Cervical Cancer Symptoms, Stages, and Treatment
What Is Cervical Cancer?
The cervix is the lower part of the uterus, where it extends into the vagina. Cancer of the uterine cervix affects over 12,000 women each year in the U.S. Most cases of cervical cancer are actually caused by an infectious agent, the human papillomavirus (HPV). It is highly curable when detected early enough.
Cervical Cancer Symptoms and Signs
At the very early stages of cervical cancer, there are usually no symptoms or signs. As the cancer grows, symptoms can include abnormal vaginal bleeding. Abnormal vaginal bleeding is bleeding that occurs between periods, during sex, or after menopause. Pain during sex and vaginal discharge are other possible symptoms.
HPV: Top Cause of Cervical Cancer
The Human Papilloma Viruses (HPVs) are a large group of viruses, about 40 of which can infect the human genital tract. Some HPVs are known to cause cervical cancers, while others cause genital warts.
HPV and Cervical Cancer Fast Facts
- Most genital HPV infections go away on their own.
- When they become chronic, genital HPV infections can cause precancerous and cancerous changes in the cells that line the uterine cervix.
- Over 90% of cervical cancers are caused by HPV infection.
HPV Symptoms
The types of HPVs that cause genital warts are different from those that cause cervical cancer. Genital warts are not precancerous lesions and will not develop into cervical cancer. The "high-risk" or potentially cancer-causing types of HPV can stay in the body for years without causing symptoms. Most infections, however, go away on their own and do not cause cellular changes. HPV symptoms in women and men may include the appearance of lesions on the outside of the skin depending on which type of HPV is present, but those HPVs that cause cervical cancer do not cause skin changes.
How Do You Get HPV?
HPV infection is extremely common. In fact, most men and women who have ever had sex will contract the infection at some point in life. In some people, the infection persists for years, even if they are not sexually active. Condoms may lower the risk of acquiring the infection, but they are not 100% effective.
Other Places Where HPV Causes Cancer
- Penis
- Anal area
- Vulva
- Vagina
- Oral cavity
How HPV Causes Cervical Cancer: Mechanism
High-risk HPV types can lead to cancer because they produce changes in the cells of the cervix. These are initially precancerous changes that can be recognized with screening tests. With time, the precancerous cells can develop into cancer cells. After cancer has developed it spreads within the cervix and eventually to surrounding and finally to distant areas.
Other Risk Factors for Cervical Cancer
Women of Hispanic or African American ethnicity have a higher risk of cervical cancer than Caucasian women.
Other Factors That Increase Cervical Cancer Risk
- Smoking
- Long-term use of oral contraceptive pills
- Having many children
- Having HIV or a weakened immune system
- Having had multiple sexual partners
Pap Test for Finding Cervical Cancer Early
The Pap test has been a success in preventing many cases of cervical cancer because it is able to detect abnormal cells often before they turn into cancer cells. A swab is taken of the cervix that is then examined for abnormal cells.
Follow your doctor's recommendations regarding how often to get Pap testing. If you are at higher risk, you may need more frequent testing. Skipping tests increases the risk of cervical cancer. Even if you have received the HPV vaccine, you still need Pap tests, because the vaccine does not protect against all the types of HPV that can cause cancer.
What If Your Pap Test Results Are Abnormal?
If there are minor changes seen on the cells in a Pap smear, the doctor may order a repeat test. He or she may also suggest a colposcopy, an examination that looks at the cervix through a magnifying device, or a biopsy of the cervix. If on a Pap test, abnormal cells appear, they can be destroyed before they turn into cancer cells, and this type of treatment is highly effective in preventing cervical cancer.
The Bethesda System and Squamous Cells
Pathologists who study Pap test cells use a set of terms known as the Bethesda System to classify the results of the test. Abnormal cells are typically divided into seven categories.
The Seven Cell Categories of the Bethesda System
- Atypical Squamous Cells (ASC) -- This is the most common group of abnormal cells. ASCs don’t appear normal, but whether they are precancerous or not is unknown. These are further divided into ASC-US and ASC-H, where ASC-H is considered more likely to be precancerous.
- Low-Grade Squamous Intraepithelial Lesions (LSILs) -- These cells have mild abnormalities due to HPV infection.
- High-Grade Squamous Intraepithelial Lesions (HSILs) -- HSILs are more likely than LSILs to progress to cancer if they remain untreated. Compared to LSILs, the sizes and shapes of HSILs are more dramatically altered from normal cells.
- Squamous Cell Carcinoma -- This is cancer, meaning the abnormal cells have crept more deeply into the cervix. This type of finding during a Pap test is very unusual in a place with extensive cancer screenings such as the United States.
- Atypical Glandular Cells (AGC) -- These are glandular cells of an uncertain type.
- Endocervical Adenocarcinoma in Situ (AIS) -- These cells are considered severely abnormal, yet they have not spread past the cervix’s gland tissue.
- Adenocarcinoma -- this is cancer, and may refer to cervical cancer, but also cancers of the uterus, uterine lining, and elsewhere.
