Cervical Cancer: Causes, Symptoms, and Prevention
Also known as: Cancer of the cervix, Cervix cancer
Overview
Cervical cancer is a malignant tumor that develops from cells in the cervix, the area connecting the uterus and vagina. In the United States, the American Cancer Society estimates about 13,490 new cases of invasive cervical cancer are diagnosed each year, causing roughly 4,200 deaths. Thanks to organized screening and vaccination, this cancer is now largely preventable and, when caught early, treatable with excellent cure rates.
Causes and risk factors
The main cause is a persistent infection with human papillomavirus (HPV), a sexually transmitted virus. Certain strains, notably HPV 16 and 18, are considered high-risk for cancer. The main risk factors are:
- Unprotected sex and multiple partners
- Early onset of sexual activity
- Smoking, which damages cervical cell DNA and weakens the immune response to HPV
- A weakened immune system (HIV, immunosuppressive treatments)
- Not keeping up with regular cervical cancer screening
Symptoms
Cervical cancer is often symptom-free in its early stages, which is why screening matters so much. When symptoms do appear, they include:
- Abnormal vaginal bleeding: between periods, after sex, or after menopause
- Unusual vaginal discharge, sometimes foul-smelling or blood-tinged
- Persistent pelvic or lower back pain
- Pain during sex (dyspareunia)
- In advanced stages: urinary or digestive issues from nearby organ compression
Diagnosis
Screening relies on cervical cytology (the Pap test) and testing for high-risk HPV. The U.S. Preventive Services Task Force recommends cytology alone every 3 years for women ages 21 to 29. For ages 30 to 65, it recommends high-risk HPV testing every 5 years as the primary approach, using either a sample collected by a doctor or one you collect yourself, with cytology alone every 3 years or HPV testing combined with cytology (cotesting) every 5 years as acceptable alternatives. Screening is not recommended before age 21, or after age 65 for women who have had adequate prior screening and have no high-risk factors.
If results are abnormal, a colposcopy is performed, with targeted biopsies to confirm the diagnosis. Additional imaging (pelvic MRI, CT scan, PET scan) may follow to determine the cancer’s stage and guide treatment.
Treatments
Treatment depends on the stage of disease and is decided by a multidisciplinary care team:
- Surgery: a cone biopsy (conization) for early stages, or a radical hysterectomy with lymph node removal for localized tumors
- External radiation and brachytherapy: alone or combined with chemotherapy for locally advanced stages
- Concurrent chemoradiation: chemotherapy given at the same time as radiation for cancer that has not spread to other parts of the body, typically with cisplatin
- Immunotherapy (pembrolizumab, used for certain patients whose cancer carries the PD-L1 biomarker) and targeted therapy (bevacizumab): for metastatic or recurrent disease
- Supportive and psychological care throughout treatment
Prevention
Prevention relies on two complementary pillars:
- HPV vaccination: routinely recommended at ages 11 to 12, and it can begin at age 9. Catch-up vaccination is recommended for anyone through age 26 who was not adequately vaccinated earlier. It is not routinely recommended for adults ages 27 through 45, though some may discuss it with their doctor.
- Regular screening: cytology every 3 years from ages 21 to 29, then high-risk HPV testing every 5 years from ages 30 to 65
- Using condoms, especially with new partners
- Quitting smoking to reduce the risk of lesions progressing
When should you see a doctor?
See a doctor promptly for unexplained vaginal bleeding (outside of your period, after sex, or after menopause), persistent abnormal discharge, or unusual pelvic pain. Don’t wait if you’re past due for cervical cancer screening.
Sources
- American Cancer Society, U.S. cervical cancer statistics
- American Cancer Society, cervical cancer risk factors
- American Cancer Society, chemotherapy for cervical cancer
- American Cancer Society, radiation therapy and concurrent chemoradiation with cisplatin
- American Cancer Society, pembrolizumab for PD-L1-positive cervical cancer and bevacizumab for disease that has spread
- American Cancer Society, colposcopy with biopsy to diagnose and MRI, CT, and PET imaging to stage
- National Cancer Institute, concurrent cisplatin-based chemoradiation as the standard of care
- U.S. Preventive Services Task Force, cervical cancer screening recommendations
- National Cancer Institute, HPV vaccine fact sheet
- National Cancer Institute, cervical cancer treatment
- MedlinePlus, U.S. National Library of Medicine health information