Cervical Cancer

Cervical Cancer Overview
Cervical cancer often does not cause noticeable symptoms in its early stages, making it difficult to detect. However, regular screening is the key to preventing this cancer.

Cervical cancer is a type of cancer that begins in the cervix, the hollow, tubular part of a woman’s uterus that connects to the vagina. Most cervical cancers start in the cells on the surface of the cervix.

Symptoms of Cervical Cancer
Many women are unaware they have cervical cancer in the early stages because symptoms usually do not appear until later. When symptoms do occur, they are often mistaken for common conditions such as menstrual irregularities or urinary tract infections (UTIs).

Common symptoms include:

• Abnormal bleeding, such as between periods, after sexual intercourse, or after menopause

• Unusual vaginal discharge, differing in color or smell

• Pelvic pain (in the hips or lower abdomen)

• Frequent urination

• Pain during urination

If you notice any of these symptoms, consult a doctor for testing.

Causes of Cervical Cancer
Most cervical cancers are caused by the sexually transmitted human papillomavirus (HPV), the same virus that causes genital warts.

There are nearly 100 types of HPV, but only a few types cause cervical cancer. The two most cancer-causing types are HPV-16 and HPV-18.

HPV infection does not always lead to cervical cancer. Most infections are cleared by the immune system within about two years.

HPV can also cause other cancers in both women and men, including:

• Vulvar cancer

• Vaginal cancer

• Penile cancer (in men)

• Anal cancer

• Rectal cancer

• Throat cancer

HPV is a very common infection. A large percentage of sexually active adults are infected at some point in their lives.

Treatment of Cervical Cancer
Cervical cancer detected at an early stage can be treated very successfully. The main treatment types are:

• Surgery

• Radiation therapy

• Chemotherapy

• Targeted therapy

Sometimes, these treatments are combined for better results.

Surgery
The goal of surgery is to remove as much cancer as possible. Sometimes, only the affected part of the cervix is removed. If the cancer has spread, other pelvic organs may also be removed.

Radiation Therapy
Radiation therapy uses high-energy X-rays to destroy cancer cells. It can be delivered externally or internally through a device inserted into the uterus or vagina.

Chemotherapy
Chemotherapy uses drugs to kill cancer cells throughout the body. Doctors give it in cycles, with breaks for the body to recover.

Targeted Therapy
Bevacizumab (Avastin) is a newer drug that works differently from chemotherapy or radiation. It blocks the formation of new blood vessels that tumors need to grow and survive. It is usually given with chemotherapy.

Precancerous cells (pre-cancer stages) in the cervix can also be treated to prevent progression to cancer. Consult a doctor for the best approach.

Stages of Cervical Cancer
After diagnosis, doctors determine the stage of the cancer, which indicates how far it has spread. This helps guide treatment decisions.

• Stage 1: Cancer is small and may have spread to lymph nodes but not elsewhere.

• Stage 2: Cancer is larger and may have spread beyond the cervix or to lymph nodes, but not other organs.

• Stage 3: Cancer has spread to the lower vagina or pelvis and may block the ureters. It has not spread to other parts of the body.

• Stage 4: Cancer has spread beyond the pelvis to organs such as lungs, bones, or liver.

Cervical Cancer Screening
The Pap smear is used to detect cervical cancer. A doctor collects cells from the cervix and sends them to a lab to check for cancerous or precancerous changes.

If abnormalities are found, a colposcopy may be done to examine the cervix in detail. A biopsy (sample of tissue) may also be taken.

The U.S. Preventive Services Task Force recommends:

• Ages 21–29: Pap smear every 3 years

• Ages 30–65: Pap smear every 3 years, or high-risk HPV (hrHPV) test every 5 years, or Pap + hrHPV co-test every 5 years

Risk Factors for Cervical Cancer
HPV is the main risk factor. Others include:

• HIV infection

• Chlamydia infection

• Smoking

• Obesity

• Family history of cervical cancer

• Low fruit and vegetable intake

• Birth control pill use

• Having three or more full-term pregnancies

• First pregnancy before age 17

Having one or more risk factors does not mean you will get cervical cancer. Steps can be taken to reduce risk.

Prognosis of Cervical Cancer

• Early-stage cervical cancer confined to the cervix has a 5-year survival rate of ~92%.

• If cancer has spread within the pelvis, the 5-year survival rate is ~56%.

• If cancer has spread to distant organs, the 5-year survival rate is ~17%.

Regular screening improves prognosis since early detection makes treatment more effective.

Types of Surgery for Cervical Cancer

• Cryosurgery: Freezes abnormal cells

• Laser Surgery: Burns abnormal cells

• Conization: Removes a cone-shaped portion of the cervix

• Hysterectomy: Removes the uterus and cervix; radical hysterectomy may include the upper vagina

• Trachelectomy: Removes cervix and upper vagina but preserves the uterus for future pregnancy

• Pelvic Exenteration: May remove the uterus, vagina, bladder, rectum, lymph nodes, and surrounding tissues depending on cancer spread

Prevention of Cervical Cancer
The most effective prevention is regular Pap smears or hrHPV testing to detect precancerous cells early.

HPV vaccines such as Gardasil protect against HPV infections and reduce the risk of cervical cancer. Vaccination before sexual activity is most effective. Both boys and girls can receive the vaccine.

Other preventive measures:

• Limit the number of sexual partners

• Use condoms or barrier methods during vaginal, oral, or anal sex

If Pap smear results are abnormal, consult your doctor about managing precancerous cells.

Statistics

• In 2022, about 14,100 American women were diagnosed with cervical cancer, and 4,280 died from it. Most patients were aged 35–44.

• Hispanic women have the highest risk in the U.S., while American Indian and Alaskan Native women have the lowest.

• Mortality rate was 2.3 per 100,000 women annually between 2002–2016, largely due to improved screening.

Cervical Cancer and Pregnancy
Cervical cancer in pregnancy is rare but possible. Most cases are detected at an early stage. Treatment can be complex and depends on the cancer stage and gestational age.

• If early-stage, treatment may begin after delivery.

• If advanced and requiring hysterectomy or radiation, decisions about continuing the pregnancy may be necessary. Doctors aim for safe delivery when the baby can survive outside the womb.