Cervical Cancer

Your cervix is the lower part of your uterus. When abnormal cells grow there, it’s called cervical cancer.

Human papillomavirus infection (HPV) is the most common cause of cervical cancer. HPV infections are extremely common and most women will acquire HPV at some point in during their lifetime. Most people’s immune systems will clear an HPV infection without it developing into cancer. But some types of HPV aren’t cleared. They can transform cervical cells into precancerous cells. If it’s not treated, these cells become cervical cancer.

Cervical cancer grows slowly, and most cases of cervical cancer in the US are caught before they spread thanks to common screening tests.

Squamous cell carcinomas make up 80–90% of cervical cancers. Adenocarcinoma makes up 10–20%. Other rare types of cervical cancer also exist.

The American Cancer Society estimates that about 13,000 people are diagnosed with invasive cervical cancer each year.

Screening and Prevention

Invasive cervical cancer is a rare disease thanks to screening, early detection, and the HPV vaccine.

Almost all cervical cancers are caused by high-risk types of human papillomavirus, or HPV. HPV is the most common sexually transmitted infection in the US. Most sexually active people with cervixes have an HPV infection during their lifetimes.

Prevention

Using condoms can reduce your risk of getting HPV.

The HPV vaccine can also greatly reduce your risk for HPV and cervical cancer. The Centers for Disease Control recommends that males and females age 9–26 get vaccinated. Adolescents under 15 years of age should receive two doses of the vaccine, spaced 6 to 12 months apart. People who are 15 years of age or older need three doses of the vaccine administered at 0, 1-2, and 6 months.  After 26, people have smaller benefit from the vaccine.

Screening

Cervical cancer screening can be performed using a Pap test (smear) or HPV testing. Cervical cancer screening should start at age 25, according to American Cancer Society guidelines. If you have abnormal results, your doctor may recommend additional evaluation.

Doctors use two tests to initially screen for cervical cancer during a gynecologic exam:

• The Pap test, which involves sampling cervical cells with a brush and spatula. Your doctor sends the cells to a lab for examination. Typically, it’s not a painful procedure.
• HPV test, also conducted by a lab using the same sampled cells.

Colposcopy

If your screening test results are abnormal, your doctor will do a more detailed exam of your cervix using a magnifying lens called a colposcope. This is called a colposcopy. Your doctor may take more tissue samples (biopsy) to identify the origin and severity of the abnormality. While this procedure can cause more discomfort than a Pap, most women tolerate it without anesthesia or pain medication.

Your doctor will recommend watching and waiting or further treatment, depending on the test results.

LEEP Procedure

LEEP, or loop electrosurgical excision procedure, is used both for diagnosis and treatment of abnormal cells on your cervix. This procedure uses a fine wire loop and an electric current to cut away a thin layer of abnormal tissue. Your doctor usually does LEEPs in the clinic after giving you local anesthesia. Sometimes, though, you will have the procedure at an outpatient clinic under general anesthesia.

A pathologist will examine the tissue, and the test results will determine if you need further treatment.

Risk Factors

HPV infection is the most important risk factor for cervical cancer, but only a small number of people with HPV have precancerous cells or invasive cancer. You can reduce your risk by getting vaccinated or by using barrier contraception like condoms and dental dams during sex. There is no treatment or cure for HPV.

Other risk factors include:

• Sexual history. The higher number of sexual partners you have, the higher risk for developing cervical cancer. Also, the younger you are when you start having sex, you’re at higher risk for getting an HPV infection and developing cervical cancer.
• Smoking. Chemicals associated with smoking cigarettes can be found in cervical mucus. These chemicals can contribute to development of cervical cancer. Smoking also reduces your body’s ability to fight HPV infection.
• Immune health. People with HIV or who are taking immunosuppressive medications have a higher risk of developing cervical cancer because they cause a weaker immune system.
• Other sexually transmitted infections. People with chlamydia, gonorrhea, syphilis, or herpes have a higher risk of developing cervical cancer.
• Lack of screening. Cervical cancer screening with the Pap and HPV tests can detect abnormal cells before they turn into cancer. People who don’t get regular cervical cancer screening increase their risk of developing invasive cervical cancer.

Cervical Cancer Symptoms and Diagnosis

Early cervical cancer doesn’t usually have symptoms. They are typically found during regular screening exams, and cure rates are very high for these people.

Symptoms

Once the cancer has invaded deeper into the cervix or nearby organs, you might have symptoms. If you have these symptoms, see your doctor immediately. You may have a biopsy -- a deeper tissue sample -- to help determine the extent of the disease.

• Pelvic pain
• Pain during intercourse
• Vaginal bleeding or spotting, especially after vaginal intercourse, bleeding or spotting in between menstrual periods, bleeding or spotting after menopause, or menstrual periods that are heavier or last longer than usual
• Vaginal discharge that can be watery, bloody, or have a foul odor

Diagnosis and Staging

If your doctor thinks you have more advanced cervical cancer, they will refer you to a gynecologic oncologist. This doctor is specially trained in gynecologic cancers. They may recommend tests that show how far the tumor has grown and spread into your body.

You might have the following diagnostic tests:

An examination under anesthesia (EUA), done as an outpatient procedure under general anesthesia. Your gynecologic oncologist will evaluate your bladder, rectum, and tissues surrounding your cervix for cancer spread.

• X-rays
• A CT (computed tomography) scan, which converts data from different angles of X-ray images of your body into pictures on a monitor.
• An MRI (magnetic resonance imaging) test, which uses powerful magnetic fields to create a 3D picture of your lower abdomen and pelvis to detect tumors.
• A PET (positron emission tomography) scan, which uses a small amount of radionuclide glucose (sugar) injected into a vein. The PET scanner rotates around your body and makes a picture of where glucose is being used in your body. Malignant tumor cells show up brighter than normal cells do.

Stages

Cancer stages denote whether cancer is confined to its site of origin or has spread into nearby tissues or further into your body. Your cancer’s stage, among other things, will determine your course of treatment.

• Stage I. Cancer is only in the cervix.
• Stage II. Cancer has spread beyond the cervix but has not spread to the pelvic sidewall or the lower third of the vagina.
• Stage III. Cancer has spread to the lower third of the vagina or to the pelvic sidewall.
• Stage IV. Cancer has spread to the bladder, rectum, or other parts of the body, such as lungs, bone, or liver.