Understanding Cervical Cancer

What Is Cervical Cancer?

Cervical cancer is cancer that starts in the cervix, which connects the vagina to the upper part of the uterus. 

Cervical cancer is the only gynecologic cancer that can be prevented, yet the American Cancer Society predicts that in 2025, about 13,360 new cases of invasive cervical cancer will be diagnosed in the United States, including 290 women in Indiana and 490 women in Illinois.

Cervical cancer is treated most effectively when it is diagnosed at an early stage, before it causes symptoms. In the early stages, cervical cancer usually doesn’t show any symptoms.

What Are Early Symptoms Of Gynecological Cancer?

"Early symptoms may include abnormal vaginal bleeding or discharge; pelvic pain or pressure; bloating or feeling full quickly; fatigue, urgent urination, changes in bowel habits, pain during intercourse; itching, burning or soreness in the vulva; and unexplained weight loss or gain," said Padmaja Venkata Sanaka, MD, a Franciscan Physician Network OBGYN. "Any abnormal vaginal bleeding should be reported to your gynecologist so cervical cancer can be ruled out with a Pap smear and uterine cancer with endometrial sampling/biopsy, pelvic ultrasound or other tests."

What Are Later Symptoms Of Cervical Cancer?

In later stages of cervical cancer, symptoms may include:

• Vaginal bleeding after intercourse or between menstrual cycles
• Painful urination, sometimes with blood
• Bloody, heavy or watery vaginal discharge, often foul smelling
• Longer or abnormally heavy periods
• Weight or appetite loss
• Back pain
• Fatigue

What Increases My Risk of Cervical Cancer?

"It is important for all women to know that they are at risk for cervical cancer,” said Tina Ayeni, MD, a gynecologic oncology surgeon with Franciscan Physician Network Gynecologic Oncology Specialists Indianapolis.

Risk factors for cervical cancer are:

• HPV infection
• Smoking
• Having multiple sexual partners
• Having a family history or personal history of cervical cancer or pre-cancer

Why Does HPV Cause Cervical Cancer?

The main risk factor for cervical cancer is contracting human papillomavirus (HPV), a common sexually transmitted disease (STD). Some HPV infections can lead to cell changes that could lead to cancer.

Women who have had multiple sexual partners or who started having intercourse before they were 16 years of age increase their chances for getting HPV. Women who haven’t had regular pelvic exams or Pap smears, which can detect cervical cancer in its early stages, also run a higher risk for developing the disease.

How Does An HPV Vaccine Help Prevent Cervical Cancer?

Nearly all cervical cancer stems from HPV, which will first cause pre-cancer cells. An HPV vaccination can prevent cervical cancer 30 or 40 years later.

The U.S. Centers for Disease Control and Prevention recommends children receive two doses of the HPV vaccine at age 11 or12. It can be started as early as age 9. The vaccine is also approved for adults who haven't yet had it up to age 45, but it works better when given at an earlier age. A vaccine against HPV is recommended by the CDC for pre-teen girls and boys, as well as women up to 45 years in age. 

“Get vaccinated, but even after getting vaccinated, you still need to get your pap smears,” said Dr. Ayeni.

Are There Ways To Reduce My Cervical Cancer Risk?

According to the American Institute of Cancer Research, maintaining a healthy weight, being physically active and eating healthy can help reduce your risk of getting several types of cancer.

"Regular moderate exercise for 150-300 minutes per week can help you stay active and prevent obesity, which is a known risk factor," Dr. Sanaka said.

Learn more about how you can reduce your cancer risk.

How Can I Be Screened For Cervical Cancer?

There are two tests used to screen for cervical cancer. Both tests can be done in a doctor's office or medical clinic.

1. The Pap test can find early changes in cells that can lead to cervical cancer. A sample of cells are collected from the cervix for testing. The test is often done at the same time as a pelvic exam. If cancer is suspected, the doctor will conduct a pelvic exam and remove tissue for a biopsy. 
2. The HPV test looks for certain strains of HPV that have been linked to cervical cancer. It’s done by testing a sample of cells from the cervix. The HPV test can be done by itself or using the same cell sample collected for a Pap test.

Both of the Pap test and HPV test can be done together. Your healthcare provider simply takes a small amount of cells from your cervix using a swab or small brush. The sample is then put in a special liquid preservative that is sent to a lab for analysis.

When Should I Have Cervical Cancer Screening?

Talk with your healthcare provider about the best approach to your future cervical cancer screenings given your age and health history. In general, cervical cancer screening guidelines are:

• If you are between the ages of 21 and 29, have a Pap test every three years.
• If you are between the ages of 30 and 65, have a Pap test every three years or a Pap test and HPV test every five years.
• Women older than age 65 who have had normal test results for the last 10 years and are not at high risk for cervical cancer should stop screening.

"It takes about 10 to 15 years between infection and that pre-cancer phase to cancer. So cervical cancer is not fast," Dr. Ayeni said. "And all the more reason why your Pap smear screening is so important. Sometimes the first Pap may not pick up anything, even if there's something subtle. The next Pap should, and we still have an opportunity to prevent disease and death."

What Do HPV And Pap Test Results Mean?

One of the most important things to remember about your Pap and HPV tests is to learn the results. Your healthcare provider should tell you when they’re ready and how to get them. Some offices will even call you with your test results. But to be safe, be sure to ask when and how your cervical cancer screening results will be given to you.

Although the Pap test and HPV test aren’t foolproof, they are highly reliable. Most cervical cancers can be detected early if you have routine Pap tests.

Once you have your results in hand, the next step is to understand what they mean.

Pap Tests

Pap test results are reported in one of three categories:

• Normal: No pre-cancerous or cancerous cells were detected during your screening. Plan to have your next Pap test in three years.
• Unclear: This result is common. It means that your cervical cells look like they could be abnormal, but the test won’t show why. "Inconclusive" and "ASC-US" are other terms your healthcare provider may use. The HPV test can show if HPV is causing cell changes identified in an "unclear" result. Your doctor will take a closer look at your cervix and may recommend more tests. It's also possible that your doctor will suggest a "watch and wait" approach to see if the changes go away before recommending more tests. More tests aren't always the best approach because they sometimes can lead to unnecessary procedures. Ask your doctor for guidance.
• Abnormal: This result means that cell changes - most likely caused by HPV - were identified on your cervix. The changes are described as "minor" (low-grade changes) or "serious" (high-grade changes). It's important to remember that most minor changes return to normal without any treatment. High-grade changes are usually called pre-cancer because without treatment, they may eventually develop into cancer. Your healthcare provider will look more closely at your cervix and recommend next steps if your results are abnormal.

About 3 million women each year have unclear or abnormal Pap tests, according to the Centers for Disease Control and Prevention. Around 10,000 of these will have cervical cancer.

HPV Tests

HPV test results are reported as either negative (no HPV type was identified) or positive (an HPV type linked to cervical cancer was identified). HPV tests should be interpreted with your Pap test result.