Cervical Cancer

Introduction

Cervical cancer forms in the tissues of a woman’s cervix, which is the lower part of the uterus that connects to the vagina. This is usually a slow-growing cancer that may not cause symptoms. Most cervical cancers can be found early with regular preventive screenings and can be prevented with the human papillomavirus (HPV) vaccine.

Infection with HPV, or human papillomavirus, is the main cause of cervical cancer. In most cases, a woman’s immune system can 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. About 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.

Risk Factors

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 factors for cervical cancer are chronic infection with HPV and lack of screening. 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 passed from person to person by skin-to-skin contact with someone infected. This happens most often through vaginal, anal or oral sex, but it can also happen in other ways. Women may have HPV but never develop cervical cancer. Women who have chronic HPV infection 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 of cervical cancer.

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 & 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.

 

Screening

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, you will be able to work with your health care team to make thoughtful decisions.

 

Diagnosis

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 – A cone-shaped sample of tissue is removed. The pathologist looks to see if abnormal cells are in the tissue below the surface of the cervix.

 

Staging

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. 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.

Treatments & Side Effects

Treatment options for cervical cancer depend primarily on the stage of the disease, your general health, and your desire to preserve fertility. You have time for a second opinion, to talk through options with your doctors, and to develop a treatment plan that best fits your needs.

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:

Newer targeted therapies have fewer traditional side effects.

Keep in mind that everyone reacts differently to treatment and experiences different side effects. There are coping mechanisms and strategies that can help.

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.

The following are treatments and their common side effects for cervical cancer:

Surgery

A surgeon removes tissues with cancerous cells. This is most often used for women with stage I tumors.

Surgery options can include:

  • Radical Trachelectomy and Pelvic Lymphadenectomy – The cervix, parametrial tissue (tissue that suspends the cervix to the pelvic sidewall), 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.
  • Radical Hysterectomy and Pelvic Lymphadenectomy – The cervix, body of the uterus, parametrial tissue (tissue that suspends the cervix to the pelvic sidewall), part of the vagina, and pelvic lymph nodes are removed. Surgery may leave you feeling weak and tiredNausea/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.

Radiation Therapy

Radiation therapy is the use of high-energy rays to kill or damage cancer cells. 

Women with early stages of cervical cancer may choose this instead of surgery. However, if the tumor is appropriate for surgical resection, this modality of treatment is preferred to avoid the long-term side effects of radiation therapy. 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. These two types of radiation therapy delivery are usually delivered for cancers that are locally advanced or in cases where surgery is not sufficient treatment. Side effects specific to cervical cancer can include hair loss in the treated area, 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.

Learn about radiation therapy

Chemotherapy

Chemotherapy involves the use of drugs to destroy cancer cells. It is a systemic (whole body) treatment. 

Chemotherapy for cervical cancer is usually given through a vein, and sometimes combined with radiation therapy.

Learn about chemotherapy

Immunotherapy

Immunotherapy uses the body’s natural defenses (the immune system) to find, attack, and kill cancer cells.

Learn about immunotherapy

Clinical trials

Be sure to ask about clinical trials. These are research studies to test new treatments or learn how to use current treatments better. In some cases, the treatments with the best chance of success may be available only through clinical trials. Trials are offered for many cancers, at many different stages. Everyone is not eligible for every trial. If you have cancer that has come back or spread, it is especially important to ask about clinical trials.

Learn about clinical trials