Cervical Cancer

What is cervical cancer?

Cervical cancer, or cancer of the cervix, begins on the surface of your cervix. It happens when the cells on your cervix begin to change to precancerous cells. Not all precancerous cells will turn to cancer, but finding these problematic cells and treating them before they can change is critical to preventing cervical cancer.

Types of cervical cancer

There are two main types of cancer of the cervix: squamous cell carcinomas and adenocarcinomas. About 80% to 90% of cervical cancers are squamous cell carcinomas, while 10% to 20% are adenocarcinomas.

What is the cervix?

The cervix is the lowest part of your uterus (where a baby grows during pregnancy). It looks a little bit like a donut and connects your uterus to the opening of your vagina. It's covered in tissues made up of cells. These healthy cells are what can grow and change to precancer cells.

How common is cervical cancer?

About 14,000 people in the United States are diagnosed with cervical cancer each year. People between the ages of 35 and 44 are most frequently diagnosed with cervical cancer. The average age at diagnosis is 50. Around 4,000 people die of cervical cancer per year. This rate is on the decline due to screenings and the HPV vaccine.

What are the most common signs and symptoms of cervical cancer?

Early stages of cervical cancer don't usually involve symptoms and are hard to detect. The first signs of cervical cancer may take several years to develop. Finding abnormal cells during cervical cancer screenings is the best way to avoid cervical cancer.

Signs and symptoms of stage 1 cervical cancer can include:

• Watery or bloody vaginal discharge that may be heavy and can have a foul odor.
• Vaginal bleeding after intercourse, between menstrual periods or after menopause.
• Menstrual periods may be heavier and last longer than normal.

If cancer has spread to nearby tissues or organs, symptoms may include:

• Difficult or painful urination, sometimes with blood in urine.
• Diarrhea, or pain or bleeding from your rectum when pooping.
• Fatigue, loss of weight and appetite.
• A general feeling of illness.
• Dull backache or swelling in your legs.
• Pelvic/abdominal pain.

If you experience abnormal bleeding, vaginal discharge or any other unexplained symptoms, you should have a complete gynecological examination that includes a Pap test.

What causes cervical cancer?

Most cervical cancers are caused by the virus HPV, a sexually transmitted infection. HPV spreads through sexual contact (anal, oral or vaginal) and can lead to cancer. Most people will get HPV at some point in their lives and not realize it because their bodies fight the infection. However, if your body doesn't fight the infection, it can cause the cells of your cervix to change to cancerous cells.

HPV and cervical cancer

There are more than 100 kinds of HPV and about a dozen of them have been shown to lead to cancer. Early detection of these types of HPV is key in preventing cervical cancer. Regular screenings with your healthcare provider can help identify cell changes before they become cancer. The HPV vaccine can help prevent HPV infection by protecting you against the HPV that causes up to 90% of all cervical cancers.

What is cervical cancer pain like?

Pain from cervical cancer may not feel like much in the early stages of the disease if you feel anything at all. As cancer progresses and spreads to nearby tissues and organs, you may experience pain in your pelvis or have issues urinating. Other people will feel generally unwell, tired or lose their appetite.

How is cervical cancer diagnosed?

Cervical cancer develops slowly and over many years. Before turning to cancer, the cells in your cervix go through a lot of changes. The once normal cells in your cervix start to appear irregular or abnormal. These abnormal cells may go away, stay the same or turn into cancer cells.

Regular gynecological screenings with a Pap test can detect most cases of cervical cancer. A Pap test, or Pap smear, is a test that collects cells from your cervix. These cells are examined for signs of precancers or other irregularities.

If your Pap comes back as abnormal, further testing is necessary. This could include an HPV test, which is a specific test that checks the cells of your cervix for HPV infection. Certain types of HPV infection are linked to cervical cancer.

Your healthcare provider may also examine your cervix and take a sample of tissue for a biopsy if they suspect you have cancer. There are many techniques that can be used to obtain the tissue, like punch biopsy or endocervical curettage. In other cases, a wire loop or conization are used to gather tissues from the cervix for biopsy.

If the biopsy confirms cancer, further tests will determine whether the disease has spread (metastasized). These tests might include:

• Liver and kidney function studies.
• Blood and urine tests.
• X-rays of your bladder, rectum, bowels and abdominal cavity.

This process is called staging.

What tests can check for cervical cancer?

The tests used to detect cervical cancer are the Pap test and the HPV test. These cervical cancer screenings can find irregular or problematic cells in their earliest form before they have a chance to turn into cancer. When these cells are found early, cervical cancer is highly treatable and less likely to become serious.

Your healthcare provider performs Pap tests and HPV tests by using a brush to swab or scrape your cervix to collect cells. You lie back on an exam table with your feet in stirrups (like during a pelvic exam). A speculum is inserted into your vagina (this opens up your vagina). Once the swab is taken, the cells are put in a liquid and sent to a lab for testing.

Screening for cervical cancer

The goal of cervical cancer screening is to detect cell changes on your cervix before they become cancer. The number of cases and deaths from cervical cancer in the U.S. has decreased significantly since people have been getting regular cervical cancer screenings.

• Pap test: This test detects abnormal or irregular cells in your cervix.
• HPV test: This test detects the high-risk types of HPV infection that are most likely to cause cervical cancer.

Your healthcare provider may suggest a combination Pap test/HPV test. This is called co-testing and may be an option for you if you are over 30.

What are the stages of cervical cancer?

• Stage I: Cancer is found only in your cervix. It hasn't spread and is small.
• Stage II: Cancer has spread beyond your cervix and uterus but hasn't yet spread to your pelvic wall (the tissues that line the part of the body between your hips) or your vagina.
• Stage III: Cancer has spread to the lower part of your vagina and may have spread to your pelvic wall, ureters (tubes that carry urine) and nearby lymph nodes.
• Stage IV: Cancer has spread to your bladder, rectum or other parts of the body like your bones or lungs.

Are routine pelvic exams necessary?

Sometimes. You and your healthcare provider can decide if you need a pelvic exam on the years that you aren't due for cervical cancer screening. This is based your health history and sexual activity.

It's still important to schedule routine care visits with your healthcare provider to discuss your sexual health and other concerns specific to your reproductive health. If you're sexually active and under the age of 25, having annual screenings for chlamydia and gonorrhea may be recommended. Additionally, a clinical breast exam may help find lumps on your breasts.

Can you feel cervical cancer with your finger?

No, you won't feel cervical cancer with your finger. Cancer cells are tiny and impossible to detect unless under a microscope. If you feel a bump or mass in your vagina, it could be a sign of a polyp or cyst. Call your healthcare provider right away if you feel a bump inside your vagina so they can examine the area.

How do you know if you have cervical cancer?

Most people will not know they have cervical cancer until they are formally diagnosed with the disease. Your healthcare provider will be able to confirm cervical cancer through a series of tests and biopsies. The first signs of cervical cancer are usually mild and can only be detected by your healthcare provider. Advanced stages of cervical cancer are more likely to cause signs and symptoms.

How is cervical cancer treated?

The cervical cancer treatment team includes a gynecologic oncologist (a doctor who specializes in cancers of female reproductive organs). Recommended treatment for cervical cancer is based on many factors including the stage of the disease, your age and general health, and if you want children in the future.

The treatments for cervical cancer are radiation, chemotherapy, surgery, targeted therapy and immunotherapy.

Radiation

Radiation therapy uses energy beams to kill cancer cells on your cervix. There are two types of radiation therapy:

• External beam radiation therapy (EBRT): Aims high-powered radiation at cancer from a machine outside your body.
• Brachytherapy: Puts the radiation in or just near cancer.

Chemotherapy

Chemotherapy (chemo) uses drugs that are injected through your veins or taken by mouth to kill cancer cells. It enters your blood and is effective for killing cells anywhere in your body. There are several drugs used for chemo and they can be combined. Chemo is often given in cycles. The length of the cycle and the schedule or frequency of chemotherapy varies depending on the drug used and where cancer is located.

Surgery

Different kinds of surgery are used to treat cervical cancer. Some of the most common kinds of surgery for cervical cancer include:

• Laser surgery: This surgery uses a laser beam to burn off cancer cells.
• Cryosurgery: This surgery freezes cancer cells.
• Cone biopsy: A surgery in which a cone-shaped piece of tissue is removed from your cervix.
• Simple hysterectomy: This surgery involves the removal of your uterus but not the tissue next to your uterus. Your vagina and pelvic lymph nodes aren't removed.
• Radical hysterectomy with pelvic lymph node dissection: With this surgery, your uterus, surrounding tissue called the parametrium, your cervix, a small portion of the upper part of your vagina and lymph nodes from your pelvis are removed.
• Trachelectomy: This procedure removes your cervix and the upper part of your vagina but not your uterus.
• Pelvic exenteration: This is the same as a radical hysterectomy but includes your bladder, vagina, rectum and part of your colon, depending on where cancer has spread.

In its earliest stages, the disease is curable by removing the cancerous tissue. In other cases, your provider may perform a simple hysterectomy or a radical hysterectomy.

Some people may have a combination of treatments. Your provider may use radiation or chemotherapy to treat cancer that has spread or come back (recurred). Sometimes your provider will use radiation and chemotherapy before or after surgery.

Targeted therapy

Targeted drug treatment destroys specific cancer cells without damaging healthy cells. It works by targeting proteins that control how cancer cells grow and spread. As scientists learn more about cancer cells, they're able to design better-targeted treatments that destroy these proteins.

Immunotherapy

Immunotherapy uses medicine to stimulate your immune system to recognize and destroy cancer cells. Cancer cells can also avoid being attacked by your immune system by sending off a signal. Immunotherapy helps to target these signals so the cancer cells can't trick your body into thinking it's a healthy cell.

Clinical trials are another treatment option. They're controlled research studies to test new treatments for cancer. Talk to your oncologist if you'd like to participate in a clinical trial.

Some people use alternative treatments like diet, herbs, acupuncture and other methods to supplement their cancer treatment. Talk to your healthcare provider about alternative methods that claim to relieve cancer symptoms. Some may help, but others could be harmful.

Who's at risk for cervical cancer?

In many cases, cervical cancer can be linked with known risk factors for the disease. Some risk factors can be avoided, while others cannot. Some risk factors within your control are:

• Screening history: Those who haven't had Pap tests are regular intervals are at increased risk of cervical cancer.
• HPV infection: Certain types of HPV are linked to cervical cancer. Lowering your risk for HPV can also lower your risk for cervical cancer.
• Sexual history: Having sexual intercourse before the age of 18 and having many sexual partners puts you at higher risk of HPV infection and chlamydia. Preventing these diseases reduces your risk of cervical cancer.
• Smoking: Cigarette smoking is associated with an increased risk of cervical cancer.
• HIV infection: Those who've been infected with HIV have a higher-than-average risk of developing cervical cancer.
• Birth control pills: There is evidence that long-term use of oral contraceptives can increase your risk of cervical cancer.
• Multiple children: Having three or more full-term pregnancies may increase your risk for developing cancer of the cervix.
• Having a weakened immune system: Having a weak immune system makes your body unable to fight infections.

Some risk factors you can't change are:

• DES (diethylstilbestrol): DES is a hormonal drug that was given to people between 1938 and 1971 to prevent miscarriage. If your mother took DES, you may be more likely to get cervical cancer.
• Family history: Cervical cancer may have a genetic component.

Can cervical cancer be prevented?

There are some things you can do to prevent cervical cancer. Receiving regular gynecological exams and getting Pap tests are the most important steps to take toward preventing cervical cancer. Other things you can do are:

• Get the HPV vaccine (if you are eligible).
• Use condoms or other barrier methods when you have sex.
• Limit your sexual partners.
• Stop smoking and using tobacco products.

How do you get screened for cervical cancer?

Most people should have regular cervical cancer screenings. Screenings include Pap tests, testing for HPV or a combination of both tests.

These are the cervical screening cancer guidelines:

• Cervical cancer screening should begin at age 21 years, regardless of sexual history. Some healthcare providers are willing to delay this until age 25.
• For those 21 to 29 years of age, screening is recommended every three years with only a Pap test (no HPV test).
• For people 30 years and older, co-testing with Pap and HPV should be done every five years, or Pap test alone every three years.
• Routine Pap testing should be discontinued (stopped) in those who have had a total hysterectomy for benign conditions and who have no history of CIN (cervical intraepithelial neoplasia) grade 2 or higher.
• Cervical cancer screening can be discontinued at age 65 in those who have two consecutive normal co-test results or three consecutive normal Pap test results in the past 10 years, with the most recent normal test performed in the past five years.
• People who have been adequately treated for CIN grade 2 or higher will need to continue screening for 20 years, even if it takes them past the age of 65.
• People 65 to 70 years of age or older who have had three or more normal Pap tests in a row and no abnormal Pap test results in the last 20 years should stop having cervical cancer screening. Those with a history of cervical cancer, DES exposure before birth, HIV infection or a weakened immune system should continue to have screening as long as they are in good health.
• Those who have had a total hysterectomy (removal of the uterus and cervix) should also stop having cervical cancer screening unless they have a history of cervical cancer or precancer. People who have had a hysterectomy without removal of their cervix should continue to follow the guidelines above.

Those with certain risk factors such as DES exposure before birth, HIV infection or a weakened immune system will follow a different schedule.

What is the cervical cancer vaccine?

The HPV vaccine is approved for children and adults ages 9 to 45 and protects against the development of cervical cancer. The vaccine works by triggering your body's immune system to attack certain human papillomavirus (HPV) types, which have been linked to many cases of cervical cancer. It is best to get the vaccine before the start of sexual activity. The vaccine is given in a series. The number of shots you need varies depending on the age you are at your first dose. Check with your healthcare provider to see if you're eligible for the vaccine.

What are the survival rates for cervical cancer?

In people with cervical cancer that's caught at the earliest stage, the five-year relative survival rate is over 90%. Almost half of all cervical cancers are diagnosed at an early stage. The five-year survival rate is 58% if the cancer has spread to other tissues or organs.

Does cervical cancer affect fertility?

It's still possible to get pregnant if your cervical cancer was treated. However, certain treatment methods can impact your ability to get pregnant. Talk to your healthcare provider about the treatments for cervical cancer and your desire to become pregnant. They should be able to discuss the risks and side effects cancer treatment could have on fertility.

Will cervical cancer treatment affect my sex life?

Yes, cervical cancer can impact your sex life. There are physical and emotional changes people experience during and after treatment for cervical cancer. Certain physical changes like having your uterus or ovaries removed or vaginal dryness can affect sex. Other times it's the emotional side effects of cancer treatment that leave a person feeling less desirable or anxious. It's normal to feel nervous about having sex after cervical cancer. Talk to your healthcare provider about how you're feeling so they can recommend how to best treat you.

Is there a cure for cervical cancer?

No, there is not a cure for cervical cancer. However, it's a highly treatable cancer, especially if it's detected early.

A note from Cleveland Clinic

Being diagnosed with cancer is both shocking and scary. Discuss any of your questions and concerns with your healthcare team to make sure you understand your diagnosis and treatment plan. Having friends and family to support you during this time may help you cope. Early detection of irregular cells on your cervix is critical to identifying and treating this terrible disease. You can take steps to reduce your risk of getting cervical cancer by scheduling regular gynecological screenings and practicing safe sex.