Cervical cancer

  • Definition
    • Cervical cancer is cancer that starts in the cervix. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina.

      Cervical cancer
  • Alternative Names
    • Cancer - cervix; Cervical cancer - HPV; Cervical cancer - dysplasia

  • Causes
    • Worldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the United States because of the routine use of Pap smears.

      Pap smear

      Cervical cancer starts in the cells on the surface of the cervix. There are 2 types of cells on the surface of the cervix, squamous and columnar. Most cervical cancers are from squamous cells.

      Cervical cancer usually develops slowly. It starts as a precancerous condition called dysplasia. This condition can be detected by a Pap smear and is 100% treatable. It can take years for dysplasia to develop into cervical cancer. Most women who are diagnosed with cervical cancer today have not had regular Pap smears, or they have not followed up on abnormal Pap smear results.

      Almost all cervical cancers are caused by HPV (human papillomavirus). HPV is a common virus that is spread through sexual intercourse. There are many different types (strains) of HPV. Some strains lead to cervical cancer. Other strains can cause genital warts. Others do not cause any problems at all.

      A woman's sexual habits and patterns can increase her risk of developing cervical cancer. Risky sexual practices include:

      • Having sex at an early age
      • Having multiple sexual partners
      • Having a partner or many partners who take part in high-risk sexual activities

      Other risk factors for cervical cancer include:

      • Not getting the HPV vaccine
      • Being economically disadvantaged
      • Having a mother who took the drug diethylstilbestrol (DES) during pregnancy in the early 1960s to prevent miscarriage
      • Having a weakened immune system
  • Symptoms
    • Most of the time, early cervical cancer has no symptoms. Symptoms that may occur include:

      • Abnormal vaginal bleeding between periods, after intercourse, or after menopause
      • Vaginal discharge that does not stop, and may be pale, watery, pink, brown, bloody, or foul-smelling
      • Periods that become heavier and last longer than usual

      Cervical cancer may spread to the bladder, intestines, lungs, and liver. Often, there are no problems until the cancer is advanced and has spread. Symptoms of advanced cervical cancer may include:

      • Back pain
      • Bone pain or fractures
      • Fatigue
      • Leaking of urine or feces from the vagina
      • Leg pain
      • Loss of appetite
      • Pelvic pain
      • Single swollen leg
      • Weight loss
  • Exams and Tests
    • Precancerous changes of the cervix and cervical cancer cannot be seen with the naked eye. Special tests and tools are needed to spot such conditions:

      • A Pap smear screens for precancers and cancer, but does not make a final diagnosis.
      • The human papillomavirus (HPV) DNA test may be done along with a Pap test. Or it may be used after a woman has had an abnormal Pap test result. It may also be used as the first test.
      • If abnormal changes are found, the cervix is usually examined under magnification. This procedure is called colposcopy. Pieces of tissue are removed (biopsied) during this procedure. This tissue is then sent to a lab for examination.
      • A procedure called a cone biopsy may also be done.
      Cervical biopsyCold cone biopsy

      If cervical cancer is diagnosed, the health care provider will order more tests. These help determine how far the cancer has spread. This is called staging. Tests may include:

  • Treatment
    • Treatment of cervical cancer depends on:

      • The stage of the cancer
      • The size and shape of the tumor
      • The woman's age and general health
      • Her desire to have children in the future

      Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. This is why routine Pap smears are so important to prevent cervical cancer. There are surgical ways to do this without removing the uterus or damaging the cervix, so that a woman can still have children in the future.

      Types of surgery for early cervical cancer include:

      • Loop electrosurgical excision procedure (LEEP): Uses electricity to remove abnormal tissue
      • Cryotherapy: Freezes abnormal cells
      • Laser therapy: Uses light to burn abnormal tissue

      A hysterectomy (surgery to remove the uterus but not the ovaries) is not often done for cervical cancer that has not spread. It may be done in women who have had repeated LEEP procedures.

      Treatment for more advanced cervical cancer may include:

      • Radical hysterectomy, which removes the uterus and much of the surrounding tissues, including lymph nodes and the upper part of the vagina.
      • Pelvic exenteration, an extreme type of surgery in which all of the organs of the pelvis, including the bladder and rectum, are removed.

      Radiation may be used to treat cancer that has spread beyond the cervix or cancer that has returned.

      Chemotherapy uses drugs to kill cancer. It may be given alone or with surgery or radiation.

  • Support Groups
    • You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

  • Outlook (Prognosis)
    • How well the person does depends on many things, including:

      • Type of cervical cancer
      • Stage of cancer (how far it has spread)
      • Age and general health
      • If the cancer comes back after treatment

      Precancerous conditions can be completely cured when followed up and treated properly. Most women are alive in 5 years (5-year survival rate) for cancer that has spread to the inside of the cervix walls but not outside the cervix area. The 5-year survival rate falls as the cancer spreads outside the walls of the cervix into other areas.

  • Possible Complications
    • Complications can include:

      • Risk of the cancer coming back in women who have treatment to save the uterus
      • Problems with sexual, bowel, and bladder function after surgery or radiation
  • When to Contact a Medical Professional
    • Call your provider if you:

      • Have not had regular Pap smears
      • Have abnormal vaginal bleeding or discharge
  • Prevention
    • Cervical cancer can be prevented by doing the following:

      • Get the HPV vaccine. The vaccine prevents most types of HPV infection that cause cervical cancer. Your provider can tell you if the vaccine is right for you.
      • Practice safer sex. Using condoms during sex reduces the risk for HPV and other sexually transmitted infections (STIs).
      • Limit the number of sexual partners you have. Avoid partners who are active in high-risk sexual behaviors.
      • Get Pap smears as often as your provider recommends. Pap smears can help detect early changes, which can be treated before they turn into cervical cancer.
      • Get the HPV test if recommended by your provider. It can be used along with the Pap test to screen for cervical cancer in women 30 years and older.
      • If you smoke, quit. Smoking increases your chance of getting cervical cancer.
  • References
    • Committee on Adolescent Health Care of the American College of Obstetricians and Gynecologists: Immunization Expert Work Group of the American College of Obstetricians and Gynecologists. Committee Opinion No. 588: human papillomavirus vaccination. Obstet Gynecol. 2014;123:712-718. PMID: 24553168

      Hacker NF. Cervical dysplasia and cancer. In: Hacker NF, Gambone JC, Hobel CJ, eds. Hacker and Moore's Essentials of Obstetrics and Gynecology. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 38.

      Jhingran A, Russell AH, Seiden MV, et al. Cancers of the cervix, vulva, and vagina. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier; 2013:chap 87.

      National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines): cervical cancer. Version 1.2016. Accessed: January 18, 2016.

      U.S. Preventive Services Task Force. Screening for Cervical Cancer: U.S. Preventive Services Task Force recommendation statement. AHRQ Publication No. 11-05156-EF-2, March 2012. Accessed: January 18, 2016.