What Is Cervical Cancer? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Cervical cancer, the fourth most common cancer in women, affects the cervix, which is the narrow, cylindrical section of tissue that serves as the gateway between the vagina and the uterus. Glandular cells cover the endocervix, the area closest to the uterus, and squamous cells cover the exocervix, near the vagina. Most cervical cancers begin in the cells at the transformation zone, the point in the cervix where glandular and squamous cells meet.

According to the American Cancer Society, almost all cervical cancers are either squamous cell carcinoma or adenocarcinoma. On rare occasions, melanoma, sarcoma, and lymphoma may also be found in the cervix. (1)

Typically, there are no symptoms for early stage cervical cancer. Most women experience symptoms only after the cancer invades nearby tissue. The most common symptoms are: (2)

• Longer or heavier than usual menstrual periods
• Bleeding after vaginal intercourse
• Post-menopausal bleeding
• Vaginal discharge that may contain blood between periods or after menopause
• Pain during vaginal intercourse, even without bleeding or discharge

The biggest risk factor for cervical cancer is infection with human papillomavirus (HPV), a group of some 150 related viruses that can cause genital warts, or papillomas. HPV is believed to be responsible for about 91 percent of cervical cancers.

The HPV virus can infect cells in several areas of the body, including the skin and the lining of the genitals, anus, mouth, and throat. Like other sexually transmitted diseases, HPV can be spread from person to person through skin-to-skin contact and vaginal, anal, or oral sex.

Other risk factors may include: (3)

• Multiple pregnancies
• Smoking cigarettes
• Long-term use of oral contraceptives
• A suppressed immune system due to organ transplant, chemotherapy, or chronic use of corticosteroids
• First sexual encounter at a young age
• Many sexual partners
• A previous cervical cancer diagnosis
• A Pap smear that showed precancerous cells
• Exposure to diethylstilbestrol (DES), a synthetic estrogen prescribed to pregnant women between 1940 and 1971 to prevent miscarriages and avoid other pregnancy problems. Research has linked prenatal exposure to DES to a higher risk of developing cervical cancer.
• HIV infection

Cervical cancer is diagnosed using a Pap smear, which is a routine procedure performed during a gynecological exam, in which cells from the cervix are collected and screened in a lab for abnormalities.

If the Pap smear detects HPV, more testing, such as a colposcopy, may be performed to look for cells that might be cancerous. During a colposcopy, your doctor will use a magnification tool called a colposcope to closely examine the cervix, vagina, and vulva. A biopsy will likely be performed on tissue with any apparent abnormalities in order to screen for cancerous changes. There are several types of biopsies that your doctor may perform, depending on your case. The types include: (4)

• Punch Biopsy During this procedure, your doctor uses a sharp tool to remove a core of tissue.
• Endocervical Curettage Your doctor will use a small instrument to scrape tissue from the cervix.
• Electrical Wire Loop Your doctor will use a low-voltage electrified wire to remove a small sample from the cervix.
• Cone Biopsy In this more extensive procedure, your doctor will remove a cone-shaped piece of tissue from the cervix

When detected at an early stage, cervical cancer is typically curable. The five-year survival rate for stage 1 cervical cancer is above 90 percent. The development of screening methods, HPV vaccination, and improved access to screening has led to a steep decline in both the incidence of cervical cancer and deaths from the disease over the past half century. (5)

Treatment options may include surgery, radiation, and chemotherapy, and is based on the kind of cancer, the patient’s age, health history, how far the cancer has spread (stage), response to any previous treatments, and whether a patient wishes to have children.

Surgery for Cervical Cancer Surgery may be recommended to remove pre-cancerous tissue. Surgery may be minimal or more extensive, depending on whether the cancer has spread.

Radiation for Cervical Cancer Radiation may be used when cancer has spread beyond the cervix, says the American Cancer Society.

Chemotherapy for Cervical Cancer Concurrent chemoradiation combines chemotherapy with radiation therapy to boost the efficacy of radiation. Drugs used in this treatment include cisplatin (Platinol), fluorouracil (Adrucil), carboplatin (Paraplatin), paclitaxel (Taxol), topotecan (Hycamtin), or gemcitabine (Gemzar). (6)

Prevention of Cervical Cancer

The American Cancer Society states that regular Pap smears to identify precancerous changes in cells combined with testing for HPV is the best way to prevent cervical cancer.

According to the National Cancer Institute, HPV vaccination with a vaccine, such as Gardasil 9 or Cervarix, can help prevent infection by the types of HPV that cause most cases of cervical cancers. But achieving widespread HPV vaccination rates continues to be a problem. According to the Centers for Disease Control and Prevention (CDC), as of 2017, only 49 percent of adolescents were up-to-date on the HPV vaccine, which is ideally administered at age 11 or 12. Geography and access to care also plays a role. Fewer adolescents in rural areas, compared with adolescents in urban areas, are getting the HPV vaccine. (7)

The American Cancer Society lists several side effects of external beam radiation therapy for cervical cancer.

• Fatigue
• Upset stomach
• Diarrhea or loose stools (if radiation is given to the pelvis or abdomen)
• Nausea and vomiting
• Skin changes (from mild redness to peeling or flaking)
• Bladder irritation and dysfunction, blood in the urine
• Vaginal pain
• Menstrual changes
• Low blood counts

When chemotherapy is combined with radiation, blood counts may be lower and fatigue and nausea tend to be worse. These side effects typically improve in the weeks after treatment is stopped. Other, long-term side effects include vaginal scar tissue, dryness, rectal bleeding, urinary problems, and weakened bones. (8)

The CDC estimates that about 13,960 new cases of invasive cervical cancer will be diagnosed and about 4,310 women will die from cervical cancer in the United States in 2023. (9)

More Black and Hispanic women get HPV-associated cervical cancer than women of other races or ethnicities, possibly because of decreased access to Pap testing or follow-up treatment. (10)

Cervivor

This online community and advocacy organization helps patients and survivors connect and thrive through collective wisdom.

Foundation for Women’s Cancer

A 501(c)(3) nonprofit, this organization is dedicated to increasing public awareness of gynecological cancer risk, prevention, early detection, and optimal treatment.

Cervical Cancer-Free Coalition

CCF-America partners with community and government organizations as an advisory committee to provide information and support while carrying out community intervention projects.

NCC: National Cervical Cancer Coalition

A cervical cancer/HPV online support community of patients and caregivers who share personal experiences in a safe, secure environment.