Cervical cancer is cancer that begins in the lining of the cervix, the narrow passageway that connects the uterus to the vagina.
It is the third most common type of cancer of the female reproductive system.
Cervical cancer develops slowly. It starts as a precancerous condition called dysplasia which can be detected by a Pap smear and is fully treatable. Undetected, these precancerous changes can develop into cervical cancer and spread to nearby organs.
What causes cervical cancer?
Almost all cervical cancers are caused by human papillomavirus (HPV), a common viral infection passed through sexual contact. There are many different strains of HPV, some of which lead to cervical cancer.
Factors that may increase a woman's risk of developing cervical cancer include:
- HPV infection
- HIV or weakened immune system
- Lack of regular Pap tests
- Multiple sex partners
- Using birth control pills for a long time
- Having many children
- Exposure to the drug DES (diethylstilbestrol)
- Giving birth at a young age
- Family history
- Lifestyle: Smoking and diet
What are the symptoms of cervical cancer?
Early cervical cancer typically doesn't cause symptoms, making regular Pap tests critical to early detection. If symptoms do occur, they may include:
- Abnormal vaginal bleeding, spotting, or discharge
- Difficulty or pain when urinating
- Pain during sexual intercourse
- Pain in the pelvic area
- Periods that are heavier and last longer than usual
How is cervical cancer diagnosed?
Diagnosis starts with:
- A thorough medical history and physical exam
- Pelvic exam
- Pap test - to obtain a sample of cervical cells for examination under a microscope, to look for cell changes
If the Pap results are abnormal, additional testing to confirm diagnosis may include:
- Colposcopy - examination of the cervix under magnification, using a device known as a colposcope
- Biopsy - removal of tissue samples for examination under a microscope to look for abnormal cells
- Endocervical curettage - cells are scraped from inside the cervical canal to evaluate an area of the cervix that cannot be seen
- Cone biopsy - removal of a cone-shaped sample of tissue to see if abnormal cells are in the tissue beneath the surface of the cervix, and to remove abnormal cells
- Loop Electrocautery Excision Procedure (LEEP) - suspicious area is removed with a loop device and the remaining tissue is vaporized with electrical current
How is cervical cancer staged?
If the diagnosis is cervical cancer, more tests may be run to determine the "stage" or extent of the disease - how far it has spread - and the best treatment strategy. These tests may include:
- Cystoscopy - to determine if the cancer has spread to the bladder
- Proctoscopy - to determine if the cancer has spread to the rectum
- Examination of the pelvis under anesthesia
- Imaging studies such as X-rays, CT scans (computed tomography), MRIs (magnetic resonance imaging), and PET scans (positron emission tomography)
How is cervical cancer treated?
Treatment depends on the individual patient and their cancer, but typically involves one or more of the following:
- Surgery - to remove or destroy the cancerous tissue
- Radiation - uses high-energy X-rays to kill cancer cells
- Chemotherapy - uses drugs typically given intravenously (through a vein) to destroy cancer cells
Can cervical cancer be prevented?
Most cervical cancer can be prevented through:
- Annual pap tests - to find and treat pre-cancerous conditions before they become cancer
- Avoiding exposure to HPV - by delaying sex, limiting partners, avoiding sex with individuals who have had many partners, using condoms and avoiding sex with uncircumcised men
- Receiving the HPV vaccine - this prevents infection against the two types of HPV responsible for most cervical cancer cases.