Cervical cancer

The cervix is the narrow part of the uterus that opens into the top of the vagina. Cancer of the cervix (cervical cancer) is almost always linked to infection with human papillomavirus (HPV). HPV can cause cervical cells to go through a series of changes (dysplasia) that, if left untreated, can become cancerous.

About the cervix#

The cervix lies at the base of the uterus and opens into the vagina. Its functions include:

• holding the fetus in the uterus during pregnancy
• producing mucus to help the movement of sperm
• producing lubrication for the vagina

Symptoms#

Infection with HPV and most cervical cell changes cause no symptoms. The only way to know your risk of developing cervical cancer is to have a cervical screening test.

Sometimes abnormal bleeding, discharge or pelvic pain can be a sign of cervical cancer. If you have these symptoms, see your healthcare provider as soon as possible.

Types of cervical cancer#

There are two main types of cervical cancer:

• Squamous cell cancer – the most common type. It starts in the cells that cover the outer surface of the cervix at the top of the vagina.
• Adenocarcinoma – less common. It starts in the glandular cells that line the cervical canal.

Most cases of both types are caused by HPV. Cervical cancer usually grows slowly, but it can sometimes develop and spread quickly, and it can occur in younger people.

Cervical cancer and HPV#

Cervical cancer almost always develops from cell changes caused by HPV. HPV is spread through genital skin-to-skin contact during sexual activity. It is very common, but most people with HPV will not develop cervical cancer. In most cases, HPV clears from the body naturally within one to two years and needs no treatment.

Sometimes the virus persists in the cervical cells and causes damage. If these changes go undetected and untreated, the risk of cervical cancer increases.

Factors that can increase the risk of cervical cancer in people with HPV include:

• smoking
• low immunity (for example, from HIV infection, other conditions or some treatments such as chemotherapy)

Children of people who took the anti-miscarriage drug diethylstilbestrol (DES) may also be at greater risk and should discuss appropriate follow-up with their healthcare provider.

Screening#

Cervical screening checks for HPV and is the best way to assess your risk of cervical cancer, even if you feel perfectly healthy. The cervical screening test (which has largely replaced the Pap test) is a quick, simple test, and the HPV-based test is expected to protect more people from cervical cancer than the older Pap test did.

If HPV is detected, a further test is usually done on the same sample to check the cells of the cervix. (If the test was self-collected, you may be asked to return to your healthcare provider so the cervical cells can be examined.) Most cell changes are not cancerous and reflect common infections or conditions that usually clear up on their own.

If HPV is not detected and you have no symptoms such as abnormal bleeding, the risk of cervical cancer is very low. If HPV is found, your provider will advise on the right follow-up.

Regular screening prevents many cervical cancers. Most people who develop cervical cancer have either never been screened or did not attend screening when it was recommended. Guidelines generally advise that women and people with a cervix who have ever been sexually active be screened regularly, even if they have had the HPV vaccine. Ask your healthcare provider how often you should be screened and at what age to start and stop. If you have had a hysterectomy, you may still need regular screening, so check with your provider.

Diagnosis#

If a screening test or symptoms suggest a problem, further tests may be used, including:

• colposcopy – examining the vagina and cervix with a magnifying instrument to check for abnormalities
• biopsy – taking a small tissue sample from the cervix, often during a colposcopy
• cone biopsy – removing a larger, cone-shaped tissue sample from the cervix under anesthetic

Treatment#

Treatment depends on how early the cancer is found and may include:

• cone biopsy – if detected early, some cervical cancers can be removed during the biopsy itself
• hysterectomy – removal of the uterus
• radiotherapy – using x-rays to destroy cancer cells
• chemotherapy – using anti-cancer drugs that stop cancer cells from multiplying

If cervical cancer is diagnosed at a later stage, it may have spread to the point where a cure is no longer possible. Treatment then focuses on improving quality of life by relieving symptoms. This is called palliative treatment.

The HPV vaccine#

The HPV vaccine helps prevent the types of HPV that cause most HPV-related cancers and disease in people of all genders. It is most effective when given to adolescents before they become sexually active, and so before they are exposed to the virus. The recommended age is generally early adolescence, around 12 to 13 years.

For most people, a single dose provides good protection, although people with significant immune-weakening conditions are recommended to receive more doses. Young people who missed the vaccine may be able to have catch-up vaccination – ask your doctor or local immunization service about what is available where you live.

Even after vaccination, regular cervical screening is still recommended, because the vaccine does not protect against every type of HPV.

Key points#

• Cervical cancer is almost always caused by persistent HPV infection.
• HPV and most cervical cell changes have no symptoms; screening is the only way to know your risk.
• See your healthcare provider promptly if you have abnormal bleeding, discharge or pelvic pain.
• Regular cervical screening prevents many cancers and is recommended even after HPV vaccination.
• The HPV vaccine is most effective when given in early adolescence, before exposure to the virus.

Where to get help#