Understanding cervical cancer
Out of the 5 types of gynecologic cancers, cervical cancer is the only one with a screening test that detects abnormal cells and a vaccine that helps prevent you from ever getting it.1 There are also simple lifestyle habits you can do to help prevent cervical cancer. There's a lot to cover here, but let's start with a break down on what cervical cancer is.
Cervical cancer is cancer that starts in the cells of the cervix (the lower part of a woman's uterus where a baby grows). The cervix is made up of two parts and each part is covered with different types of cells. The spot where these two parts of the cervix come together is called the transformation zone. It’s the place where cells are constantly changing, so it’s no surprise that most cervical cancers start there. When cells change abnormally, they’re called precancerous cells. They either go away with treatment or turn into cancer.2
What are the types of cervical cancer?
There are a number of different kinds of cancer that may show up in the cervix. Almost all cervical cancers are either carcinomas or adenocarcinomas. Here’s what those are:3
- Squamous cell carcinoma: This starts in the outer part of the cervix where squamous cells call home. (They’re the cells that live on the outer part of your skin.) 90% of cases are squamous cell carcinomas.
- Adenocarcinoma: This starts in the glandular cells that live in the opening of the cervix. (These cells make mucus and help your menstrual flow.)
Rarely, both of these cancers happen at the same time. But, if they do it’s called an adenosquamous carcinoma, or mixed carcinoma.
Early diagnosis may be crucial for a successful treatment. There are two important screening tests that help spot early signs of cervical cancer (like those precancerous cells we mentioned above). You’re likely familiar with them.4,5
- Pap smear: Like a cotton swab, but for your cervix. Your doctor uses a little brush or cotton swab to gather a sample of cells and mucus from your cervix to be tested for precancerous cells. Keep in mind, this test is different from a pelvic exam, which is used to screen for signs of other reproductive problems, like ovarian cancer. Once you turn 21 (or when your doctor tells you it’s time) you might want to consider getting regular Pap smears. And, if your results are normal, you might be able to wait three years before your next one.6
- Human papilloma virus (HPV) test: This one is important to know about. Most cervical cancers are caused by HPV, which is a sexually transmitted disease. However, the actual test is no different from a Pap smear. Your doctor swabs the cervix to collect cells to be tested for the types of HPV most likely to cause cancer. Did you know having HPV is the strongest risk factor for getting cervical cancer? That's a very good reason you’ll want to make sure you’re regularly tested — typically between the ages of 30 and 65. If your results are normal, you may be able to wait 5 years before your next test.5
Depending on your personal health and risk factors, your doctor may only recommend having one of these tests, or both (known as a co-test). Both tests are an effective way to detect early signs of cervical cancer, so be sure to stay on top of your preventive screenings — no matter which one you get.
If your doctor catches something suspicious, you’ll likely have a diagnostic test done for a more conclusive diagnosis. That could be a colposcopy or biopsy.6
Early cervical cancers and precancers typically don’t cause any symptoms (which is why those screenings are so important). You may not notice symptoms until the cancer grows into nearby tissue. When this happens, you might notice things like:7,8
- Abnormal vaginal bleeding (like bleeding after sex, heavier than normal periods or bleeding after menopause)
- Heavy vaginal discharge that may be watery and bloody, and have a foul odor
- Pain during sex
- Pelvic pain
If the cancer is more advanced, you may have swollen legs, problems going to the bathroom or bloody urine. Some of these symptoms may be uncomfortable to bring up to your doctor, but it’s important to see your provider right away if you notice any of these signs. Remember, they’ve probably seen and heard it all. It's ok to be open about explaining what’s going on with your body.
Even though there are known risk factors for cervical cancer, women who have them may still have a low chance of ever developing it. And, women without any risk factors at all rarely get cervical cancer. So, that’s positive. That said, here’s a list of risk factors:9
- HPV infection: Did you know there are more than 150 related HPV viruses? More than one might think. Some low-risk types of HPV may simply cause warts (papillomas), while other high-risk types may cause cancers. The HPV test is a good way to check for infection and catch it early.
- Sexual history: It's not always easy to talk about, but your sex life does play a role in your risk for cervical cancer. Things like: becoming sexually active younger than 18, having many partners (or a partner who has many sexual partners themselves, or HPV). Being open with your doctor about this topic may help them better understand how best to take care of your health.
- Smoking: Tobacco use doubles your chance of getting cervical cancer. Plus, smoking limits your immune system’s ability to fight HPV infections.
- Weakened immune system: Speaking of, your immune system is important for killing cancer cells. So, if yours is weakened, your chances of a precancer developing into cancer may be higher.
- Family history: If your mom or sister was diagnosed, your chances go up.
The best way to prevent cervical cancer is to get your regular Pap smear and/or HPV test. Other things you can do is practice safe sex and limit the number of sexual partners you have. And also, be sure to stay away from tobacco or try to quit.
Because most cervical cancers are linked to HPV, getting the HPV vaccine may help to prevent it. Talk to your doctor about whether this vaccine is right for you.10
The best treatment may depend on how advanced your cancer is. It’ll also depend on plans you may have for having a baby. After talking with your doctor and care team, you’ll decide on the plan that’s best for you. Here’s how each type of treatment works:11, 12
- Surgery: This is often how early cervical cancer is treated. Small cancers may be removed while leaving the cervix intact, while others may be treated with surgery to remove the cervix, and possibly the uterus.
- Radiation: This kills cancer cells and is often used with low doses of chemotherapy to treat cervical cancer that has locally spread. Radiation may also be used after surgery if there’s a good chance the cancer will come back.
- Chemotherapy: Chemotherapy medicines also kill cancer cells. Like radiation, chemotherapy is used to fight cervical cancer that has spread to nearby tissue. For advanced cancers, chemotherapy is often used by itself.
- Targeted therapy: This approach targets a cancer’s weaknesses and blocks them so medicine can head in there to kill it.
- Immunotherapy: This approach works a little like a vaccine — but for cervical cancer. It may help your body recognize and fight off cancer cells.
Surgery is the most common treatment for early cervical cancers. But, it’s a big decision. Be sure to do your research, ask your provider questions and think about your plans for having kids if that is part of your future plans.
Who should I see if I'm concerned about cervical cancer?
If you think you have some of the symptoms listed above, visit your primary provider (the doctor or provider you might see for your yearly physical, and regular Pap smear and HPV test). Bring a list of your symptoms, medicines you’re taking, and jot down anything else your doctor might ask about. (Maybe also include some notes about your sexual history — it’ll likely come up.) Depending on how the conversation goes, your doctor may order some tests to find out whether or not your symptoms are being caused by cervical cancer. Plus, they may recommend you schedule an appointment with your gynecologist.13