Cervical Cancer: A Comprehensive Guide

Overview

Cervical cancer is a type of cancer that occurs in the cells of the cervix — the lower part of the uterus that connects to the vagina. Various strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cervical cancer cases.

When exposed to HPV, the body's immune system typically prevents the virus from doing harm. In a small percentage of people, however, the virus survives for years, contributing to the process that causes some cervical cells to become cancer cells.

You can reduce your risk of developing cervical cancer by having screening tests and receiving a vaccine that protects against HPV infection.

Who It Affects

Cervical cancer most commonly affects people between the ages of 35 and 44, with the average age at diagnosis being 50. It rarely develops in people younger than 20. Many older women do not realize that the risk of developing cervical cancer is still present as they age. More than 15% of cases of cervical cancer are found in women over 65.

Prevalence

According to the World Health Organization (WHO):

• Cervical cancer is the fourth most common cancer in women globally.
• In 2020, an estimated 604,000 women were diagnosed with cervical cancer worldwide and about 342,000 women died from the disease.
• More than 95% of cervical cancer cases are attributable to HPV infection.

In the United States, the Centers for Disease Control and Prevention (CDC) reports that approximately 12,000 new cases of cervical cancer are diagnosed each year, and about 4,000 women die from the disease annually.

Symptoms

Early-stage cervical cancer generally produces no signs or symptoms. Signs and symptoms of more advanced cervical cancer include:

• Vaginal bleeding after intercourse, between periods or after menopause: This is the most common symptom of cervical cancer. Bleeding may be light or heavy and may be accompanied by a foul-smelling discharge.
• Watery, bloody vaginal discharge that may be heavy and have a foul odor: This discharge may occur between periods or after menopause.
• Pelvic pain or pain during intercourse: Pain may range from a dull ache to sharp pains and can occur during sexual intercourse, which is also known as dyspareunia.

If you experience any of these signs or symptoms, make an appointment to see your doctor. It's important to note that these symptoms can also be caused by conditions other than cervical cancer, but it's crucial to get them checked out.

Causes and Risk Factors

Cervical cancer begins when healthy cells in the cervix develop changes (mutations) in their DNA. A cell's DNA contains the instructions that tell a cell what to do. Healthy cells grow and multiply at a set rate, eventually dying at a set time. The mutations tell the cells to grow and multiply out of control, and they don't die. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can break off from a tumor to spread (metastasize) elsewhere in the body.

Risk Factors

Several factors can increase your risk of cervical cancer, including:

• Many sexual partners: The greater your number of sexual partners — and the greater your partner's number of sexual partners — the greater your chance of acquiring HPV.
• Early sexual activity: Having sex at an early age increases your risk of HPV.
• Other sexually transmitted infections (STIs): Having other STIs — such as chlamydia, gonorrhea, syphilis and HIV/AIDS — increases your risk of HPV.
• A weakened immune system: You may be more likely to develop cervical cancer if your immune system is weakened by another health condition and you have HPV.
• Smoking: Smoking is associated with squamous cell cervical cancer.
• Exposure to miscarriage prevention drug: If your mother took a drug called diethylstilbestrol (DES) while pregnant in the 1950s, you may have an increased risk of a certain type of cervical cancer called clear cell adenocarcinoma.

Diagnosis

Cervical cancer is typically diagnosed through a combination of tests and procedures. If cervical cancer is suspected, your doctor may recommend:

Screening Tests

• Pap test: During a Pap test, your doctor scrapes and brushes cells from your cervix, which are then examined in a lab for abnormalities. A Pap test can detect abnormal cells in the cervix, including cancer cells and cells that show changes that increase the risk of cervical cancer.
• HPV DNA test: The HPV DNA test involves testing cells collected from the cervix for infection with any of the types of HPV that are most likely to lead to cervical cancer.

Diagnostic Procedures

• Colposcopy: If your Pap test or HPV test is abnormal, you may need to undergo a colposcopy. During this procedure, your doctor uses a special magnifying instrument (colposcope) to examine your cervix.
• Biopsy: During a biopsy, your doctor removes a small sample of cervical tissue for laboratory testing. To obtain tissue, your doctor may use:
  • Punch biopsy, which involves using a sharp tool to pinch off small samples of cervical tissue.
  • Endocervical curettage, which uses a small, spoon-shaped instrument (curette) or a thin brush to scrape a tissue sample from the cervix.

Staging

If your doctor determines that you have cervical cancer, you'll undergo further tests to determine the extent (stage) of your cancer. Staging exams include:

• Imaging tests such as X-rays, CT scans, MRI, and PET scans to determine if the cancer has spread.
• Visual examination of your bladder and rectum to see if cancer has spread to these areas.

The stages of cervical cancer are indicated by Roman numerals ranging from 0 to IV, with the lowest stages indicating that the cancer is small and confined to the cervix. By stage IV, the cancer has spread to other areas of the body.

Treatment Options

Treatment for cervical cancer depends on several factors, such as the stage of the cancer, other health problems you may have and your preferences. Surgery, radiation, chemotherapy or a combination of the three may be used.

Surgery

Early-stage cervical cancer is typically treated with surgery. Options may include:

• Surgery to cut away the cancer only: For a very small cervical cancer, it might be possible to remove the entire tumor with a cone biopsy. This procedure involves cutting away a cone-shaped piece of cervical tissue, but leaving the rest of the cervix intact.
• Surgery to remove the cervix (trachelectomy): Early-stage cervical cancer might be treated with a radical trachelectomy procedure, which removes the cervix and some surrounding tissue. The uterus remains after this procedure, so it may be possible to become pregnant, depending on how the surgery is done.
• Surgery to remove the cervix and uterus (hysterectomy): Most early-stage cervical cancers are treated with a radical hysterectomy operation, which involves removing the cervix, uterus, part of the vagina and nearby lymph nodes. A hysterectomy can cure early-stage cervical cancer and prevent recurrence. But removing the uterus makes it impossible to become pregnant.

Radiation

Radiation therapy uses high-powered energy beams, such as X-rays or protons, to kill cancer cells. Radiation therapy is often combined with chemotherapy as the primary treatment for locally advanced cervical cancers. It can also be used after surgery if there's an increased risk that the cancer will come back.

Chemotherapy

Chemotherapy uses medications to kill cancer cells. It's often combined with radiation therapy (chemoradiation) for locally advanced cervical cancers. For very advanced cervical cancer that has spread to other areas of the body, chemotherapy may be recommended to control symptoms and prolong life.

Targeted Therapy

Targeted drug treatments focus on specific weaknesses present within cancer cells. By blocking these weaknesses, targeted drug treatments can cause cancer cells to die. Targeted therapy is usually combined with chemotherapy. It may be an option for advanced cervical cancer.

Immunotherapy

Immunotherapy is a drug treatment that helps your immune system to fight cancer. Your body's disease-fighting immune system may not attack cancer because the cancer cells produce proteins that blind the immune system cells. Immunotherapy works by interfering with that process. For cervical cancer, immunotherapy might be considered when the cancer is advanced and other treatments aren't working.

Living with Cervical Cancer

Living with cervical cancer involves managing symptoms, handling treatment side effects, and maintaining emotional well-being. Here are some tips to help you cope:

Managing Symptoms and Side Effects

• Fatigue: Get plenty of rest and prioritize activities. Light exercise, such as walking, can also help boost energy levels.
• Pain: Work with your healthcare team to manage pain effectively. This may include medications, physical therapy, or alternative treatments like acupuncture.
• Nausea and vomiting: Eat small, frequent meals and stay hydrated. Anti-nausea medications can also help.
• Diarrhea or constipation: Maintain a balanced diet with plenty of fiber and fluids. Your doctor may recommend medications to help manage these issues.

Emotional Well-being

• Seek support: Connect with friends, family, or support groups. Talking to others who understand what you're going through can be incredibly helpful.
• Counseling: Professional counseling or therapy can provide strategies to cope with the emotional impact of a cancer diagnosis.
• Mind-body practices: Techniques such as meditation, yoga, and deep breathing can help reduce stress and improve your overall sense of well-being.

Follow-up Care

Regular follow-up care is essential to monitor your health, manage any long-term side effects of treatment, and check for any signs of cancer recurrence. Your follow-up care plan may include:

• Regular physical exams and Pelvic exams.
• Pap tests and HPV testing.
• Imaging tests, such as CT scans or MRIs, as needed.

Prevention

To reduce your risk of cervical cancer:

• Get vaccinated against HPV: Vaccination is available for girls and women ages 9 to 45. The vaccine is most effective if given to girls before they become sexually active.
• Have routine Pap tests: Pap tests can detect precancerous conditions of the cervix, so they can be monitored or treated to prevent cervical cancer. Most medical organizations suggest beginning routine Pap tests at age 21 and repeating them every few years.
• Practice safe sex: Using a condom, having fewer sexual partners and delaying intercourse may reduce your risk of cervical cancer.
• Don't smoke: If you don't smoke, don't start. If you do smoke, talk to your doctor about strategies to help you quit.

Complications

Complications of cervical cancer and its treatment can include:

• Infertility: Treatment for cervical cancer, such as hysterectomy or radiation therapy, can cause infertility.
• Early menopause: If your uterus is removed (hysterectomy) or if radiation therapy damages your ovaries, you may experience menopause earlier than expected.
• Lymphedema: If lymph nodes are removed or damaged during treatment, you may experience lymphedema, a condition characterized by swelling in the legs due to fluid buildup.
• Bowel and bladder problems: Radiation therapy can cause changes to the bowel and bladder, leading to symptoms such as diarrhea, urinary urgency, or incontinence.
• Sexual dysfunction: Treatment for cervical cancer can affect your sexual health, leading to issues such as vaginal dryness, pain during intercourse, or decreased libido.
• Recurrence: Cervical cancer can recur after treatment. Regular follow-up care is essential to monitor for any signs of recurrence.

When to Seek Emergency Care

Sources and Additional Information

For more information about cervical cancer, please visit these reputable sources:

• Mayo Clinic
• Centers for Disease Control and Prevention (CDC)
• National Cancer Institute (NCI)
• World Health Organization (WHO)
• Cleveland Clinic