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Cervical Cancer

(Cancer of the Cervix)

Definition

Cervical cancer is cancer cells that start and grow in the cervix. The cervix is the lower, narrow part of the uterus. It connects the uterus with the vagina.

Causes

Cancer happens when cells divide without control or order. These cells grow together to form a tumor. They can invade and damage nearby tissues. They can also spread to other parts of the body.

Human papillomavirus (HPV) is a sexually transmitted infection. It can cause changes in cervical cells. These changes can lead to cancer.

It is not clear what causes changes in the cells. It is likely a combination of genes and environment.

Risk Factors

Cervical cancer is more common in women 40 to 49 years old. The risk is higher in developing countries.

The most common risk is having HPV infection and cervical dysplasia. Other things that raise the risk are:

  • Having many sexual partners, or unprotected sex
  • Sexual activity before age 18
  • A history of being pregnant more than once, or before age 19
  • Smoking
  • Using birth control pills for more than 5 years
  • A history of a sexually transmitted infection (STI)
  • A weak immune system, such as with HIV
  • A family history of cervical cancer

Symptoms

Symptoms usually do not appear until the cells are cancerous. Then, they invade nearby tissue. When this happens, the most common symptom is abnormal bleeding. This may include:

  • Bleeding between menstrual periods
  • Bleeding after sex, douching, or a pelvic exam
  • Long lasting or heavy menstrual bleeding
  • Vaginal bleeding after menopause
  • Increased vaginal discharge
  • Pelvic discomfort or backache

Diagnosis

Many women are diagnosed after an abnormal pap test.

Others may go to the doctor due to symptoms. The doctor will ask about symptoms and health history. A pelvic exam and will be done.

Tests may include:

  • Blood and urine tests
  • Colposcopy —a lighted device to examine the cervix
  • Biopsy —a sample of cervical tissue or lymph nodes is removed for testing

Imaging tests may include:

The exam and test results will be used for staging. This will outline how far and fast the cancer has spread.

Treatment

The goal is to get rid of the cancer. Treatment depends on the stage of the cancer. A combination of treatments may be used.

Options may be:

  • Surgery to remove the tumor, nearby tissue, and sometimes nearby lymph nodes
  • Hysterectomy—may be needed in some cases
  • Removal of more tissue, such as ovaries and fallopian tubes—if the cancer is late stage
  • External or internal radiation treatment—to kill cancer cells or shrink tumors
  • Chemotherapy by pills, injection, or IV—to kill cancer cells
  • Medicines to control pain and bleeding—when a cure is no longer possible

Prevention

The risk of cervical cancer may be reduced by:

  • Regular pap tests—to screen for tissue changes in the cervix
  • Safe sex—limiting the number of sex partners and using latex condoms
  • The HPV vaccine
RESOURCES:

American Cancer Society
https://www.cancer.org

National Cancer Institute
https://www.cancer.gov

CANADIAN RESOURCES:

Canadian Cancer Society
http://www.cancer.ca

Health Canada
https://www.canada.ca

REFERENCES:

Cervical cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/cervical-cancer.html. Accessed March 17, 2021.

Cervical cancer. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/cancer/cervical. Accessed March 17, 2021.

Cervical cancer. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/cervical-cancer . Accessed March 17, 2021.

General information about cervical cancer. National Cancer Institute website. Available at: https://www.cancer.gov/types/cervical/patient/cervical-treatment-pdq. Accessed March 2021.

Human papillomavirus (HPV) vaccines. National Cancer Institute website. Available at: https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet. Accessed March 17, 2021.

Immunization schedules. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/vaccines/schedules/index.html. Accessed March 17, 2021.

Practice Bulletin No. 183 summary: postpartum hemorrhage. Obstet Gynecol. 2017;130(4):923-925.

Last reviewed January 2021 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP  Last Updated: 3/17/2021