Doru Paul, MD, is triple board-certified in medical oncology, hematology, and internal medicine. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology Oncology at the New York Presbyterian Weill Cornell Medical Center.
Yearly, in the US, about 13,000 women are diagnosed with cervical cancer, with almost 4,300 yearly cervical cancer deaths. The condition is usually asymptomatic and most cases are attributed to human papillomavirus (HPV), a sexually transmitted infection. The cancer is usually preceded by cervical dysplasia or cervical neoplasia, which are alterations of cervical cell and tissue characteristics.
Prevention includes protection from HPV exposure and early detection. Screening with a Pap smear is recommended every five years, and HPV testing may be done as well. Cervical cancer can be diagnosed with a cervical biopsy and imaging tests. Staging and grading are important aspects of treatment planning. Treatment can include surgery, radiation, chemotherapy, immunotherapy, and targeted therapy.
Cervical cancer is usually caused by HPV infection. Exposure to multiple sexual partners, especially without using a condom, increases the risk of HPV. Long-term use of birth control pills and/or in utero diethylstilbestrol (DES) exposure (having a mother who took DES during pregnancy) increases the risk as well. Smoking increases the risk of cervical cancer in women who have HPV.
Cervical cancer is manageable and can be cured if diagnosed and treated at an early stage. Cervical dysplasia can be treated with cryotherapy (freezing the cells). Cervical cancer treatment includes surgery, radiation, chemotherapy, targeted therapy, and/or immunotherapy. The overall five-year survival rate is 66%. When treated while the cancer is still localized, the five-year survival rate is about 90%.
Cervical cancer is usually not hereditary; the inherited predispositions to this type of cancer are. If your mother or sister had cervical cancer, your chances of developing the disease are higher than if no one in the family had it. The condition is associated with acquired genetic mutations (changes) in the cervical cells that are caused by the HPV virus.
Preventing cervical cancer includes vaccination against HPV, avoiding HPV exposure, cervical dysplasia screening, and avoiding smoking. In the US, the HPV vaccine is recommended in girls and women ages 9 through 45 for the prevention of cervical cancer. If primary HPV testing isn’t available, an HPV test with a Pap test (co-testing) every 5 years, or a Pap test alone every 3 years is acceptable.
A Pap smear is used to screen for HPV, cervical dysplasia, and cervical cancer. A biopsy is needed to identify cervical cancer. Cervical cancer diagnosis and grading rely on the characteristics seen on a biopsy. Together with this information, imaging tests help classify cervical cancer in different stages according to the amount of local growth and invasion of the tumor, and its metastatic spread.
Adenocarcinoma is a type of cancer that arises from gland cells that produce hormones or mucus. Gland cells are normally present in many organs, including the cervix, and they can be damaged by HPV. About 25% of cervical cancer is adenocarcinoma, and it can be detected with a Pap smear and confirmed with a biopsy.
The cervix is the narrow lower part of the uterus that leads into the vagina. During childbirth, it expands and shortens. Sperm flows from the vagina, through the cervix, and to the uterus and fallopian tubes. Menstrual blood flows from the uterus through the cervix, and then out of the body through the vagina. The cervix can be affected by vaginal and other pelvic diseases or infections.
A type of cervical biopsy in which a scoop-like surgical device is used to sample tissue for a microscopic evaluation. This is done during a colposcopy, which is a pelvic exam that’s done with the use of a magnifying instrument. The tissue sampled is larger with ECC than with Pap smear or punch biopsy, and the procedure is not recommended during pregnancy.
HPV is a sexually transmitted infection. Some strains cause warts, while others do not cause symptoms, but can lead to cervical dysplasia or cervical cancer. HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58 are associated with cervical dysplasia. HPV 16, 18, 31, 33, 45, 52, and 58 are associated with cervical cancer. HPV has been associated with approximately 50% of penile cancer in men and it can be transmitted to and from men through sexual intercourse.
Malignant cancers are tumors that have the potential to grow rapidly, invade locally, and/or spread in the body. Generally, malignant cancer cells are substantially altered in comparison to normal cells, and they can invade local tissue, blood vessels, lymph nodes, travel at distance from the primary tumor, and grow in other organs. Benign and malignant cancers differ in that benign tumors do not spread or invade other tissue.
A Pap test (also called Pap smear) is a screening test in which the doctor inserts a speculum into a woman’s vagina and takes a sample of surface tissue with a special brush. The sample is examined to identify abnormalities in the cervical cells. Pap tests are estimated to prevent 95% of cervical cancers due to early detection. A Pap test does not identify the HPV virus.
A punch biopsy is used to sample skin or other superficial tissue (such as the lining of the cervix) with a sharp, circular device that cuts a small sample. This is an in-office procedure and one or two sutures may be needed to close the resulting wound. The biopsy sample is examined for cancer characteristics.
This type of cancer starts in the squamous cells. Squamous cells line the cervix, and they can be damaged by HPV infection. Squamous cell carcinoma is the most common type of cervical cancer. The altered squamous cells can be detected with a Pap smear and the presence of dysplasia or cancer can be confirmed with a biopsy. The severity of dysplasia can range from low grade to high grade.
American Cancer Society. Key statistics for cervical cancer. Updated July 30, 2020.
American Cancer Society. Risk factors for cervical cancer. Updated January 3, 2020.
American Cancer Society. Survival rates for cervical cancer. Updated January 3, 2020.
Cao C, Hong P, Huang X, Lin D, Cao G, Wang L, Feng B, Wu P, Shen H, Xu Q, Ren C, Meng Y, Zhi W, Yu R, Wei J, Ding W, Tian X, Zhang Q, Li W, Gao Q, Chen G, Li K, Sung WK, Hu Z, Wang H, Li G, Wu P. HPV-CCDC106 integration alters local chromosome architecture and hijacks an enhancer by three-dimensional genome structure remodeling in cervical cancer. J Genet Genomics. 2020 Jun 11:S1673-8527(20)30092-8. doi: 10.1016/j.jgg.2020.05.006
Centers for Disease Control and Prevention. HPV vaccine recommendations. Updated March 17, 2020.
Fontham ETH, Wolf AMD, Church TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA: A Cancer Journal for Clinicians. 2020;70(5):321-346. doi:10.3322/caac.21628.
American Cancer Society. What is cervical cancer? July 30, 2020
Liu AH, Walker J, Gage JC, Gold MA, Zuna R, Dunn ST, Schiffman M, Wentzensen N. Diagnosis of Cervical Precancers by Endocervical Curettage at Colposcopy of Women With Abnormal Cervical Cytology. Obstet Gynecol. 2017 Dec;130(6):1218-1225. doi: 10.1097/AOG.0000000000002330. PMID: 29112672; PMCID: PMC5709212
Backes DM, Kurman RJ, Pimenta JM, Smith JS. Systematic review of human papillomavirus prevalence in invasive penile cancer. Cancer Causes Control. 2009 May;20(4):449-57. doi: 10.1007/s10552-008-9276-9.
US Department of Health and Human Services. Pap and HPV tests. January 31, 2019.
Gad MM, Galal SB, Helmy W, Abd El-Fattah NH. Screening of Cervical Cancer: Visual Inspection with Acetic Acid (VIA) and Site of Lesion Verified by Multiple Punch Biopsies. Folia Med (Plovdiv). 2019 Jun 1;61(2):289-295. doi: 10.2478/folmed-2018-0074. PMID: 31301660.
Petca A, Borislavschi A, Zvanca ME, Petca RC, Sandru F, Dumitrascu MC. Non-sexual HPV transmission and role of vaccination for a better future (Review). Exp Ther Med. 2020 Dec;20(6):186. doi:10.3892/etm.2020.9316