Here’s What to Know About Cervical Cancer Symptoms, Screenings, and Treatment, Say Expert Doctors
Updated: Apr. 09, 2024
Here are the symptoms, treatments, and causes of cervical cancer, which expert doctors say is among the top five female cancers but significantly underdiagnosed.
If you were asked to name the top cancers that affect women, breast cancer is sure to be among the first, perhaps with colon cancer or skin cancer near the top of your list. Cervical cancer isn’t high on the mainstream radar, but it’s one of the top five most common cancers that affect women or people with vaginas.
According to the American Cancer Society, about 14,000 new cases of cervical cancer are diagnosed and 4,000 to 5,000 women die each year in the United States. But that’s not the only important statistic: An additional 200,000 women are diagnosed with cervical precancers each year.
These numbers are likely a significant underestimation, as only two-thirds of women are getting regularly tested for it, says Pari Ghodsi, MD, an OB/GYN and women’s health specialist in Los Angeles, CA.
“The sad fact about cervical cancer is that the majority of these deaths were preventable through the HPV vaccine and proper screening and treatment,” she says. “Saving womens’ lives starts with greater awareness of cervical cancer and increased access to the vaccine and regular screenings. When it’s caught early, it’s one of the most treatable cancers.”
What is cervical cancer?
“Cervical cancer is a growth of cancerous cells that starts in the cervix,” says Kim L. Thornton, MD, a board-certified reproductive endocrinologist at Boston IVF and assistant professor at Harvard Medical School.
So, what is the cervix? Despite the fact that every female assigned at birth has a cervix, many people have never heard of cervical cancer—and that may be because folks (even those with cervixes) don’t know what or where the cervix is. Dr. Thornton explains that the cervix is a doughnut-shaped organ that makes up the lower one-third of the uterus, considered to be the “neck” of the uterus that separates the uterus from the vaginal canal. The cervix measures three to five centimeters in length and two to three centimeters in diameter.
The cervix responds to hormone changes, making it quite a dynamic organ. Dr. Thornton explains that throughout a woman’s life, the cervix can soften, flex, lengthen, thin, dilate, and other functions required for menstruation, conception, pregnancy and childbirth. “Sperm travels through it, menstrual fluid passes out of it, and, of course, babies exit through it. It also acts as a barrier for infection,” Dr. Thornton says.
The cervix is made up of two parts. The exocervix is the bottom of the cervix, or the part the doctor can see when performing an internal pelvic exam (yes, the “scoot down further!” type with the speculum). The endocervix is the top part that goes into the uterus. Both parts of the cervix are made up of a different type of cell, and where they meet in the middle is called the “transformation zone.” Most cervical cancers begin in the cells in the transformation zone.
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Types of cervical cancer
There are two main types of cervical cancer:
Squamous cell carcinoma
Over 90% of all cervical cancers are this type, according to the American Cancer Society. These cancers develop from squamous cells in the exocervix, most often starting in the transformation zone.
Adenocarcinoma
The other 10% of cervical cancers are adenocarcinomas, or cancers that develop from glandular cells found in the endocervix.
Mixed
Rarely, there are cervical cancers that have features of both squamous cell carcinomas and adenocarcinomas. These are called mixed or adenosquamous carcinomas.
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Causes of cervical cancer
Over 90% of cases of cervical cancer are caused by human papillomaviruses (HPV), a class of viruses transmitted through sexual contact. HPV “turns off” tumor-suppressing genes in the cell. This can cause the cells of the cervix to grow too much and cause a cascade of additional genetic changes. In some cases this can lead to cancer. It should be noted that most people who have HPV will not develop cervical cancer.
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For people who get cervical cancer and don’t test positive for HPV, it may be caused by anything that damages the body’s cells, like smoking, or compromises the immune system, like an HIV infection.
Risk factors for cervical cancer
The biggest risk factor for cervical cancer is having a cervix—being a female assigned at birth.
“One of the more scary myths I see about cervical cancer is that gay women or transgender men have less risk of cervical cancer or cannot get it,” Dr. Ghodsi says. “This is not true and they should get screened on the same schedule as heterosexual and cis women.”
Next is your age. This type of cancer is most frequently diagnosed in women aged 35 to 44, with the average age at diagnosis being 50 years old, according to the American Cancer Society. It is rare to find it in women under 20, but more than 20% of cases of cervical cancer are found in women over age 65. However, these cases in older women rarely occur if the woman has been getting regular tests to screen for cervical cancer before they were 65—yet another plug for regular screenings!
Then take a look at your sexual history. Because HPV is the most common cause of cervical cancer and it is a sexually transmitted infection, the earlier a woman becomes sexually active, the longer a woman is sexually active and the more partners she has, the higher her risk of getting HPV.
Other known risk factors of cervical cancer include:
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Smoking
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HIV or a compromised immune system
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A previous chlamydia infection
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Being on the birth control pill for years
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Having multiple full-term pregnancies
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Having a first baby at younger than 20 years old
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Poor nutrition
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A family history of cervical cancer
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Symptoms of cervical cancer
Cervical cancer is often missed in the early stages because cervical cancer symptoms can be subtle and easily mistaken for other things, Dr. Thornton says. In fact, it’s quite common for women to not notice any symptoms at all at the beginning or have “silent symptoms.”
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The symptoms often don’t appear until the cancer becomes larger, growing into nearby tissue. At this stage, the most common symptoms include:
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Bleeding after vaginal sex
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Vaginal bleeding after menopause
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Irregular periods
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Longer, heavier periods
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Unusual discharge from the vagina, either clear or tinged with blood
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Pain during sex
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Pain or pressure in the pelvic region
As the disease advances, other symptoms may include:
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Swollen legs
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Problems urinating or having a bowel movement
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Bloody urine
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Testing for cervical cancer
“With regular testing we can catch it early, while it’s still curable, or even prevent precancerous cells from developing into cancer,” Dr. Ghodsi says. “No woman should die from cervical cancer and we must push for more women to be screened.”
The goal of cervical cancer screening is to find abnormal cells in the cervix or cervical cancer early when it is more treatable and curable. The primary tools for screening for cervical cancer are regular HPV tests and pap smears.
HPV test
During a pelvic exam, the doctor will lightly scrape the surface of your cervix and send those cells to a lab where they will be tested for the high-risk types of HPV that are more likely to cause cancer. Just because you test positive for HPV does not mean it will develop into cancer. HPV infection has no treatment, but the vaccine can help prevent getting it.
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Pap smears
Similarly, the cervical cells gathered during the pelvic exam can be examined under a microscope to look for precancerous changes.
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The American Cancer Society recommends that all individuals with a cervix follow these cancer-screening guidelines:
- Age 25: Get your first cervical cancer screening
- Age 25 to 65: Get a primary HPV test every five years. This may be combined with a Pap smear. Otherwise, if you’re getting just a Pap smear, get one at least every three years. (Many doctors advise that an annual Pap test is preferable.)
- Age 66 and older: If you’ve had a regular screening in the past 10 years with normal results, then you may no longer need screening for cervical cancer.
- The American Cancer Society adds: “If you have a history of a serious pre-cancer, you should continue to have testing for at least 25 years after that condition was found, even if the testing goes past age 65.”
An abnormal pap smear combined with a positive HPV test will alert your doctor to investigate further.
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How cervical cancer is diagnosed
Cervical cells don’t suddenly go from healthy to cancer—rather, it’s a process, Dr. Thornton explains. It starts when normal cells gradually develop abnormal changes that over time can turn into cancer. If your cells are abnormal but not yet cancerous, you’ll likely be diagnosed with “precancer.”
These precancerous cells are graded on a scale of 1 to 3 based on how much of the cervical tissue looks abnormal.
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In stage 1 (or CIN1), most of the tissue looks normal and often the abnormal cells will change back to normal over time.
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In stages 2 and 3 (CIN2 or CIN3), more of the cells look abnormal. This indicates a higher risk that the cells can become cancer and will need to be monitored closely or removed.
All cervical cancers start with abnormal cells, but not every person with abnormal cervical cells will get cervical cancer. In fact, for most women, these abnormal cells will go away without any treatment. But because sometimes they do turn into invasive cancer, screening and follow-up care for all abnormal cells is necessary, Dr. Ghodsi says.
“When caught early, we can prevent precancerous cells from developing into cancer,” Dr. Ghodsi says.
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Treating cervical cancer
Treatments for cervical cancer include surgery, radiation therapy, chemotherapy, targeted drug therapy, and immunotherapy. Which treatments you need will depend on the type of cancer you are diagnosed with and the stage of its progression.
Early stages of cervical cancer are often treated with either surgery or radiation combined with chemotherapy. Later stages are treated with radiation combined with chemotherapy. Chemotherapy on its own is often used to treat advanced cervical cancer. A gynecological oncologist is a doctor who specializes in helping patients find the right treatment plan for cervical cancer.
Preventing cervical cancer
“The best way to prevent cervical cancer is to get the HPV vaccine, and both men and women should get it,” Dr. Ghodsi says.
The first HPV vaccine is recommended for young people around age 12, before sexual activity is started. It is recommended the series of two shots be completed by age 26 for young women and age 21 for young men. After these ages, the vaccine provides little or no protection so it’s not generally recommended.
The vaccine should always be used in combination with regular HPV tests and pap smears—having the vaccine doesn’t remove the need for regular screening, she adds.
Always practice safe sex to reduce your risk of contracting HPV, including using condoms and getting regular STD screenings.
Because there is a connection between stress and HPV infections, doctors also recommend lowering your stress as a way to help prevent cervical cancer.
In addition to reducing your exposure to HPV, recent research has found that women who have ever used an intrauterine device (IUD) had a lower risk of cervical cancer throughout their lifetime, even after the IUD was removed.
And if you are a smoker, the best time to quit smoking is now.
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Additional resources
American Cancer Society: Cervical Cancer
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Kim L. Thornton, MD, a board-certified Reproductive Endocrinologist at Boston IVF and an Assistant Professor at Harvard Medical School.
Pari Ghodsi, MD, an OB/GYN and women's health specialist in Los Angeles, California
Originally Published: January 09, 2024
