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Cervical cancer: causes, treatments & prevention
What is cervical cancer?
The location that cancer begins in the body determines its name. The cervix connects the top of the vagina (birth canal) to the lower part of the uterus. When cancer begins in the cervix, it is called cervical cancer. Cervical cancer is currently the leading cause of cancer-related death worldwide for women.
What causes cervical cancer?
Human papillomavirus (HPV) is the leading cause of cervical cancer. HPV is a sexually transmitted virus that causes almost all pre-cancer and cancer of the cervix (and other HPV-related cancers). HPV is common and contagious, as any skin touching between intimate partners can lead to its spread and most people infected with HPV have no symptoms and do not know they carry the virus.
About 80% of sexually active people will contract HPV at some point in their lives. There are hundreds of types of HPV, but HPV 16 and 18 cause 70% of all cervical cancers. The good news is that most women will clear or get rid of HPV naturally without any intervention or treatment. The body will produce antibodies to attack and remove the virus. Women who smoke, are HIV positive, or on medications that suppress their immune system will have more difficulty clearing HPV. Because of this, these women are at higher risk of having cervical cancer, as well as other HPV-related cancers.
Signs of cervical cancer
Cervical cancer generally does not present symptoms in its early stages. Once women present with symptoms, typically irregular vaginal bleeding or pelvic pain, cervical cancer is often at an advanced stage. Fortunately, in the United States, routine screening has dramatically decreased how frequently cervical cancer occurs and how deadly it is for women who do get it. When cervical cancer is found early, it is highly treatable. Before cells turn cancerous, they are precancerous. Screening protocols allow for diagnosing and treating these precancerous lesions, preventing women from ever progressing to cervical cancer.
Screening for cervical cancer starts for most women at age 21 with cervical cytology, commonly known as the "Pap smear" (named after its creator, Dr. George Nicholas Papanicolaou, a Greek pathologist). During a Pap smear, cervical cells are collected and sent to a pathologist for examination under a microscope. Pathologists look for cellular changes that would signify a pre-cancer or cancer of the cervix, as well as the HPV virus. If abnormal cells or high-risk HPV are present, the doctor will make a recommendation. They may recommend closer monitoring with repeat Pap smears, or a closer look at the cervix with biopsies, known as colposcopies.
Cervical cancer stages
Treatment depends on the cancer stage and type of cervical cancer. Cervical cancer stages depend on the lesion's size and whether it has spread to the surrounding organs. Specifically:
- In stage 1, cancer is in the cervix only.
- In stage 2, cancer has spread to parts of the vagina or tissue surrounding the uterus.
- In stage 3, cancer has spread through the vagina and to the pelvic wall and/or caused issues with the kidneys or lymph nodes.
- In stage 4, cervical cancer has spread beyond the pelvis to other parts of the body.
Cervical cancer treatment
There are currently 5 treatment types for cervical cancer:
- Radiation therapy
- Targeted therapy
Small cervical cancers (micro-invasive lesions only visible under a microscope) that have not invaded the surrounding structures can be treated with surgery.
Surgery can be a biopsy, where a surgeon removes a piece of tissue from the cervix and cervical canal. These procedures are often called LEEP (loop electrosurgical excision procedure) procedures. Or surgery could be a hysterectomy, where the surgeon removes the uterus with or without other organs or tissues.
Cervical cancer larger than a 4cm lesion or that has spread to surrounding organs is considered advanced-stage and requires more extensive treatments. These could be:
- Radiation therapy uses high-energy x-rays to kill cancer cells or keep them from growing.
- Chemotherapy uses drugs to stop the division of cancer cells.
- Targeted therapy uses drugs to attack specific cancer cells without harming noncancerous cells.
- Immunotherapy uses the patient's immune system to direct the body's natural defenses to fight cancer.
Though cervical cancer is the most common form of cancer in women, it's also the most preventable. The HPV vaccine is a powerful preventative tool and can be given to males and females as young as nine and up to age 45. The most commonly administered HPV vaccine prevents the nine HPV strains most likely to cause cervical cancer and genital warts. The vaccine is most effective if administered before someone has their first sexual contact (and therefore before they have come in contact with HPV).
Even those diagnosed with HPV or with a history of abnormal Pap smears can still receive the HPV vaccine. It can prevent infection from additional strains of HPV. The FDA-approved vaccines for HPV are well-studied, safe, effective, and available at any routine health care visit.
Other ways to prevent cervical cancer include:
- Regular cancer screenings/Pap smears
- Smoking cessation
- Safe sex via condoms and limiting the number of sexual partners (and therefore HPV exposure)
Cervical cancer is the most common and preventable form of cancer in women. Regular screenings and the HPV vaccine can reduce the risk of getting cancer. Cancer treatments depend on the stage and type of cervical cancer and include surgery, radiation, and chemotherapy.
Talk to your doctor if you have questions or concerns about cervical cancer.