Cervical Cancer

Cervical cancer forms in the tissue of the cervix, the lower, narrow part of the uterus that connects it to the vagina. It usually grows slowly over time and is almost always caused by a long-lasting infection with certain high-risk types of human papillomavirus (HPV).

Cervical cancer was once one of the leading causes of cancer death in women. Thanks to the Pap test and widespread screening that began in the 1950s, the number of cervical cancer deaths in the United States has dropped dramatically. Today, prevention focuses on three things: education, regular screening and HPV vaccination.

Types & Stages

Types of cervical cancer include:

• Squamous cell carcinoma is the most common type and accounts for most cervical cancers. It begins in the thin, flat cells that line the outer part of the cervix, called the ectocervix.
   
• Adenocarcinoma begins in the glandular cells that line the inner part of the cervix, called the endocervix. These cells make mucus. Clear cell adenocarcinoma is a rare form of cervical adenocarcinoma.
   
• Adenosquamous carcinoma, also called mixed carcinoma, has features of both squamous cell carcinoma and adenocarcinoma. Very rarely, cervical cancer may start in other cells of the cervix.

Cervical cancer stages describe how far the cancer has spread:

• Stage I means the cancer is found only in the cervix.
   
• Stage II means the cancer has spread beyond the cervix and uterus but not to the pelvic wall or the lower part of the vagina.
   
• Stage III means the cancer has spread to the lower part of the vagina, the pelvic wall or nearby lymph nodes, or it is affecting how the kidneys work.
   
• Stage IV means the cancer has spread to the bladder, rectum or distant parts of the body, such as the lungs, liver or bones.

Your care team will use the cancer type, stage and your overall health to recommend a treatment plan.

Signs & Symptoms

Early cervical cancer often causes no symptoms at all. This is one reason regular screening is so important. As the cancer grows, symptoms may appear.

Visit a doctor if you are experiencing any of these symptoms:

• Vaginal bleeding that is not normal for you
• Bleeding after sex
• Bleeding between periods or after menopause
• Vaginal discharge that is not normal for you
• Pelvic pain or pressure
• Pain during sex

Many of these symptoms can be caused by conditions that are not cancer. Still, it is important to pay attention to your body. If you have unusual vaginal bleeding, see a doctor right away.

Diagnosis

Tests and procedures used to diagnose cervical cancer may include:

• Pelvic exam. Your doctor checks the reproductive organs, including the cervix, uterus and ovaries, to look for anything unusual.
   
• Colposcopy. A special magnifying instrument called a colposcope is used to closely examine the cervix for signs of cancer. During this exam, your doctor may remove a sample of cervical cells for lab testing. To collect the sample, you may need one of the following:
   
  • Punch biopsy. This uses a sharp tool to pinch off small samples of cervical tissue.
     
  • Endocervical curettage. This uses a small, spoon-shaped instrument called a curet, or a thin brush, to scrape a tissue sample from the cervix.

If these results are concerning, you may need more tests, such as:

• Electrical wire loop, also called LEEP. A thin, low-voltage electrified wire is used to take a small tissue sample. This is usually done in your doctor’s office. You receive medicine to numb the area to lessen any discomfort. It is also known as a loop electrosurgical excision procedure.
   
• Cone biopsy, also called conization. This procedure allows your doctor to take deeper layers of cervical cells for testing. A cone biopsy is often done in a hospital. You may receive medicine to put you in a sleep-like state so you are not aware during the procedure.
   
• Imaging tests. If cancer is found, imaging tests such as CT, MRI or PET scans may be used to learn the size of the cancer and whether it has spread.

Treatment

Treatment for cervical cancer depends on the type and stage of cancer, whether it has spread, your overall health and your personal goals. As with most cancers, the main options include surgery, radiation therapy and chemotherapy.

Treatment may include:

• Surgery may be used to remove the cancer, especially in earlier stages. Depending on the stage, this may involve removing part of the cervix, the cervix and uterus, or surrounding tissues and lymph nodes.
   
• Robotic-assisted minimally invasive surgery may be used for staging and treatment. This approach gives surgeons enhanced vision, magnification, depth perception and precise instrument control. Compared with traditional open surgery, minimally invasive surgery may offer benefits such as faster recovery, fewer wound complications and less postoperative pain for some patients.
   
• Radiation therapy uses high-energy beams or internal radiation to kill cancer cells. It may be used alone, with chemotherapy or after surgery, depending on the stage.
   
• Chemotherapy uses medicines to kill cancer cells or slow their growth. It may be combined with radiation or used for cancer that has spread or returned.
   
• Targeted therapy uses medicines that focus on specific features of cancer cells. It may be an option for some advanced or recurrent cervical cancers.
   
• Immunotherapy helps the immune system recognize and attack cancer cells. It may be used for some advanced or recurrent cervical cancers with certain tumor features.

Clinical trials may also be available. These research studies test new treatments or new ways to use current treatments. Ask your care team whether a clinical trial may be right for you.

Causes & Risk Factors

Nearly all cervical cancers are caused by a long-lasting infection with high-risk types of HPV. Many people will have an HPV infection at some point, and most infections go away on their own. When an infection lasts a long time, it can lead to changes in cervical cells that may become cancer.

Factors that may increase cervical cancer risk include:

• Persistent HPV infection. A long-lasting infection with high-risk HPV is the main cause of cervical cancer.
   
• Smoking. Smoking cigarettes slightly increases the risk of cervical cancer.
   
• A weakened immune system. A weakened immune system, such as from HIV infection or certain medicines, can make it harder for the body to clear an HPV infection.
   
• Sexual history. Becoming sexually active at a young age or having more sexual partners may increase the chance of HPV exposure, since HPV often causes no symptoms.
   
• Long-term use of oral contraceptives. Using birth control pills for many years may slightly increase risk.
   
• Lack of regular screening. Skipping regular screening can allow precancerous changes to go unnoticed until they become harder to treat.

You can take several steps to help lower your risk:

• Get the HPV vaccine. Because HPV is linked to cervical cancer, vaccination is an important part of prevention.
   
• Follow safe sex practices, including using barrier protection, since HPV is often symptomless.
   
• Don’t smoke, as smoking slightly raises the risk.
   
• Support a healthy immune system.

Screening

Regular screening is one of the most effective ways to prevent cervical cancer. Screening can find precancerous changes in the cervix before they become cancer. Talk with your provider about which option is best for you.

Current American Cancer Society screening guidance includes:

• Under age 25: No screening is recommended.
   
• Ages 25 to 65: A primary HPV test alone every 5 years is the preferred option. Co-testing with both an HPV test and a Pap test every 5 years, or a Pap test alone every 3 years, are also acceptable.
   
• Over age 65: Screening may stop if you have had adequate, regular screening with normal results in the previous years. If you do not have a record of normal prior screening, you should continue until you meet the criteria to stop.

Some people may need a different screening plan, such as those with a weakened immune system, a history of cervical precancer or cancer, or prior DES exposure. Talk with your provider about the right plan for you.

A Pap test and HPV test screen for cervical cancer. These tests do not screen for ovarian, uterine, fallopian tube, peritoneal, vaginal or vulvar cancers.

HPV Vaccination

Vaccination against HPV is an important step in preventing cervical cancer. The HPV vaccine works best when given before any exposure to HPV. Current CDC guidance includes:

• Routine vaccination is recommended at ages 11 to 12 and can start as early as age 9.
   
• Catch-up vaccination is recommended through age 26 for anyone not adequately vaccinated earlier.
   
• Some adults ages 27 to 45 may still benefit from vaccination and should talk with their provider about whether it makes sense for them.

If you have abnormal vaginal bleeding, discharge or other symptoms, do not wait for a screening test. Talk with a healthcare provider right away.