Cervical cancer — one of the most common cancers among women — 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.
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 early and treat them if necessary,” says Jo Marie Janco, MD, a gynecologic oncologist at Scripps MD Anderson Cancer Center and Scripps Clinic.
Yes. Most cervical cancers are related to exposure to certain strains of human papillomavirus (HPV). There is a vaccine that can protect 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.
“Many people are exposed to HPV and it does not become an issue for them. But it is very important to 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, she adds.
“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 immunosuppressive medications for people who have had organ transplants — can increase the risk of cervical dysplasia and cancer.
Women who smoke have about twice the risk of developing cervical cancer as non-smokers, especially if they have HPV.
Women whose mothers were treated with this drug during their pregnancy have a higher risk of cervical cancers. DES was used until 1971 to prevent miscarriage.
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 cervical cancer can develop at any age.
Chlamydia is a sexually transmitted bacterial infection that 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, so an individualized plan for contraception should be discussed with your physician.
Abnormal bleeding or discharge are the most common symptoms of cervical cancer.
Abnormal bleeding after menopause, or in between menstrual cycles, should be evaluated.
Persistent abnormal discharge that is brownish, tan, bad-smelling, watery/heavy should be evaluated.
“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.
Back pain, leg swelling, and pelvic pain can be associated with cervical cancer but are less common.
“There may be other causes of those symptoms, which is why evaluation by your physician is important,” Dr. Janco says.
Many cervical dysplasias and cancers do not cause symptoms and are detected by screening tests.
The vulva, vagina, and cervix are examined during a pelvic exam. The physician can perform biopsies 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 and is performed 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.
“Skipping a Pap test can raise your risk of cell changes going undetected early and becoming cancerous,” she 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.”
Treatment depends on whether there is pre-cancer (dysplasia), or cancer, and if cancer - how far the cancer has spread (stage).
When cervical cancer is found before it has spread beyond the cervix (stage I), the 5-year survival rate is 92%.
Treatment may include surgery, radiation, chemotherapy, or a combination of those treatments and is individualized depending on the stage and type of cervical cancer.
“Any procedure will depend on the patient’s diagnosis and other factors, such as fertility and reproductive plans, and prior treatment,” Dr. Janco says.
Several procedures can remove pre-cancerous cells or early-stage cervical cancers that have not spread, including:
- Cryosurgery, also known as cryotherapy, freezes and destroys abnormal cells.
- Laser surgery uses a laser beam to destroy abnormal cells.
- LEEP (loop electro-surgical excision procedure) uses a small wire heated with low-voltage, high-frequency radio waves to remove abnormal cells/tissue from the cervix.
- Cone biopsy, also called conization, removes abnormal cells/tissue.
- Trachelectomy is the removal of the cervix.
- Hysterectomy is the removal of the uterus, including the cervix.