What Is Cervical Cancer? Symptoms, Diagnosis and Treatments

The cervix is a part of the female anatomy that is located in the lower part of the uterus.

It opens into the vagina.

When abnormal cells grow out of control in the cervix, it can create cervical cancer.

In most cases, cervical cancer is caused by a virus called human papillomavirus (HPV).

You can contract this virus by having sexual intercourse with someone who has it.

It is important to understand that not all types of HPV cause cervical cancer.

If you are infected with HPV, it can go away on its own.

In some cases, it can result in genital warts.

Finally, in more serious cases, it can lead to cervical cancer.

Cervical Cancer History

Cervical cancer has a history that goes back thousands of years ago.

There has been information about cervical cancer back even before medical equipment and medical testing was invented.

Below is a timeline of the history and our knowledge of cervical cancer.

• Cervical cancer has been around since 400 BCE. It was then that Hippocrates noted that it was an incurable disease.
• After over 1,000 years, some progress was made and the colposcope was invented. The colposcope is an instrument that is used to examine and illuminate the cervix, the vagina, and the vulva with a magnified view.
• Just a few years later, Dr. Papanicolaou invented the Papanicolaou technique, which led to Pap smear screening. This is the best way to test for cervical cancer. Just 5 years later, the Aylesbury spatula was developed to scrape the cervix to collect cells for cancer detection. Since these methods and tools were invented, the number of deaths caused by cervical cancer dropped by over 60 percent.
• Finally, in 2006, the first HPV vaccine was approved by the FDA to prevent cervical cancer. This was a huge step in medicine.
• In the early 20th century, doctors believed that cervical cancer was an STD that was only a problem for prostitutes. Finally, in the 1930s, doctors began to realize that it was a form of cancer that started out with abnormal cells.

Risk Factors

As with most diseases, there are certain risk factors that make you more susceptible to developing cervical cancer.

Having these risk factors doesn’t mean that you are guaranteed to develop cervical cancer, however, it does make it more likely.

If a person doesn’t have any of the risk factors mentioned below, they can still get cervical cancer.

• Having a lasting, high-risk form of HPV: HPV is a sexually transmitted infection and it is the most common cause of cervical cancer. If a woman has HPV and doesn’t know and they aren’t treated, it can easily result in cervical cancer.
• High-risk sexual behavior: Having sex with many different partners puts you at risk for HPV, which can lead to cervical cancer. Also, if you have a sexual partner who has many other sexual partners, you are also at great risk. Even if you are monogamous, if your partner isn’t, you are at risk.
• Having an impaired immune system: If you have a condition that weakens your immune system such as HIV, you have a higher chance of developing HPV, leading to cervical cancer.
• Cigarettes. Cigarette smokers are at high risk for a variety of types of cancer, including cervical cancer. Breathing in second-hand smoke can also put you at great risk.

Screening

A screening is a test to look for cancer even if you don’t have any of the symptoms.

This is extremely helpful because it can catch cancer in the very early stages.

The sooner the cancer is caught, the easier it can be treated.

Also, the survival rate is much higher.

With cervical cancer, the cells develop over time.

Before cancer shows up in the cervix, the cervical cells will go through something called dysplasia.

This is when abnormal cells start to appear in the cervical tissue.

This does not mean that you have cervical cancer.

It just means that you are at risk.

These cells are caught during a Pap smear.

Women are advised to have a Pap smear each year after they turn 18 years old.

During the Pap smear, the doctor would open up the cervix using a speculum.

Next, the inside of the cervix would be scraped so that cells can be removed for further study.

If it is determined that there are abnormal cells in the cervix, the doctor would often inform you, and schedule a follow-up appointment in 3 to 6 months for another Pap smear.

This would give the doctor a chance to see if the abnormal cells have normalized or if they are cancerous.

Regular cervical cancer screenings are the only way to quickly diagnose cervical cancer for early treatment.

Symptoms

In the very early stages, cervical doesn’t have any symptoms.

This is why it is so important to be screened each year for the disease.

In some cases, cervical cancer shows a few common symptoms.

The problem is that these symptoms often mimic other, less serious, diseases, and conditions.

A few of these common symptoms include:

• Vaginal bleeding. All pre-menopausal women have vaginal bleeding every month. If you are pre-menopausal and you are bleeding in between periods, it is a sign of cervical cancer. Also, very heavy, very painful periods are also a sign. This is a very common symptom of many other problems. Another symptom is vaginal bleeding after sex. Finally, if a woman is post-menopausal and she has vaginal bleeding, it is a common symptom of cervical cancer.
• Unusual vaginal discharge. Like many other symptoms, vaginal discharge can be a sign of many different conditions. This symptom combined with the other cervical cancer symptoms makes it easier to notice. If your discharge is pink, watery, and foul-smelling, you should see a doctor for a Pap smear.
• Pelvic pain. If you have pelvic pain during intercourse or at other times, it is a sign that there are some abnormal changes going on in the cervix. These changes could be related to cervical cancer or a variety of other conditions. It would take a visit to the doctor to determine if the pain is due to cancer or due to something else.

In the later stages, it is possible for cervical cancer to metastasize or spread within the pelvis and to the lymph nodes and other areas of the body.

This is when cervical cancer is considered to be in the late stages.

There are several symptoms that you could exhibit if you are in the advanced stages of cervical cancer.

These signs include:

• Weight loss. During the later stages of cancer, you can start losing weight. Even if you are not dieting or exercising, you can still lose weight. Since this is a symptom of so many other diseases, it can be difficult to determine the cause.
• Loss of appetite. People in the advanced stages of cervical cancer will lose their appetite. This can contribute to weight loss, however, in many cases, it is only a small part of the reason.
• Back pain. The back pain associated with advanced cervical cancer is often dull and nagging. Some people experience the pain all the time while others experience it intermittently. It is easy to blame the back pain on a strained muscle, however, when it is combined with other symptoms, it becomes more obvious.
• Swelling in the legs or leg pain. This symptom, like back pain, can be explained away until it is combined with other symptoms.
• Leaking from the vagina. This is one of the most common symptoms of cervical cancer. If you notice that there is urine or feces leaking from your vagina that you cannot control, you could be in the advanced stages of cervical cancer.
• Bone fractures. Your bones can become fragile when you are in the advanced stages of cervical cancer. Older women often blame age and osteoporosis for the condition. It is easier to stop in younger women, as they often have strong bones unless there is something else going on, such as cervical cancer.

Diagnosis and Stages

There are several stages of cervical cancer.

The different states are described using the TNM system.

This stands for tumor, lymph node, and metastasis.

The TNM system goes from stage 0 through Recurrent.

Each stage is classified by the cancer cells and the symptoms.

Stage 0 Cervical Cancer

During this stage, the cancer cells are still confined to the surface of the cervix.

This stage has other names such as carcinoma in situ (CIS) or cervical intraepithelial neoplasia (CIN).

The terminology used depends on the doctor’s preference.

Stage I Cervical Cancer

During the stage of cervical cancer, it has grown a bit further into the cervix, however, it has not yet spread beyond the cervix.

Stage I is separated into two subcategories.

The first subcategory is Stage IA.

During this stage, there is only a very small amount of cancer present.

To be classified as Stage IA, cancer would be 5mm deep and less than 7mm wide.

Cancer in this stage can only be seen under a microscope.

If the cancer is Stage IB, cancer would measure 4 cm or less.

The cells would measure more than 5mm deep and 7mm wide.

At this stage, it can only be seen under a microscope.

Stage II Cervical Cancer

During this stage of cancer, it has grown beyond the cervix and the uterus.

It has not yet reached the lower part of the vagina or the walls of the pelvis.

During this stage, it has not yet traveled to the lymph nodes or other distant sites.

Like Stage I, Stage II has two subcategories. The first is State IIA.

This means that the cancer is not yet in the tissues next to the cervix or the parametria, however, it may have grown in the upper area of the vagina.

Next would be Stage IIB.

This means that cancer has spread into the tissue of the cervix and the parametria.

Stage III Cervical Cancer

During Stage III cervical cancer, cancer has spread to the lower part of the vagina and into the pelvis.

It has not yet moved into the lymph nodes nearby or any other parts of the body.

This stage is broken up into two subcategories.

The first is Stage IIIA.

This means that cancer has not spread to the walls of the pelvis, but it has spread to the lower third of the vagina.

During Stage IIIB, cancer has grown into the walls of the pelvis.

Also, it may have blocked both of the ureters.

During this stage, cancer may also have spread to the lymph nodes and not to the distant sites.

By this stage, the chances of survival become grimmer and grimmer.

Stage IV Cervical Cancer

This stage of cervical cancer is very serious.

By now, cancer has spread to the nearby organs and to other parts of the body.

This type of cervical cancer is separated into two subcategories.

The first is Stage IVA.

By now, the cancer is in the bladder or the rectum.

It has not yet reached the lymph nodes or distant sites.

During Stage IVB, cancer has spread well beyond the pelvis and other organs, such as the lungs and the liver.

Recurrent Cervical Cancer

Recurrent cervical cancer occurs if cancer is detected months or years after you have completed your cancer treatment regimen and after your doctor has confirmed that you are in remission.

In some cases, the recurrence can be local, which is contained to just the cervix.

If the cervical cancer cells break off from the tumor and travel to other areas of the body through the circulatory system or the lymphatic system and reattach to a new location, it is called a metastatic recurrence.

The most common places that cancer spreads during a metastatic recurrence occurs is in the bladder, kidneys, and lymph nodes.

The symptoms of a recurrence vary from patient to patient, however, most of the symptoms mimic those of the early stages and the advanced stages of cervical cancer.

If you have a recurrence, you should be able to recognize the symptoms since you have already had them the first time you had cervical cancer.

As soon as you suspect that you are having a recurrence of your cervical cancer, you should contact your doctor.

Cervical Cancer Diagnosis

There are several tests that can diagnose cervical cancer.

The type of testing would depend on the symptoms and the preference of the doctor.

• Pap smear. As mentioned above, a pap smear is a great way for a doctor to test for any abnormalities in the cervix. They can use the test to determine if there are abnormal cells or actual cancer cells. This is where the doctor will start off in diagnosing cervical cancer. Later, they will determine the stage.
• HPV DNA test. During this test, cells would be collected from the cervix and then tested for infection of any of the types of HPV. It would be able to tell the doctor if you have the form of HPV that causes cervical cancer. This test is most often given to women who are 30 years old or over. Younger women are often given just the Pap smear.
• Colposcope. If cervical cancer is suspected, the doctor would perform this type of exam. It allows them to get a good look at the cervix to check for any abnormal cells.
• Punch biopsy. This is one of the two biopsy options. During the punch biopsy, the doctor would pinch off small samples of the cervical tissue using a sharp tool.
• Endocervical curettage. This is the second of the two biopsies. The doctor would scrape a sample of the tissue from the cervix using a curet, which is a small, spoon-shaped instrument.
• Electrical wire loop. If the doctor didn’t like the results from either of the biopsies listed above, they might use this method. It is done under local anesthesia, and the doctor would use a low-voltage, thin electrical wire to get a sample of the tissue.
• Cone biopsy. This is another procedure commonly used if the doctor doesn’t like the results from either of the first two biopsies. This biopsy allows the doctor to get a sample of the cervical cells from a much deeper area of the pelvis. This would be done under general anesthesia in the hospital. Once the cells are retrieved, they would be sent off to the lab for testing.

Staging

If the testing above determines that you have cervical cancer, you would need to undergo further testing.

The doctor would need to determine what stage your cancer is in.

The stage of cervical cancer would determine who aggressive the treatment would have to be.

• Imaging Tests. There are several imaging tests that the doctor would use to determine how much cancer has spread if it has even spread at all. The most commonly used tests are X-rays, CT scans, an MRI, or a PET scan.
• Scoping (a visual exam of the rectum or bladder). If the imaging tests show a need, the doctor will use a scope to see the inside of your bladder and rectum. It will give them a chance to see if cancer has spread there. This would mean that it is at Stage IVA.

Cervical Cancer Treatment By Stage

There are several factors when it comes to the treatment plan that your doctor would recommend.

The stage of cancer, the location, your age, your overall health, and if you still want children are all factors in your treatment.

Below is a list of the most common treatments based on the stage of cancer.

Stage 0 (carcinoma in situ)

While Stage 0 is classified as an actual stage, most doctors consider it to be pre-cancer.

This is because the cancer cells have not passed the surface of the cervix or penetrated into the tissue.

A pap smear would show Stage 0 cancer and the treatment would depend on the type of cancer that you have.

Treatment for squamous cell carcinoma in Stage 0:

• Cryosurgery
• Laser surgery
• Cold knife conization
• Loop electrosurgical procedure (LEEP/LEETZ)
• Simple hysterectomy (this treatment is either used as the first treatment or if other treatments are used and cancer returns.

Treatment for adenocarcinoma in Stage 0:

• Cone biopsy. This is the best treatment if you still want to have children. For this to be a possible treatment, there can be no cancer on the edges of the cone specimen. After the procedure, you would need to be watched closely. After you have finished having children, your doctor would recommend a hysterectomy.
• Hysterectomy. This is the most effective treatment and it is used if you are done having children.

Stage IA1

The treatment for this stage of cancer would first depend on whether you want to continue having children.

It would also depend on whether or not cancer has spread to the lymph vessels or the blood.

• Cone biopsy. This is best if you still want to have children after the cancer is in remission. If there are no cancer cells in the edges of the cone, you would be watched very closely for a recurrence. If there are cancer cells on the edges, a repeat cone biopsy or a radical trachelectomy would be done, This is the removal of the upper vagina or the cervix. The radical trachelectomy is the preferred treatment if the cancer is in the lymph vessels or the blood.
• Simple hysterectomy. This is the best option if you still want to have children and cancer has not invaded the blood or the lymph vessels.
• Radical hysterectomy. This type of treatment would be necessary if cancer has spread to the lymph vessels or the blood. You may also need to have the pelvic lymph nodes removed.

Stage IA2

• Cone biopsy with a pelvic lymph node dissection. This is best if you want kids.
• Radical trachelectomy with a dissection of the pelvic lymph node. Also best if you want kids.
• External beam radiation therapy (EBRT) and brachytherapy. Best if you don’t want kids.
• Radical hysterectomy, along with a sampling of the para-aortic lymph nodes and removal of the pelvic lymph nodes. A second option if you don’t want kids.

Stages IB and IIA

• Chemotherapy or a combination of chemotherapy and radiation;
• Radiation alone;
• EBRT and chemotherapy;
• EBRT and brachytherapy;
• Radiation, brachytherapy, and EBRT.

The chosen treatment would depend on if the tumor has grown into the blood and lymph nodes.

It would also depend on the woman’s desire to have children and her health.

Stages IB2 and IIA2

• Chemoradiation;
• Radical hysterectomy with a dissection of the lymph nodes;
• In severe cases, radiation and chemotherapy would be given first and then a hysterectomy.

Stages IIB, III, and IVA

• Chemoradiation

Stage IVB

By this stage, cancer has spread out of the pelvis to other areas of the body and it is not considered curable.

The doctor may use radiation and chemo to slow the growth and help relieve the symptoms.

You could also be put into a clinical trial to test experimental drugs.

Recurrent Cervical Cancer

The treatment for recurrent cancer would depend on how far cancer has spread after the recurrence.

Coping and Support

Most people don’t have the same feelings when they are diagnosed with cervical cancer.

Some people experience a variety of feelings all at once.

Some of these feelings can include:

• A numb feeling where there is no emotion at all at first.
• Guilty because you think that you may have done something to cause cancer.
• Frightened of what is going to happen next.
• Angry and resentful at yourself and the healthy people around you.
• Confused.

While most of these emotions may seem unreasonable to others, they wouldn’t understand unless they were in your shoes.

These feelings are very normal.

There are a few things that you can do to help yourself cope better.

• Help yourself

There are a few things that you can do to help yourself when you find out you have cancer.

The first is to ask your doctor as many questions as you need to.

The more you understand your diagnosis, your prognosis, and the treatment plan available, and the side effects, the better you might feel.

You shouldn’t be embarrassed or afraid to ask as many questions as you need.

It is your body and your disease, therefore, you have a right to learn as much as possible about your cancer.

• Talk to other people

It is best to try to talk to your family and friends about your diagnosis, no matter how hard it will be at first.

Don’t be afraid to show emotion because your family will be more at ease if they see that you are accepting and understanding your condition.

Some people are afraid to let their family show their fear.

This isn’t helpful for you or your family.

If you are having trouble talking to your friends and family, you should consider joining a support group for people who have cervical cancer.

It can be very refreshing to talk to people who understand what you are going through.

You can even find chat rooms and web discussions designed specifically for people who are suffering from cervical cancer.

• Dealing with the fatigue

Cancer and treatment can make you very tired.

If you are struggling with fatigue, you should discuss it with your doctor.

They can go over ways to cope with the fatigue.

Also, make sure that you are getting enough rest and you are not pushing yourself the way that you did before you were diagnosed with cancer.

The more you allow your body to rest, the easier it will be to fight cancer.

• Dealing with Loss of Fertility

If cancer had progressed to the point that you have to lose your fertility, it can be a very traumatic experience.

This is especially true if you don’t have any children yet.

For most women, it is a huge loss.

Many mental health professionals compare the loss of fertility with the loss of an actual child.

There are also issues with the feelings that you have after a hysterectomy.

Many women who go through a radical hysterectomy go through a very dark period where they feel as though they are no longer a woman.

It would take the help of a licensed healthcare professional to help you get through it.

For many women, after they go into remission, their only option is adoption.

Coping Practically

Cancer causes more than just emotional and medical problems. It can also wreak havoc on every aspect of your life.

There can be some serious financial concerns associated with cancer.

If your insurance doesn’t cover all of the necessary treatments, it can be a huge financial burden.

The same is true if you cannot work due to the side effects of the treatment.

If you have children, you may also need help with that.

Rather than stressing about these problems on your own, your doctor can recommend the name of a social worker who can help you to navigate through the insurance problems and all of the other issues that you may not know how to deal with on your own.

You have enough to worry about with the medical and emotional issues, you should get as much help as you can with the financial and practical issues.

Cervical cancer is a very serious and dangerous condition.

This is especially true if the condition was not caught early enough.

Prevention is extremely important.

Avoiding certain high-risk behaviors, getting the HPV vaccine, and routine screenings are very important.

If you develop cervical cancer, you should learn as much as you can about the disease, the prognosis, the treatment, and ways to cope with cancer.