Cervical Cancer: A Guide to Symptoms, Prevention and Treatment

Summit Medical Group can partner with you to conduct regular screenings for cervical cancer as part of your overall care plan. For additional information regarding Summit Medical Group, or to find a provider near you, visit www.SummitMedical.com.

Cancer is a disease in which cells in the body grow out of control, and is typically named for the part of the body where it starts, even if it spreads to other body parts later. When cancer starts in the cervix, it is called cervical cancer. Cervical cancer starts in the cells lining the cervix -- the lower part of the uterus (womb). The cervix connects the body of the uterus (the upper part where a fetus grows) to the vagina (birth canal). Cancer starts when cells in the body begin to grow out of control.

All women are at risk for cervical cancer. It occurs most often in women over age 30. Long-lasting infection with certain types of human papillomavirus (HPV) is the main cause of cervical cancer. HPV is a common virus that is passed from one person to another during sex. At least half of sexually active people will have HPV at some point in their lives, but few women will get cervical cancer.

In order to better understand cervical cancer, it is important to first understand the different features that comprise the cervix. The cervix is made of two parts and is covered with two different types of cells.

  • The endocervix is the opening of the cervix that leads into the uterus. It is covered with glandular cells.
  • The exocervix (or ectocervix) is the outer part of the cervix that can be seen by the doctor during a speculum exam. It is covered in squamous cells.

The place where these two cell types meet in the cervix is called the transformation zone. The exact location of the transformation zone changes as women get older and if they give birth. Most cervical cancers begin in the cells in the transformation zone.

Risk Factors

Several risk factors can increase your chance of developing cervical cancer. Women without any of these risk factors rarely develop cervical cancer. Although these risk factors can increase the odds of developing cervical cancer, many women with these risks do not develop this disease.

When you think about risk factors, it helps to focus on those you can change or avoid (like smoking or human papillomavirus infection), rather than those you cannot (such as your age and family history). However, it is still important to know about risk factors that cannot be changed, because it's even more important for women who have these factors to get regular screening tests to find cervical cancer early.

Infection by the human papillomavirus (HPV) is the most important risk factor for cervical cancer - and one that can possibly be controlled. HPV is a group of more than 150 related viruses. Some of them cause a type of growth called papillomas, which are more commonly known as warts.

  • HPV can infect cells on the surface of the skin, and those lining the genitals, anus, mouth and throat, but not the blood or internal organs such as the heart or lungs.
  • HPV can spread from one person to another during skin-to-skin contact. One way HPV spreads is through sexual activity.
  • Different types of HPV cause warts on different parts of the body. Some cause common warts on the hands and feet; others tend to cause warts on the lips or tongue.

It is important to note that certain types of HPV may cause warts on or around the female and male genitals. These are called low-risk types of HPV because they are seldom linked to cancer.

Other types of HPV are called high-risk types because they are strongly linked to cancers. Infection with HPV is common, and in most people the body can clear the infection by itself. Sometimes, however, the infection does not go away and becomes chronic. Chronic infection, especially when it is caused by certain high-risk HPV types, can eventually cause certain cancers, such as cervical cancer.

Although there is currently no cure for HPV infection, there are ways to treat the warts and abnormal cell growth that HPV causes. Also, HPV vaccines are available to help prevent infection by certain types of HPV and some of the cancers linked to those types.

Another preventable risk factor for cervical cancer is smoking. Women who smoke are about twice as likely as those who don't smoke to get cervical cancer. Tobacco by-products have been found in the cervical mucus of women who smoke. Researchers believe that these substances damage the DNA of cervix cells and may contribute to the development of cervical cancer. Smoking also makes the immune system less effective in fighting HPV infections.

Additional preventable risk factors include sexual history, use of birth control, pregnancies, and diet. For additional information on these factors, click here.

Pre-cancers of the cervix

Cells in the transformation zone do not suddenly change into cancer. Instead, the normal cells of the cervix first gradually develop abnormal changes that are called pre-cancerous. Doctors use several terms to describe these pre-cancerous changes, including cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL), and dysplasia.

When the pre-cancers are checked in the lab, they are graded on a scale of 1 to 3 based on how much of the cervical tissue looks abnormal.

  • In CIN1 (also called mild dysplasia or low grade SIL), not much of the tissue looks abnormal, and it is considered the least serious cervical pre-cancer.
  • In CIN2 or CIN3 (also called moderate/severe dysplasia or high-grade SIL) more of the tissue looks abnormal; high-grade SIL is the most serious pre-cancer.

Although cervical cancers start from cells with pre-cancerous changes (pre-cancers), only some of the women with pre-cancers of the cervix will develop cancer. For most women, pre-cancerous cells will go away without any treatment. But, in some women pre-cancers turn into true (invasive) cancers. The good news is that treating cervical pre-cancers can prevent almost all cervical cancers. We will speak more about this later on.

Types of cervical cancer

Cervical cancers and cervical pre-cancers are classified by how they look in the lab under a microscope. The main types of cervical cancers are squamous cell carcinoma and adenocarcinoma.

  • Most (up to 9 out of 10) cervical cancers are squamous cell carcinomas. These cancers develop from cells in the exocervix. Squamous cell carcinomas most often begin in the transformation zone (where the exocervix joins the endocervix).
  • Most of the other cervical cancers are adenocarcinomas. Adenocarcinomas are cancers that develop from glandular cells. Cervical adenocarcinoma develops from the mucus-producing gland cells of the endocervix.
  • Less commonly, cervical cancers have features of both squamous cell carcinomas and adenocarcinomas. These are called adenosquamous carcinomas or mixed carcinomas.

Although almost all cervical cancers are either squamous cell carcinomas or adenocarcinomas, other types of cancer also can develop in the cervix. These other types, such as melanoma, sarcoma, and lymphoma, occur more commonly in other parts of the body.

Signs and Symptoms of Cervical Cancer

Women with early cervical cancers and pre-cancers usually have no symptoms. Symptoms often do not begin until the cancer becomes larger and grows into nearby tissue. When this happens, the most common symptoms are:

  • Abnormal vaginal bleeding, such as bleeding after vaginal sex, bleeding after menopause, bleeding and spotting between periods, or having (menstrual) periods that are longer or heavier than usual.
  • An unusual discharge from the vagina − the discharge may contain some blood and may occur between your periods or after menopause.
  • Pain during sex
  • Pain in the pelvic region

Signs and symptoms seen with more advanced disease can include:

  • Swelling of the legs
  • Problems urinating or having a bowel movement
  • Blood in the urine

These signs and symptoms can also be caused by conditions other than cervical cancer. Still, if you have any of these symptoms, see a health care professional right away. Ignoring symptoms may allow the cancer to grow to a more advanced stage and lower your chance for successful treatment.

Early detection is key

For the best chances for treatment to be successful, don't wait for symptoms to appear.

The best way to find cervical cancer early is to have regular screening tests. The tests for cervical cancer screening are the HPV test and the Pap test. These tests can be done alone or at the same time (called a co-test). Regular screening has been shown to prevent cervical cancers and save lives. The most important thing to remember is to get screened regularly, no matter which test you get.

Early detection greatly improves the chances of successful treatment of pre-cancers and cancer. Being aware of any signs and symptoms of cervical cancer can also help avoid delays in diagnosis.

Screening Tests for Cervical Cancer

The HPV Test

The most important risk factor for developing cervical cancer is infection with human papillomavirus (HPV). Doctors can test for the high-risk HPV types that are most likely to cause cervical cancer by looking for pieces of their DNA in cervical cells. The HPV test is most often used in 2 situations:

  • The ACS recommends the primary HPV test* as the preferred test for cervical cancer screening for people 25-65 years of age. (*A primary HPV test is an HPV test that is done by itself for screening. The US Food and Drug Administration has approved certain tests to be primary HPV tests.)

  • Some HPV tests are approved only as part of a co-test, when the HPV test and the Pap test are done at the same time to screen for cervical cancer. Because a primary HPV test may not be an option everywhere, a co-test every 5 years or a Pap test every 3 years are still good options.

All the screening tests (primary HPV test, co-test, and Pap test) are good at finding cancer and pre-cancer. The primary HPV test is better at preventing cervical cancers than a Pap test done alone and does not add more unnecessary tests, which can happen with a co-test. The result of the HPV test, along with your past test results, determines your risk of developing cervical cancer. If the test is positive, this could mean more follow-up visits, more tests to look for a pre-cancer or cancer, and sometimes a procedure to treat any pre-cancers that might be found.

Because there are many different follow-up or treatment options depending on your specific risk of developing cervical cancer, it is best to talk to your healthcare provider about your screening results in more detail, to fully understand your risk of cervical cancer and what follow-up plan is best for you.

The PAP (Papanicolaou) Test

The Pap test is a procedure that collects cells from the cervix so that they can be looked at closely in the lab to find cancer and pre-cancer. During a PAP test, your health care professional collects a sample of cells and mucus from the exocervix using a small brush or spatula. A small brush or a cotton-tipped swab is then inserted into the opening of the cervix to take a sample from the endocervix . If your cervix has been removed (due to a trachelectomy or hysterectomy) as a part of the treatment for a cervical cancer or pre-cancer, the cells from the upper part of the vagina (known as the vaginal cuff) will be sampled. The samples are then looked at in the lab.

Although the Pap test has been more successful than any other screening test in preventing a cancer, it's not perfect. One of the limitations of the Pap test is that the results need to be examined by the human eye, so an accurate analysis of the hundreds of thousands of cells in each sample is not always possible. Engineers, scientists, and doctors are working together to improve this test. Because some abnormalities may be missed (even when samples are looked at in the best labs), it's best to have this test regularly.

Making your Pap tests more accurate

You can do several things to make your Pap test as accurate as possible:

  • Try not to schedule an appointment for a time during your menstrual period. The best time is at least 5 days after your period stops.
  • Don't use tampons, birth-control foams or jellies, other vaginal creams, moisturizers, or lubricants, or vaginal medicines for 2 to 3 days before the Pap test.
  • Don't have sex for 2 days before the Pap test.

A pelvic exam is not the same as a Pap test, Many people confuse pelvic exams with Pap tests. The pelvic exam is part of a woman's routine health care. During a pelvic exam, the doctor looks at and feels the reproductive organs, including the uterus and the ovaries and may do tests for sexually transmitted disease. Pelvic exams may help find other types of cancers and reproductive problems. A Pap test can be done during a pelvic exam , but sometimes a pelvic exam is done without a Pap test. A Pap test is needed to find early cervical cancer or pre-cancers so ask your doctor if you had a Pap test with your pelvic exam.

When to Get Screened

21 to 29 Years Old: You should start getting Pap tests at age 21. If your Pap test result is normal, your doctor may tell you that you can wait three years until your next Pap test.

30 to 65 Years Old: Talk to your doctor about which testing option is right for you.

  • A Pap test only. If your result is normal, your doctor may tell you that you can wait three years until your next Pap test.
  • An HPV test only. This is called primary HPV testing. If your result is normal, your doctor may tell you that you can wait five years until your next screening test.
  • An HPV test and Pap test. This is called co-testing. If both of your results are normal, your doctor may tell you that you can wait five years until your next screening test.

Older Than 65:

Your doctor may tell you that you don't need to be screened anymore if:

  • You have had normal screening test results for several years, or
  • You have had your cervix removed as part of a total hysterectomy for non-cancerous conditions, like fibroids.

Test Results

It can take as long as three weeks to receive the results of your screening tests. If your test shows that something might not be normal, your doctor will contact you and figure out how best to follow up. There are many reasons why test results might not be normal; however, it usually does not mean you have cancer.

If your test results show cells that are not normal, but could possibly become cancer, your doctor will let you know if you need to be treated. In most cases, treatment prevents cervical cancer from developing. It is important to follow up with your doctor right away to learn more about your test results and receive any treatment that may be needed. If your test results are normal, your chance of getting cervical cancer in the next few years is very low. Your doctor may tell you that you can wait several years for your next cervical cancer screening test. But you should still go to the doctor regularly for a checkup.

By being proactive and watching for signs and symptoms, cervical cancer can often be found early, and sometimes even prevented, by having regular screening tests. If detected early, cervical cancer is one of the most successfully treatable cancers.

Summit Medical Group can partner with you to conduct regular screenings for cervical cancer as part of your overall care plan. For additional information regarding Summit Medical Group, or to find a provider near you, visit www.SummitMedical.com.