Introduction

Cervical cancer is a type of cancer that develops in the cervix, which is the lower part of the womb that connects to the vagina. Having a good understanding of cervical cancer is important because early detection means early intervention and better treatment outcomes. 

This is your cervical cancer FAQs article for quick, impactful and pointed insight that will help shield you from the disease.

General information

What is cervical cancer?

Cervical cancer starts in the cells of the cervix, which is the lower part of the uterus (womb) that connects to the vagina. This type of cancer usually develops slowly. Before cancer forms, the cells in the cervix change and become unusual and aberrant, a condition called dysplasia. If these unusual cells are not treated, they can turn into cancer that spreads more extensively into the cervix and to nearby areas of the pelvis.

The cervix, like a road, has two main parts: 

• The outer ectocervix
  • This is the part of the cervix that is visible during a gynecologic exam
  • It is covered with thin, flat cells resembling a smooth, paved surface
• The inner endocervix
  • This forms a canal connecting the vagina to the uterus 
  • It is lined with column-shaped glandular cells, like tall buildings lining a street. These cells produce mucus 

Think of the transformation zone (also known as the squamocolumnar junction) as the intersection of the ectocervix and endocervix. This is also the area where most cervical cancers start, like the busiest spot in town.

How common is cervical cancer?

According to the World Health Organization (WHO), cervical cancer is the fourth most common cancer in people assigned female at birth (AFAB).¹ In 2022, about 660,000 people AFAB were diagnosed with cervical cancer globally, and sadly, around 350,000 women lost their lives to this disease.

What causes cervical cancer?

Prolonged infection with certain types of human papillomavirus (HPV) – such as high-risk strains including HPV 16 and HPV 18 – is the main cause of almost all cervical cancers globally. These high-risk HPV types are responsible for about 70% of cervical cancers worldwide.²

Nearly everyone who is sexually active will get HPV at some point, but most infections go away on their own within two years as the body fights them off. Short-term infections usually do not lead to cancer. However, if a high-risk HPV infection sticks around for many years, it can cause changes in cervical cells, leading to precancerous lesions. If these lesions are not found and treated, they can eventually turn into cervical cancer. 

Risk factors

Certain health factors, such as having a weak immune system due to diseases like HIV/AIDS or taking medications that suppress the immune system, increase the risk of HPV infections turning into cancer. 

Smoking (or being around second-hand smoke) can also increase the chances of developing cervical cancer. Additionally, using birth control pills or having many children may raise the risk, but the reasons why this is the case are not fully understood. 

Obesity can also make it harder to find precancerous lesions during screening, which could mean a higher risk of cancer due to lack of treatment.³ 

Symptoms and early signs

In its early stages, cervical cancer might not show any symptoms, so regular screening is important. When symptoms do develop, they might include:

• Abnormal vaginal bleeding
  • This can happen after sex, between periods, or after menopause
• Unusual vaginal discharge
  • The discharge might be watery, bloody, or have a bad smell
• Pain during intercourse
  • You might feel discomfort or pain during sex
• Pelvic pain
  • Ongoing pain in your pelvic area can be a sign of cervical cancer

If you notice any such symptoms, it’s important to see your doctor right away. Regular check-ups can catch issues early and make treatment more effective.

Screening and diagnosis 

Cervical screening (formerly called a smear test) is important in preventing cancer as it checks for pre-cancerous changes in the cells of your cervix. During cervical screening, a sample of cells is collected from your cervix and is checked for high-risk types of HPV that can lead to changes in the cells. If these types of HPV are found to be present, then the same is tested for changes to the cells of the cervix, meaning that they can be treated before they can develop into cancer.

The following tests help in diagnosing cervical cancer:

• Colposcopy
  • If your cervical screening returns abnormal results, your doctor might do a colposcopy, which uses a special microscope to take a closer look at your cervix
• Biopsy
  • During a colposcopy, if any areas look suspicious, your doctor will take a small tissue sample (biopsy) for further examination under a microscope
• Imaging tests 
  • Diagnostic imaging tests such as CT, MRI, and PET-CT scans can show how far cervical cancer has spread and help doctors get a clearer picture of the disease

These tests are essential for diagnosing and, therefore, treating cervical cancer early.

Stages of cervical cancer

Cervical cancer is staged from 0 to IV based on how far it has spread:⁴

• Stage 0 (Carcinoma in situ)
  • Abnormal cells are on the surface of the cervix only
• Stage I
  • Cancer is only in the cervix
• Stage II
  • Cancer has spread from the cervix but not to the pelvic wall or lower vagina
• Stage III
  • Cancer has reached the pelvic wall or lower vagina and may cause kidney issues
• Stage IV
  • Cancer has spread to other body parts like the bladder, rectum, or distant organs

Treatment options

In treating cervical cancer, various options are available, including surgery, radiotherapy, chemotherapy, targeted therapy and immunotherapy:

Surgery

There are several types of surgery for the treatment of cervical cancer, including:

• Conization
  • Conization (often called a cone biopsy) removes a cone-shaped piece of tissue from the cervix
• Hysterectomy
  • A hysterectomy is the removal of the uterus, sometimes along with the cervix (total hysterectomy) 
  • A radical hysterectomy removes the uterus, cervix, surrounding tissues of the cervix, fallopian tubes and part of the vagina
• Trachelectomy
  • A trachelectomy removes the cervix while keeping the uterus, making it suitable for women wishing to preserve their fertility

Radiation therapy

Radiation therapy (also called radiotherapy) uses high-energy x-rays to eliminate cancer cells. It is administered externally or internally through brachytherapy.

Chemotherapy

Chemotherapy employs drugs to eradicate cancer cells. It is often combined with radiation therapy for advanced cases of cervical cancer.

Targeted therapy

Targeted therapy for cervical cancer utilises drugs like bevacizumab (Avastin) to target specific cancer growth molecules.

Immunotherapy

Immunotherapy assists the immune system in recognising and attacking cancer cells by employing drugs like pembrolizumab (Keytruda) for specific, advanced cervical cancer types.

Prevention

Preventing cervical cancer involves several strategies.

• HPV vaccinations, such as Gardasil and Cervarix, shield against high-risk HPV types responsible for most cervical cancers and are recommended for those starting at ages 11-12 
• Regular cervical screenings from age 21 onward, help identify early changes to cervical cells 
• Practicing safe sex by using condoms and limiting the number of sexual partners reduces the risk of HPV infection
• Quitting smoking lowers the chances of developing cervical and other cancers 
• Maintaining overall health through a balanced diet, exercise, and stress management bolsters the immune system, reducing the risk of persistent HPV infections

Living with cervical cancer

Dealing with a cancer diagnosis can feel like a lot to handle. Finding support from healthcare professionals, counsellors and support groups can make it easier to cope with the emotional and physical challenges. 

There are many organisations and support groups offering help to cervical cancer patients and their families, offering guidance, advice and a listening ear when you need it most. 

Treatment might bring side effects like tiredness, nausea, and hair loss, but your healthcare team can offer ways of dealing with these issues. After treatment, it's important to attend regular check-ups to watch for any signs of the cancer coming back and to take care of any ongoing health concerns.

FAQs

How effective is the HPV vaccine?

• The HPV vaccine is highly effective at preventing infections from certain types of HPV, which can cause cervical cancer. Vaccine effectiveness ranges from 74%-93% for those aged 9-14 years⁵ 
• By getting vaccinated, you’re taking a big step in protecting yourself from this disease 
• It works best if you get it before becoming sexually active, so you haven’t yet been exposed to the virus

Can cervical cancer be cured?

• Yes, cervical cancer can often be cured, especially when it’s caught early 
• If diagnosed in the early stages, treatment is usually very successful, and many people fully recover 
• Regular cervical screenings are crucial because they help find pre-cancerous changes to cervical cells so they can be treated before getting a chance to turn into cancer

What are the chances of recurrence?

• The chance of cervical cancer coming back depends on how advanced it was when first diagnosed and how well the initial treatment worked 
• For many people with early-stage cancer, the risk of recurrence is low 
• Regular check-ups are important to monitor your health and catch any signs of cancer returning as soon as possible

How does cervical cancer affect fertility?

• Treatments for cervical cancer can impact your ability to have children 
• For example, a hysterectomy (which removes the uterus) makes pregnancy impossible 
• However, other treatments, like a trachelectomy, remove only the cervix and can preserve the uterus, allowing for the possibility of future pregnancies 
• Talk to your doctor about your options if you’re concerned about fertility

What lifestyle changes can help in prevention and recovery?

• Adopting healthy lifestyle habits can make a big difference in both preventing cervical cancer and helping you recover if you’ve been treated for the disease 
• Eating a balanced diet rich in fruits and vegetables, staying active, quitting smoking, and practicing safe sex are all important 
• These steps improve your overall health and support your body’s ability to heal and stay strong

Who is at higher risk for cervical cancer?

Certain factors can increase your risk of developing cervical cancer. These include: 

• Having multiple sexual partners 
• Having sex at a young age 
• Using contraceptive pills for a long time 
• Smoking
• Having a weakened immune system (like from HIV/AIDS)
• Not getting regular cervical cancer screenings 
• HPV vaccinations and regular cervical screenings are essential steps in protecting yourself

Summary

• Cervical cancer is the fourth most common cancer in people assigned female at birth (AFAB). This type of cancer usually develops slowly
• The main cause is prolonged infection with high-risk strains of human papillomavirus 
• Key risk factors for cervical cancer include having a weakened immune system, smoking
• Cervical screening is important in preventing cervical cancer as it checks for pre-cancerous changes in the cells of your cervix
• HPV vaccination, along with regular screening can significantly reduce the risk 
• Stay informed, stay proactive about your health, and encourage others to do the same. Remember, early detection can save lives