What is Cervical Cancer?
Cervical cancer forms in the tissues of a woman’s cervix, the lower part of the uterus, connecting it to the vagina.This is usually a slow-growing cancer that may not cause symptoms, but it can be found early with regular preventive screenings.
Infection with HPV, or human papillomavirus, is the main cause of cervical cancer. In most cases, a woman’s immune system is able to prevent HPV from causing harm. The virus survives in a small percentage of women and develops into cancer. HPV infection and other risk factors may act together to increase the risk. Approximately half of all cervical cancer cases occur in women ages 35-55.
It is very important for women ages 21 to 65 to have regular preventive screenings in the form of Pap tests.
Research is improving our understanding of cervical cancer and its causes. The following are known risk factors for the disease:
- Human Papilloma Virus (HPV) Infection – The main risk factor for cervical cancer is chronic infection with human papilloma virus. HPV is the name for a group of more than 100 related viruses; those that cause cancer are called “high risk” HPVs. An HPV infection is usually passed from person to person through vaginal, anal or oral sex; however, all that is needed is skin-to-skin contact with someone infected. Women may have HPV but never develop cervical cancer. Women who have HPV plus one or more risk factors have a higher risk of developing cervical cancer.
- Birth Control Pills – Long-term use of birth control pills may increase the risk of cervical cancer. The risk increases the longer a woman takes birth control pills but the risk decreases after she stops.
- Chlamydia Infection – Women who have a past or current chlamydia infection are at greater risk for cancer of the cervix.
- Diet – Diets low in fruits and vegetables are linked to an increased risk of cervical cancer.
- Diethylstilbestrol (DES) – Daughters of women who took DES during pregnancy have a higher risk. DES is a hormone drug that was used between 1940 and 1971 to prevent miscarriages.
- Human Immunodeficiency Virus (HIV) – Research shows that people living with HIV may be more vulnerable to cervical cancer because their immune systems are less able to fight both HPV and early cancers.
- Multiple Pregnancies/Early Pregnancy – A woman who has had three or more full-term pregnancies has an increased risk of this cancer. Women who were younger than 17 years when they had their first full-term pregnancy are almost twice as likely to develop cervical cancer later in life.
- Smoking – Women who smoke are twice as likely to get cervical cancer.
Signs and Symptoms
Early cervical cancers normally do not cause symptoms. As the cancer grows, a woman may notice one or more of these symptoms:
- Abnormal Vaginal Bleeding – Bleeding that occurs between regular menstrual periods, after sexual intercourse, after douching, after a pelvic exam or after menopause.
- Menstrual Period Irregularity/Increased Vaginal Discharge – A period that lasts longer or is heavier than before or an increase in vaginal discharge.
- Pelvic Pain/Pain During Sex – Increases in pelvic pain or pain during sex can be a symptom of cervical cancer.
Early cervical cancer usually does not cause symptoms. To reduce the risk of cervical cancer, doctors recommend regular Pap tests. These tests, also called Pap smears or cervical smears, can find abnormal cells that can lead to cervical cancer. Finding and treating these abnormal cells early can prevent most cervical cancer. During a Pap test, a doctor or nurse scrapes a sample of cells from the cervix. A lab checks the cells for abnormalities or HPV infection. Once you learn the results of the tests or procedures, you will be able to work with your health care team to make thoughtful decisions.
If a woman has abnormal Pap results, the doctor will use one or more of the following tests to make a diagnosis:
Colposcopy – The doctor looks at the cervix with a colposcope, a tool with a bright light and magnifying lens.
Biopsy – A tissue sample is removed and examined under a microscope for abnormal cells. There are several types of biopsies:
- Punch Biopsy – A sharp tool is used to pinch off samples of tissue from the cervix.
- LEEP – An electric wire loop is used to slice a thin, round piece of cervical tissue.
- Endocervical Curettage – A curette, or small spoon-like device, is used to scrape a sample of tissue.
- Conization – The sample of tissue removed is cone-shaped so the pathologist can see if abnormal cells are in the tissue below the surface of the cervix.
Stages of Cervical Cancer
If cervical cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is used to find out whether the cancer has spread, and if so, to which parts of the body. If your cancer spreads to the bone, visit our bone metastases page. The following stages are used for cervical cancer:
Stage I: The tumor has invaded the cervix beneath the top layer of cells. Cancer cells are found only in the cervix.
Stage II: The tumor extends to the upper part of the vagina. It may extend beyond the cervix into nearby tissues toward the pelvic wall (the lining of the part of the body between the hips). The tumor is not in the lower third of the vagina or the pelvic wall.
Stage III: The tumor extends to the lower part of the vagina. It may also have invaded the pelvic wall. If the tumor blocks the flow of urine, one or both kidneys may not be working well.
Stage IV: The tumor invades the bladder or rectum, or the cancer has spread to other parts of the body.
Treatment options for cervical cancer depend on the stage of the disease, how quickly it is growing and your age and general health. You have time for a second opinion and to talk through options with your doctors and develop a treatment plan that best fits your needs.
The following are common treatments for cervical cancer:
A surgeon removes tissues with cancerous cells. This is most often used for women with stage I tumors.
Surgery options can include:
- Radical Trachelectomy – The cervix, part of the vagina, and pelvic lymph nodes are removed. This is often used for women with small tumors who may want to become pregnant in the future.
- Total Hysterectomy – The cervix and uterus are removed. Fallopian tubes and ovaries may also be removed.
- Radical Hysterectomy – The cervix and uterus are removed, as well as some tissue around the cervix and part of the vagina. The fallopian tubes and ovaries may also be removed.
Radiation uses high-energy rays to kill cancer cells. Women with early stages of cervical cancer may choose this instead of surgery. Radiation can also be used after surgery to destroy remaining cancer cells. Some people receive (external) radiation from a large machine aimed at the pelvis. Others receive (internal) radiation through a thin tube placed inside the vagina.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy for cervical cancer is usually given through a vein, and sometimes combined with radiation therapy.
Follow-up care after treatment for cervical cancer is important. Women need regular check-ups to monitor changes in health. Check-ups may include physical exams, Pap tests, chest x-rays and other procedures. Talk to a doctor right away if you have any symptoms or concerns.
Immunotherapy uses a person’s own immune system to recognize and attack cancer cells. The first drug of this type approved for cervical cancer patients is pembrolizumab (Keytruda®), approved for advanced cervical cancer with positive results for the PD-L1 biomarker.
Side Effects Management
It helps to learn more about the side effects from your treatment(s) before you begin, so you will know what to expect. When you know more, you can work with your health care team to manage your quality of life during and after treatment.
There are effective and readily available medications to address traditional side effects from cancer treatment such as nausea, diarrhea, constipation and mouth sores. Newer targeted therapies have fewer traditional side effects.
Keep in mind that everyone reacts differently to treatment and experiences side effects differently. There are coping mechanisms and strategies that can help.
The following are the common side effects by treatment:
Surgery and Hysterectomies
Surgery may leave you feeling weak and tired. Nausea, vomiting, bladder and bowel problems may occur. After a hysterectomy, women no longer have menstrual periods and cannot become pregnant. When the ovaries are removed, menopause begins immediately. Symptoms of menopause caused by surgery may be more troublesome than ones caused by natural menopause.
Side effects depend on dosage and the part of the body treated. They commonly include fatigue, hair loss in the treated area, nausea, vomiting, diarrhea and urinary problems. Radiation may make the vagina narrower, causing difficulties with sex and follow-up exams. Radiation of the pelvic area can also harm the ovaries.
The side effects depend mainly on which drugs are given and how much. Chemotherapy kills cancer cells but can harm normal cells as well. Damage to normal cells can cause side effects. Side effects include bruising or bleeding easily, infections, fatigue, hair loss, nausea, vomiting, diarrhea and mouth or lip sores.
Common side effects of PD-1 inhibitors include fatigue, rash, itching and diarrhea. In rare instances, side effects can be severe. If you are on immunotherapy, it is important to let your health care team know of any change in how you are feeling.