How Would You Know If You Had Cervical Cancer? Symptoms

Diagnosis of cervical cancer can be confirmed after a thorough physical examination and laboratory procedures including:

• Pap smear: Cells from the cervix are scraped off and tested for cancerous and precancerous conditions. It can be combined with a human papillomavirus (HPV) test.
• HPV test: A sample of cells is removed from the cervix and tested for HPV infection.
• Bimanual pelvic examination: This test involves inserting two fingers into the vagina while the other hand is over the abdomen to detect any abnormalities or changes in the cervix or surrounding organs.
• Speculum examination: A device called a speculum that retracts the vaginal wall helps visualize the cervix and identify any changes in the vagina or the cervix.
• Colposcopy: A thin tube with a lighted camera at the end called a colposcope is used to obtain a magnified view of the inside of the vagina and cervix.
• Visual inspection with acetic acid (VIA): A dilution of white vinegar is applied to the cervix and inspected for any changes.
• Cervical biopsy: Cervical tissue is collected and analyzed under a microscope to confirm the presence of cancer cells:
  • Endocervical curettage (ECC): A small, spoon-shaped instrument called a curette is used to scrape a small amount of tissue from the cervix.
  • Loop electrosurgical excision procedure (LEEP): A tissue sample is removed by using an electrical current passed through a thin wire hook.
  • Conization or cone biopsy: A cone-shaped piece of tissue is taken from the cervix.

If cervical cancer is detected in the biopsy, a gynecologic oncologist may recommend additional tests to determine whether the cancer has spread beyond the cervix.

• Computed tomography or computerized axial tomography scan: X-rays are taken to view detailed and three-dimensional images of the body.
• Magnetic resonance imaging: Magnetic fields are used to produce detailed images of the body.
• Positron emission tomography scan: Pictures of organs and tissues are created by injecting a small amount of a radioactive substance, and a scanner then detects this substance throughout the body.

Cervical cancer occurs when the cells in the cervix (also called the neck of the uterus) grow abnormally and out of control. The five stages of cervical cancer are as follows:

• Stage 0: Cancer cells are limited to the surface of the cervix.
• Stage I: Cancer cells extend into the uterus and may spread to nearby lymph nodes but have not spread distantly.
• Stage II: Cancer has spread outside the cervix and uterus and involves local lymph nodes but has not spread to distant sites.
• Stage III: Cancer has spread to the vagina or the pelvic wall, may or may not involve lymph nodes, but has not spread to distant sites.
• Stage IV: Cancer has spread to other parts of the body, such as the bladder, rectum, lungs, and liver, or distant lymph nodes.

Based on the cells in which the cancer originates, cervical cancer is divided into two types:

• Squamous cell carcinoma
  • Originates in the cells that line the surface of the cervix
  • Accounts for up to 80%-90% of all cervical cancers
• Adenocarcinoma
  • Originates in the glandular cells in the internal part of the cervix
  • Accounts for about 10%-20% of all cervical cancers

The following risk factors may increase the likelihood of developing cervical cancer:

• Human papillomavirus (HPV) infection: HPV is the most common and important risk factor for cervical cancer. HPV16 and HPV18 strains are most frequently associated with cervical cancer.
• Age: Cervical cancer is most often diagnosed in women ages 35-44. The average age of diagnosis is 50; in rare cases, it affects women under 20.
• Ethnicity: Hispanic and Black women are at higher risk of developing the disease.
• Herpes infection: Genital herpes raises the risk of developing cervical cancer.
• Smoking: Women who smoke are two times more likely to develop cervical cancer than those who do not smoke.
• Immune system deficiency: Women with low immunity are more vulnerable to developing the disease, such as those who are infected by HIV infection, have a history of organ transplantation, or are on corticosteroid medications.
• Oral contraceptives: Some research suggests that long-term use of birth control pills may be associated with a higher risk of cervical cancer.
• Diethylstilbestrol (DES) exposure: Women whose mothers were exposed to DES during pregnancy to prevent abortions are at an increased risk of developing a rare type of cervical cancer.

Cervical cancer can be prevented by:

• Regular screenings via pap smear
• Receiving the HPV vaccine (Gardasil is approved by the FDA for the prevention of cervical cancer caused by HPV for women ages 9-45 years)

The American Society of Clinical Oncology (ASCO) recommends HPV vaccination for girls to prevent cervical cancer. Additional measures that can be taken to reduce the risks include:

• Practice safe sex by using condoms
• Limit the number of sexual partners
• Avoid sexual contact with people who have had multiple sexual partners
• Avoid sexual contact with people who have genital warts or other symptoms of sexually transmitted diseases (STDs)
• Quit smoking

Treatment depends on the stage of cervical cancer. It may consist of one or a combination of the following:

• Cryosurgery
• Laser surgery
• Hysterectomy
• Radiation therapy
• Chemotherapy
• Targeted therapy
• Immunotherapy

The 5-year survival rate for people with cervical cancer is 66%. However, survival rates vary depending on factors such as: 

• Ethnicity
• Age
• Stage of cervical cancer:
  • 92% when detected at an early stage
  • 58% when the cancer has spread to the surrounding tissues or organs and regional lymph nodes
  • 17% when the cancer has spread to distant parts of the body