Cervix Carcinoma

Cervical cancer is a disease that starts in the cells of the cervix, where the lower part of the uterus connects to the vagina. While it was once one of the leading causes of cancer death among women, screening tests and vaccines have made this cancer largely preventable and highly treatable when found early.

Table of contents

• What is cervical cancer?
• Types of cervical cancer
• Anatomy of the cervix
• What causes cervical cancer?
• Signs and symptoms
• Who is at risk?
• Prevention and screening
• Treatment options
• Living with cervical cancer

What is cervical cancer?

Cervical cancer is cancer that starts in the cells of the cervix. The cervix is the lower, narrow end of the uterus (womb). The cervix connects the uterus to the vagina (birth canal).^[1]

Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia (when abnormal cells begin to appear in the cervical tissue). Over time, if not destroyed or removed, the abnormal cells may become cancer cells and start to grow and spread more deeply into the cervix and to surrounding areas.^[2]

About 14,000 people in the United States receive a cervical cancer diagnosis each year. Women between the ages of 35 and 44 are most likely to receive a diagnosis.^[3] Globally, cervical cancer is the fourth most common cancer in women, with around 660,000 new cases and around 350,000 deaths in 2022.^[6]

Cervical cancer is a largely preventable disease. When cervical cancer is found early, it is highly treatable and associated with long survival and good quality of life.^[4]

Types of cervical cancer

Cervical cancers are named after the type of cell where the cancer started. The two main types are:^[2]

• Squamous cell carcinoma: Most cervical cancers (up to 90%) are squamous cell carcinomas. These cancers develop from cells in the ectocervix (the outer part of the cervix).
• Adenocarcinoma: Cervical adenocarcinomas develop in the glandular cells of the endocervix (the inner part of the cervix that forms a canal connecting the vagina to the uterus). Clear cell adenocarcinoma, also called clear cell carcinoma or mesonephroma, is a rare type of cervical adenocarcinoma.

Sometimes, cervical cancer has features of both squamous cell carcinoma and adenocarcinoma. This is called mixed carcinoma or adenosquamous carcinoma.^[2]

• Cervix
• Uterus
• Vagina

Anatomy of the cervix

The cervix has two main parts:^[2]

The ectocervix (also called exocervix) is the outer part of the cervix that can be seen during a gynecologic exam. The ectocervix is covered with thin, flat cells called squamous cells.

The endocervix is the inner part of the cervix that forms a canal that connects the vagina to the uterus. The endocervix is covered with column-shaped glandular cells that make mucus.

The squamocolumnar junction (also called the transformation zone) is the border where the endocervix and ectocervix meet. Most cervical cancers begin in this area.^[2]

What causes cervical cancer?

Most cervical cancers are caused by HPV (human papillomavirus), a sexually transmitted infection. HPV spreads through sexual contact (anal, oral or vaginal) and can lead to cancer.^[3]

Human papillomavirus (HPV) is a common sexually transmitted infection which can affect the skin, genital area and throat. Almost all sexually active people will be infected at some point in their lives, usually without symptoms. In most cases the immune system clears HPV from the body.^[6]

Persistent infection with high-risk HPV can cause abnormal cells to develop, which go on to become cancer. Most people will get HPV at some point in their lives and not realize it because their bodies fight off the infection. But if your body doesn’t fight off the infection, it can cause the cells of your cervix to change to cancerous cells.^[3]

There are more than 100 kinds of HPV, and about a dozen of them have been shown to lead to cancer. Early detection of these HPV strains is key in preventing cervical cancer.^[3]

Women living with HIV are 6 times more likely to develop cervical cancer compared to women without HIV.^[6]

Signs and symptoms

Early stages of cervical cancer don’t usually involve symptoms and are hard to detect. The first signs of cervical cancer may take time to develop.^[3] Many cervical cancer symptoms are also seen with other, less serious conditions.^[2]

Signs and symptoms of Stage I cervical cancer can include:^[3]

• Watery or bloody vaginal discharge that may be heavy and can have a foul odor
• Vaginal bleeding after sex, between menstrual periods or after menopause
• Pain during sex (dyspareunia)

If cancer has spread to nearby tissues or organs, symptoms may include:^[3]

• Difficult or painful urination, sometimes with blood in your urine
• Diarrhea, pain or bleeding from your rectum when pooping
• Fatigue, loss of weight and appetite
• A general feeling of illness
• Dull backache or swelling in your legs
• Pelvic or abdominal pain

If you experience abnormal bleeding, unusual vaginal discharge or any other unexplainable symptoms, you should contact a healthcare provider.^[3]

Who is at risk?

Any woman with a cervix is at risk for cervical cancer. It occurs most often in women over age 30.^[4]

Some risk factors within your control are:^[3]

• Screening history: People who haven’t had Pap tests at regular intervals are more likely to get cervical cancer (because Pap tests can detect precancerous cells).
• HPV infection: Certain types of HPV cause cervical cancer. Lowering your risk for HPV can also lower your risk for cervical cancer.
• Sexual history: Becoming sexually active at a young age, having many sexual partners and having a high-risk partner can increase the risk for cervical cancer. Chlamydia infection also increases an individual’s risk for cervical cancer.^[7]
• Smoking: Individuals who smoke are about twice as likely to get cervical cancer as those who don’t smoke.^[7]
• Immune system deficiency: A weakened immune system can increase the risk of developing cervical cancer. A weakened immune system can be a result of immune suppression from corticosteroids, organ transplant, other cancer treatments or from HIV.^[7]
• Family history: Cervical cancer can run in some families. If an immediate family member had cervical cancer, you have a higher risk of developing the disease than you would if no one in your family had it.^[7]

Prevention and screening

Screening tests and the HPV vaccine can help prevent cervical cancer.^[4] Primary prevention and screening are the most effective modalities for decreasing the healthcare burden and mortality attributable to cervical cancer.^[7]

HPV Vaccine

One of the easiest and most effective ways to prevent cervical cancer and a variety of additional cancers is by getting vaccinated against the human papillomavirus (HPV). The vaccine is recommended for girls and boys aged 11-12 years, but it can be given up to age 45.^[22] The HPV vaccine can help prevent HPV infection by protecting you against the HPV that causes up to 90% of all cervical cancers.^[3]

Screening Tests

Getting regular Pap tests and HPV tests is crucial for the early detection of cervical cancer. Pap tests can help detect abnormal cells in the cervix before they turn cancerous. HPV testing detects the virus that is associated with the development of almost all cervical cancers.^[22]

In the United States and other developed countries, most screening and diagnostic efforts are directed toward the early identification of high-risk human papillomavirus (HPV) lesions through HPV testing and Papanicolaou (Pap) smears. Although HPV testing is not recommended in women younger than 30 years, low-risk younger women should begin screening with Pap tests at age 21 and continue until age 65, per the United States Preventive Services Task Force (USPSTF) recommendations. Newer recommendations offer 3- to 5-year intervals between screenings based on a patient’s prior results and the use of Pap and HPV cotesting.^[7]

Other Prevention Steps

• Practice safe sex: Having a sexually transmitted disease (STD) can elevate the chances of developing cervical cancer. Adopting safer sex practices, such as consistent condom use and limiting sexual partners, can greatly decrease your risk of cervical cancer.^[22]
• Eat a balanced diet: Eating a healthy diet that includes plenty of fruits, vegetables, and whole grains provides essential vitamins, minerals, and antioxidants – all of which supports a strong immune system and can help reduce the risk of cervical cancer. A diet rich in fruits and vegetables can lower your risk of developing cervical cancer.^[22]
• Avoid smoking: Smoking weakens the immune system, making it easier for HPV to cause cancer. Women who smoke are about twice as likely to get cervical cancer as those who don’t smoke.^[22]
• Exercise regularly: According to research, individuals who did not get regular physical activity had an increased risk of cervical cancer. Just 30 minutes of aerobic exercise, such as walking, swimming or cycling, can significantly reduce a person’s risk.^[27]

Treatment options

Different types of treatment are available for cervical cancer. You and your cancer care team will work together to decide your treatment plan, which may include more than one type of treatment. Many factors will be considered, such as the stage of the cancer, your overall health, and your preferences.^[12]

Cervical cancer is treated in several ways. It depends on the kind of cervical cancer and how far it has spread. Treatment may include:^[14]

• Surgery: An operation in which doctors cut out the cancer. Surgery is often the main treatment for cervical cancer, especially if the cancer is found early.^[12]
• Chemotherapy: Use of special medicines to shrink or kill the cancer. The drugs can be pills you take or medicines given in your veins, or sometimes both.^[14]
• Radiation therapy: Use of high-energy rays (similar to x-rays) to kill the cancer. Radiotherapy for cervical cancer can be given from outside or inside the body (brachytherapy).^[16]
• Immunotherapy: Works with your body’s immune system to help it fight cancer cells or to control side effects from other cancer treatments.^[14]
• Targeted therapy: Use of drugs to block the growth and spread of cancer cells. The drugs can be pills you take or medicines given in your veins.^[14]

More than 90 percent of early-stage cancers are treated successfully with surgical procedures and do not require any further treatment.^[18]

If you are concerned about whether treatment will affect your fertility, talk with your cancer care team before treatment begins about what to expect. Depending on the stage of your cancer, it may be possible to preserve your fertility.^[12]

Living with cervical cancer

When you first learn that you have cervical cancer, it is normal to feel a mix of emotions. You may wonder how you will cope with the upcoming changes in your life. One step you can take is to be informed of the changes that may occur and what resources are available to help you cope.^[23]

Special Concerns

Because cervical cancer tends to occur in people of reproductive age, and because of where it forms in the body, certain aspects of your diagnosis and treatment are of special concern:^[23]

Fertility issues: For some people, infertility can be one of the most difficult and upsetting long-term effects of cervical cancer treatment. Although it might feel overwhelming to think about, you may benefit from talking with your doctor about how treatment may affect your fertility and about options to preserve fertility.^[23]

Sexual problems: Some treatments for cervical cancer can cause short-term or long-term problems with sex after treatment. Sexual problems are often caused by changes to your body. These changes result from chemotherapy, radiation therapy, surgery, or certain medicines.^[23]

Body changes: Cervical cancer and its treatment can change how you look and feel about yourself. Know you aren’t alone in how you feel. Coping with these changes can be hard. But, over time, most people learn to adjust to them and move forward.^[23]

Emotional Support

Talking to your friends and relatives about your cancer can help and support you. But some people are scared of the emotions this could bring up and won’t want to talk. It can strain relationships if your family or friends don’t want to talk. But talking can help increase trust and support between you and them.^[20]

You might find it easier to talk to someone other than your own friends and family. Specialist nurses can help if you’re finding it difficult to cope or if you have any problems. They can get you the help you need. They can also give you information and signpost you to support in your local area.^[20]

Because cervical cancer results from a sexually transmitted infection with human papillomavirus (HPV), you may worry that some people assume your behavior caused your cancer. Or you may blame yourself for lifestyle choices you think could have led to your cancer. It is important to remember almost everyone will have an HPV infection at some point in their lives and that most HPV infections of the cervix will not cause cervical cancer. Having cervical cancer is not your fault.^[23]

Practical Steps

You may be more able to cope and make decisions if you have information about your type of cancer and its treatment. Taking in information can be difficult, especially when you have just been diagnosed. Make a list of questions before you see your doctor. Take someone with you to remind you what you want to ask.^[20]

You can also do practical things such as making lists to help you, having a calendar with all appointments, having goals, and planning enjoyable things around weeks that might be emotionally difficult for you.^[20]

Now more than ever, self-care is imperative. Even though you’ve entrusted your health to medical professionals, you should also feel free to explore complementary health practices that may support your body and mind. Always check with your oncologist before embarking on alternative therapies because some may not be compatible with your treatments.^[25]