Cervical Cancer: What You Need To Know About IT For Healthy Living

What is cervical cancer?

Cervical cancer is a type of cancer that starts in the cervix. The cervix is a hollow cylinder that connects the lower part of a woman’s uterus to her vagina. Most cervical cancers begin in cells on the surface of the cervix.

Cervical cancer was once a leading cause of death among American women. That has changed since screening tests became widely available. 

This cancer can affect the deeper tissues of women's cervix and may spread to other parts of their body (metastasize), often the lungs, liver, bladder, vagina, and rectum.

Most cases of cervical cancer are caused by infection with human papillomavirus (HPV), which is preventable with a vaccine. 

Cervical cancer grows slowly, so there’s usually time to find and treat it before it causes serious problems. It kills fewer and fewer women each year, thanks to improved screening through Pap tests.

Women 35 to 44 years old are most likely to get it. More than 15% of new cases are in women over age 65, however, especially those who haven’t been getting regular screenings.

What causes cervical cancer?

Most cervical cancer cases are caused by the sexually transmitted human papillomavirus (HPV). This is the same virus that causes genital warts.

There are about 100 different strains of HPV. Only certain types cause cervical cancer. The two types that most commonly cause cancer are HPV-16 and HPV-18.

Being infected with a cancer-causing strain of HPV does not mean you will get cervical cancer. Your immune system eliminates the vast majority of HPV infections, often within two years.

HPV can also cause other cancers in women and men. These include:

vulvar cancer

vaginal cancer

penile cancer

anal cancer

rectal cancer

throat cancer

HPV is a very common infection.

Cervical cancer risk factors.

HPV is the biggest risk for cervical cancer. Other factors that can also increase your risk include:

human immunodeficiency virus (HIV)

chlamydia

smoking

obesity

a family history of cervical cancer

a diet low in fruits and vegetables

taking birth control pills

having three full-term pregnancies

being younger than 17 when you got pregnant for the first time

Even if you have one or more of these factors, you’re not destined to get cervical cancer. Learn what you can start doing right now to reduce your risk.

Symptoms of cervical cancer

Many women with cervical cancer don’t realize they have the disease early on, because it usually doesn’t cause symptoms until the late stages. When symptoms do appear, they’re easily mistaken for common conditions like menstrual periods and urinary tract infections (UTIs).

Typical cervical cancer symptoms are:

unusual bleeding, such as in between periods, after sex, or after menopause

vaginal discharge that looks or smells different than usual

pain in the pelvis

needing to urinate more often

dysuria (pain during urination).

If you notice any of these symptoms, see your doctor for an exam. Find out how your doctor will diagnose cervical cancer.

What are the stages of Cervical cancer?

After you’ve been diagnosed, your doctor will assign your cancer a stage. The stage tells whether the cancer has spread, and if so, how far it’s spread. Staging your cancer can help your doctor find the right treatment for you.

Stage 1: The cancer is small. It may have spread to the lymph nodes. It hasn’t spread to other parts of your body.

Stage 2: The cancer is larger. It may have spread outside of the uterus and cervix or to the lymph nodes. It still hasn’t reached other parts of your body.

Stage 3: The cancer has spread to the lower part of the vagina or to the pelvis. It may be blocking the ureters, the tubes that carry urine from the kidneys to the bladder. It hasn’t spread to other parts of your body.

Stage 4: The cancer may have spread outside of the pelvis to organs like your lungs, bones, or liver.

Cervical cancer test.

A Pap smear is a test doctors use to diagnose cervical cancer. To perform this test, your doctor collects a sample of cells from the surface of your cervix. These cells are then sent to a lab to be tested for precancerous or cancerous changes.

If these changes are found, your doctor may suggest a colposcopy, a procedure for examining your cervix. During this test, your doctor might take a biopsy, which is a sample of cervical cells.

The U.S. Preventive Services Task Force (USPSTF)Trusted Source recommends the following screening schedule for women by age:

Ages 21 to 29: Get a Pap smear once every three years.

Ages 30 to 65: Get a Pap smear once every three years, get a high-risk HPV (hrHPV) test every five years, or get a Pap smear plus hrHPV test every five years.

The most important advance in cervical cancer screening is broader use of the Papanicolaou test (Pap smear) and high-risk HPV testing. A Pap smear is part of a woman’s regular pelvic exam. Your doctor collects cells from the surface of your cervix, and a technician looks at them under a microscope. If they spot anything unusual, your doctor will take out a bit of cervical tissue in a procedure called a biopsy.

Other tools can find changes in your cervix. They include:

A colposcopy is a like a pelvic exam. Your doctor may use it if a Pap smear finds unusual cells. They stain your cervix with a harmless dye or acetic acid so the cells are easier to see. Then, they use a microscope called a colposcope, which magnifies your cervix by eight to 15 times, to look for unusual cells for biopsy. You can usually have this procedure in your gynecologist's office. You might need another biopsy later if the colposcopy shows signs of invasive cancer.

In the loop electrosurgical excision procedure (LEEP), your doctor uses an electrified loop of wire to take a sample of tissue from your cervix. You might have this in your gynecologist's office.

Your doctor can do a conization (removal of part of your cervix) in the operating room while you are under anesthesia. They might use a LEEP, a scalpel (cold knife conization), or a laser. These are usually outpatient procedures, so you can go home the same day.

LEEP and cold knife conization procedures give your doctor a better look at the types of unusual cells in your cervix and whether they’ve spread.

Precancerous changes.

Unusual changes in cells on the surface of your cervix are usually called squamous intraepithelial lesions (SIL). "Lesion" means an area of unusual tissue; “intraepithelial” means these cells are only in the surface layer.

These are precancerous cells. They might not become cancerous or invade deeper layers of tissue for months or years.

Invasive cancer

If a biopsy shows cancer that’s further along, your doctor will probably do more tests to see whether it’s spread and how far. They include:

A chest X-ray to check your lungs

Blood tests to see whether it’s spread to your liver; you might have a CT scan to refine the results

An intravenous pyelogram (IVP) or CT scan to look at your urinary tract; a cystoscopy can check your bladder and urethra.

A colposcopy to look at your vagina

A proctosigmoidoscopy and barium enema to check your rectum

CT, MRI, or PET scans of your lymph nodes

Your doctor uses these tests to "stage" the cancer according to how big the lesions are, how deep they go, and how far they’ve spread. Cervical cancer ranges from stage 0 (least severe) to stage IV (metastatic disease, the most severe).

Treatment for Precancerous Lesions.

If you have a low-grade lesion, you may not need treatment, especially if your doctor took out the area during a biopsy. Get regular checkups to watch for problems later on.

Your doctor might use LEEP conization, cold knife conization, cryosurgery (freezing), cauterization (burning, also called diathermy), or laser surgery to destroy the precancerous area with little damage to nearby healthy tissue.

In cryocautery, a steel tool that’s cooled to subzero temperatures freezes cells on the surface of your cervix. They die and fall off, to be replaced by new cells.

Laser ablation uses a laser beam to destroy cells in areas or layers of cervical tissue, leaving healthy cells in their place.

You’ll need a follow-up exam and Pap smear after cryocautery or laser ablation to make sure all the precancerous cells are gone.

You could also have a hysterectomy, in which your doctor removes your uterus. It will keep you from getting cervical cancer. But because it takes out your reproductive organs, you can’t become pregnant afterward.

What are the Treatment of Cervical Cancer?

Surgery and radiation therapy are the most common treatments for invasive cervical cancer. Others are chemotherapy and biological therapy.

If the cancer is only on the surface of your cervix, your doctor can remove or destroy the cancerous cells with procedures like LEEP or cold knife conization.

If cancerous cells have passed through a layer called the basement membrane, which separates the surface of your cervix from underlying layers, you’ll probably need surgery. If the disease has invaded deeper layers of your cervix but hasn’t spread to other parts of your body, you might have an operation to take out the tumor.

If it’s spread into your uterus, your doctor will probably recommend a hysterectomy. Talk with them about the pros and cons.

Radiation therapy (radiotherapy) uses high-energy rays to damage cancer cells and stop their growth. As with surgery, the radiation affects cancer cells only in the treated area.

Your treatments might be external, internal, or both.

External radiation comes from a large machine that aims a beam of radiation at your pelvis. You’ll probably get treatments, which take only a few minutes, 5 days a week for 5 to 6 weeks. Finally, you may have an extra dose of radiation called a "boost."

Internal radiation (also called implant radiation or brachytherapy) comes from a capsule containing radioactive material, which your doctor puts into your cervix. The implant puts cancer-killing rays close to the tumor while sparing most of the healthy tissue around it.

Chemotherapy.

Chemotherapy uses powerful drugs to kill cancer cells. Doctors often use it for cervical cancer that’s locally advanced or has spread to other parts of the body.

Chemotherapy happens in cycles of intensive treatment followed by recovery periods. Most people have it as an outpatient (in an outpatient clinic at the hospital, at the doctor's office, or at home).

Biological therapy or immunotherapy targets “checkpoints” in your immune cells that are turned on or off to set off an immune response. A medicine called pembrolizumab (Keytruda) blocks a protein on the cells to shrink tumors or slow their growth.

Doctors use it if chemotherapy is not working or if the cancer has spread. You’ll get it through a vein (called intravenous, or IV) every 3 weeks.

Cervical Cancer Home Care.

Certain things can ease the physical and mental stresses of cervical cancer and treatment.

One of the best things you can do is get the right nutrition. You may lose your appetite or have trouble eating during treatment. But if you get enough calories and protein, you’ll have more strength and energy, and you’ll be able to handle treatment better. You might want to work with a nutritionist to keep up your calorie and protein intake. They may suggest you eat smaller portions more often.

Other lifestyle changes may help keep you stronger and more comfortable during treatment:

Get mild physical activity to keep up your energy level. Make sure it doesn't wear you out.

Get enough rest at night, and take naps if you need.

Quit smoking.

Don't drink alcohol. You may not be able to drink alcohol while taking some medications.

Cervical Cancer Treatment Follow-Up

Regular pelvic exams and Pap smears are important for every woman but especially those who’ve had precancerous cells or cervical cancer.

Follow your doctor’s advice about having a full pelvic exam, a Pap smear, and other tests on a regular basis.

Cervical cancer treatment may have side effects many years later. Get regular checkups, and tell your doctor about any health problems.

Cervical Cancer Prevention

The key to preventing invasive cervical cancer is to detect cell changes early, before they become cancerous. Regular pelvic exams and Pap tests are the best way to do this. Experts recommend this schedule:

Get a Pap test every 3 years once you’re 21 or older.

If you’re 30 to 65 years, you can get both a Pap test and a human papillomavirus (HPV) test every 5 years. Beyond that age, you may be able to stop testing if your doctor says you’re at low risk.

Women of any age don’t need screening if they’ve had their cervix removed and have no history of cervical cancer or precancerous lesions.

If you are sexually active and have a higher risk for STDs, get tests for chlamydia, gonorrhea, and syphilis each year. Take an HIV test at least once, or more often if you are at high risk.

Avoiding HPV is also important. Steps to prevent infection include:

Don’t have sex.

Use a barrier, like a condom, if you have sex.

Get the HPV vaccine. The FDA has approved Gardasil for males and females ages 9 to 26. It protects against two strains of HPV that cause 70% of cervical cancers and over 50% of precancerous lesions of the cervix, vulva, and vagina. Gardasil also protects against the types of HPV that are linked to over 90% of cases of genital warts.

Because cigarette smoking also raises your odds of having cervical cancer, quitting can lower your risk.

Outlook for Cervical Cancer

The survival rate is close to 100% when you find and treat precancerous or early cancerous changes. The prognosis for invasive cervical cancer depends on the stage.

More than 90% of women with stage 0 survive at least 5 years after diagnosis.

Stage I cervical cancer patients have a 5-year survival rate of 80% to 93%.

Women with stage II cervical cancer have a 5-year survival rate of 58% to 63%.

The survival rate for women with stage III cervical cancer is 32% to 35%.

Sixteen percent or fewer women with stage IV cervical cancer survive 5 years.

Health care providers who treat cancer often use the term "remission" rather than "cure." Many women who have cervical cancer recover completely, but it can still come back.

Sources:

www.webMD.com

www.healthline.com

www.mayoclinic.org