Squamous Cell Carcinoma of the Cervix

Squamous cell carcinoma of the cervix is the most common type of cervical cancer, accounting for up to 90% of all cases. This cancer develops when cells on the cervix’s surface become abnormal, usually due to infection with the human papillomavirus (HPV). While cervical cancer remains a significant health concern worldwide, it is largely preventable through regular screening and the HPV vaccine.

Table of contents

• What is squamous cell carcinoma of the cervix?
• Understanding the cervix and where cancer develops
• What causes this cancer?
• Who is at risk?
• Signs and symptoms
• How to prevent cervical cancer
• Testing and diagnosis
• Treatment options
• What to expect
• Living after treatment

What is squamous cell carcinoma of the cervix?

Squamous cell carcinoma of the cervix is a type of cancer that starts in the flat, skin-like cells covering the cervix’s outer surface. The cervix is the lower part of the uterus that connects to the vagina. This cancer type makes up between 80% and 90% of all cervical cancers^[1][4].

Cervical cancer is the fourth leading cause of cancer in women worldwide, following breast, lung, and colorectal cancer^[1]. About 14,000 people in the United States receive a cervical cancer diagnosis each year, with women between the ages of 35 and 44 being most likely to be diagnosed^[3].

The good news is that cervical cancer is largely preventable. Thanks to widespread screening programs using Pap smears (tests that check for abnormal cells on the cervix), doctors can now detect changes in cervical cells before they turn into cancer^[1]. These early changes can be removed, preventing cancer from developing. However, in low and middle-income countries where screening programs are less available, cervical cancer remains a common problem^[1].

Understanding the cervix and where cancer develops

• Cervix
• Uterus
• Vagina

The cervix is a cylindrical structure measuring about 2.5 cm in length. It forms the lower, narrow end of the uterus (womb)^[1]. Inside the cervix is a passage called the cervical canal, which connects the uterus above to the vagina below.

The cervix has two main parts. The outer part that can be seen during a gynecologic exam is called the ectocervix. It is covered with thin, flat cells called squamous cells^[4]. The inner part that forms the canal is called the endocervix. This part is lined with column-shaped glandular cells that produce mucus^[4].

The area where these two types of cells meet is called the squamocolumnar junction or transformation zone^[1][4]. This is the most important area because most cervical cancers begin here. Squamous cell carcinoma develops specifically in the squamous cells of the ectocervix.

What causes this cancer?

Almost all cases of cervical cancer are caused by infection with human papillomavirus (HPV), a virus that spreads through sexual contact^[2][3]. HPV is very common—over 85% of the general population has been exposed to it at some point^[2].

There are more than 100 types of HPV, and about a dozen of them can lead to cancer. The most dangerous types are HPV-16 and HPV-18, which are responsible for most cervical cancer cases^[1][3]. HPV spreads through skin-to-skin contact during sexual activity, including vaginal, anal, and oral sex^[3].

Most people who get HPV never realize they have it because their bodies fight off the infection naturally. However, when the body cannot clear the infection, HPV can cause changes in cervical cells. Over time, these changes can develop into cervical intraepithelial neoplasia (CIN), which are abnormal but not yet cancerous cells^[7]. If left untreated, CIN can eventually progress to invasive cancer, though this process usually takes several years^[1].

Who is at risk?

While HPV infection is the primary cause, several factors can increase your risk of developing cervical cancer. Some risk factors you cannot control include your age and whether your mother took a medication called diethylstilbestrol (DES) during pregnancy with you^[3].

Risk factors within your control include:

• Lack of regular screening: Women who do not have Pap tests at regular intervals are more likely to develop cervical cancer because precancerous changes go undetected^[3].
• Sexual history: Having multiple sexual partners or having sex at a young age increases exposure to HPV^[2][3].
• Smoking: Tobacco use combined with HPV infection increases cancer risk^[3].
• Weakened immune system: Conditions or medications that suppress the immune system, including HIV infection, make it harder for the body to fight off HPV^[3].
• Long-term birth control pill use: Taking oral contraceptives for many years may slightly increase risk in women with HPV^[3].
• Multiple pregnancies: Having three or more full-term pregnancies, especially when the first pregnancy occurs before age 20, increases risk^[3].

Signs and symptoms

Early-stage cervical cancer often causes no symptoms at all, which is why regular screening is so important^[3][10]. When cancer is very small or limited to the surface, you may not notice anything unusual.

As the cancer grows, the first signs may include:

• Abnormal vaginal bleeding, such as bleeding after sex, between menstrual periods, or after menopause^[3]
• Watery or bloody vaginal discharge that may be heavy or have a foul odor^[3]
• Pain during sex^[3]

If the cancer has spread to nearby tissues or organs, you might experience:

• Difficult or painful urination, sometimes with blood in the urine
• Diarrhea, pain, or bleeding from the rectum during bowel movements
• Fatigue, weight loss, and loss of appetite
• A general feeling of being unwell
• Dull backache or swelling in the legs
• Pelvic or abdominal pain^[3]

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

How to prevent cervical cancer

Cervical cancer is one of the most preventable cancers. The two most important steps you can take are getting the HPV vaccine and having regular screening tests^[2][3].

HPV vaccination is highly effective at preventing infection with the HPV types that cause up to 90% of cervical cancers^[3]. The vaccine works best when given before a person becomes sexually active, but it can still provide benefits to those already exposed to some HPV types.

Regular screening with Pap tests can detect abnormal cells before they become cancer. During a Pap test, your healthcare provider collects cells from your cervix to examine under a microscope. HPV tests can also be done to check for the presence of high-risk HPV types^[3]. These screenings allow doctors to find and remove precancerous changes early.

Other prevention steps include:

• Not smoking
• Using condoms during sex, from start to finish
• Limiting your number of sexual partners
• Avoiding sexual contact with people who have HPV or genital warts^[3]

Testing and diagnosis

Diagnosing cervical cancer typically involves several steps. The process usually begins with a Pap test during a routine gynecologic exam. If the Pap test shows abnormal cells, your doctor may recommend additional tests^[3].

A colposcopy is a procedure where the doctor uses a special magnifying instrument to examine your cervix more closely. During this exam, the doctor may take a small sample of tissue, called a biopsy, to examine under a microscope^[3].

If cancer is confirmed, additional tests help determine how far it has spread. These may include:

• Blood and urine tests
• Imaging tests such as X-rays, CT scans, MRI scans, or PET scans
• Examination of the bladder or rectum with special instruments^[3]

These tests help doctors determine the cancer’s stage, which describes the size of the tumor and whether it has spread. Staging is crucial for planning the most appropriate treatment.

Treatment options

Treatment for squamous cell carcinoma of the cervix depends on several factors, including the stage of cancer, how large the tumor is, whether it has spread, and your general health^[1]. The main treatment options include surgery, radiation therapy, chemotherapy, and targeted medicines.

Surgery is often the main treatment for early-stage cervical cancer^[15]. The type of surgery depends on how far the cancer has spread. For very small cancers, doctors may remove only part of the cervix. For larger cancers, they may need to remove the cervix and sometimes the upper part of the vagina, the uterus, ovaries, and fallopian tubes^[15].

Radiation therapy uses high-energy rays to kill cancer cells. It can be given from outside the body (external beam radiation) or from inside the body (brachytherapy). Radiation is often used as the main treatment for larger cancers or after surgery to help prevent the cancer from coming back^[15]. Studies have shown that radiation therapy alone can achieve good results, with 5-year survival rates of over 90% for early-stage disease^[14].

Chemotherapy uses medicines to kill cancer cells throughout the body. It is often given together with radiation therapy (called chemoradiotherapy) as the main treatment, or after surgery to help prevent cancer from returning^[15]. For advanced cancers, chemotherapy may be used to help shrink tumors and control symptoms.

Targeted medicines and immunotherapy are newer treatments that work differently from chemotherapy. Targeted medicines attack specific features of cancer cells, while immunotherapy helps your immune system fight cancer. These treatments may be options if you have advanced cervical cancer or if the cancer has come back^[15].

What to expect

The outlook for squamous cell carcinoma of the cervix depends largely on the stage at diagnosis. When detected early, cervical cancer is highly treatable and often curable^[3].

For early-stage cervical cancer, survival rates are very good. Studies show 5-year survival rates of over 93% for stage Ib disease, 77% for stage II, and 60% for stage III/IVa when treated with radiation therapy^[14]. The most important factor affecting survival is the stage of the cancer—smaller cancers that have not spread have the best outcomes^[13].

Most women diagnosed with early-stage cervical cancer are cured, though they may experience side effects from treatment. Common side effects can include infertility (inability to have children), early menopause, and changes in sexual function^[7].

For women with advanced cancer or cancer that comes back after treatment, the outlook is more challenging. These cases typically have a life expectancy of fewer than 2 years^[7]. However, treatments can help control the cancer and improve quality of life.

Living after treatment

After treatment for cervical cancer, you will need regular follow-up visits with your healthcare provider. These check-ups help detect any signs that the cancer has come back and manage any long-term side effects of treatment^[17].

Treatment can affect your sex life and fertility. If you have not yet gone through menopause, certain treatments may cause early menopause. This happens if you have radiation therapy to the pelvic area or surgery to remove your ovaries^[24]. Symptoms of early menopause can include hot flushes, night sweats, mood swings, vaginal dryness, and loss of interest in sex.

Radiation therapy can cause additional changes, including shortening and narrowing of the vagina, vaginal dryness, and pain during sex^[24]. Your healthcare team can suggest treatments and strategies to help manage these side effects, including hormone replacement therapy (HRT) if appropriate, vaginal moisturizers, and other supportive measures.

It is safe to resume sexual activity a few weeks after finishing treatment. Having sex will not make your cancer worse or more likely to come back. Cancer of the cervix is not contagious—your partner cannot catch it from you^[24].

Many people experience emotional challenges after cancer treatment, including anxiety about the cancer returning. Support groups, counseling, and talking openly with your partner and healthcare team can help you adjust to life after treatment and address concerns about your physical and emotional well-being^[17].