The cervix is the opening of the uterus that extends through the top of the vagina. It is lined with cells that are prone to developing precancer (dysplasia) and cancer.
It is now known that nearly all of these precancers and cancers are caused by a virus called human papilloma virus or HPV. Throughout the world, cervical cancer is one of the most common gynecologic cancers. It is lower in the USA and other developed countries because many more women have regular PAP smears and precancer (cervical dysplasia) is detected and treated.
If cervical cancer is found early, it is 90% curable. It is lower if the cancer is more advanced when it is noticed. There is a very good screening test for cervical cancer called the PAP test. It is meant to detect cells in an early precancerous phase.
Three kinds of PAPs are abnormal and usually require further testing:
- ASCUS (atypical cells of undetermined significiance)
- LGSIL (low grade dysplasia)
- HGSIL (high grade dysplasia)
HGSIL has the highest chance of turning into an invasive cancer, and needs to be treated.
Risk Factors
The risk factor profile for cervical cancer and precancer is very different from that of other gynecologic cancers. Cervical cancer is essentially a sexually transmitted disease, or sorts, in that it is caused by a sexually transmitted virus, HPV. There are over a 100 types of HPV and nearly every sexually active person is exposed to at least one of them during a lifetime. Not all HPV strains can cause cervical cancer. In fact, only about 15% of them can, and these are considered "high risk" HPV strains.
Although this virus is most common in teens and early 20s, your body is typically able to suppress the virus well at this age, so it rarely causes cancer at this age. Cancer is more common after age 40, so we become much more concerned about HPV when we notice it in a person who is more than 30 years old, and that's when we start screening for HPV as part of your annual exam.
Any risk factor that increases your risk for STDs will increase your risk for cervical cancer:
- more than 5 lifetime sexual partners
- not using condoms
- having had another STD
- young age at first sexual intercourse
- having a male sexual partner whose previous partner had abnormal PAPs or cervical cancer
Any factor that suppresses your body's immune capability (and thus its ability to suppress HPV) can increase the risk:
- smoking
- HIV infection
- stress
- being on immune suppressant medications (organ transplant, autoimmune disease)
Symptoms of Cervical Cancer
Usually there are none. That's why having a regular PAP is so important.
If you do have symptoms, they may be:
- pain or bleeding with sex
- abnormal vaginal discharge
- abnormal bleeding pattern
These symptoms do not always mean cancer, but should be reported to your physician if they occur.
Diagnosis
If you have an abnormal PAP or symptoms of cervical cancer, the next steps may be:
- Colposcopy - looking at the cervix with a telescopic lens, using special stains, to see what cannot be seen with the naked eye.
- Biopsy - taking a small sample from the cervix to send to the lab to analyze
- Cone biopsy - a cone shaped wedge is removed from the cervix and sent to pathology
- LEEP - a thin electrical wire is used to remove specific parts of the cervix and send them to the lab for further study.
Staging
If you do have an invasive cancer, it is important to know how widespread it is. Various tests are done to "stage" or determine how far the cancer has spread. These may include a pelvic and rectal exam, a cystoscopy (lighted device placed into the bladder for further exam) and proctoscopy (lighted device placed inside the rectum for further exam). CT scans, MRI, ultrasound and laparoscopy may also be performed.
Treatment
If you have invasive cervical cancer, we will usually refer you to a gynecologic oncologist (a gynecologic surgeon who subspecializes in gynecologic cancer). Treatments may involve surgery, and/or radiation and/or chemotherapy, so sometimes the gynecologic oncologist will consult with a radiation oncologist and/or a medical oncologist.
If surgery is done, it is usually a "radical hysterectomy" which includes removal of the surrounding connective tissue and top of the vagina in addition to the cervix and uterus. The ovaries are usually spared.
Follow-up
Because cervical cancer can recur after treatment, careful follow-up is needed. Typically this involves exams, PAPs and sometimes imaging.
Cervical cancer is much easier to treat successfully if caught early. For this reason, regular annual exams and PAPs are very important.
The following ACOG Brochures provides more information on this important topic:
Another ACOG Publication that we recommend is Protect and Detect.
