Cervical cancer affects the entrance to the uterus (womb). The cervix is the narrow part of the lower uterus, often referred to as the neck of the womb.
The majority of cervical cancer cases are caused by HPV (human papillomavirus). The HPV vaccine successfully prevents HPV.
Facts on cervical cancer
Here are some key points about cervical cancer. More detail and supporting information is in the main article.
More than 11,000 women are diagnosed with invasive cervical cancer each year.
Having many sexual partners or becoming sexually active early is a risk factor.
Survival rates are good if cervical cancer is caught early.
Symptoms include bleeding between periods and after sex.
Symptoms and early signs
HPV can lead to cervical cancer.
In the early stages of cervical cancer, a person may experience no symptoms at all. As a result, women should have regular cervical smear, or Pap, tests.
A Pap test is preventive. It aims not to detect cancer but to reveal any cell changes that indicate that cancer could develop, so that early action can be taken.
The most common symptoms of cervical cancer are:
- bleeding between periods
- bleeding after sexual intercourse
- bleeding in post-menopausal women
- discomfort during sexual intercourse
- smelly vaginal discharge
- vaginal discharge tinged with blood
- pelvic pain
These symptoms can have other causes, including infection. Anyone who experiences any of these symptoms should see a doctor.
Working out the stage of a cancer is important as it helps decide what kind of treatment can be effective.
Staging aims to assess how far the cancer has developed and whether it has reached nearby structures or more distant organs.
There are different ways of describing the stages, but a 4-stage system is commonly used.
Stage 0: Precancerous cells are present.
Stage 1: Cancer cells have grown from the surface into deeper tissues of the cervix, and possibly into the uterus and to nearby lymph nodes
Stage 2: The cancer has is now beyond the cervix and uterus, but not as far as the walls of the pelvis or the lower part of the vagina. It may or may not affect nearby lymph nodes.
Stage 3: Cancer cells are present in the lower part of the vagina or the walls of the pelvis, and it may be blocking the ureters, the tubes that carry urine from the bladder. It may or may not affect nearby lymph nodes.
Stage 4: The cancer affects the bladder or rectum and is growing out of the pelvis. It may or may not affect the lymph nodes. Later in stage 4, it will spread to distant organs, including the liver, bones, lungs, and lymph nodes.
It is important to undergo screening and to see a doctor if any symptoms occur, as early treatment increases the chance of survival.
Cancer is the result of the uncontrolled division and growth of abnormal cells. Most of the cells in our body have a set lifespan and when they die, new cells are produced to replace them.
Abnormal cells can have two problems:
they do not die
they continue dividing
This results in an excessive accumulation of cells, which eventually forms a lump, otherwise known as a tumor. Scientists are not completely sure why cells become cancerous.
However, there are some risk factors that are known to increase the risk of developing cervical cancer. These risk factors include:
HPV (human papillomavirus): A sexually transmitted virus. There are more than 100 different types of HPV, at least 13 of which can cause cervical cancer.
Having many sexual partners or becoming sexually active early: Cervical cancer-causing HPV types are nearly always transmitted as a result of sexual contact with an infected individual.
Women who have had many sexual partners generally have a higher risk of becoming infected with HPV. This raises their risk of developing cervical cancer.
Smoking: This increases the risk of cervical and other cancers.
A weakened immune system: The risk is higher in those with HIV or AIDS, and people who have undergone a transplant, necessitating the use of immunosuppressive medications.
Long-term mental stress: High levels of stress over a sustained period may make it harder to fight off HPV. A study published in 2016 supported this. The reseachers found that: “Women who reported self-destructive coping strategies, like drinking, smoking cigarettes or taking drugs when stressed, were more likely to develop an active HPV infection.”
Giving birth at a very young age: Women who give birth before the age of 17 years are significantly more likely to develop cervical cancer, compared with women who have their first baby after the age of 25 years.
Several pregnancies: Women who have had at least three children in separate pregnancies are more likely to develop cervical cancer, compared with women who have never had children.
Birth control pills: Long-term use of some common contraceptive pills slightly raises a woman’s risk.
Other sexually transmitted diseases (STD): Chlamydia, gonorrhea, and syphilis increase the risk of developing cervical cancer.
Socio-economic status: Rates appear to be higher in areas where income are low.
Cervical cancer treatment options include surgery, radiotherapy, chemotherapy, or combinations of these.
Deciding on the kind of treatment depends on several factors, such as the stage of the cancer, as well as the patient’s age and state of health.
Treatment for early-stage cervical cancer, when it is confined to the cervix, has a good success rate. The further the cancer has spread out of the area it originated from, the lower the success rate tends to be.
Early stage cervical cancer treatment options
Surgery is commonly used when the cancer is confined to the cervix. Radiotherapy may be used after surgery if a doctor believes there may still be cancer cells inside the body.
Radiotherapy may also be used to reduce the risk of recurrence (cancer coming back). If the surgeon wants to shrink the tumor to make it easier to operate, the person may receive chemotherapy although this is not a very common approach.
Treatment for advanced cervical cancer
When the cancer has spread beyond the cervix, surgery is not usually an option.
Advanced cancer is also referred to as invasive cancer because it has invaded other areas of the body.
This type of cancer requires more extensive treatment, which will typically involve either radiotherapy or a combination of radiotherapy and chemotherapy.
In the later stages of cancer, palliative therapy is administered to relieve symptoms and improve quality of life.
Radiotherapy is commonly used to treat advanced forms of cervical cancer. Around 40% of all cancer patients undergo some form of radiotherapy.
Radiotherapy is also known as radiation therapy, radiation oncology, and XRT. It involves the use of beams of high-energy X-rays or particles (radiation) to destroy cancer cells.
Radiation that is aimed at the pelvic area may cause the following side effects, some of which may not emerge until after the treatment is over:
- upset stomach
- bladder irritation
- narrowing of the vagina
- interrupted menstrual cycle
- early menopause
Chemotherapy is the use of chemicals (medication) to treat any disease. In this context, it refers to the destruction of cancer cells.
Chemotherapy for cervical cancer, as with most other cancers, is used to target cancer cells that surgery cannot or did not remove, or to help the symptoms of people with advanced cancer.
Side effects of chemotherapy can vary, and they depend on the specific drug being used. Below is a list of the more common side effects:
- hair loss
- early menopause
Cervical cancer clinical trials
Participating in a clinical trial may be the best treatment option for some people. Many of the current treatments that are available are the results of clinical trials.
Clinical trials are an integral part of the cancer research process. They are done to determine how safe and effective new treatments are, and whether they are better than existing ones. People who participate in clinical trials are contributing to cancer research and innovation.
The stage at which cervical cancer is diagnosed can help indicate the chances that a person will survive for at least 5 years more years.
Stage 1: In early stage 1, the chance of surviving at least 5 years is 93 percent, and in late stage 1, it is 80 percent.
Stage 2: In early stage 2, the rate is 63 percent, falling to 58 percent by the end of stage 2.
Stage 3: During this stage, the chances fall from 35 percent to 32 percent.
Stage 4: There is a 15 to 16 percent chance of surviving another 5 years.
These are average survival rates and do not apply to everyone. In some cases, treatment is successful up to stage 4.
There are a number of measures that can be taken to reduce the chances of developing cervical cancer.
Human papillomavirus (HPV) vaccine
The link between the development of cervical cancer and some types of HPV is clear.
If every female adheres to current HPV vaccination programs, cervical cancer could potentially be reduced.
Safe sex and cervical cancer
The HPV vaccine only protects against two HPV strains. There are other strains which can cause cervical cancer. Using a condom during sex helps protect from HPV infection.
Regular cervical screening will make it much more likely that signs of cancer are picked up early and dealt with before the condition can develop, or spread too far. Screening does not detect cancer but detects changes to the cells of the cervix.
Having fewer sexual partners
The more sexual partners a woman has, the higher the risk of transmitting the HPV virus, which can lead to a higher likelihood of developing cervical cancer.
Delaying first sexual intercourse
The younger a female is when she has her first sexual intercourse, the higher the risk of HPV infection. The longer she delays it, the lower her risk.
Women who smoke and are infected with HPV have a higher risk of developing cervical cancer than people who do not.
The earlier cervical cancer is diagnosed, the more successful treatment for it can be.
Women aged 30 years and over are advised to undergo a regular Pap, or cervical smear, test, to detect early signs of cancer of the uterus and cervix. HPV testing can be done at the same time.
Cervical smear test
Screening does not detect cancer, but it looks for abnormal changes in the cells of the cervix. If left untreated, some abnormal cells can eventually develop into cancer.
HPV DNA testing
This test determines whether the patient is infected with any of the HPV types that are the most likely to cause cervical cancer. It involves collecting cells from the cervix for lab testing.
The test can detect high-risk HPV strains in cell DNA before any cervix cell abnormalities appear.
If there are signs and symptoms of cervical cancer, or if the Pap test reveals abnormal cells, additional tests may be recommended.
- Colposcopy: A visual examination of the vagina using a speculum and a coloscope, a lighted magnifying instrument.
- Examination under anesthesia (EUA): The doctor can examine the vagina and cervix more thoroughly.
- Biopsy: A small section of tissue is taken under general anesthesia.
- Cone biopsy: Small, cone-shaped section of abnormal tissue is taken from the cervix for examination.
- LLETZ: Diathermy, using a wire loop with an electric current, is used to remove abnormal tissue. The tissue is sent to the lab to be checked.
- Blood tests: A blood cell count can help identify liver or kidney problems.
- CT scan: A barium liquid may be used to show up any abnormalities.
- MRI: Special types of MRI may be able to identify cervical cancer in its early stages.
- Pelvic ultrasound: High-frequency sound waves create an image of the target area on a monitor.