Cervical Cancer: HPV, Symptoms, Screening, Treatment and Prevention

What it is

Cervical cancer starts in the cells of the cervix, the lower, narrow end of the uterus (womb), which opens into the vagina (birth canal). It usually develops slowly: cells first turn abnormal — "precancers" — and if they aren't destroyed or removed, can become cancer that grows and spreads. Screening finds abnormal cells so they can be treated before they become cancer, and finds cancer early, when it's usually easier to treat.

What causes it

Almost all cervical cancers come from a long-lasting infection with human papillomavirus (HPV). Of its many types, the ones that cause cancer are "high-risk HPV" — which is very common. It spreads through close skin-to-skin contact, usually during vaginal, anal or oral sex, and most people who have it have no symptoms. Usually the immune system clears it within a year or two, but if not, it can last for years and gradually turn normal cervical cells abnormal, and then cancerous.

Who is at higher risk

Cervical cancer is most common after age 30. With a high-risk HPV infection of the cervix, you're more likely to develop it if you:

• have a weakened immune system, from a disease such as HIV or from medicines that suppress immunity (for some cancers or autoimmune diseases);
• smoke or breathe secondhand smoke;
• use birth control pills, or have given birth to many children;
• have obesity;
• were exposed before birth to DES (diethylstilbestrol), a drug sometimes given in pregnancy from 1940 to 1971 to prevent miscarriage and later linked to health problems, including cervical cancer.

Symptoms

Early cervical cancer usually has no symptoms. Later symptoms may include:

• abnormal vaginal bleeding, such as after sex or between periods;
• watery vaginal discharge with a strong odor or blood;
• pelvic pain or pain during sex.

If it spreads, there may also be difficult or painful bowel movements or rectal bleeding, difficult or painful urination or blood in the urine, a dull backache, swollen legs, belly pain and fatigue.

Diagnosis

After symptoms or an abnormal screening result, your provider will take your medical and family history, do a pelvic exam, and may suggest:

• colposcopy — examining the cervix for abnormal areas with a device called a colposcope;
• cervical biopsy — removing a small tissue sample to look for cancer under a microscope, usually in the provider's office.

Treatment

The best treatment depends on your health, how much cancer there is, whether it has spread, and your preferences. You may have more than one:

• surgery to remove the cancer;
• radiation therapy, from a machine or from a radioactive source placed near the cancer;
• chemotherapy, as pills or through a vein;
• targeted therapy, which blocks cancer cells' growth and spread;
• immunotherapy, which helps the immune system fight the cancer.

Prevention

Almost all cervical cancer can be prevented by:

• HPV vaccination — most protective before exposure to HPV, so best before becoming sexually active; experts recommend vaccinating children at ages 9 to 12;
• routine screening — a Pap smear, which looks for abnormal cells, and an HPV test, which looks for high-risk HPV, both from a swab of cervical cells;
• the right follow-up treatment when screening finds abnormal cells or high-risk HPV.

Not smoking lowers your risk. Condoms, used correctly, lower the chance of HPV infection though they don't prevent it completely, and condom use has been linked to fewer cervical cancers; polyurethane condoms are an option for a latex allergy.

Sources

Based on "Cervical Cancer," MedlinePlus, National Library of Medicine, with its summary from the National Cancer Institute, National Institutes of Health; a work of the United States government in the public domain.