Although it used to be widespread in the U.S., cervical cancer – a type of gynecologic cancer – now has a high survival rate thanks to screening tests and the HPV vaccine. The American Cancer Society reports that about 14,000 new cases of cervical cancer will be diagnosed in the U.S. in 2022, and about 4,200 people are expected to die from it. In honor of Gynecologic Awareness month, this article will help you understand your risk of cervical cancer, its symptoms, how it’s diagnosed, and treatment options.
What is cervical cancer?
Between a person’s vagina (the canal that receives a tampon or a penis during sex) and the uterus (the womb where a baby grows) lies a small pinkish, round, doughnut-shaped muscle. That’s the cervix! The cervix is like a gate that controls the outside world’s access to the uterus.
Cervical cancer occurs when cells grow abnormally in the cervix. It is commonly diagnosed in people with a cervix who are 30 years or older, although the average age at diagnosis is 50.
Causes and risk factors of cervical cancer
While the exact cause of cervical cancer is still unknown, infection with the human papillomavirus (HPV) is a common link. In fact, 9 out of 10 cases of cervical cancer are caused by HPV – a group of more than 150 viruses that is very common and highly contagious.
HPV is often thought to be transmitted only during sex. While sex is the most common form of HPV transmission, you can also get HPV through direct skin-to-skin contact with an infected area of the body or an infected object.
In addition to HPV, other risk factors for cervical cancer include:
- Having had sex with someone who has HPV infection
- Having several sexual partners
- Having sexually transmitted infections (STI) such as the human immunodeficiency virus (HIV) or chlamydia
- Having sex at a young age
- Having a condition that weakens your immune system
- Taking birth control pills for a long time
- Having given birth multiple times
- Giving birth at a young age (younger than 20 years old)
- Having limited access to healthcare services and cancer screening
Some other risk factors that cannot be changed are:
- Having been exposed to the hormonal drug diethylstilbestrol (DES) while you were in your mother’s womb
- Having a family history of cervical cancer
Cervical cancer symptoms to watch for
Many people have no symptoms in the early stage of cervical cancer. However, as cervical cancer grows or spreads into nearby tissue, you may experience:
- Unusual vaginal bleeding – bleeding after vaginal sex, spotting or bleeding after menopause, bleeding in between your menstrual periods
- Menstrual periods that last longer or are heavier than usual
- Abnormal vaginal discharge, bloody or non-bloody
- Pelvic pain
- Pain during sex
As the disease becomes more advanced, some people may notice:
- Leg swelling
- Difficulty urinating, blood in the urine, or pain with urination
- Pain or bleeding with bowel movement
How is cervical cancer diagnosed?
Cervical cancer develops slowly and is most commonly detected through screening tests. It is the only gynecologic cancer that has screening tests available. These tests are the Pap test and the HPV test.
A Pap test (Pap smear) is done by a healthcare provider who takes a sample of cells from your cervix during your gynecologic exam. This test can help find cancer cells early before they become cancerous. An HPV test looks for high-risk types of HPV that can cause cervical cancer. These two tests are sometimes done together.
If your Pap test is abnormal, your doctor will do more tests to investigate further.
An HPV test can either be positive or negative. A positive HPV test result means that you have an HPV infection and may be at risk for cervical cancer.
If cervical cancer is diagnosed, you will need even more tests to determine the type of cancer cells and how far the tumor has spread – this is called staging.
Stages of cervical cancer
During staging, your doctor will do a series of exams. This is an important step to help determine your cancer’s stage and decide the best treatment options.
Cervical cancer is described in 4 stages:
- Stage I: The tumor is on the surface of the cervix and has not spread to other parts of the body.
- Stage II: Tumor cells are deeper in the cervix and the uterus but have not spread to nearby lymph nodes or other body parts.
- Stage III: The tumor has spread down to your vagina, the pelvis, or nearby lymph nodes, but it has not spread to other parts of the body.
- Stage IV: Tumor cells have grown in other body parts such as the bladder, rectum, lungs, or bones.
Within each stage, there are substages that further characterize the tumor based on other features.
How is cervical cancer treated?
Your treatment options depend on your cancer stage, overall health, and preferences. The most common treatments for cervical cancer are:
- Surgery: The type of surgery will be based on the tumor size and other factors. This can include a conization to remove the tumor only, a trachelectomy to remove the entire cervix, a hysterectomy to remove the cervix and uterus, or a more involved surgery.
- Radiation therapy: This treatment kills cancer cells through high-powered energy x-rays that are given either internally or externally or a combination of both. Your doctor may recommend surgery first, followed by radiation to destroy any remaining cancer cells. Sometimes, radiation therapy is given together with chemotherapy to increase its efficacy.
- Chemotherapy: These anti-cancer drugs destroy cancer cells or slow their growth. Not everyone with cervical cancer will need chemotherapy.
- Targeted therapy: These medicines affect the cancer cells without damaging normal cells.
- Immunotherapy: These drugs boost your immune system to fight cancer cells.
It’s important to remember that you and your team of physicians will determine the best treatment options. Sometimes, getting a second opinion may help you feel more comfortable about your treatment decisions.
Thanks to screening tests, cervical cancer can be caught early when it’s likely to be successfully treated. The CDC recommends Pap tests starting at age 21. If you are over age 30, you can be screened with a combination of the Pap test and HPV test – this is called co-testing. Besides getting your regular gynecologic exams, talk to your healthcare provider about receiving the HPV vaccine, warning signs that you may be experiencing, if you have a family history of cervical cancer, if you have risk factors, or any concerns that you may have. Finding cervical cancer early can save your life.
Risk factors for cervical cancer may include sexual habits that increase your risk of being infected with HPV, smoking, being immunosuppressed, and having a family history of cervical cancer.
While you may not have symptoms in the early stage of cervical cancer, getting your gynecologic exams regularly and getting screened with the Pap test and HPV test are the best ways to catch this disease early.
In addition to getting screening tests, check with your healthcare provider if you’re eligible for the HPV vaccine to help protect you against certain types of HPV infection.
Some common symptoms to talk to your doctor about are abnormal vaginal bleeding, vaginal discharge, unusual menstrual periods, pain during sex, or pelvic pain.
American Cancer Society. Key Statistics for Cervical Cancer.
American Cancer Society. Risk Factors for Cervical Cancer.
American Cancer Society. What is Cervical Cancer?
Centers for Disease Control and Prevention. Basic Information About Cervical Cancer.
Centers for Disease Control and Prevention. Basic Information About HPV and Cancer.
Centers for Disease Control and Prevention. Cervical Cancer What Should I Know About Screening?
Foundation for Women’s Cancer. Cervical Cancer – Your Guide.
MedlinePlus. Cervical Cancer.
MedlinePlus. Cervical Cancer – Screening and Prevention.
National Cancer Institute. Cervical Cancer Prevention.