Over 12,000 women in the U.S. are diagnosed with cervical cancer each year and over 4,000 will die from the disease. Because it is relatively slow to develop, and due to the presence of vaccines for a virus that can cause it, cervical cancer is also one of the most treatable and preventable of cancers faced by women.
Cervical cancer starts in the cells that line the cervix, the narrow opening from the vagina into the uterus. The ectocervix (or exocervix) is covered with thin, flat squamous cells, while the endocervix (or cervical canal) is made up of glandular cells. The area where these cells meet is known as the transformation zone, and is the most common location for abnormal cells to develop precancerous changes, which may turn into cancer.
Cervical Cancer Causes and Risk Factors
Nearly all cases of cervical cancer are caused by an infection with certain strains of human papillomavirus (HPV). HPV is sexually transmitted disease (STD) and is so common that most people will have it at some point in their lives. HPV initiates the production of the E6 and E7 proteins, which shut down some tumor-suppressor genes. This causes the cells in the cervical lining to grow uncontrollably and change additional genes, which in some cases will lead to cervical cancer.
Most strains of HPV do not result in cervical cancer, and the infection will go away on its own. But when it doesn’t, the risk of developing the disease increases significantly. About two-thirds of all cervical cancers are caused by HPV strains 16 and 18.
The following factors increase the risk of developing cervical cancer in women with the HPV virus:
Tobacco: Women who smoke are twice as likely to develop cervical cancer than those who don’t. Researchers say that tobacco and tobacco byproducts damage the DNA of cervix cells, contributing to the development of the disease. Smoking also weakens the immune system, making it more difficult to fight HPV infections.
Weak Immune Systems: Women who have HIV or AIDS, those undergoing treatment for an autoimmune disease, and those who have an organ transplant are at greater risk of cervical cancer as a result of their weakened immune systems.
Chlamydia: Studies have shown an increased risk of cervical cancer in women whose cervical mucus and blood tests show evidence of current or past chlamydia infection.
Poor Diet and Being Overweight: The risk of cervical cancer is greater in women carrying excess body fat, and in those whose diet does not contain plenty of fruits and vegetables.
Long-term Use of Oral Contraceptives: Growing evidence suggests that long-term use of the birth control pill can increase the risk of cancer of the cervix. That risk decreases once the pill is stopped, returning to normal after 10 years.
Multiple Pregnancies: Women who have had three or more full-term pregnancies are at greater risk of developing the cancer. This may be due to the increased risk of HPV exposure with unprotected sex.
Young Pregnancies: Women who had their first full-term pregnancy at age 17 or younger are nearly twice as likely to develop cervical cancer than those who first became pregnant at age 25 and older.
Economic Status: Without access to necessary health care services, such as Pap smears, women may be unable to get screened or treated for precancers.
Family History: Your risk of developing cervical cancer are two to three times higher if your mother or sister currently has or has had the disease. This may be caused by an inherited condition that makes some women less successful in fighting off the HPV infection.
Symptoms, Diagnosis and Types of Cervical Cancer
The main types of cervical cancer are squamous cell carcinoma, which begins in the cervical lining, and adenocarcinoma, which starts in the cervical cells that produce mucus and other fluids. With either type, precancerous cell changes and early stages of the disease won’t always present cervical cancer symptoms. This is why regular screening consisting of Pap and HPV tests is so important.
If you notice cervical cancer symptoms, contact your healthcare provider. Common symptoms include:
- Abnormal vaginal bleeding
- Pain during sex or urination
- Vaginal discharge
The first step in diagnosing cervical cancer is usually the evaluation of an abnormal Pap test result, which will lead to further diagnostic testing, including:
- Colposcopy: Magnified examination of the vagina, cervix, and vulva with a surgical instrument called a colposcope.
- Cervical Biopsies: Several biopsies, including a colposcopic biopsy, endocervical scraping, and cone biopsy (using loop electrosurgical procedure or cold knife cone biopsy).
If a biopsy reveals the presence of cancer, the physician may order further testing to determine how much the cancer has spread. Not every test is required for every patient, and decisions are made based on the results of the patient’s physical exam and biopsy. Additional tests include:
- Cystoscopy, proctoscopy, and physical exams under anesthesia: Performed only with the existence of large tumors and rarely when the cancer is detected early.
- Imaging: Chest x-rays, CT scans, MRIs, intravenous urography, and PET scans to determine if the cancer has spread.
Stages of Cervical Cancer
The International Federation of Gynecology and Obstetrics (FIGO) staging system is typically used to determine the stage of cervical cancer. The stages are defined according to the descriptions below.
Cervical Cancer Stages
|The cancer has invaded the cervix but has yet to grow outside the uterus or spread to nearby lymph nodes or other sites.|
|Stage IA: The earliest form of this stage where cancer can only be seen with a microscope.|
Stage IA1: Cancer is less than 3 mm deep and less than 5 mm wide.
Stage IA2: The cancerous area is between 3 mm and 5 mm deep by 7 mm wide.
|Stage IB: Cancer has spread deeper than 5 mm inch or wider than 7 mm into the cervix’s connective tissue but has yet to spread into lymph nodes or other sites.|
Stage IB1: Cancer is no larger than 4 cm.
Stage IB2: Cancer is larger than 4cm
|The cancer has grown beyond the cervix and uterus, but has yet to spread to the pelvic walls, lower vagina, lymph nodes, or other sites.|
|Stage IIA1: Cancer is no larger than 4 cm.|
Stage IIA2: Cancer is larger than 4 cm.
|Stage IIB: Cancer has spread into the parametria (tissues next to cervix).|
|Cancer has spread to the walls of the pelvis and the lower third of the vagina but not to the lymph nodes or other sites.|
|Stage IIIA: Cancer has only spread to pelvic walls and lower third of vagina.||Stage IIIB: Cancer has invaded the pelvic walls and/or blocked one or both ureters creating problems with the kidneys, and spread to the lymph nodes.|
|The most advanced stage of cervical cancer, the cancer has spread to nearby organs and other parts of the body.|
|Stage IVA: Cancer has spread to the rectum or bladder but not to the lymph nodes or other sites.||Stage IVB: Cancer has spread to organs such as the liver or lungs.|
Cervical Cancer Survival Rates and Life Expectancy
Survival rates and life expectancy among cervical cancer patients vary depending on how early the cancer is caught and individual circumstances. As expected, higher survival rates are associated with early-stage cancers, which is why it’s crucial to get regular Pap and HPV tests to detect the disease before it spreads.
The following survival rates are estimated at each stage of cervical cancer:
5-Year Cervical Cancer Survival Rates
|Cervical Cancer Stage||5-Year Survival Rate|
|Stage IA||About 93%|
|Stage IB||About 80%|
|Stage IIA||About 63%|
|Stage IIB||About 58%|
|Stage IIIA||About 35%|
|Stage IIIB||About 32%|
|Stage IVA||About 16%|
|Stage IVB||About 15%|
Cervical Cancer Prevention
Cervical cancer most often begins with precancerous changes, which can be found through regular Pap and HPV tests and treated before they become cancerous.
- Regular Pap tests (also known as a Pap smear): This is a generally painless (if somewhat uncomfortable) routine procedure during which cells are gently scraped from the cervix for microscopic inspection.
- HPV tests: These tests are performed on the same sample of cells from the Pap test.
Aside from regular screenings, the most important steps you can take to prevent cervical cancer include:
- Avoiding exposure to HPV by practicing safe sex or abstaining
- Getting an HPV vaccine, available to women from age 9 through 25
- Avoiding smoking
- Eating an adequate amount of fruit and vegetables
- Maintaining a healthy weight
If you are concerned about your chances of developing cervical cancer, the most important step you can take it to get regular screenings. Doctors recommend that women aged 21-65 repeat Pap testing every three years. Women aged 30 and older should consider having a Pap test every five years if the exam is combined with HPV testing. Contact your doctor or gynecologist to learn more about protecting yourself from HPV.
Cervical Cancer Treatments and Therapies
Cervical cancer treatment options mainly depend on the stage of the cancer and how far it has spread. Treatment of early-stage cervical cancer typically incorporates either surgery or radiation combined with chemotherapy. More advanced stages often require the combination of radiation and chemotherapy.
Cancer tissue is removed surgically. The types of surgery used with cervical cancer can vary significantly, and newer technologies allow somewhat less invasive procedures, depending on the stage and of the cancer and whether it has metastasized. Different surgery types include:
Conization: Using a scalpel or a laser knife, the doctor will remove a cone-shaped piece of tissue from the cervix. If no cancerous cells are found around the outside of the cone, then the tumor may have been removed.
Cryosurgery: Doctors kill abnormal cells through a freezing process by placing a very cold metal probe directly on the cervix.
Laser surgery: A small, focused laser beam can be used to burn off cancer cells or remove small amounts of tissue.
Hysterectomy: A radical hysterectomy is sometimes a treatment, especially if the cancer has spread from the cervix into the uterus.
Specific medicines are used to shrink or eradicate the cancer. The medication may be in pill form or administered intravenously, and sometimes both. Typical chemo regimens for cervical cancer consist of a combination of the following approved drugs.
- Gemcitabine (Gemzar)
- Paclitaxel (Taxol)
Other chemotherapy drugs that may be used to treat cervical cancer include:
- 5-fluorouracil (5-FU)
- Docetaxel (Taxotere)
- Ifosfamide (Ifex)
- Irinotecan (Camptosar)
Avastin (Bevacizumab), a targeted immunotherapy drug that prevents the creation of blood vessels in cancerous tumors, may also be combined with a chemotherapy cocktail.
With radiotherapy, doctors use highly targeted, high-energy rays to stop cancer growth and reduce tumor size, potentially making masses easier to be removed through surgical means. It can also be used on its own as a primary cervical cancer treatment.
There are two types of radiation therapy used to treat cervical cancer:
External Beam Radiation: This is what most people probably think of when considering cancer treatments, a large machine that shoots a radiation beam at the cancer from outside the body. It is not much different from getting an X-ray, except that the dose of radiation is much stronger and can cause a number of side effects, including nausea/vomiting, diarrhea, skin irritation or peeling. Women who undergo external beam radiation for cervical cancer can also experience frequent urination, vaginal pain, menstrual changes, and low blood counts (such as anemia or leukopenia).
Brachytherapy: A less commonly known type of radiation is brachytherapy, which places a radiation source in the body near the cancer. This type of radiation allows a more targeted treatment, which does less damage to surrounding healthy tissue. Cervical cancer patients are treated with intracavitary brachytherapy, which places the radiation device in the vagina or cervix. Side effects are typically less severe and more localized than external beam radiation.
In some cases, both types of radiotherapy may be used to treat cervical cancer.
Some patients are eligible to participate in clinical trials studying new and emerging treatment and therapies for cervical cancer. Each trial has its own eligibility criteria, but women who meet those criteria may have a chance to receive potentially life-extending care that they otherwise would not have access to. This is especially important for those women who do not respond to conventional treatments like surgery and chemotherapy.