What is cervical cancer? It’s when cancer develops in the lower end of the womb, most of the time after a human papillomavirus (HPV) infection.
With vaccines, screening, and quick action, cervical cancer has become one of the big success stories in cancer treatment.
What is cervical cancer?
Inside a woman, the vagina connects through the cervix to the rest of the uterus. The entire uterus, including the cervix, is also called the womb.
Most cervical cancers begin in an area called the transformation zone. Get ready for some tongue twisters — that’s where the endocervix meets the ectocervix. You can see a photo here.
Some 90 percent of the cervical cancers diagnosed in American women are triggered by the human papillomavirus (HPV), a sexually-transmitted disease that finds its way into nearly 70 percent of all women who have sex. In 2006, Americans first had the chance to get vaccinated against HPV. It’s best to get the vaccine before beginning any sexual activity.
Who gets cervical cancer?
Exposure to HPV is the big risk, so your chances are higher if you’re not vaccinated and start having sex before you’re 18, or have many partners, either male or female.
(Men can get HPV, too, and end up with cancer of the penis or an anal cancer.)
As you’d guess, a partner who has had many partners is also more likely to have HPV.
Other cervical cancer risk factors include smoking, a chlamydia infection, three or more babies or a first child before the age of 20, and taking birth control pills for many years.
What are the symptoms of cervical cancer?
Usually there are no symptoms in the early stages, which is a good reason to stay up to date on your Pap smear if you are sexually active, especially with more than one partner.
If you have any bleeding beyond your period — especially bleeding related to sex or a pelvic exam — pelvic pain, or an unusual vaginal discharge, see your gynecologist.
What are the stages of cervical cancer?
Precancers are considered Stage 0. These can be removed surgically.
In the early stages, if you are not hoping to have children, one option is a hysterectomy, surgery that removes the uterus and sometimes tissue nearby. It is possible to have this procedure without cutting through the abdomen.
Stages IIB–IVA, also called locally advanced cervical cancer, has spread beyond the cervix to surrounding pelvic tissues in the vagina, rectum, or bladder. You may need chemotherapy or radiation as well as surgery.
Stage IVB and recurrent cervical cancer have spread beyond the pelvis (into the lungs or liver, for example), or have come back after a treatment.
How do you prevent cervical cancer?
The vaccine will prevent you against most kinds of HPV, but it’s not foolproof. You’ll still need testing as the years go by, though there’s debate about how often.
As of 2018, the FDA-approved Gardasil 9 (for 9 types of HPV) for women and men ages 27 to 45.
In your 20s, without a vaccine, it’s standard to have Pap smears, also called a cervical screening, every three years.
From age 30 to 65, you could have the Pap test every three years or, if you wait for five years, a Pap test plus an additional HPV test.
After age 65, you might no longer need these tests if you’re not at high risk for another reason.
Your doctor will tell you if you’ve tested positive for a type of HPV that could lead to cancer (not all do).
Be clear: the fact that you’ve tested positive doesn’t mean you have cancer.
Cervical cancer usually takes years to grow and, if you catch an infection early, can be prevented in an office procedure.
If you test positive, the next step is usually for your gynecologist to check for abnormal cells in your cervix using a magnifying instrument called a colposcope. Your doctor will take a sample of cervical cells (biopsy) and send them to a lab for testing.
The suspicious cells might be tiny warts caused by HPV or precancer cells, which fall into two types.
The outer surface of the cervix is made up of squamous cells. Up to nine out of 10 precancers and cancers in the cervix affect these cells. You could have a mild squamous cell case (classified as CIN 1) or a moderate to severe (CIN 2 or 3) one.
Glandular cells line the cervix canal. A precancer there is called AIS.
Not all of these precancers would develop into cancer. But if you remove them, you’re safer.
You might have one of three treatments to remove the precancer cells: cryosurgery (freezing), laser (high-energy light), and excision [surgical removal, also called cone biopsy or conization, or loop electrosurgical excision procedure (LEEP)].
You can see the five-year survival rates for cervical cancer at different stages here.
December 23, 2020
Janet O'Dell, RN