Many women know very little about cervical cancer, despite how common and devastating it is. Start a search online to learn more about how this type of cancer is screened for, diagnosed and treated.
Cervical cancer is a slow-growing cancer that affects women and occurs in the cervix – the lower part of the uterus. Its most common symptom is abnormal vaginal bleeding, which can easily be attributed to other causes.
Causes of Cervical Cancer
The primary cause of cervical cancer is persistent infection with certain strains of the Human Papillomavirus (HPV), a common virus transmitted through sexual contact. While HPV infections are widespread and often clear up on their own, in some cases, the virus persists and causes changes in cervical cells that can develop into cancer.
Other risk factors contributing to the development of cervical cancer include a weakened immune system, long-term use of oral contraceptives, smoking, and having multiple full-term pregnancies. Understanding these risk factors can help in taking proactive steps towards prevention and early detection.
The progression from a pre-cancerous lesion to full-blown cancer can take decades, which provides opportunities for screening, early detection, and prevention.
At one time, cervical cancer was one of the most common causes of cancer death among American women. Fortunately, this death rate has dropped precipitously with the almost universal use of the Papanicolaou (Pap) smear, or Pap test, for cervical cancer screening. The Pap test or smear collects cells from the cervix to be looked at under a microscope to find pre-cancers and cancer.
Another screening tool that has emerged is the HPV DNA test. This test can be performed on the same sample of cells collected for the Pap test.
Because early cervical cancer diagnosis improves the success of treatment, the United States Preventive Services Task Force (USPSTF) recommends the following as routine cervical cancer screening:
- 21 to 29 Years: Pap smear alone every three years.
- 30 to 65 Years: Pap smear alone every three years, HPV DNA test alone every five years, or Pap smear plus HPV DNA test every five years.
Not every woman has to undergo screening for cervical cancer. At the moment, the USPSTF recommends against screening for cervical cancer in women:
- Younger than 21 years old;
- Older than 65 years old who had adequate prior screening and are not otherwise considered high-risk for cervical cancer, and;
- Who have had a hysterectomy with removal of the cervix and a personal history of a high-grade pre-cancerous lesion or cervical cancer.
As far as cervical cancer prevention, the recent development of an HPV vaccine has been tabbed as one of the most important preventative actions.
As of 2017, Gardasil 9 is the only HPV vaccine available in the United States. It prevents infections with HPV types 16 and 18, which account for 70 percent of all cervical cancers, along with the other high-risk HPV types 6, 11, 31, 33, 45, 52, and 58. All nine of these HPV types account for 90 percent of all cervical cancers.
The CDC recommends the HPV vaccine be routinely administered to adolescents starting at age 11 or 12, with catch-up vaccination through age 26. Although the public health benefit may be minimal, the HPV vaccine is recommended for all women and men age 27 to 45 who did not receive the vaccine as an adolescent.
The following may prevent pre-cancerous lesions and certain conditions that can lead to pre-cancers:
- Regular cervical cancer screening with the Pap smear and/or HPV DNA test;
- Avoiding/quitting smoking;
- Limiting/reducing your sex partners;
- Safe sex with regular use of condoms, and;
- Delaying your first sexual encounter.
While most women are diagnosed with pre-cancerous cervical lesions in their 20s and 30s, most women are diagnosed with cervical cancer in their mid-50s. This difference highlights the slow-growing nature of this disease and the potential effectiveness of screening and prevention programs.
Pap and HPV DNA Test
The first step in the diagnosis of cervical cancer is the Pap test with or without an HPV DNA test. The tests often have an abnormal result whether it be screening (presenting with no symptoms) or diagnostic (presenting with symptoms) in nature.
Prior to the Pap test, your doctor will ask a series of questions about your current and past medical history, focusing on areas such as your current symptoms, family history, and risk factors. For example, you may be asked:
- What are your symptoms and how long have you been experiencing them?
- What is the severity of your symptoms and what makes them better or worse?
- When was your last Pap smear and have you ever had an abnormal Pap smear result?
- Have you ever been diagnosed with an STI?
- Have you ever been on oral contraceptives and if so, how long?
Next, your doctor will perform a thorough physical examination, including a pelvic exam, to evaluate your state of health. At this point, your doctor may pursue further testing to rule in or rule out cervical cancer. Your doctor may perform a colposcopy, which utilizes the colposcope to directly visualize any abnormal cervical tissue. If the colposcopy reveals any abnormal tissue, samples of these areas (biopsies) can be taken for evaluation of the cells under the microscope.
It should be kept in mind that the only way to definitively diagnose cervical cancer is through a biopsy. Your doctor has the choice of several methods, including:
- Punch Biopsy: Uses a sharp instrument to pinch off small samples.
- Endocervical Curettage: Uses a small, spoon-shaped instrument (curette) to scrape a small sample from inside the opening of the cervix.
- Loop Electrosurgical Excision Procedure (LEEP): Uses an electrified (low voltage) loop of wire to obtain samples.
- Cone Biopsy: Also known as conization. Removes a cone-shaped piece of the cervix and sent to the laboratory.
The latter two methods (LEEP and cone biopsy) can be used to obtain biopsies and remove pre-cancerous lesions and early-stage cervical cancers. Additionally, the LEEP can be performed under local anesthesia in your doctor’s office, while a cone biopsy is usually performed in the hospital under general anesthesia.
If the biopsy reveals cervical cancer, your doctor may order imaging studies, such as computed tomography, magnetic resonance imaging, and positron emission tomography, to determine the staging of cervical cancer.
There are various options for the treatment of cervical cancer. Staging allows doctors to characterize the aggressiveness of cervical cancer, which ultimately determines the treatment option(s) available to you.
Choosing the best treatment option for your cervical cancer should entail an in-depth conversation with your doctor. In this conversation, make sure to take the following into consideration:
- The stage of disease;
- Your age and general level of health;
- Location of the tumor;
- Type of cervical cancer, and;
- The desire for fertility.
Surgery: Possibilities for surgery include cryosurgery, laser surgery, conization, or removal of the uterus.
Radiation Therapy: Kills cervical cancer cells using high-energy X-rays. The two main types are external beam and internal beam, which is also known as brachytherapy.
Chemotherapy: Drugs/chemicals that kill cervical cancer cells. They are commonly administered by injection into a vein or by mouth.
Targeted Therapy: Kills cervical cancer cells by inhibiting the formation of new blood vessels (angiogenesis), which is crucial for cancer growth.
Immunotherapy: It allows an individual’s immune system to more effectively detect and destroy cervical cancer cells. It is best for Stage IV cervical cancer or if the cancer has returned after initial treatment.
Complications of cervical cancer can be the result of advanced disease or side effects of treatment. The most alarming complication of cervical cancer is metastasis. Metastasis is the spread of cancer to other parts of the body. Common sites for metastasis of cervical cancer include lymph nodes, pelvis, abdomen, ureters, liver, lungs, and bones. This spread of the cancer may limit — sometimes severely — your treatment options, leading to lower survival rates. Many times patients with Stage IV cervical cancer have to be referred for hospice and/or palliative care.
Other complications of advanced cervical cancer may include:
- Kidney failure
- Blood clots
- Bleeding, especially from the vagina or rectum
- A fistula, an abnormal connection between the vagina and rectum
Complications or side effects of cervical cancer treatment may include:
- Early menopause, resulting from surgical removal of the ovaries or damage from chemotherapy or radiation therapy
- Narrowing of the vagina, resulting from radiation therapy
- A build-up of fluid in the legs
Learn More Today
Cervical cancer is one of the most common cancers for women, but many know almost nothing about this disease. Take the time to learn more about cervical cancer with an online search today. It could just save your life, or the life of someone you love.