Cervical cancer: Symptoms, causes, stages, and treatment

The American Cancer Society estimates that doctors will make 13,170 new diagnoses of cervical cancer by the end of 2019 in the United States. More than 4,200 women in the U.S. will die from cervical cancer this year.

Human papillomavirus (HPV) causes the majority of cervical cancer cases. The HPV vaccine successfully prevents HPV.

The Centers for Disease Control and Prevention (CDC) initially recommended the vaccine for all people aged 9–26 years. However, the CDC now advise that the vaccine is also available for all women and men aged 26–45 years who did receive the vaccine as a preteen.

Symptoms and early signs

In the early stages of cervical cancer, a person may experience no symptoms at all.

As a result, women should have regular cervical smear tests, or Pap tests.

A Pap test is preventive. It aims not to detect cancer but to reveal any cell changes that indicate the possible development of cancer so that a person can take early action to treat it.

The most common symptoms of cervical cancer are:

• bleeding between periods
• bleeding after sexual intercourse
• bleeding in post-menopausal women
• discomfort during sexual intercourse
• vaginal discharge with a strong odor
• 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.

Stages

Working out the stage of a cancer is important, as it helps a person decide the most effective type of treatment.

Staging aims to assess how far the cancer has spread and whether it has reached nearby structures or more distant organs.

A 4-stage system is the most common way to stage cervical cancer.

• 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 now moved 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.

Undergoing screening and seeking medical attention if any symptoms occur can help a person access early treatment and increase the chances of survival.

Some doctors refer to radiation therapy as radiation oncology or XRT.

It involves the use of beams of high-energy X-rays or radiation to destroy cancer cells.

When the treating doctor aims radiation at the pelvic area, it may cause the following side effects, some of which may not emerge until after the treatment is over:

• diarrhea
• nausea
• upset stomach
• bladder irritation
• narrowing of the vagina
• interrupted menstrual cycle
• early menopause

Chemotherapy

Chemotherapy is the use of chemicals (medication) to treat any disease. In this context, it refers to the destruction of cancer cells.

Doctors use chemotherapy to target cancer cells that surgery cannot or did not remove, or to help the symptoms of people with advanced cancer.

The side effects of chemotherapy can vary, and they depend on the specific drug. More common side effects include:

• diarrhea
• nausea
• hair loss
• fatigue
• infertility
• early menopause

Cervical cancer clinical trials

Participating in a clinical trial may be the best treatment option for some people.

Clinical trials are an integral part of the cancer research process. Researchers carry them out to determine the safety and effectiveness of new treatments, and whether they are better than existing ones.

People who participate in clinical trials are contributing to cancer research and innovation.

Visit this government resource to learn more about which clinical trials are currently open.

Prevention

A number of measures can help 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 keeps to the current HPV vaccination programs, they could reduce the frequency of cervical cancer.

Safe sex and cervical cancer

The HPV vaccine only protects against two HPV strains. Other strains can cause cervical cancer. Using a condom during sex helps protect from HPV infection.

Cervical screening

Regular cervical screening might help a person identify and deal with signs of cancer before the condition can develop or spread too far. Screening does not detect cancer but indicates 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 becomes. This can lead to a higher risk of developing cervical cancer.

Delaying first sexual intercourse

The younger a woman is when she has sexual intercourse for the first time, the higher the risk of HPV infection becomes. The longer she delays it, the lower her risk.

Stopping smoking

Women who smoke and have HPV face a higher risk of developing cervical cancer than people who do not.

Early cervical cancer diagnosis improves the success rate of treatment.

Women aged 30 years and over should undergo a regular Pap test, or cervical smear test, to detect early signs of cancer of the uterus and cervix. A healthcare professional can test for HPV at the same time.

Cervical smear test

The American Cancer Society estimate that healthcare professionals will make over 13,000 new diagnoses of invasive cervical cancer in 2019. The disease will be fatal in around 4,000 women. However, regular screening could prevent most of these deaths.

Screening does not detect cancer but looks for abnormal changes in the cells of the cervix. Without treatment, some abnormal cells can eventually develop into cancer.

HPV DNA testing

This test determines whether the individual has any of the types of HPV 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 anomalies become clear in the cervical cells.

If there are signs and symptoms of cervical cancer, or if the Pap test reveals abnormal cells, additional tests may be recommended.

These include:

• Colposcopy: This is visual examination of the vagina using a speculum and a colposcope, a lighted magnifying instrument.
• Examination under anesthesia (EUA): The doctor can examine the vagina and cervix more thoroughly.
• Biopsy: The doctor takes a small section of tissue under general anesthesia.
• Cone biopsy: The doctor takes a small, cone-shaped section of abnormal tissue from the cervix for examination.
• LLETZ: Diathermy using a wire loop with an electric current helps remove abnormal tissue. The healthcare professional then sends the tissue to the lab for checking.
• Blood tests: A blood cell count can help identify liver or kidney problems.
• CT scan: A medical professional might use a barium liquid to show up any cellular 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.

Outlook

The stage at which a person receives a cervical cancer diagnosis can help indicate their chances of survival for at least 5 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: People with stage-4 cervical cancer have 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.

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