• Cervical cancer is primarily caused by persistent infection with high-risk types of Human Papillomavirus (HPV).
• Prevention is highly effective through HPV vaccination and regular cervical cancer screening (Pap tests and HPV tests).
• Early stages of cervical cancer often present with no symptoms, making routine screening essential for detection.
• Common symptoms, when they do appear, include abnormal vaginal bleeding, pelvic pain, and pain during intercourse.
• Treatment options vary based on the cancer stage and may include surgery, radiation, chemotherapy, targeted therapy, or immunotherapy.

What Is Cervical Cancer?

Cervical cancer is a malignant condition characterized by the uncontrolled growth of cells in the cervix. The cervix is a narrow, cylindrical passage forming the lower part of the uterus, connecting it to the vagina. This cancer typically develops slowly over many years, often starting as precancerous changes known as dysplasia, which can be detected and treated before they become cancerous.

Globally, cervical cancer remains a leading cause of cancer-related death among women, particularly in low- and middle-income countries where access to screening and vaccination is limited. According to the World Health Organization (WHO), it is the fourth most common cancer among women worldwide, with an estimated 604,000 new cases and 342,000 deaths in 2020. However, in regions with comprehensive screening programs, incidence and mortality rates have significantly declined, highlighting the impact of preventive measures.

Causes and Prevention of Cervical Cancer

The primary factor contributing to the development of cervical cancer is persistent infection with high-risk types of the Human Papillomavirus (HPV). HPV is a very common sexually transmitted infection, and while most HPV infections clear on their own, persistent infection with certain types, particularly HPV-16 and HPV-18, can lead to cellular changes in the cervix that may progress to cancer over time. It is important to note that not everyone infected with high-risk HPV will develop cervical cancer, as other co-factors play a role.

Beyond HPV, several other factors can increase an individual’s risk. These include a weakened immune system (e.g., due to HIV infection or immunosuppressant drugs), smoking, long-term use of oral contraceptives, multiple full-term pregnancies, and a family history of cervical cancer. These factors can either make an individual more susceptible to persistent HPV infection or accelerate the progression of precancerous lesions.

Effective strategies exist for how to prevent cervical cancer, focusing on both primary and secondary prevention:

• HPV Vaccination: This is the most effective primary prevention method. HPV vaccines protect against the high-risk types of HPV that cause the majority of cervical cancers. The Centers for Disease Control and Prevention (CDC) recommends routine HPV vaccination for adolescents aged 11-12 years, though it can be given starting at age 9 and up to age 26 for those not previously vaccinated.
• Regular Screening: Secondary prevention involves routine cervical cancer screening through Pap tests (Papanicolaou tests) and HPV tests. Pap tests detect abnormal cervical cells, while HPV tests identify the presence of high-risk HPV. Regular screening allows for the detection and treatment of precancerous lesions before they can develop into invasive cancer.
• Safe Sexual Practices: Using condoms consistently and correctly can reduce the risk of HPV transmission, although condoms do not offer complete protection as HPV can infect areas not covered by a condom. Limiting the number of sexual partners can also reduce exposure risk.
• Avoiding Smoking: Smoking has been identified as a significant co-factor that increases the risk of cervical cancer in women with HPV infection. Quitting smoking can reduce this risk.

Cervical Cancer Symptoms and Diagnosis

One of the challenging aspects of cervical cancer is that in its earliest stages, it often presents with no discernible symptoms. This asymptomatic nature underscores the critical importance of regular screening tests, such as Pap tests and HPV tests, which can detect precancerous changes or early-stage cancer before symptoms appear. When cervical cancer early signs do manifest, they can be subtle and easily mistaken for other common conditions, making prompt medical evaluation essential.

Recognizing Cervical Cancer Symptoms

As cervical cancer progresses, more noticeable cervical cancer symptoms typically emerge. These symptoms are often related to abnormal bleeding or discomfort in the pelvic area. It is vital to consult a healthcare provider if any of these symptoms are experienced, as early detection significantly improves treatment outcomes. Common symptoms include:

• Abnormal Vaginal Bleeding: This is the most common symptom and can manifest as bleeding between periods, after sexual intercourse, after douching, or after menopause.
• Unusual Vaginal Discharge: Discharge that may be watery, bloody, or have a foul odor.
• Pelvic Pain or Pain During Intercourse: Persistent pain in the pelvic region or discomfort during sexual activity.
• Pain During Urination: In more advanced stages, the cancer may affect the bladder, leading to painful urination.
• Swelling in the Legs: Advanced cancer can sometimes block blood vessels or lymph nodes, causing leg swelling.

Cervical Cancer Diagnosis Procedures

The process of cervical cancer diagnosis typically begins with screening tests and progresses to more definitive procedures if abnormalities are found. The diagnostic pathway is designed to confirm the presence of cancer, determine its type, and assess its stage.

The initial steps involve:

1. Pap Test (Papanicolaou Test): A procedure to collect cells from the cervix to look for abnormal changes that could indicate precancerous conditions or cancer.
2. HPV Test: A test that detects the presence of high-risk types of HPV in cervical cells, which are known to cause most cervical cancers.

If screening tests reveal abnormalities, further diagnostic procedures are performed:

Accurate diagnosis and staging are crucial for developing an effective treatment plan tailored to the individual’s specific condition.

Cervical Cancer Treatment Options

The selection of cervical cancer treatment options is highly individualized, depending on several factors including the stage of the cancer, the size and type of the tumor, the patient’s age and overall health, and their desire to preserve fertility. A multidisciplinary team of specialists, including gynecologic oncologists, radiation oncologists, and medical oncologists, typically collaborates to develop the most appropriate treatment plan.

For very early-stage cervical cancer, particularly precancerous lesions or microinvasive cancer, treatment may involve procedures that remove only the abnormal tissue while preserving the cervix. These include Loop Electrosurgical Excision Procedure (LEEP) or cold knife cone biopsy, which remove a cone-shaped piece of tissue from the cervix. These methods can often be curative and may allow for future pregnancies.

As the cancer progresses to more advanced stages, a combination of therapies is often employed. The main treatment modalities include:

• Surgery: This can range from a simple hysterectomy (removal of the uterus and cervix) to a radical hysterectomy (removal of the uterus, cervix, part of the vagina, and surrounding lymph nodes). In some cases, pelvic exenteration may be performed for recurrent or very advanced cancer, involving removal of the bladder, rectum, or both.
• Radiation Therapy: This uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. It can be delivered externally (external beam radiation) or internally (brachytherapy), where radioactive material is placed directly into or near the tumor. Radiation is often used in combination with chemotherapy.
• Chemotherapy: These are drugs that kill cancer cells, usually given intravenously. Chemotherapy can be used to shrink tumors before surgery or radiation, to kill any remaining cancer cells after other treatments, or to treat cancer that has spread to other parts of the body.
• Targeted Therapy: These drugs specifically target certain molecules involved in cancer growth and progression, often with fewer side effects than traditional chemotherapy. For cervical cancer, targeted therapies might focus on blocking the growth of new blood vessels that feed the tumor.
• Immunotherapy: This treatment harnesses the body’s own immune system to fight cancer. Immunotherapy drugs can help the immune system recognize and attack cancer cells. It is typically used for advanced or recurrent cervical cancer that has not responded to other treatments.

Patients undergoing treatment for cervical cancer will receive ongoing care and monitoring to manage side effects, assess treatment effectiveness, and detect any recurrence. Support services, including pain management, nutritional counseling, and psychological support, are also integral to comprehensive care.