Cervical cancer is a type of cancer of the female genital tract that stands tall as the fourth most common gynecological cancer in women. Despite having a death toll of over 4000 every year in the States alone, cervical cancer and precancerous cervical lesions can be diagnosed early if screened in reproductive ages.
Every year, around 13,000 women will be diagnosed with cervical cancer in the USA, but is there any possibility that you might be one of those too?
What Is Cervical Cancer? (ICD-10 code: C53. 9 Malignant neoplasm: Cervix uteri, unspecified.)
The ovaries, fallopian tubes, uterus, cervix, vulva, and vagina constitute the female genital tract. The cervix or cervix uteri, a cylindrical muscular canal, is the lowermost extension of the uterus (the maternal womb) which connects it to the upper part of the vagina. The cervix serves as a cylindrical cavity that facilitates the passage of the fetus during childbirth.
Cervical cancer is a malignant tumor of the cells of the cervix which usually affects women in their reproductive ages. Over the past three decades, there has been a 30% increase in the cases of cervical cancer, which largely contributes to deaths in developing and underdeveloped countries.
Cervical cancer is usually diagnosed between the third and fourth decades of life, with a majority of deaths occurring around age 50.
What Causes Cervical Cancer in Women?
Cervical Cancer owes 75% of its cases to a chronic infection of Human Papillomavirus (HPV), which is the most common cause of sexually transmitted infections. Strains 6 and 8 cause genital warts which are fairly benign, while strains 16 and 18 are attributed to the development of HPV cervical cancer. HPV can also cause low-risk and high-risk (16, more commonly) precancerous lesions which can develop signs of cervical cancer in females and warrant rigorous screening for any changes.
Over 50,000 cases are diagnosed positive with HPV every year, but low-grade infections usually resolve within a couple of years. Precancerous low-risk cervical lesions can be treated with immunotherapy with eventual resolution within 6 – 12 months. High-risk precancerous lesions can persist, and lead to malignant HPV cervical cancer.
The most common risk factor for the development of cervical cancer is unprotected sexual intercourse which contributes to easy transmission of HPV.
Another risk factor which contributes to the development of cervical cancer is having intercourse in young teenage years (<16) as there is less awareness about using protection.
Oral contraceptive pills, while being protective against endometrial and ovarian cancer, have been known to explicitly increase the risk of cervical cancer if used for more than 5 years. Plus, women who use non-barrier contraceptive methods and have multiple sexual partners are at more risk of contracting STIs, especially HPV.
Apart from HPV, low socio-economic status supplemented by no access to screening methods, and smoking are also known to cause cervical cancer.
Cervical Cancer Symptoms and Signs
Cervical cancer, like other aggressive and malignant cancers, is usually asymptomatic or displays symptoms similar to those of STIs in its early stages. Cervical cancer symptoms usually develop when the disease has progressed and the cancerous cells have advanced to neighboring lymph nodes or body sites.
- Postmenopausal vaginal bleeding (bleeding per vagina after attaining menopause should always warrant a gynecological consultation. Post-menopausal bleeding is most likely linked to endometrial cancer, but can also occur in cervical cancer.)
- Vaginal bleeding after intercourse
- Intermenstrual bleeding or vaginal bleeding that occurs between consecutive periods
- Dull ache in the pelvis, lower abdomen, or lower back during sex
- Bloody or foul-smelling vaginal discharge
- Heavy menstrual periods
- Pain during urination or defecation (passing stool)
- Bleeding per urethra or rectum (blood in urine or stool)
- Urinary storage symptoms such as increased frequency and urgency of urine
- Tiredness, fatigue, and weight loss
- Swelling in legs or lymphoedema caused due to lymphatic fluid buildup
The majority of cervical cancer symptoms are also found in other gynecological cancers as well as in sexually transmitted infections. Vaginal bleeding and malodorous vaginal discharge are two cervical cancer symptoms that can also occur in the early stages of the disease. For this reason, screening early for cervical cancer is necessary before the disease spreads and becomes metastatic.
How Long Does It Take For Cervical Cancer to Develop?
While women are usually diagnosed in their 50s, they might begin undergoing precancerous cervical changes in their early 20s or 30s. This is why cervical screening tests are necessary to detect any abnormal cell development in the cervix as treatment might still be possible before cancer becomes invasive.
Women with a cervix are screened once every 5 years for cervical cancer from the ages of 25 – 65 years. AS HPV is the most common cause of cervical cancer, women aged 21-24 would also undergo screening prior to 2020, but HPV infections were found to be self-limiting in this age group. Women aged 65 or beyond, whose cervical screening tests have shown to be consistently inconclusive, may opt out of the screening.
There are two types of cervical screening tests that are now the hallmark of detecting slow-growing cancer in its early or late stages.
The PAP Smear/Test is the most commonly used screening test which assesses cervical cells for any abnormal development or evidence of precancerous lesions.
The HPV test detects evidence of infection caused by high-risk strains (primarily 16 and 18). It was approved in 2014 by the FDA as a screening method for cervical screening but initially was only used to triage patients with atypical cervical cells.
Women with HIV and weak immunity such as transplant recipients and people on immunosuppressive medications impose a high risk of developing cervical cancer.
The HPV test is preferably ordered once every 5 years while the PAP Smear test is conducted once every 3 years. If the PAP smear detects any evidence of abnormal cytology – even if the lesion is at low-risk or borderline risk – the HPV test is performed to check cervical cells for the cancer-causing strains of HPV.
Co-testing with Pap Smear and HPV is, however, also acceptable and usually conducted once every 5 years in women aged 25-65 years old. Screening is not advised for women who have been treated for cervical cancer or have already undergone cervical screening with a biopsy recently.
Is Cervical Cancer Treatable?
The treatment of cervical cancer largely depends on the stage and progression of the disease. But, other factors such as the age and health of the patient as well as the choice to continue or start a family also play a role. Surgical options include removing the uterus with the cervix and/or other female reproductive organs.
Regular cervical screening tests such as the PAP Smear and HPV test can help detect abnormal cells prematurely, helping you to get started on treatment without allowing the disease to progress.
This blog is for informational & educational purposes only, and does not intend to substitute any professional medical advice or consultation. For any health related concerns, please consult with your physician, or call 911.
About The AuthorDr. Syra Hanif M.D.
Board Certified Primary Care Physician
Dr. Syra Hanif is a board-certified Primary Care Physician (PCP) dedicated to providing compassionate, patient-centered healthcare.Read More