talk to your physician about whether the HPV vaccine would be appropriate for you, as well as guidelines and recommendations for vaccinating your children,” Dr. Janco says.
Medical conditions or medications that lower the immune system’s function — such as HIV, or medications for people who have had organ transplants — can increase the risk of cervical cancer.
Women who smoke have about twice the risk of developing this type of cancer as non-smokers, especially if they have HPV.
Most women who develop cervical cancer are between 20 and 50 years old. The risk is lower for women over 65 who have had regular screenings, but this type of cancer can develop at any age.
Having multiple sexual partners and having unprotected sex may increase the risk of HPV infection.
This sexually transmitted infection may raise cervical cancer risk.
Cervical cancer risk increases the longer oral contraceptives are used and decreases when pills are stopped. However, use of oral contraceptives can decrease the risk of other cancers, including ovarian and endometrial cancers. An individualized plan for contraception should be discussed with your physician.
Women who have carried three or more pregnancies to term have a higher risk of cervical cancer.
Women whose mother or sister had cervical cancer are also at higher risk.
Women whose mothers were treated with this drug during their pregnancy are also a higher risk. DES was used until 1971 to prevent miscarriage.
Early on, cervical cancer may not cause signs and symptoms. As it advances, it may cause:
- Abnormal bleeding after menopause, or in between menstrual cycles
- Persistent abnormal discharge that is brownish, tan, bad-smelling, watery/heavy
“The physician will generally perform a pelvic examination and additional tests, such as a Pap test, or sometimes a biopsy, to determine whether there is an abnormality in the cells,” Dr. Janco says.
Other symptoms may include:
- Back pain
- Leg swelling
- Pelvic pain
“There may be other causes of those symptoms, which is why evaluation by your physician is important,” Dr. Janco says.
Cervical cancer can be found through screening tests. Many cervical dysplasias and cancers do not cause symptoms and are detected only by screening.
Early detection leads to early treatment, which is when it is most effective. When cervical cancer is found before it has spread beyond the cervix (stage I), the 5-year survival rate is 92%.
The vulva, vagina, and cervix are examined during a pelvic exam. A biopsy may follow if there are any visible abnormal growths.
A Pap test or Pap smear is a fast, relatively painless test that can identify abnormal changes in cervical cells. It is done during a pelvic exam by collecting cells from the cervix with a brush.
This test checks for active HPV infection. HPV and Pap tests can be done at the same time.
“Your doctor can discuss with you how often you need these tests and perform them during your well woman exam. Depending on your prior screening and personal risk factors, you may need to be screened more often,” Dr. Janco says.
“While guidelines now support spacing Pap and HPV testing for low-risk women, that does not mean skipping a pelvic examination or well woman exam.
Remember that your physician can evaluate for other problems and discuss your gynecologic health in general.”
Skipping a Pap test can raise your risk of cell changes going undetected early and becoming cancerous, she adds.
Treatment depends on whether there is pre-cancer or cancer, and if it has spread.
At Scripps, treatment is individualized depending on the stage and type of cervical cancer.
Treatment may include surgery, radiation, chemotherapy, or a combination.
“Any procedure will depend on the patient’s diagnosis and other factors, such as fertility, reproductive plans and prior treatment,” Dr. Janco says.
Surgical procedures may include:
- Cryosurgery, which freezes and destroys abnormal cells.
- Laser surgery, which uses a laser beam to destroy abnormal cells.
- LEEP, which uses a small wire heated with low-voltage, high-frequency radio waves to remove abnormal cells/tissue from the cervix.
- Cone biopsy removes abnormal cells/tissue.
- Trachelectomy is the removal of the cervix.
- Hysterectomy is the removal of the uterus, including the cervix.