What Is Cervical Cancer?
Cervical cancer is cancer that begins in the lining of the cervix, the lowest portion of the uterus which can be seen at the top of 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.
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 is the most important risk factor.
- HIV, chronic steroid use, or weakened immune system
- Lack of regular Pap tests that could have diagnosed dysplasia
- Exposure to the drug DES (diethylstilbestrol)
Can Cervical Cancer Be Prevented?
Most cervical cancer can be prevented through:
- Annual pap tests - to find and treat pre-cancerous (dysplasia) 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 – the vaccine prevents infection against the most common types of HPV responsible for most cervical cancer cases. The HPV vaccine is recommended for all children 9-26 years of age, and can also be provided to at risk adults
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 pre-cancerous 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. This is usually performed in the operating room.
- 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
- 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 - Surgery can be used in early cervical cancer to remove the cancerous cells, usually by removing the uterus (radical hysterectomy) and surrounding lymph nodes.
- Radiation - uses high-energy X-rays to kill cancer cells
- Chemotherapy - uses drugs typically given intravenously (through a vein) to destroy cancer cells
- Immunotherapy. Some patients with uterine cancers are candidates for immunotherapy. Immunotherapy is also given through an infusion into a vein but works by stimulating the immune system against the cancer.