Worldwide, cervical cancer is the third most common type of cancer in women. (The cervix is the lower part of the uterus [womb] that opens into the vagina.) It is much less common in the United States because of the routine use of Pap smears, which allow your doctor to examine cervical tissue closely and check for cancer cells.
Cervical cancer usually develops very slowly, starting as a pre-cancerous condition called dysplasia (an abnormal growth of cells). Dysplasia can be detected by a Pap smear and is 100 percent treatable. This is why it is so important for women to get regular Pap smears. Today, most women that are diagnosed with cervical cancer have not had regular Pap smears, or they have not followed up on abnormal results.
Undetected, pre-cancerous changes can develop into cervical cancer and spread to the bladder, intestines, lungs, and liver. It can take years for pre-cancerous changes to turn into cervical cancer. Patients with cervical cancer do not usually have symptoms until the cancer is advanced and has spread.
Causes and Risk Factors
Almost all cervical cancers are caused by HPV (Human Papilloma Virus). HPV is a common virus that is spread through sexual intercourse. There are many different types of HPV. Some strains lead to cervical cancer. (Other strains may cause genital warts, while others do not cause any problems at all.)
Other risk factors for cervical cancer include:
- Having sex at an early age
- Multiple sexual partners
- Sexual partners who have multiple partners or who participate in high-risk sexual activities
- Women whose mothers took the drug DES (diethylstilbestrol) during pregnancy in the early 1960s to prevent miscarriage
- Weakened immune system
- Women who do not get regular Pap smears
Many factors influence the outcome of cervical cancer. These include:
- Type of cancer
- Stage of the disease
- Age and general physical condition of the woman
Pre-cancerous conditions are curable with proper treatment and follow-up. The chance of being alive in five years (five-year survival rate) for cancer that has spread to the inside of the cervix walls, but not outside the cervix area, is about 92 percent.
Most of the time, early cervical cancer has no symptoms. Symptoms that may occur can include:
- Continuous vaginal discharge, which may be pale, watery, pink, brown, bloody or foul-smelling
- Abnormal vaginal bleeding between periods, after intercourse or after menopause
- Periods that become heavier and last longer than usual
- Any bleeding after menopause
Symptoms of advanced cervical cancer may include:
- Loss of appetite
- Weight loss
- Pelvic, back, and/or leg pain
- Single swollen leg
- Heavy bleeding and/or leaking of urine or feces from the vagina
- Bone fractures
Regular Pap smears screen for cancer and precancerous conditions, but do not confirm a final diagnosis of cervical cancer. If abnormal changes are seen, the cervix is usually examined under magnification. This is called colposcopy. Pieces of tissue are surgically removed (biopsied) during this procedure and sent to a laboratory for examination.
Other tests or treatments for cervical pre-cancers may include:
- Endocervical Curettage (ECC) to examine the opening of the cervix
- LEEP (loop electrosurgical excision procedure) uses electricity to remove abnormal tissue
- Cervical cone biopsy is an extensive cervical biopsy
If the diagnosis of cervical cancer is confirmed, the health care provider may order more tests to find out how far the cancer has spread. This is called staging.
The survival rate for women treated for pre-invasive cancer is nearly 100 percent. When detected at an early stage, invasive cervical cancer is one of the most successfully treatable cancers with a 5-year survival rate of 92 percent for localized cancers (those that have not spread to other organs). Treatment for cervical cancer will depend on the individual patient and the stage of the cancer.
For cancers still limited to the lining of the cervix (pre-invasive), the procedures may include
Cancers that invade beyond the lining of the cervix may require
- Surgery, chemotherapy, and/or radiation
Treatment for early cervical cancer may include:
- Radical hysterectomy, which removes the uterus, cervix, surrounding tissues, pelvic lymph nodes and upper part of the vagina. Learn more about radical pelvic/reconstructive surgery. Our surgeons may suggest fertility-sparing surgery, if possible, depending on whether it is right for you.
- Combination chemotherapy/radiation may be recommended to treat early stage cervical cancers where the size/shape of the tumor is not appropriate for surgical removal.
Treatment for advanced cervical cancer may include:
- Generally, a combination of chemotherapy/radiation, which allows the cancer cells to be more sensitive to the effects of radiation, resulting in a better response to treatment.
- Radiation may be used to treat larger tumors, cancers that have spread beyond the pelvis, or cancer that has returned. Radiation therapy is either external or internal.
Pelvic exenteration is an extreme type of surgery in which all of the organs of the pelvis, including the bladder and rectum, are removed. The bladder and vagina are rebuilt from the patient's own tissues. This procedure is performed on women who have recurrent cervical cancer, meaning the cancer keeps coming back after treatment.
Exenteration is a procedure performed only in cases where no other treatment option is available. The good news is that 50 percent of patients who have exenteration are cured, and have no recurrence of cancer.
Our team at MedStar Harbor Hospital specializes in performing advanced gynecologic oncology procedures like exenteration for advanced cervical cancer. Your surgeons analyze your treatment up until this point, and make a determination if this surgical approach is the right one for you to treat the cancer.
Protect Against Cervical Cancer
Most cervical cancers form in the cells lining the cervix and gradually develop precancerous changes that, if undetected, progress into cancer. Cervical cancer often goes unnoticed because it has minimal symptoms. This lack of detection causes an unsettling number of women to lose their battle to cervical cancer each year, even though it is a highly preventable and treatable disease.
Protect yourself against cervical cancer with these recommended prevention and screening practices:
- HPV Vaccine: The majority of cervical cancers are caused by human papillomavirus (HPV). There are now two vaccines available (Gardasil® and Cervarix®) to prevent infection against the most frequent HPV subtypes. The vaccine is administered as three injections over a six-month period to girls and young women ages 9 to 26. Studies have shown that the vaccines appear to prevent early-stage cervical cancer and precancerous lesions.
- Regular Pap Tests: This potentially lifesaving screening detects pre-cancerous changes, which can be treated before they turn into cervical cancer. Pap smears work well in spotting such changes, but they must be done regularly. Annual gynecologic examinations should start when a woman becomes sexually active, or by the age of 20 in a woman who is not sexually active. Pap smear testing should begin at the age of 21. If abnormal changes are seen, a colposcopy with biopsy should be performed. A colposcopy is a painless procedure in which your doctor uses a lighted microscope to view your cervix.
- Safe Sex: Practicing safe sex (using condoms) also reduces your risk of HPV and other sexually transmitted diseases. HPV infection causes genital warts. These may be barely visible or several inches wide. If a woman sees warts on her partner's genitals, she should avoid intercourse with that person. To further reduce the risk of cervical cancer, women should limit their number of sexual partners and avoid partners who participate in high-risk sexual activities.