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Overview
Cervical cancer is a type of cancer that occurs in the cells of the cervix — the lower part of the uterus that connects to the vagina.
Various strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cervical cancer.
When exposed to HPV, the body’s immune system typically prevents the virus from doing harm. In a small percentage of people, however, the virus survives for years, contributing to the process that causes some cervical cells to become cancer cells.
Signs and Symptoms
Cervical Cancer screenings, which typically include a Pelvic exam and Pap Smear have significantly reduced the number of cervical cancer incidence and death rates in the United States. These screenings are especially important because symptoms of cervical cancer often go undetected until the disease is more advanced – says Dr. Albana B Mihali, MD
Signs and symptoms of more-advanced cervical cancer include:
· Vaginal bleeding after intercourse, between periods or after menopause
· Watery, bloody vaginal discharge that may be heavy and have a foul odor
· Pelvic pain or pain during intercourse.
Risk Factors
· Many sexual partners. The greater your number of sexual partners, or if your partner has more than one sexual partner— the greater your chance of acquiring HPV.
· Early sexual activity. Having sex at an early age increases your risk of HPV.
· Other sexually transmitted infections (STIs). Having other STIs — such as chlamydia, gonorrhea, syphilis and HIV/AIDS — increases your risk of HPV.
· A weakened immune system. You may be more likely to develop cervical cancer if your immune system is weakened by another health condition and you have HPV.
· Smoking. Smoking is associated with squamous cell cervical cancer.
· Exposure to miscarriage prevention drug. If your mother took a drug called diethylstilbestrol (DES) while pregnant in the 1950s, you may have an increased risk of a certain type of cervical cancer called clear cell adenocarcinoma.
To Reduce Risk Factors
· Ask your doctor about the HPV VACCINE. Receiving a vaccination to prevent HPV infection may reduce your risk of cervical cancer and other HPV-related cancers. Ask your doctor whether an HPV vaccine is appropriate for you.
· Have routine PAP TEST can detect precancerous conditions of the cervix, so they can be monitored or treated in order to prevent cervical cancer. Most medical organizations suggest beginning routine Pap tests at age 21 and repeating them every few years.
· Practice safe sex. Reduce your risk of cervical cancer by taking measures to prevent sexually transmitted infections, such as using a condom every time you have sex and limiting the number of sexual partners you have.
· Don’t smoke. If you don’t smoke, don’t start. If you do smoke, talk to your doctor about strategies to help you quit.
Survival Rate
Cervical cancer is most often diagnosed between the ages of 35 and 44. The average age of diagnosis is 50. About 20% of cervical cancers are diagnosed after age 65. Usually, these cases occur in people who did not receive regular cervical cancer screenings before age 65. It is rare for people younger than 20 to develop cervical cancer.
Survival rates depend on many factors, including the stage of cervical cancer that is diagnosed. When detected at an early stage, the 5-year survival rate for people with invasive cervical cancer is 92%. If cervical cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the 5-year survival rate is 58%. If the cancer has spread to a distant part of the body, the 5-year survival rate is 17%.
Statistics adapted from the American Cancer Society’s (ACS) publications, Cancer Facts & Figures 2021, Cancer Facts & Figures 2020, and Cancer Facts & Figures 2018, and the ACS website (sources accessed January 2021)
Stages of Cancer
Doctors assign the stage of the cancer by evaluating the tumor and whether the cancer has spread to other parts of the body.
Staging is based on the results of a physical exam, imaging scans, and biopsies.
Stage I: The cancer has spread from the cervix lining into the deeper tissue but is still just found in the uterus. It has not spread to other parts of the body. This stage may be divided into smaller groups to describe the cancer in more detail (see below).
Stage IA: The cancer is diagnosed only by viewing cervical tissue or cells under a microscope. Imaging tests or evaluation of tissue samples can also be used to determine tumor size.
Stage IA1: There is a cancerous area of less than 3 millimeters (mm) in depth.
Stage IA2: There is a cancerous area 3 mm to less than 5 mm in depth.
Stage IB: In this stage, the tumor is larger but still only confined to the cervix. There is no distant spread.
Stage IB1: The tumor is 5 mm or more in depth and less than 2 centimeters (cm) wide. A centimeter is roughly equal to the width of a standard pen or pencil.
Stage IB2: The tumor is 2 cm or more in depth and less than 4 cm wide.
Stage IB3: The tumor is 4 cm or more in width.
Stage II: The cancer has spread beyond the uterus to nearby areas, such as the vagina or tissue near the cervix, but it is still inside the pelvic area. It has not spread to other parts of the body. This stage may be divided into smaller groups to describe the cancer in more detail (see below).
Stage IIA: The tumor is limited to the upper two-thirds of the vagina. It has not spread to the tissue next to the cervix, which is called the parametrial area.
Stage IIA1: The tumor is less than 4 cm wide.
Stage IIA2: The tumor is 4 cm or more in width.
Stage IIB: The tumor has spread to the parametrial area. The tumor does not reach the pelvic wall.
Stage III: The tumor involves the lower third of the vagina and/or: has spread to the pelvic wall; causes swelling of the kidney, called hydronephrosis; stops a kidney from functioning; and/or involves regional lymph nodes. Lymph nodes are small, bean-shaped organs that help fight infection. There is no distant spread.
Stage IIIA: The tumor involves the lower third of the vagina, but it has not grown into the pelvic wall.
Stage IIIB: The tumor has grown into the pelvic wall and/or affects a kidney.
Stage IIIC: The tumor involves regional lymph nodes. This can be detected using imaging tests or pathology. Adding a lowercase “r” indicates imaging tests were used to confirm lymph node involvement. A lowercase “p” indicates pathology results were used to determine the stage.
Stage IIIC1: The cancer has spread to lymph nodes in the pelvis.
Stage IIIC2: The cancer has spread to para-aortic lymph nodes. These lymph nodes are found in the abdomen near the base of the spine and near the aorta, a major artery that runs from the heart to the abdomen.
Stage IVA: The cancer has spread to the bladder or rectum, but it has not spread to other parts of the body.
Stage IVB: The cancer has spread to other parts of the body.
Recurrent: Recurrent cancer is cancer that has come back after treatment. Cervical cancer can come back either in the pelvis where it began or spread to other areas throughout the body, such as the lungs, lymph nodes, and bones. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence.
Source: Bhatla N, et al. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynecol Obstet 2019; 1–7.