Cervical Cancer
Written by Adam Felman.
Medically reviewed by Christina Chun, MPH on January 23, 2019
Cervical cancer affects the entrance to the womb. The cervix is the narrow part of the lower uterus, often referred to as the neck of the womb. Human papillomavirus (HPV) causes the majority of cervical cancer cases. The HPV vaccine successfully prevents HPV. The Centers for Disease Control and Prevention (CDC) initially recommended the vaccine for all people aged 9–26 years. However, the CDC now advise that the vaccine is also available for all women and men aged 26–45 years who did receive the vaccine as a preteen. In this article, we look at cervical cancer, its symptoms, and ways to prevent and treat it.
Symptoms and early signs
Pelvic pain is a possible symptom of cervical cancer.
In the early stages of cervical cancer, a person may experience no symptoms at all. As a result, women should have regular cervical smear tests, or Pap tests. A Pap test is preventive. It aims not to detect cancer but to reveal any cell changes that indicate the possible development of cancer so that a person can take early action to treat it.
The most common symptoms of cervical cancer are:
- bleeding between periods
- bleeding after sexual intercourse
- bleeding in post-menopausal women
- discomfort during sexual intercourse
- vaginal discharge with a strong odor
- vaginal discharge tinged with blood
- pelvic pain
These symptoms can have other causes, including infection. Anyone who experiences any of these symptoms should see a doctor.
Stages
Working out the stage of a cancer is important, as it helps a person decide the most effective type of treatment. Staging aims to assess how far the cancer has spread and whether it has reached nearby structures or more distant organs. A 4-stage system is the most common way to stage cervical cancer.
- Stage 0: Precancerous cells are present.
- Stage 1: Cancer cells have grown from the surface into deeper tissues of the cervix, and possibly into the uterus and to nearby lymph nodes
- Stage 2: The cancer has now moved beyond the cervix and uterus, but not as far as the walls of the pelvis or the lower part of the vagina. It may or may not affect nearby lymph nodes.
- Stage 3: Cancer cells are present in the lower part of the vagina or the walls of the pelvis, and it may be blocking the ureters, the tubes that carry urine from the bladder. It may or may not affect nearby lymph nodes.
- Stage 4: The cancer affects the bladder or rectum and is growing out of the pelvis. It may or may not affect the lymph nodes. Later in stage 4, it will spread to distant organs, including the liver, bones, lungs, and lymph nodes.
Undergoing screening and seeking medical attention if any symptoms occur can help a person access early treatment and increase the chances of survival.
Causes
Cancer is the result of the uncontrolled division and growth of abnormal cells. Most of the cells in our body have a set lifespan, and, when they die, the body generates new cells to replace them.
Abnormal cells can have two problems:
- they do not die
- they continue dividing
This results in an excessive buildup of cells, which eventually forms a lump, or tumor. Scientists are not completely sure why cells become cancerous. However, some risk factors might increase the risk of developing cervical cancer. These include:
- HPV: This is a sexually transmitted virus. More than 100 different types of HPV can occur, at least 13 of which may cause cervical cancer.
- Having many sexual partners or becoming sexually active early: The transmission of cancer-causing HPV types nearly always occur as a result of sexual contact with an individual who has HPV. Women who have had many sexual partners generally have a higher risk of HPV infection. This increases their risk of developing cervical cancer.
- Smoking: This increases the risk of cervical cancer, as well as other types.
- A weakened immune system: The risk of cervical cancer is higher in those with HIV or AIDS, and people who have undergone a transplant, leading to the use of immunosuppressive medications.
- Birth control pills: Long-term use of some common contraceptive pills slightly raises a woman's risk.
- Other sexually transmitted diseases (STD): Chlamydia, gonorrhea, and syphilis increase the risk of developing cervical cancer.
- Socio-economic status: Rates appear to be higher in areas where income are low.
Treatment
Cervical cancer treatment options include surgery, radiotherapy, chemotherapy, or combinations of these. Deciding on the kind of treatment depends on several factors, such as the stage of the cancer, as well as age and overall state of health. Treatment for early-stage cervical cancer, when the cancer remains within the cervix, has a good success rate. The further a cancer spreads from its original area, the lower the success rate tends to be.
Early-stage options
Surgery is a common treatment method when the cancer has not spread from the cervix. Radiation therapy may help after surgery if a doctor believes that cancer cells might be present inside the body. Radiation therapy may also reduce the risk of recurrence (cancer coming back). If the surgeon wants to shrink the tumor to make it easier to operate, the person may receive chemotherapy although this is not a very common approach.
Treatment for advanced cervical cancer
When the cancer has spread beyond the cervix, surgery is not usually an option. Doctors also refer to advanced cancer as invasive cancer, because it has invaded other areas of the body. This type of cancer requires more extensive treatment, which will typically involve either radiation therapy or a combination of radiation therapy and chemotherapy.
In the later stages of cancer, healthcare professionals provide palliative therapy to relieve symptoms and improve quality of life.
Radiation therapy
Doctors commonly use radiation therapy to treat advanced forms of cervical cancer.
Some doctors refer to radiation therapy as radiation oncology or XRT. It involves the use of beams of high-energy X-rays or radiation to destroy cancer cells. When the treating doctor aims radiation at the pelvic area, it may cause the following side effects, some of which may not emerge until after the treatment is over:
- diarrhea
- nausea
- upset stomach
- bladder irritation
- narrowing of the vagina
- interrupted menstrual cycle
- early menopause
Chemotherapy
Chemotherapy is the use of chemicals (medication) to treat any disease. In this context, it refers to the destruction of cancer cells. Doctors use chemotherapy to target cancer cells that surgery cannot or did not remove, or to help the symptoms of people with advanced cancer. The side effects of chemotherapy can vary, and they depend on the specific drug. More common side effects include:
- diarrhea
- nausea
- hair loss
- fatigue
- infertility
- early menopause
Cervical cancer clinical trials
Participating in a clinical trial may be the best treatment option for some people. Clinical trials are an integral part of the cancer research process. Researchers carry them out to determine the safety and effectiveness of new treatments, and whether they are better than existing ones. People who participate in clinical trials are contributing to cancer research and innovation.
Prevention
A number of measures can help reduce the chances of developing cervical cancer.
Human papillomavirus (HPV) vaccine
The link between the development of cervical cancer and some types of HPV is clear. If every female keeps to the current HPV vaccination programs, they could reduce the frequency of cervical cancer.
Safe sex and cervical cancer
The HPV vaccine only protects against two HPV strains. Other strains can cause cervical cancer. Using a condom during sex helps protect from HPV infection.
Cervical screening
Regular cervical screening might help a person identify and deal with signs of cancer before the condition can develop or spread too far. Screening does not detect cancer but indicates changes to the cells of the cervix.
Having fewer sexual partners
The more sexual partners a woman has, the higher the risk of transmitting the HPV virus becomes. This can lead to a higher risk of developing cervical cancer.
Delaying first sexual intercourse
The younger a woman is when she has sexual intercourse for the first time, the higher the risk of HPV infection becomes. The longer she delays it, the lower her risk.
Stopping smoking
Women who smoke and have HPV face a higher risk of developing cervical cancer than people who do not.
Diagnosis
A Pap smear test can help identify the early signs of cervical cancer.
Early cervical cancer diagnosis improves the success rate of treatment.
The U.S. Preventive Services Task Force (USPSTF) recommend the following as routine screening:
Under 21 years: The USPSTF do not recommend screening.
From 21–29 years: People should undergo screening every 3 years for cervical cancer.
From 30–65 years: The frequency depends on the type of screening. The USPSTF recommend one of the following:
- screening for cervical cancer every 3 years, or
- screening for HPV every 5 years, or
- screening for both HPV and cervical cancer every 5 years
Over 65 years: The USPSTF do not recommend screening for those who have had adequate screening in the past, unless they have a high risk of cervical cancer.
People who have had a hysterectomy with removal of the cervix do not need screening, unless they have had precancerous lesions or cervical cancer in the past.
These are the overall screening recommendations, but a doctor can advise each person about their screening needs.
Cervical smear test
The American Cancer Society estimate that healthcare professionals will make over 13,000 new diagnoses of invasive cervical cancer in 2019. The disease will be fatal in around 4,000 women. However, regular screening could prevent most of these deaths.
Screening does not detect cancer but looks for abnormal changes in the cells of the cervix. Without treatment, some abnormal cells can eventually develop into cancer.
HPV DNA testing
This test determines whether the individual has any of the types of HPV most likely to cause cervical cancer. It involves collecting cells from the cervix for lab testing.
The test can detect high-risk HPV strains in cell DNA before any anomalies become clear in the cervical cells.
If there are signs and symptoms of cervical cancer, or if the Pap test reveals abnormal cells, a doctor may recommend additional tests.
These include:
- Colposcopy: This is visual examination of the vagina using a speculum and a colposcope, a lighted magnifying instrument.
- Examination under anesthesia (EUA): The doctor can examine the vagina and cervix more thoroughly.
- Biopsy: The doctor takes a small section of tissue under general anesthesia.
- Cone biopsy: The doctor takes a small, cone-shaped section of abnormal tissue from the cervix for examination.
- LLETZ: Diathermy using a wire loop with an electric current helps remove abnormal tissue. The healthcare professional then sends the tissue to the lab for checking.
- Blood tests: A blood cell count can help identify liver or kidney problems.
- CT scan: A medical professional might use a barium liquid to show up any cellular abnormalities.
- MRI: Special types of MRI may be able to identify cervical cancer in its early stages.
- Pelvic ultrasound: High-frequency sound waves create an image of the target area on a monitor.
Outlook
The stage at which a person receives a cervical cancer diagnosis can help indicate their chances of survival for at least 5 more years:
- Stage 1: In early stage 1, the chance of surviving at least 5 years is 93 percent, and in late stage 1, it is 80 percent.
- Stage 2: In early stage 2, the rate is 63 percent, falling to 58 percent by the end of stage 2.
- Stage 3: During this stage, the chances fall from 35 percent to 32 percent.
- Stage 4: People with stage-4 cervical cancer have a 15 to 16 percent chance of surviving another 5 years.
These are average survival rates and do not apply to everyone. In some cases, treatment is successful up to stage 4.
REFERENCES
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aap.org/en-us/about-the-aap/aap-press-room/pages/Stress-and-Depression-is-Linked-to-HPV-Related-Health-Problems.aspx - Cervical cancer risks and causes - smoking. (2014).
cancerresearchuk.org/about-cancer/type/cervical-cancer/about/cervical-cancer-risks-and-causes#smoking - Cervical cancer screening. (2016).
acog.org/Patients/FAQs/Cervical-Cancer-Screening - Cervical cancer stages. (2017).
cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/staged.html - Deliver HPV vaccination programmes. (n.d.).
who.int/immunization/hpv/deliver/en/ - FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old. (2018).
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who.int/mediacentre/factsheets/fs380/en/ - Key statistics for cervical cancer. (2016).
cancer.org/cancer/cervical-cancer/about/key-statistics.html - Screening for cervical cancer: U.S. Preventive Services Task Force recommenation statement. (2018).
jamanetwork.com/journals/jama/fullarticle/2697704 - Survival rates for cervical cancer, by stage. (2017).
cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/survival.html - The HPV DNA test. (2014).
cancer.org/cancer/cervicalcancer/moreinformation/cervicalcancerpreventionandearlydetection/cervical-cancer-prevention-and-early-detection-h-p-v-test - What are the key statistics about cervical cancer? (2016).
cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-key-statistics - What are the risk factors for cervical cancer? (2016).
cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-risk-factors
