Cervical Cancer

Cancer is made of changed cells that grow out of control. The changed (abnormal) cells often grow to form a lump or mass called a tumor. Cancer cells can also grow into (invade) nearby areas. And they can spread to other parts of the body. This is called metastasis.

Cervical cancer is cancer that starts in the cervix. The cervix is the lower end of the womb (uterus). It connects the uterus to the vagina. Most cervical cancers start with changes in the squamous cells on the surface of the cervix. Squamous cells are the cells that make up most of the skin and other surfaces of the body. These cancers are called squamous cell carcinomas.

When cells in the cervix begin to grow in ways that are not normal, it is called dysplasia. Dysplasia is not cancer, but it can lead to cancer if not treated. Once cancer forms, there are 3 possible types:

• Squamous cell carcinoma. This starts in the thin, flat cells on the surface of the cervix. This is by far the most common form of cervical cancer.

• Adenocarcinoma. This starts in gland cells of the cervix.

• Mixed carcinoma or adenosquamous carcinoma. This is cancer in both types of cells.

In most women, cervical cancer is caused by the human papillomavirus (HPV). HPV infection is very common and often goes away on its own. But in some cases, over time, HPV may lead to cervical cancer. HPV infection is strongly linked to cervical cancer. But it's important to know that most women with HPV don’t develop cervical cancer.

Other risk factors include:

• Smoking.

• Other lifestyle factors such as diet and activity.

• Being overweight.

• Long-term use of birth control pills (oral contraceptives).

• Having chlamydia or herpes (sexually transmitted diseases).

• Having a weak immune system.

• Having multiple full-term pregnancies.

• Having a full-term pregnancy before age 17.

• Having a family history of cervical cancer.

Talk with your healthcare provider about your own risk for cervical cancer.

A risk factor is anything that may increase your chance of having a disease. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer. Some risk factors may not be in your control. But others may be things you can change. 

The risk factors for cervical cancer include:

• HPV (human papillomavirus) infection.

• Sex at a young age or with multiple partners.

• Smoking.

• Infection with HIV, or a weak immune system.

• Long-term use of birth control pills.

• Three or more full-term pregnancies.

• First full-term pregnancy before age 17.

• No regular Pap tests.

• Personal or family history of cervical cancer.

• Past chlamydia infection.

• Excess weight.

• Your mother took the medicine DES (diethylstilbestrol) while pregnant with you.

Talk with your healthcare provider about your risk factors for cervical cancer and what you can do about them.

Cervical cancer most often starts with pre-cancer cell changes. You can take steps to help prevent these changes that lead to cervical cancer. To help lower your risk:

• Get routine Pap tests. Regular testing with a Pap test, with or without an HPV test, can help find cervical cell changes before they become cancer. Treating these changes can keep cancer from starting. Cervical cancer grows slowly. So regular testing can also help find this cancer early--when it's small and easier to treat.

• Get vaccinated. HPV vaccine can protect against certain types of HPV infection. The vaccine only works if given before an infection with HPV. So it should be given before a person becomes sexually active. It's available for girls and boys ages 9 to 14 to be vaccinated using a 2-dose schedule. If the vaccine is given from ages 15 to 26, a 3-dose schedule should be used. It is a preventive vaccine. It is not effective for people who have already been exposed to HPV. No vaccine gives full protection against all cancer-causing types of HPV. It’s still important to get routine Pap and HPV tests.

• Don't smoke. Smoking has been linked to cervical precancer and cancer. Women who smoke are about twice as likely as nonsmokers to get cervical cancer. Tobacco smoke contains many cancer-causing chemicals that are carried throughout the body in the blood. These chemicals have been found in the cervical mucus of women who smoke.

• Use condoms. Condoms need to be used correctly and every time you have sex. Condoms don't offer total protection against HPV infection. That’s because the HPV virus can still be spread through skin-to-skin contact with any infected part of the body. This includes the skin in the genital area that can’t be covered by a condom. Condoms can provide some protection as well as help protect against other sexually transmitted diseases.

Talk with your healthcare provider about cervical cancer screening schedule that's best for you. Also talk about how to prevent cervical cancer.

Are there screening tests for cervical cancer? 

Screening means checking for a health problem before a person has symptoms. Screening can sometimes find certain cancers early, when they’re small and before they have spread. Cervical cancer screening with a Pap test can also find cervical cell changes before they become cancer. Treating these changes can keep cancer from ever starting.

The Pap test can find cervical cancer early or cervical precancers, and the HPV test can identify infection with one of the HPV types linked to cervical cancer.

Regular testing with a Pap test, with or without an HPV testing helps prevent cervical cancer. Talk with your healthcare provider about cervical cancer screening schedule that’s best for you.

Women with pre-cancer cells and early cancers on their cervix rarely have symptoms. Symptoms tend to start when the cancer cells grow and invade the deeper parts of the cervix or other pelvic organs. 

Symptoms of cervical cancer include:

• Abnormal vaginal bleeding, such as between your periods or after sex.

• Unusual vaginal discharge that’s watery or bloody.

• Pain during sex. 

• Pain in the pelvis or low back.

Many of these may be caused by other health problems. But it’s important to see your healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

Cervical cancer is found when doing a routine Pap test. Your healthcare provider will ask you about your health history, symptoms, risk factors, and family history of disease. Your provider will do a physical exam and a pelvic exam. 

You may also have one or more of these tests:

• Pap and HPV tests.

• Colposcopy.

• Biopsy.

A biopsy is the only way to confirm cancer. Small pieces of tissue are taken from the cervix and checked for cancer cells. 

After a diagnosis of cervical cancer, you’ll likely need other tests. These help your healthcare providers learn more about the cancer. They can help determine the stage of the cancer. The stage is how much and how far the cancer has spread (metastasized) in your body. It’s one of the most important things to know when deciding how to treat the cancer. 

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Be sure to ask your healthcare provider to explain the stage of your cancer to you in a way you can understand.

Your treatment choices depend on the type of cervical cancer you have, test results, and the stage of the cancer. You also may need to think about whether you want to be able to have kids. The goal of treatment may be to cure you, control the cancer, or to help ease problems caused by cancer. Talk with your healthcare team about your treatment choices, the goals of treatment, and what the risks and side effects may be.

Types of treatment for cancer are either local or systemic. Local treatments remove, destroy, or control cancer cells in one area. Surgery and radiation are local treatments. Systemic treatment is used to destroy or control cancer cells that may have traveled around your body. When taken by pill or injection, chemotherapy and targeted therapy are systemic treatments. You may have just one treatment or a combination of treatments.

Cervical cancer may be treated with:

• Surgery.

• Radiation therapy.

• Chemotherapy.

• Targeted therapy.

Talk with your healthcare providers about your treatment options. Make a list of questions. Think about the benefits and possible side effects of each option. Some treatments may affect your ability to have children in the future. Talk about your concerns with your healthcare provider before making a decision.

Cancer treatment such as chemotherapy and radiation can damage normal cells. This can cause side effects like hair loss, mouth sores, and vomiting. 

Talk with your healthcare provider about side effects you might have and ways to manage them. There may be things you can do and medicines you can take to help prevent or control side effects.

Many people feel worried, depressed, and stressed when dealing with cancer. Getting treatment for cancer can be tough on your mind and body. Keep talking with your healthcare team about any problems or concerns you have. Work together to ease the effect of cancer and its symptoms on your daily life.

Here are tips:

• Talk with your family or friends.

• Ask your healthcare team or social worker for help.

• Speak with a counselor.

• Talk with a spiritual advisor, such as a minister or rabbi.

• Ask your healthcare team about medicines for depression or anxiety.

• Keep socially active.

• Join a cancer support group.

Cancer treatment is also hard on the body. To help yourself stay healthier, try to:

• Eat a healthy diet, with a focus on high-protein foods.

• Drink plenty of water, fruit juices, and other liquids.

• Keep physically active.

• Rest as much as needed.

• Talk with your healthcare team about ways to manage treatment side effects.

• Take your medicines as directed by your team.

Your healthcare provider will talk with you about when to call. You may be told to call if you have any of the below:

• New symptoms or symptoms that get worse.

• Signs of an infection, such as a fever.

• Side effects of treatment that affect your daily function or don’t get better with treatment.

Ask your healthcare provider what signs to watch for and when to call. Know how to get help after office hours and on weekends and holidays.