Cervical cancer

What is cervical cancer?

The cervix is a small, donut-shaped structure. It is located at the top of the vagina. It is the entrance to the uterus.

Cervical cancer begins in the outer layer of the cervix. This outer layer is called the cervical epithelium. Tiny changes begin in epithelial cells. Over time, cells may become cancerous and grow out of control.

Almost all cervical cancer is caused by infection with human papilloma virus (HPV). HPV can damage the cells that line the cervix. Sometimes the damage occurs in the genes of the cells, which may lead to cervical cancer. Cervical cancer usually grows slowly. It can remain in the cervical covering for up to 10 years. Once cervical cancer moves beyond this layer, it invades nearby tissue. This includes the uterus, vagina, bladder, and rectum.

Smokers are more likely to develop cervical abnormalities if they are infected with HPV. Women infected with human immunodeficiency virus (HIV) are also at higher risk. HPV is a very common infection among sexually active women. But only a small number of women with HPV develop cervical cancer.

Symptoms of cervical cancer

In its early stages, cervical cancer does not cause any symptoms. When cervical cancer does cause symptoms, a woman may experience:

• blood-tinged or discolored vaginal discharge
• spotting after sex
• heavier and/or more prolonged menstrual bleeding
• vaginal bleeding between periods.

These symptoms do not mean that you have cervical cancer. In fact, a woman may experience these symptoms for many reasons.

More advanced cervical cancer can cause:

• pelvic pain
• loss of appetite
• weight loss
• a decrease in red blood cells (anemia).

Diagnosing cervical cancer

Diagnosis of cervical cancer usually begins with a pelvic exam. The doctor inspects your cervix and vagina. He or she performs a Pap test. During a Pap test the doctor obtains a sample of cells from the surface and canal of your cervix. The cells are sent to a laboratory for examination. The Pap test is a quick, painless procedure.

If the Pap test indicates abnormal or possibly cancerous cells, a gynecologist will do one or more of the following:

• Examine your cervix and vagina with a magnifying instrument.
• Perform a biopsy. Your doctor removes a small piece of tissue from the cervix to be examined in a laboratory.
• Take a scraping of the cells inside the inner opening of the cervix.
• Perform a DNA test to check for HPV infection.

Your HPV DNA test may suggest a higher risk of developing cancer. If that is the case, your doctor may recommend further testing be done soon. Women who have a lower risk may be able to wait a few months before having a follow-up Pap smear. DNA testing can also identify the type of HPV. This is important because some types of HPV are more likely than others to cause cancer.

Expected duration of cervical cancer

Cervical cancer grows slowly and can take years to invade nearby tissues. However, it will continue to grow until it is treated.

Preventing cervical cancer

Almost all cervical cancer is caused by infection with HPV. There are currently two available HPV vaccines that target the major cervical cancer-causing types of HPV. The vaccines do not protect against all types of HPV.

The Centers for Disease Control and Prevention (CDC) recommends that all females starting at ages 11 or 12 get the HPV vaccine. Older girls and young women up to age 26 also should be vaccinated. Girls as young as 9 years old may receive the vaccine. The vaccine is given as a set of two or three shots over six months, depending on the age when vaccination is started.

Detecting cervical cancer early dramatically increases your chances of a cure. That is why Pap tests are an important part of prevention.

Women at average risk of cervical cancer should begin regular screening with a Pap test between the ages of 21 and 25. Pap smears should be done at least once every three years until age 30, as long as prior Pap smears have been normal. HPV screening for women who are under age 30 and have an average risk of cervical cancer may be considered.

Women age 30 and over have several options for screening if they have had normal Pap smears in the past:

• an HPV test once every five years
• combined HPV and Pap test once every five years
• Pap test once every three years.

Women that have an increased risk of cervical cancer need more frequent screening. Usually this means at least once per year. Risk factors that increase risk include:

• HIV infection
• conditions or medications that decrease immunity
• having a mother that took the drug diethylstilbestrol (DES) during pregnancy
• any prior cervical biopsies that showed cancerous cells.

Other steps to help prevent cervical cancer:

• Limit your number of sexual partners to reduce possible exposure to HPV.
• Use condoms during vaginal sex (unless you have only one sexual partner who you know does not have any sexually transmitted diseases).
• If you smoke, quit.

Treating cervical cancer

The cancer's stage is determined by how far the cancer has spread. Treatment depends on the stage.

• Stage 0 cancer remains within the surface layer.
• Stage I cancer remains within the cervix.
• Stage II cancer extends beyond the cervix, but not to the pelvic wall or into the lower portion of the vagina.
• Stage III cancer extends into the pelvic wall, the lower portion of the vagina, or the tubes that connect the kidneys to the bladder.
• Stage IV cancer extends beyond the pelvis or involves the bladder, the rectum, or both.

When recommending treatments for Stage 0 or Stage I cancer, your doctor will consider whether you want to have children. A pregnant woman diagnosed with Stage 0 or Stage I cervical cancer may be able to postpone treatment until after birth.

A woman with Stage 0 cancer who still wants to have children is usually treated with a surgical procedure to do one of the following:

• heat and vaporize the surface tissue layer
• freeze epithelial tissue to destroy abnormal cells
• surgically remove a cone-shaped piece of cervical tissue
• remove abnormal cells from the cervix using an electric current.

In women with Stage I cancer who plan to become pregnant, doctors may remove a cone-shaped piece of cervical tissue. For women who don't plan to become pregnant, the treatment for a minimally invasive Stage I cancer is usually a total hysterectomy. A total hysterectomy is the removal of the uterus and cervix. For two years after these procedures, women should have frequent Pap tests to check for abnormal cells.

For larger Stage I and Stage II cancers, doctors usually recommend a radical hysterectomy or radiation therapy plus chemotherapy. A radical hysterectomy is the removal of the uterus, cervix, ovaries, fallopian tubes, and pelvic lymph nodes. The choice between surgery and radiation therapy partly depends on the woman's age and health. The doctor should also consider the patient's concerns about potential side effects or complications.

The usual treatment for Stage III and Stage IV is a combination of radiation and chemotherapy. Immunotherapy and targeted therapy may also be recommended.

When to call a professional

Report any of the following symptoms to your doctor:

• abdominal pain
• weight loss
• unusual discharge from the vagina
• blood spots or light bleeding outside the time of your normal period
• significant pain or bleeding during sex.

Remember that these symptoms don't necessarily mean that you have cancer.

For women with advanced cervical cancer, significant vaginal bleeding requires immediate medical attention.

Prognosis

Survival depends on the stage at which the cancer is discovered and treated. Almost 100% of women with Stage 0 disease are cured. Women with Stage 1 and Stage 2 disease have a very good chance for cure. Cure rate is lower if cervical cancer is discovered at a later stage.

Additional info

National Cancer Institute (NCI)
https://www.cancer.gov/

American Cancer Society (ACS)
https://www.cancer.org/

Cancer Research Institute
https://www.cancerresearch.org/