The uterine cervix is the lowest portion of a woman's uterus (womb), connecting the uterus with the vagina. Cervical cancer occurs when the cells of the cervix grow abnormally and invade other tissues and organs of the body. When it is invasive, this cancer affects the deeper tissues of the cervix and may have spread to other parts of the body (metastasis), most notably the lungs, liver, bladder, vagina, and rectum.
However, cervical cancer is slow-growing, so its progression through precancerous changes provides opportunities for prevention, early detection, and treatment. Better means of detection have meant a decline in cervical cancer in the U.S. over the decades. Most women diagnosed with precancerous changes in the cervix are in their 20s and 30s, but the average age of women when they are diagnosed with cervical cancer is the mid-50s. This difference in the age at which precancerous changes are most frequently diagnosed and the age at which cancer is diagnosed highlights the slow progression of this disease and the reason why it can be prevented if adequate steps are taken.
As in many cancers, you may have no signs or symptoms of cervical cancer until it has progressed to a dangerous stage. They may include:
- Pain, when the cancer is advanced
- Abnormal vaginal bleeding (other than during menstruation)
- Abnormal vaginal discharge
- Pelvic pain
- Kidney failure due to a urinary tract or bowel obstruction, when the cancer is advanced
Cervical cancer begins with abnormal changes in the cervical tissue. The risk of developing these abnormal changes is associated with infection with human papillomavirus (HPV). In addition, early sexual contact, multiple sexual partners, and taking oral contraceptives (birth control pills) increase the risk of cervical cancer, because they increase exposure to HPV. Cigarette smoking (nicotine) increases the growth rate of HPV.
Forms of HPV, a virus whose different types cause skin warts, genital warts, and other abnormal skin disorders, have been shown to lead to many of the changes in cervical cells that may eventually lead to cancer. Genetic material that comes from certain forms of HPV (high-risk subtypes) has been found in cervical tissues that show cancerous or precancerous changes.
In addition, women who have been diagnosed with HPV are more likely to develop a cervical cancer. Girls who begin sexual activity before age 16 or within a year of starting their menstrual periods are at high risk of developing cervical cancer.
Cigarette smoking is another risk factor for the development of cervical cancer. The chemicals in cigarette smoke interact with the cells of the cervix, causing precancerous changes that may over time progress to cancer. The risk of cervical cancer in cigarette smokers is two to five times that of the general population.
Oral contraceptives ("the pill"), especially if taken longer than five years, may increase the risk for cervical cancer because they reduce the use of condoms.
When to Seek Medical Care
The ranges of conditions that can cause vaginal bleeding are diverse and may not be related to cancer of the cervix. They vary based on your age, fertility, and medical history.
- Vaginal bleeding after menopause is never normal. If you have gone through menopause and have vaginal bleeding, see your care provider as soon as possible.
- Very heavy bleeding during your period or frequent bleeding between periods warrants evaluation by your health care provider.
- Bleeding after intercourse, especially after vigorous sex, does occur in some women. If this occurs only occasionally, it is probably nothing to worry about. Evaluation by your health care provider is advisable, especially if the bleeding happens repeatedly.
- If you have vaginal bleeding that is associated with weakness, feeling faint or light-headed, or actual fainting, go to a hospital emergency department for care.
Pap Smear Test for Cancer Detection
The most important progress that has been made in early detection of cervical cancer is widespread use of the Papanicolaou test (Pap smear) and high-risk HPV testing. A Pap smear is done as part of a regular exam. During the procedure, cells from the surface of the cervix are collected and examined for abnormalities. Diagnosis of cervical cancer requires that a sample of cervical tissue (called a biopsy) be taken and analyzed under a microscope. This would be done if the Pap smear is abnormal.
Self-treatment is not appropriate for cancer. Without medical treatment, the cervical cancer will continue to grow and spread. Eventually, vital body organs will not be able to function properly because the cancer will take their oxygen and nutrients, crowd them out, or injure them. The result is very often death
Although self-treatment is inappropriate, there are things you can do to reduce the physical and mental stresses of cervical cancer and its treatment.
Maintaining good nutrition is one of the best things you can do. You may lose your appetite during treatment for cervical cancer. Common side effects of chemotherapy include nausea, vomiting, and sores inside the mouth.
However, if you take in enough calories and protein, you will maintain your strength and energy and better tolerate the side effects of treatment. Your cancer specialist (oncologist) or gynecologist may be able to recommend a nutritionist who can provide suggestions for keeping up your calorie and protein intake.
The following lifestyle changes may help keep you stronger and more comfortable during treatment:
- Engage in mild physical activity to keep up your energy level. Make sure it doesn't wear you out.
- Get enough rest at night, and take naps if needed.
- Quit smoking.
- Avoid alcohol. You may not be able to drink alcohol with some of the medications you are taking. Be sure to ask your health care provider.
Outlook for Cervical Cancer
For cervical cancer, the survival rate is close to 100% when precancerous or early cancerous changes are found and treated. The prognosis for invasive cervical cancer depends on the stage of the cancer when it is found.
The stage of a cancer is a measure of how far it has progressed, namely, what other organs or tissues have been invaded.
- For the earliest stage of cervical cancer -- stage I -- more than 90% of women survive at least five years after diagnosis.
- Stage II cervical cancer patients have a five-year survival rate of 76%.
- The five-year survival rate for women with stage III cervical cancer is anywhere from 50% to 62%.
- Twenty percent or fewer of women with stage IV cervical cancer survive five years.
- Health care providers who treat cancer often use the term "remission" rather than "cure." Although many women with cervical cancer recover completely, medical professionals sometimes avoid the word "cure," because the disease can recur.