An Overview of Cervical Cancer

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Cervical cancer is a slowly progressive cancer usually caused by human papillomavirus (HPV), a sexually transmitted infection. It generally does not cause symptoms until late stages, and it can be diagnosed with a Pap smear or a biopsy before symptoms appear. Treatment is more effective in the early stages and can include surgery, chemotherapy, and radiation. 

The American Cancer Society estimates that there are more than 13,000 new cases of invasive cervical cancer and approximately 4,000 cervical cancer-related deaths in the United States each year. Cervical cancer is one of the preventable types of cancer. Prevention strategies include safe sex, HPV vaccination, and regular Pap smears that can identify early pre-cancerous changes. 

Symptoms

HPV infection and cervical cancer typically do not cause any symptoms. However, there are a few signs and symptoms you can watch out for, especially if you already know that you have HPV. Cervical cancer in late stages is more likely to cause symptoms than early stage cervical cancer. 

Symptoms can include:

  • Genital warts: While they can be a red flag indicating HPV infection, which is a precursor of cervical cancer, most women who have HPV or genital warts do not develop cervical cancer. 
  • Abnormal vaginal bleeding
  • Pelvic pain
  • Vaginal discharge: This may be colorless or reddish, odorless or not.
  • Back pain
  • Leg swelling
  • Bowel and bladder symptoms, such as urinary incontinence and blood in the urine
  • Symptoms of metastasis, such as shortness of breath, confusion, and bone fractures

Causes

Cervical cancer is most common between the ages of 45 and 65. Around 15 percent of cervical cancers are diagnosed in women over 65. It is rarely seen in women under the age of 20.

cervical cancer: newly diagnosed cases
Illustration by Verywell 

In the United States, women of Hispanic background are the most likely to get cervical cancer, followed by African-Americans, Asians, and Caucasians. Native Americans, by contrast, have the lowest risk of cervical cancer in the United States.

There is a strong link between cervical cancer and HPV. HPV is a common sexually transmitted virus that many people are exposed to at some stage in their lives. More than 95 percent of all cervical cancer diagnoses are associated with HPV, making early detection of the virus all the more important.

  • Smoking
  • Having multiple sexual partners
  • Pregnancy before the age of 20
  • A compromised immune system, such as in women with HIV

Cervical Dysplasia

Cervical cancer is the abnormal and uncontrollable growth of cells in the cervix that can spread to other parts of the body. It is a slowly progressive disease that often takes years to develop. Prior to the development of cancerous cells and tumors, the cervix will undergo abnormal changes called cervical dysplasia, which can serve as an early warning sign of a developing malignancy.

Cervical dysplasia is defined as abnormal changes in the lining of the cervix. While cervical dysplasia can sometimes lead to cervical cancer, it is not considered a cancer diagnosis.

Diagnosis

Cervical cancer is diagnosed with an examination of tissue, which is taken from the cervix. There are several methods used to obtain a sample, with Pap smear being the most commonly used method. If there is a chance that cervical cancer has spread, or if symptoms involve other areas of the body, imaging tests may be needed to determine the extent of metastasis (the spread of cancer).

Methods used to diagnose cervical cancer include:

  • Physical examination: Your doctor will do a pelvic examination, which can assess for changes in the appearance of the vagina and cervix, as well as surrounding areas, and identify lesions or genital warts. A colposcopy, which is an examination using a device that visually magnifies the cervix, can help your doctor get a more detailed look at the cervix. 
  • Pap smear: A Pap smear is the most useful way to diagnose cervical dysplasia. Using a special brush, your doctor can collect cells from the cervix for examination under a microscope. This test can identify very early changes when it is still possible to completely remove the abnormal tissue before it becomes cancerous. 
  • Biopsy: Removal of a larger amount of tissue than what is obtained during a Pap smear can help define the size and edges of cervical cancer or dysplasia if there is an abnormality identified on a Pap smear. 
  • Imaging studies: If you have cervical cancer that could have spread beyond a small area of the cervix, you may need to have imaging tests, such as an X-ray, a CT scan, an ultrasound, or an MRI of the pelvic area or of other areas of the body that could be affected. You may need imaging tests even if you have not been diagnosed with cervical cancer, but preliminary tests suggest that you could have disease extending beyond the cervix. 

    Cervical dysplasia is classified based on the extent of abnormalities of the cells that are sampled. The classifications, in order of those that indicate abnormalities that are only slightly different from normal cells to abnormalities that are highly suggestive of cancer, are ASCUS, AGUS, LGSIL, and HGSIL.

    Cervical cancer is also staged based on how far the disease has progressed. Stages range from I to IV, with the former indicating a very small lesion that has invaded the cervix, but can only be seen with a microscope; those with this stage cancer have a 95 percent survival rate over a five-year period if it is removed. Stage IV, in contrast, is defined as cervical cancer that has spread to distant organs and is associated with a 15 percent to 20 percent five-year survival rate. 

    Treatment

    When left untreated, cervical dysplasia starts off as mild, progresses to moderate dysplasia, and then may turn into severe dysplasia before developing into cervical cancer.

    If you have cervical cancer, there is no need to panic, but you do need to make sure that you get the proper surgical or medical treatment as soon as possible.

    Cervical cancer treatment can be a simple procedure for removal of tissue. If your doctors can confirm that the whole tumor was removed and that it has not spread, you might not need to have further treatment.

    On the other hand, if the cancer is large or appears to have spread, you may need to have extensive surgery, chemotherapy, and/or radiation, which can impact your life during the time of treatment. Surgical options include a loop electrosurgical excision procedure (LEEP)cryosurgeryconization, trachelectomy (removal of the cervix), or hysterectomy (removal of the uterus). 

    Prevention

    Regular medical examinations are the best way to identify cervical cancer risk factors or early signs of dysplasia. You can get tested for HPV, and your doctor may also be able to visualize genital warts or other lesions that would prompt a more thorough evaluation.

    Having regularly scheduled Pap smears based on the recommendations for your age is considered the best prevention against cervical cancer, and these check-ups can help you stick to your screening schedule. If cervical dysplasia is found, regular screening should help ensure that it is caught (and removed) early before it can progress to cancer.

    Beyond that, preventing HPV infection is key. The HPV virus is a very common sexually transmitted infection, and you are less likely to be exposed to it if you have few sexual partners and practice safe sex using a condom. 

    Vaccination is also a helpful strategy, as there are more than 100 different types of HPV, and Gardasil 9 guards against those most likely to cause cervical cancer.

    Finally, smoking is highly correlated with cervical cancer, likely due to cancer-inducing toxins it introduces and that circulate throughout the body. Quitting smoking can reduce your chances of developing cervical cancer, especially if you have been infected with the HPV virus. 

    A Word From Verywell

    Cervical cancer is one of the most common types of cancer in women. There are effective treatments for cervical cancer, but it is worth repeating—the disease is associated with a much better survival rate if it is caught early. Cervical cancer is a preventable type of cancer, but, because HPV is a prevalent virus, there is a high chance of becoming exposed to it. Be diligent about screening, pay attention to your body, and do what you can to protect yourself.

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