Cervical Cancer

Cervical cancer is the uncontrolled growth of cells in the cervix, which connects the vagina to the upper area of the uterus. It usually occurs in people over 30. The main cause of cervical cancer is infection with human papillomavirus (HPV), which is transmitted through sexual activity.

Over half of all sexually active adults acquire an HPV infection at some point in their lives, but not every person with a cervix will develop cervical cancer after acquiring HPV. This is typically a slow-growing cancer, which is why regular screening is important.

Cervical Cancer Symptoms

Many times, especially early on, you may not notice any specific symptoms of cervical cancer. This is why regular checkups with a gynecologist are important, as well as regular screenings.

Early Signs of Cervical Cancer

Early-stage cervical cancer usually doesn’t have symptoms, but when they are present, they can include:

• Vaginal bleeding after sex
• Post-menopausal vaginal bleeding
• Bleeding between periods, or abnormal periods like heavier bleeding than usual or longer periods
• Watery vaginal discharge
• Pelvic pain
• Pain during sexual intercourse
  

Symptoms After Cancer Has Spread

After the cancer has spread, symptoms usually become apparent and can include:

• Painful bowel movements and/or rectal bleeding
• Painful urination, trouble with urination, and/or blood in the urine
• Fatigue
• Abdominal pain
• Dull ache in the back
• Leg edema (swelling)
  

What Causes Cervical Cancer?

Persistent infection with high-risk strains of HPV causes almost all instances of cervical cancer. The vast majority of sexually active people will acquire an HPV infection at some point in their lives, and about half of these infections are with high-risk strains. HPV16 and HPV18 are the two most common strains that cause most cervical cancers.

In most cases, the immune system clears the HPV infection. When the infection isn’t controlled or cleared, it stays active in your cells. This is when it can cause changes that can lead to cancer.

Although rare, fetal exposure to diethylstilbestrol (DES) can cause cervical cancer after birth. DES was a drug given to pregnant people from 1940–1971 to help prevent miscarriage and preterm labor but later turned out to have adverse effects.

Cervical Cancer Risk Factors

Along with HPV infection, other risk factors that can increase the risk of developing cervical cancer:

• Smoking cigarettes or exposure to secondhand smoke
• Becoming sexually active at a young age
• Having multiple sexual partners
• Having a weakened immune system
• Using birth control pills
• Having multiple births
  

Cervical Cancer Diagnosis

If you have symptoms of cervical cancer or screening tests show the possibility of cervical cancer, your healthcare provider will want to do follow-up tests to determine what’s going on. Along with a medical history, pelvic exam, and rectovaginal exam, you may undergo the following procedures and tests:

• Colposcopy: This procedure uses an illuminated magnifying instrument (colposcope) to look for cell changes on the cervix and collect samples for testing.
• Biopsy (collecting a tissue sample to analyze in the lab): Procedures include loop electrosurgical excision procedure (LEEP) or cone biopsy.
• Imaging tests: These may look for signs that the cancer is spreading and can include chest X-ray, positron emission tomography (PET), and magnetic resonance imaging (MRI).
• Lab tests like complete blood count.
• Cystoscopy: A thin tube with a camera is inserted through the urinary opening into the bladder.
• Sigmoidoscopy: A thin tube with a camera is inserted through the anus to examine the rectum and the last third of the colon.
  

Cervical Cancer Stages

The stages of cancer describe how far the cancer has spread in a person’s body. The stage of the cancer also helps to guide treatment decisions. The stages of cervical cancer are as follows:

• Stage 1: Cancer is in the cervix only. It is separated into stages IA and IB, depending on how deep the cancer is.
• Stage 2: Cancer has either spread to the upper two-thirds of the vagina or the surrounding vaginal tissues. It is divided into substages depending on the size of the tumor and the spread of cancer.
• Stage 3: The cancer has spread to the bottom third of the vagina and/or the pelvic wall, and/or is causing kidney issues, and/or is found in lymph nodes. It is subdivided into stages based on the extent of the spread.
• Stage 4: Cancer has spread past the pelvis, to the lining of the bladder or rectum, or to other parts of the body. It is divided into two substages based on where the cancer has spread.
  

Cervical Cancer Treatment

Treatment for cervical cancer varies, depending on the stage of the cancer and where it spreads. A combination of treatments may prove useful.

Surgery

Surgery may remove cancerous tissue or, when it has spread, various organs. It can include:

• Cold-knife conization: Removal of cancerous tissue on the cervix using a cold knife, performed in a hospital under general anesthesia
• Sentinel node biopsy: Removal of a lymph node close to the primary tumor to check for the spread of the cancer
• Hysterectomy: Removal of the uterus and cervix
• Radical trachelectomy: Removal of the cervix and upper vagina
• Bilateral salpingo-oophorectomy: Removal of both fallopian tubes and ovaries
• Total pelvic exenteration: Removal of the uterus, cervix, bladder, vagina, rectum, and part of the colon
  

Radiation

Radiation uses high-energy X-rays to kill cancer cells. Radiation can be administered internally (called brachytherapy) with a radiation source placed in the vagina, or externally from a machine. It can also help relieve pain and shrink tumors.

Chemotherapy

Chemotherapy is medication that kills cancer cells or interferes with their replication. You can take it by itself or in conjunction with other therapies or drugs. Typical chemotherapy drugs for cervical cancer treatment include:

• Platinol (cisplatin)
• Paraplatin (carboplatin)
• Gemzar (gemcitabine)
• Ifex (ifosfamide)
• Camptosar (irinotecan)
• Taxol (paclitaxel)
• Hycamtin (topotecan)
• Navelbine (vinorelbine)
  

Targeted Therapy

Targeted therapy uses medications to interfere with certain enzymes, proteins, or other factors that are involved in cancer growth. For cervical cancer, targeted therapies include:

• Avastin (bevacizumab)
• Tivdak (tisotumab vedotin)
  

Can Cervical Cancer Impact Fertility?

Cervical cancer and its treatment can impact fertility, depending on what kind of treatment you have for it. Though healthcare providers often recommend radical hysterectomy and pelvic node dissection for early-stage cervical cancers, these also render you unable to get pregnant because they remove the uterus.

If you get diagnosed with early-stage cervical cancer, you might want to pursue surgery (a fertility-sparing radical trachelectomy, for example). This allows part of the cervix and all of the uterus to stay in your body, enabling you to conceive and then give birth by cesarean section.

How to Prevent Cervical Cancer

Though there is no way to ever fully prevent any kind of cancer, there are steps you can take to reduce your risk of developing cervical cancer.

Screenings for Cervical Cancer

Regular screening tests are the best way to catch cervical cancer in its earliest stages when it’s easiest to treat. Two screening tools for cervical cancer include the Pap test and the HPV test. You can take them together or alone during a pelvic exam.

The Pap test takes cells from the cervix to check them for any abnormalities, including cancer and pre-cancer. The HPV test swabs the cervix for cells and looks for high-risk strains likely to cause cervical cancer. It does this by looking at the cells for any pieces of the virus DNA.

HPV Vaccination for Cervical Cancer

Another way to help reduce the risk of cervical cancer is getting vaccinated against HPV. Vaccination can begin at age 9 and is recommended for everyone (all sexes) between the ages of 11 and 12. The vaccine is given in two doses, six to 12 months apart.

If a person is 15 or older when they get their first vaccination, they need three doses of the vaccine. Those with weakened immune systems should also get three doses.

The vaccine is not generally recommended for those over 26 because those over this age have already likely been exposed to HPV. If you are 26–45 and are interested in vaccination, talk with a healthcare provider about your risk for HPV and the possible benefits of the vaccine.

Cervical Cancer Outlook

Cervical cancer is a slow-growing cancer. When caught early, cervical cancer that is confined to the cervix has a five-year relative survival rate of 92%. After spreading to nearby tissues, organs, or lymph nodes in the pelvic region, the survival rate falls to 59%.

Though these are just statistics and do not represent individual cases, early detection and treatment are important for survival, which is why regular screenings are key.

Knowing symptoms, going for regular checkups, and having regular Pap tests and HPV tests can help your healthcare providers find any cervical abnormalities as early as possible. This allows them to monitor you and make treatment recommendations if they progress.

With the availability of the HPV vaccine, healthcare providers can prevent many cases of cervical cancer.