Cancer of the cervix can occur at any age. It occurs most often in women older than 40 years, but it can occur in younger women. However, it rarely occurs in women younger than 21 years. Cervical cancer is largely preventable by having regular Pap tests. About one half of cervical cancer cases occur in women who have never had a Pap test. If cervical cancer is found and treated early, more than 90% of women who have it can be cured. The more advanced the disease, the lower the cure rate.
How Cervical Cancer Develops
A woman's cervix (the opening of the uterus at the top of the vagina) is covered by a thin layer of tissue made up of cells. Healthy cells grow, divide, and are replaced as needed. Cancer of the cervix occurs when these cells change. Cancer cells divide more rapidly. They may grow into deeper cell layers or spread to other organs. The cancer cells eventually form a mass of tissue called a tumor.
It often takes several years for cervical cancer to develop. During this time, the cells on or around the cervix become abnormal. The early cell changes that occur before cancer is present are called dysplasia or cervical intraepithelial neoplasia (CIN). The Pap test, sometimes called cervical cytology screening, checks for abnormal cell changes of the cervix. This allows early treatment so the abnormal cells do not become cancer.
The Role of Human Papillomavirus
The main cause of cervical cancer is human papillomavirus (HPV) infection. There are many types of HPV. Some types of HPV, called "high-risk types," can cause cancer of the anus, cervix, vulva, vagina, and penis. They also can cause cancer of the head and neck. Other types have been linked to genital warts.
HPV infection is very common. It is passed from person to person through sexual contact. Some research suggests that at least three out of four people who have sex will get a genital HPV infection at some time during their lives. However, being infected with HPV does not necessarily mean that a person will get genital warts or develop cancer.
HPV enters cells and causes them to change and grow abnormally. Usually, a woman's immune system gets rid of the virus quickly, and the infection goes away by itself. But in a small number of women, HPV does not go away. These infections are described as "persistent." The longer HPV is present and the older the woman, the greater the risk that the virus will damage cervical cells.
Currently, two vaccines are available to protect against some types of HPV, including the two types that cause the most cases of cervical cancer. The vaccines trigger the immune system to fight off these types of HPV if a person is exposed to them.
An HPV test also is available. It is used along with the Pap test in women 30 years and older and as a follow-up test when a woman has an abnormal Pap test result. It can detect many high-risk types of HPV even before there are visible changes to cervical cells.
Your risk of cancer of the cervix depends on your sexual history, your immune system, your health, and your lifestyle. The most important factor is infection with the types of HPV linked to cancer. The following factors increase your risk of becoming infected with HPV:
- Multiple sexual partners
- Having a male sexual partner who has had multiple sexual partners
- Early age at which you first had sex (younger than 18 years)
Other risk factors include the following:
- A personal history of dysplasia of the cervix, vagina, or vulva
- A family history of cervical cancer
- Smoking
- Certain sexually transmitted diseases, such as chlamydia
Women who have problems with their immune systems also are at increased risk of cervical cancer, such as women infected with human immunodeficiency virus (HIV) or who have had an organ transplant.
Women born to mothers who took a drug called diethylstilbestrol (DES) during pregnancy have an increased risk of a rare type of cervical cancer. DES was a drug given to pregnant women between 1940 and 1971 to prevent miscarriage.
Symptoms
Cervical dysplasia and cancer of the cervix often have no symptoms. By the time symptoms appear, the cancer cells may have already spread. When symptoms do occur, the first signs may be abnormal bleeding, spotting, or watery discharge from the vagina. Menstrual bleeding may be heavier than usual, and bleeding may occur after sex. Most of the time, these signs are caused by other health problems besides cancer. However, if you have any of these symptoms, you should see your health care provider.
Signs of advanced cancer can include pelvic pain, problems urinating, and swollen legs. If the cancer has spread to nearby organs or the lymph nodes, the tumors can affect how those organs work. For instance, a tumor might press on your bladder or block blood flow in a vein. These symptoms do not always mean cancer. If you have any of these symptoms, see your health care provider without delay.
Diagnosis
If your health care provider suspects that you have cancer of the cervix, a biopsy may be done. For certain abnormal Pap test results that require treatment, the abnormal cervical tissue may be removed and sent to a lab to be studied. Cancer can be detected with a Pap test, but a biopsy is needed to be sure.
If cervical cancer is diagnosed, your doctor will assess the size of the cancer and the extent (if any) to which the disease has spread. This process may include the following tests:
- A pelvic exam (which may include a rectal exam)—An examination in which your doctor checks the uterus, ovaries, and other organs near the cervix
- Cystoscopy—A test in which the inside of the urethra and bladder are studied with a lighted device
- Colonoscopy—A test in which the entire colon is examined with a slender, lighted instrument called a colonoscope
Because cervical cancer can spread to other areas of the body, your doctor may order tests to check these areas. These tests may include X-rays, ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET).
Treatment
Your health care provider may consult with or refer you to a gynecologic oncologist (a specialist in cancer of the female reproductive organs) for treatment. You also may be referred to other specialists, such as a radiation oncologist or a medical oncologist. They will work as a team to recommend the best treatment for you.
Follow-up
Depending on the stage of cancer and the type of treatment, cervical cancer usually does not return. However, close follow-up is needed. Routine checkups and Pap tests are important, even after treatment ends.
Your doctor may suggest two or three Pap tests each year for the first few years after treatment to make sure that all the cancer cells were removed. Even if your cervix has been removed to treat your cancer, you still need Pap tests. Cells are taken from the upper vagina instead of the cervix.
You also may need other tests and procedures. Your doctor will work with you to arrange the follow-up care you need.
Finally…
There are many treatments available for cervical cancer. Finding the cancer early, getting prompt treatment, and following a schedule of routine checkups after treatment are essential. If you have questions about your diagnosis or treatment, be sure to ask your doctor.
The above information is courtesy of ACOG
