Cervical Cancer: Symptoms, Diagnosis, Treatment & Prevention

By BSc, MSC, PhD (gynecologist), (embryologist) and (invitra staff).
Last Update: 01/14/2021

Cancer of the cervix is one of the most common cancers in women, although breast cancer is the most common. Thanks to advances in medicine, the survival and cure of women diagnosed with these types of cancer is quite high today.

However, cancer treatments to cure cancer can cause infertility in women. It is therefore advisable to inform the patient of the possibility of preserving her fertility if she wishes to become a mother in the future.

Moreover, cervical cancer is not transmitted from generation to generation, i.e. it is not hereditary. In contrast, family history is a risk factor for this type of cancer, as is long-term use of birth control pills.

What is cervical cancer?

Cervical cancer is a type of cancer characterized by the growth of malignant cells in the lower part of the uterus that connects with the vagina.

The cervix is made up of two parts called the endocervix and the exocervix. In each of them, we find a specific cell type: glandular and squamous cells respectively.

When these two types of cells appear it is known as transformation zoneand its location changes as the woman's age increases and if she goes into labor.

These cells in the transformation zone do not suddenly become malignant, but are gradually changed. These precancerous changes may or may not lead to cervical cancer. Therefore, routine gynecological check-ups are essential.

Types

The most widely used classification for cervical cancer is based on observing the appearance of the cells that cause it. Thus, there are two types of cervical cancers:

Squamous cell carcinoma
is the most common type of cervical cancer. This type of uterine cancer is caused by changes in the squamous cells of the exocervix.
Adenocarcinoma
occurs due to alterations in the glandular cells of the endocervix.

Occasionally, some women develop adenosquamous carcinomas, also known as mixed carcinomas. These cases are the least common, but it can happen that a woman has cancer with the characteristics of both models.

Symptoms

Cervical cancer usually does not cause prominent symptoms in its early stages of development. However, as their development progresses, women can manifest themselves:

  • Vaginal bleeding after sex, intermenstrual or in the menopausal phase.
  • Watery, bloody vaginal discharge.
  • Pelvic pain.
  • Painful sex.
  • Increased vaginal discharge.

In women with advanced cervical cancer, leg swelling, problems with urination, or bleeding in the urine may occur.

However, all these symptoms and clinical manifestations are not exclusive to cervical cancer, but may also be indicative of other pathologies. In the presence of any symptoms, it is best to consult a gynecologist.

Risk Factors

As in any other pathology or cancer, there are some factors that cause an increase in the probability of a woman suffering from cervical cancer. For example, infection with human papillomavirus (HPV) is the most important risk factor for this disease, but not the only one.

Other risk factors for cervical cancer include the following:

  • Have plenty of sexual activity.
  • Multiple sexual partners.
  • Smoking.
  • Weak immune system.
  • Chlamydia infection.
  • Family history.

In addition, there is scientific evidence of an increased likelihood of cervical cancer risk when using birth control pills for long periods of time. However, this risk is reduced when a woman stops taking these oral contraceptives.

Diagnosis of cervical cancer

The best way to diagnose cervical cancer is through screening tests. Routine gynaecological examinations are therefore necessary, as the HPV test and the Pap test allow early detection of this type of cancer and therefore greater success in the corresponding treatment.

The Pap test consists of taking a small sample of cells from the area with a light scraping with a cotton swab. The cells will then be tested for abnormal cells or cells that may become cancerous.

Other tests that can help diagnose cervical cancer include the following:

Colposcopy
a test to examine the cervix, vagina, and vulva through a colposcope. This test is recommended when the Pap test provides a positive result.
Curette
consists of scraping the area of the endocervix to get tissue to be analyzed in the laboratory.
Study by image
either through an x-ray, a CT scan, or a magnetic resonance imaging (MRI) scan.

If the results of any of these tests indicate the existence of cervical cancer, the doctor may request additional tests to examine the extent of the tumor mass. For example, a cystoscopy or proctoscopy will allow the bladder and rectum to be evaluated.

Degrees of cervical cancer

Once the physician has diagnosed the presence of a mass of tumor on the woman's cervix, he or she will establish the severity of the disease. To do this, the specialist will establish the stage in which the cancer is found and be able to decide how to treat it.

This is done by examining the size of the tumor mass, whether it has reached nearby structures and spread to the lymph nodes.

According to the FIGO ( International Federation of Gynecology and Obstetrics) staging system, cervical cancer is classified as:

  • Clinical stage: based on the diagnostic tests and physical examination of the patient.
  • Pathological stage: depending on what is observed after surgery.

These stages will be listed in Roman terminology from I to IV, with stage IV being the most advanced cervical cancer. In addition, each of these numbers will be assigned a letter depending on the size of cancer and its spread. Thus, type A cancers are less advanced and widespread than type C cancers.

Treatment

One of the aspects to evaluate before establishing a treatment for cervical cancer is the woman's reproductive desire, as long as the severity of the disease allows it.

One option to cure cervical cancer would be conization. This therapeutic option consists of removing some of the abnormal tissue from the uterus and is advised when the tumor mass is located in one spot.

However, if cancer begins to invade other structures, more aggressive treatment will be necessary. This is the case with total hysterectomy, which means that the entire uterus is removed from the woman, and it may even be necessary to remove part of the vagina and pelvic nodes. However, this option is the least common, provided that early detection of the disease is made.

Radiation therapy and chemotherapy can also cure early-stage cervical cancer, although it is essential to know the possible side effects they may have on a woman's fertility.

In any case, every woman is different and not all circumstances are the same. Therefore, it is vitally important to establish an individualized treatment plan and, in some cases, it involves the integration of surgery, chemotherapy, and radiation therapy.

Cervical Cancer and Pregnancy

One of the concerns of most women is not to be able to have children. When a woman is diagnosed with cervical cancer or any other type of cancer, it can pose a risk to her fertility. In particular, a large proportion of cervical cancer diagnoses are made in women of reproductive age.

Oncology treatments affect the reproductive capacity of cancer patients. Thanks to advances in medicine, achieving pregnancy after cancer treatment is possible.

One option is to preserve fertility before undergoing chemotherapy or radiotherapy treatment, as long as the severity of the condition allows. Therefore, one of the obligations of the specialists would be to inform patients of this option.

Another alternative would be ovarian transposition, i.e. moving the ovaries to another location outside the radiation field. However, this option is still being experimented with, as is the case with the freezing of ovarian tissue.

Prevention and HPV vaccine

The HPV vaccine prevents about 75% of cervical cancer cases. However, this vaccine does not protect against all virus strains, i.e. it does not strictly prevent contagion. Therefore, continuing with annual medical check-ups is essential, as well as undergoing routine Pap smears and tests.

In addition, not smoking and keeping relationships safe by using condoms can help reduce the risk of cervical cancer.

FAQs from users

Does cervical cancer always result from HPV infection?

By Dr. Marita Espejo Catena BSc, MSC, PhD (gynecologist).

Cervical cancer remains one of the most common cancers in women worldwide, with the majority of deaths (up to 90%) occurring in countries with low socioeconomic status.

The cervix is the lowest part of the uterus and is composed of different types of cells: those that line the endocervical canal and those that line the cervix in the intravaginal area. It is at the border of these two epithelia, the so-called transformation zone, where almost all cervical carcinomas originate. However, the cervix can be invaded by other cancerous lesions due to the invasion of tumors that originate in nearby locations such as the mucous membrane that lines the uterus, vagina or rectum, for example.

However, primary cervical cancer, i.e., cancer originating in the cervix, is a type of cancer that is associated with long-term persistence of infection with one of the 15 high-risk types of human papillomavirus (HPV).

Human papillomavirus is easily transmitted and it is estimated that up to 80% of women can become infected with one of the high-risk types of HPV. However, it is also known that not all women who acquire such an infection will develop uterine cancer since only in one case in 10 the infection becomes permanent and will eventually lead to the development of pre-cancerous lesions, which, if detected early, can be treated and prevent the progression of the disease to cervical cancer.

Can cervical cancer be prevented?

By Marta Barranquero Gómez (embryologist).

Yes, HPV vaccination and routine gynecological screening are essential to prevent cervical cancer. Cervical cancer usually begins with pre-cancerous lesions, so early detection prevents the development of a more advanced stage of the disease.

Can cervical cancer be cured?

By Marta Barranquero Gómez (embryologist).

Yes, thanks to advances in medicine and therapeutic options, cervical cancer is curable. In the mildest cases and where the tumor mass is localized, it is possible to perform the removal without damaging the uterus. This is known as conization.

If the cancer becomes invasive, another therapeutic option would be the complete removal of the uterus. In addition, oncological treatments of chemotherapy and radiotherapy also help to treat this disease.

What is recurrent cervical cancer?

By Marta Barranquero Gómez (embryologist).

Recurrent cervical cancer is when it recurs in a woman after she has undergone treatment. The tumor mass can appear in the cervix, although it is also possible to appear in other locations.

Generally, cancer recurrence occurs within 3 years of diagnosis, although this is not an exact science. For this reason, periodic revisions to avoid any relapse of the disease.

What does cervical cancer IIIB mean?

By Marta Barranquero Gómez (embryologist).

A cervical cancer classified as IIIB corresponds to an invasive cancer that has reached the walls of the pelvis and/or is preventing the function of one or both ureters. However, the cancer has not spread to lymph nodes or other distant locations.

Suggested for you

The drawback of cancer treatments is that they can cause infertility in both men and women. If you want more in-depth information on this topic, you can visit the following article: How does cancer affect fertility in men and women?

In addition, one of the options for curing cervical cancer is conization. For more detailed information about this surgery, we recommend you visit the following article: Conization of the cervix: complications and advice.

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

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Olusola P, Banerjee H, V Philley J, Dasgupta S. Human Papilloma Virus-Associated Cervical Cancer and Health Disparities. Cells. 2019 Jun 21;8(6):622. doi: 10.3390/cells8060622.

Tsikouras P, Zervoudis S, Manav B, Tomara E, Iatrakis G, Romanidis C, Bothou A, Galazios G. Cervical cancer: screening, diagnosis and staging. J BUON. Mar-Apr 2016;21(2):320-5.

Wardak S. Human Papillomavirus (HPV) and cervical cancer. Med Dosw Mikrobiol. 2016;68(1):73-84.

Zhang S, McNamara M, Batur P. Cervical Cancer Screening: What's New? Updates for the Busy Clinician. Am J Med. 2018 Jun;131(6):702.e1-702.e5. doi: 10.1016/j.amjmed.2018.01.020. Epub 2018 Feb 3.

FAQs from users: 'Does cervical cancer always result from HPV infection?', 'Can cervical cancer be prevented?', 'Can cervical cancer be cured?', 'What is recurrent cervical cancer?' and 'What does cervical cancer IIIB mean?'.

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Authors and contributors

Dr. Marita Espejo Catena
Dr. Marita Espejo Catena
BSc, MSC, PhD
Gynecologist
Graduated in Medicine and Surgery from the University of Valencia in 1992. Specialist in Gynaecology and Obstetrics. Doctor in Medicine from the University of Valencia in 2000. Master in Assisted Human Reproduction by the Rey Juan Carlos University and IVI in 2008. Currently, she is the director of Instituto FIVIR. More information about Dr. Marita Espejo Catena
License: 464616497
 Marta Barranquero Gómez
Marta Barranquero Gómez
Embryologist
Graduated in Biochemistry and Biomedical Sciences by the University of Valencia (UV) and specialized in Assisted Reproduction by the University of Alcalá de Henares (UAH) in collaboration with Ginefiv and in Clinical Genetics by the University of Alcalá de Henares (UAH). More information about Marta Barranquero Gómez
License: 3316-CV
Adapted into english by:
 Romina Packan
Romina Packan
inviTRA Staff
Editor and translator for the English and German edition of inviTRA. More information about Romina Packan

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