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Cervical cancer

Top questions about cervical cancer

What you should know about cervical cancer

Cervical cancer develops in the cervix, the lower portion of the uterus that connects the uterus to the vagina. Once the leading cause of cancer deaths in American women, the introduction of the Pap smear—a routine screening test done in the doctor’s office—in the 1950s has resulted in a more than 60 percent decline in both incidence and death rates.

What is cervical cancer?

Cervical cancer is diagnosed when cells in the cervix mutate, or change. The cells first become pre-cancerous and then cancerous, forming growths on the surface of the cervix. More than 12,000 new cases of invasive cervical cancer are diagnosed each year, the majority of which affect women between the ages of 35 to 44.

What causes cervical cancer?

The vast majority of cervical cancers are caused by the human papillomavirus (HPV), a sexually transmitted group of more than 150 viruses. HPV infections are common and spread during vaginal, anal and oral sex. The U.S. Centers for Disease Control and Prevention (CDC) warns that HPV can be passed even when an infected person has no symptoms. A healthy person will typically fight off an HPV infection, but certain strains of the virus may cause genital warts and cancer. In addition to cervical cancer, HPV also causes vulvar, vaginal, penile, anal and oropharyngeal cancers, which include cancer of the throat, tongue and tonsils.

Learn more about cancer vaccines

What are the symptoms?

Some patients with cervical cancer do not have any symptoms, but those that do may experience include pain during sex, vaginal bleeding during or after sex, vaginal bleeding after menopause, heavy or long menstrual periods, pelvic pain and abnormal vaginal discharge that may be watery, bloody or heavy and have a foul odor.

What are the risk factors for cervical cancer?

Persistent HPV infection, typically over a period of 10 to 20 years, presents the greatest risk for developing cervical cancer. Smoking further increases your cervical cancer risk, as does having multiple sex partners and a history of cervical dysplasia (abnormal cell growth). Women who are chronically immunosuppressed due to taking certain medications, such as steroids, or having a transplant or HIV infection, are also at an increased risk.

Can I lower my risk for getting cervical cancer?

Julian Schink, MD, Chief of Gynecologic Oncology at Cancer Treatment Centers of America® (CTCA), stresses that women should be diligent about following screening guidelines that call for getting a routine Pap smear, or a cervical swab performed in the doctor’s office. The U.S. Preventive Services Task Force recommends a Pap smear every three years for women between 21 and 65 years old, or combined testing for women aged 30 to 65, including a Pap smear and HPV testing every five years. Dr. Schink calls the Pap smear “one of the most reliable and effective screening tests available.”

The HPV vaccine, approved by the U.S. Food and Drug Administration in 2006, is designed to protect against cervical, vulvar and vaginal cancers, as well as several other non-gynecologic cancers, including penile, anal and head and neck malignancies. The CDC recommends both regular Pap smears and the HPV vaccine to reduce the risk of cervical cancer. Limiting the number of sexual partners, using condoms and not smoking are also recommended risk-reduction measures.

How long does it take for cervical cancer to develop?

Cervical cancer begins when normal cells in the lower portion of the uterus change or mutate. They first become pre-cancerous. When pre-cancerous cells grow out of control, they may spread to nearby tissue, as well as other parts of the body, and if left untreated, they may grow into a mass, or tumor. The process of pre-cancerous cells developing into cancer often takes years. Cervical cancer is most frequently diagnosed in women between the ages of 35 and 55. It’s uncommon for cervical cancer to be diagnosed in women under age 20, while about 20 percent of cases are diagnosed in women older than 65.

Questions to ask your doctor about cervical cancer

Do I have cervical cancer?

If you are experiencing symptoms, such as bleeding or spotting between periods, unusual or bloody discharge, pain during sex, bleeding during or after sex or bleeding after menopause, see your doctor right away. These signs may indicate less serious conditions, such as an infection, but they also may be signs of cervical cancer. Diagnosing cervical cancer in its early stages may increase your treatment options and improve your outcomes. The American Cancer Society reports that with early detection, “cervical cancer is one of the most successfully treatable cancers.”

How can I preserve my quality of life during treatment?

Throughout treatment, it is important to communicate with your care team about how you are feeling and how your body is reacting to chemotherapy, targeted therapy or radiation therapy, and/or how it’s recovering from surgery. To help you prepare for treatment, it is important to know ahead of time what side effects you may experience, so you can be proactive in managing them. Several medications may help alleviate nausea and vomiting, for example, and a nutritionist may recommend a personalized diet that provides sufficient nutrients from foods you can tolerate and enjoy. For chemotherapy or radiation patients experiencing diarrhea or constipation, a nutritionist can help you adjust your diet appropriately.

Supportive care such as talk therapy, meditation, acupuncture, chiropractic care, pain management and spiritual support may also help you manage physical and psychological issues, such as stress and insomnia.

Should I consider preventive surgeries if I have risk factors for cervical cancer?

Unlike with breast or ovarian cancer, there is no recommended prophylactic surgical procedure to prevent cervical cancer. But one important step women can take is to follow medical screening guidelines, which call for getting a Pap smear every three years for women aged 21 to 29, and getting tested for HPV beginning at age 30—and to get the HPV vaccine. Getting a Pap smear and an HPV test at the same time, every five years, known as co-testing—is the preferred screening for women aged 30 to 65, according to the American Cancer Society.

Women in high-risk groups (those with compromised immune systems or who have a history of cervical dysplasia, for example) may require more frequent testing and should follow their health care providers’ screening recommendations.

It’s important to note that even if you have received the HPV vaccine, you should still follow screening guidelines for early cervical cancer detection.

Questions about cervical cancer treatment

Women who are diagnosed with cervical cancer in the early stages typically have more treatment options available to them. Treatment plans often take into account a number of factors, including the patient’s age, desire for future fertility, stage of cancer, general health and potential side effects.

Will I need surgery?

Surgery to remove the cancer is often part of the treatment regimen for women with cervical cancer. Surgery may be combined with chemotherapy and/or radiation or targeted therapy. Ask your doctor about the specific treatment options available to you.

What are the most common surgical procedures?

The most common techniques include:

Loop electrosurgical excision procedure (LEEP): This procedure may be used to treat squamous cell carcinoma in situ, which is defined by the National Cancer Institute as severely abnormal cells found on the surface of the cervix. In this operation, the surgeon uses an electrical wire loop to remove the cancerous cells by cutting a thin layer of abnormal tissue.

Cone biopsy (also referred to as a conization): This surgery may be used to treat certain early-stage cervical cancers in some women who want to preserve their ability to become pregnant. In this procedure, a cone-shaped piece of cervical tissue is removed from the cervix with a scalpel or laser knife or with a LEEP. If cancer cells are detected in the margins of the cervical tissue that has been removed, additional treatment may be necessary.

Radical Hysterectomy: A radical hysterectomy removes the uterus, cervix, upper vagina and tissues surrounding the cervix. The ovaries and fallopian tubes are usually left intact but may be removed for a specific medical reason.

Pelvic exenteration: Rarely, surgery to remove the pelvic structures (uterus, vagina, lower colon, rectum or bladder) may be performed to treat recurrent cervical cancer that has spread to those organs after radiation therapy.

What other therapies are used to treat cervical cancer?

There are many variables taken into account when considering cervical cancer treatment, including whether the cancer is confined to one area or if it has spread, where it has spread, the patient’s age and overall health, as well as fertility concerns.

Radiation therapy: Two types of radiation therapy are combined to treat cervical cancer. External beam radiation therapy (EBRT) delivers high doses of radiation to the pelvis from outside the body. High-dose rate (HDR) brachytherapy (internal radiation) delivers high doses of radiation inserted close to or inside the tumor.

Chemotherapy: This treatment uses anti-cancer drugs given intravenously. Chemotherapy and radiation are usually given at the same time in a treatment known as chemoradiation.

Targeted therapy: These drugs are used to disrupt tumor growth by targeting the cancer cells directly, rather than with systemic treatments, like chemotherapy, that attack all the body’s cells, both cancerous and non-cancerous. Sometimes targeted therapy is used to help other treatments like chemotherapy work better.

What are the possible side effects of treatment?

Side effects vary from patient to patient and also depend on the type and dose of drugs and/or radiation used during treatment.

Common side effects of chemotherapy include fatigue, nausea and/or vomiting, hair loss, loss of appetite and mouth sores. Patients may also experience a drop in their red or white blood cell counts, resulting in diarrhea, shortness of breath, bleeding or bruising from minor injuries and/or a weakened immune system.

Side effects most often caused by radiation therapy include fatigue, nausea, vomiting or upset stomach, diarrhea and skin irritation. Longer-term side effects may include narrowing of the vagina, vaginal dryness, weakening of the bones, lymphedema, sensitivity in the vulva and vagina, low blood counts and bladder irritation, which may cause discomfort and an urge to urinate often. Talk with your doctor about ways to reduce side effects.

Targeted therapy side effects may include fatigue, high blood pressure, loss of appetite, blood clots and other bleeding issues, as well as problems with wound healing. Neuropathy (weakness, numbness, tingling and pain in fingers and toes) is caused by damage to the peripheral nervous system, which may develop as a result of radiation therapy and certain chemotherapy treatments. An estimated 10 percent to 20 percent of cancer patients experience peripheral neuropathy, which may be managed with over-the-counter medications to ease mild pain, or prescribed painkillers, nerve blocks or implanted pain pumps for more severe symptoms. Acupuncture, chiropractic care and oncology rehabilitation techniques like physical therapy may also be used to improve balance, mobility and range of motion.

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