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Cervical Cancer – Symptoms, Causes, and Management

Medically reviewed by Dr. Sadaf Iftikhar, MBBS, FCPS—Written by Dr. Ramisha Farooq, MBBS on August 14, 2021.

Cervical cancer is the result of abnormal growth in the cells of the narrow, lower part of the uterus that connects to the vagina. This usually involves the cells of the surface of the cervical lining at the beginning but later spreads into the deeper tissues of the cervix and other parts of the body. It is the leading cause of death among women of reproductive age all over the world but regular screening and timely diagnosis provide a good prognosis.

Symptoms of cervical cancer

Cervical cancer is asymptomatic in the beginning but as it progresses some noticeable symptoms are present. Some of the most commonly experienced symptoms are:

  • Pain in the pelvis, that is dull in character but sometimes intermittent, sharp pains along with a feeling of pressure are also experienced
  • Dyspareunia
  • Vaginal bleeding after sexual intercourse
  • Inter menstrual bleeding
  • Postmenopausal bleeding
  • Smelly vaginal discharge
  • Dysuria
  • Urinary incontinence
  • Sudden weight loss
  • Loss of appetite
  • Lethargy and fatigue
  • Dizziness
  • Pedal edema

Causes of cervical cancer

Most of the cases of cervical cancer is due to human papilloma viral infection, which is a sexually transmitted disease. Human papillomavirus has more than 100 strains but HPV 16 and HPV 18 are responsible for this cancer. The body’s immune system fights against the viral infection in the beginning but the HP virus survives for years, allowing the cervical cells to enter an abnormal growth pattern and become cancerous. 

Types of cervical cancer

There are different types of cervical cancer depending upon the types of cells involved:

  • Squamous cell carcinoma begins in the squamous cells, which line the outer part of the cervix. These are thin, flat cells that cover the cervical os, the structure that projects into the vaginal canal. This is the most common type of cervical cell carcinoma.
  • Adenocarcinoma affects the glandular cells in the cervical canal. These cells are responsible to produce mucus.
  • Mixed carcinoma involves both types of cells.

Stages of cervical cancer

Stages of cancer are useful in planning out the treatment and assessing the severity and spread of cancer. There are 5 stages of cervical cancer, stage 0 being the least harmful to stage 4 being the most malignant.

  • Stage 0: Only precancerous cells are seen in the squamous cell layer
  • Stage 1: Cancerous cells start invading into deeper tissues of the cervix from the surface epithelium. The spread is as far as into the uterus and neighboring lymph nodes
  • Stage 2: Cancer has spread beyond the cervix and uterus but the peritoneum and lower part of the vagina is still unaffected
  • Stage 3: Pelvic walls and lower end of the vagina also contain cancerous cells. The cells may also block the ureters by continuous growth
  • Stage 4: Cancer has spread to distant areas including lungs, bones, brain, liver, and lymph nodes

Risk factors

Human papillomavirus is the largest risk factor but there are some other factors that may contribute, some of these are:

  • Family history
  • Precancerous conditions
  • Immune deficiency
  • Use of contraceptive pills
  • Obesity
  • Smoking
  • Alcohol consumption
  • Chlamydial infection
  • Other sexually transmitted diseases
  • Early pregnancy
  • Multiple full-term pregnancies
  • Early menarche
  • Multiple sexual partners
  • Sexual intercourse at a very young age
  • Bad hygiene

Complications of cervical cancer

Complications due to cervical cancer range from minor to life-threatening:

  • Urinary incontinence
  • Dysuria
  • Abnormal vaginal bleeding
  • Anemia
  • Kidney failure

How to prevent cervical cancer?

This is one of the very few preventable carcinomas before their precancerous cells develop into cancer. This can be done by:

  • Regular screening with pap smear
  • Maintain hygiene
  • Avoid multiple sexual partners
  • Use protection while having sexual intercourse
  • Get vaccinated for HPV
  • Delay first sexual intercourse
  • Abstain from drinking too much alcohol

Screening for cervical cancer

Screening is recommended as per the schedule:

  • Age below 21 years: No screening is recommended
  • The age group of 21 to 29: Pap smear every 3 years
  • The age group of 30 to 65: Depending upon the result of previous screening, you have to get screened every 3 years, or get screened for HPV every five years, or for both HPV and cervical cancer every 5 years.
  • Over the age of 65 years: In case of negative tests results of prior screenings, no further screening is required.

Management of cervical cancer

Cervical cancer is a common type of cancer in females but can be easily diagnosed and treated by taking a few measures.

Diagnosis

  • Pap smear for HPV can detect precancerous lesions
  • HPV DNA testing can determine the high-risk strain of HPV which is responsible for causing abnormal changes in cervical cells
  • Visual examination of cervix by Colposcopy
  • Biopsy of cervical cells, cone biopsy is mostly done to assess the deeper layers as well
  • LEEP, loop electrosurgical excision procedure, involves taking a sample by using an electrified wire
  • Cervical curettage to scrape tissue from the cervix
  • Blood test to identify any infection
  • Tumor markers to detect the cancer
  • Ultrasound of pelvis can be used to rule out other causes
  • MRI to detect cancer in the early stages
  • MRI or PET scan for lymph node involvement
  • Some other investigations can also be advised to assess the degree of metastasis and staging of cancer:
  • Chest X-ray to examine the lungs
  • CT scan for liver
  • Intravenous pyelogram for urinary tract
  • Barium enema for rectum

On-time diagnosis of cervical cancer helps in the successful treatment of the condition.

Treatment

The treatment plan is made based on the extent of the disease.

Precancerous lesions:

  • LEEP conization, cauterization, cryosurgery, or laser is employed to destroy the precancerous lesions while protecting the surrounding healthy tissue.
  • Pap smear follow-ups are required to ensure complete removal of precancerous cells.
  • Elderly patients who don’t wish to conceive in the future can also opt for a hysterectomy.

Cervical Cancer:

Surgical treatment, chemotherapy, and radiation therapy are the most commonly employed treatment options.

  • In the early stages of cervical cancer, the abnormal cells can be removed with cold knife conization or LEEP.
  • If the cancerous cells have exceeded the basement membrane, surgical excision of the tumor is required.
  • Trachelectomy involves removal of the cervix and some of the surrounding tissue, this preserves the uterus and is done in females who wish to get pregnant in the future.
  • If cervical cancer is metastatic, all affected organs are also surgically conserved by excising the abnormal tissue.
  • Radiotherapy is used after surgical treatment to damage the cancer cells and stop their further growth. Radiation therapy can be given externally, by using external beam radiation at the affected area, or internally by placing a device, inside your vagina, containing radioactive material.
  • Chemotherapy involves strong drugs to kill the cells, but this also affects healthy sales and is an extremely painful treatment option.
  • Immunotherapy is used to set on or off an immune response. Pembrolizumab is used to block a certain protein on cancerous cells, thus, hindering their growth.
  • Targeted therapy is used for advanced cancer and focuses primarily on certain weaknesses present within the cancerous cells and targeting a drug to kill these cells. This is often used in combination with chemotherapy for optimal results.
  • Supportive treatment is only used to provide relief from discomfort and pain caused by the illness and its treatment.

Lifestyle changes and home remedies

Cervical cancer cannot be treated at home but the condition and the mental stress that accompany it can be eased by taking small steps:

  • Take right nutrition, your body needs a lot of strength to cope with the disease
  • Mild physical activity should be regularly done to keep the energy levels up
  • Quit alcohol and smoking
  • Take regular naps and don’t wear yourself out
  • Join cancer support groups to discuss your concerns and feelings regarding the illness
  • Do not skip regular screening and follow-ups

When to consult a doctor?

If you have been infected with HPV you should get a screening test for cervical cancer as soon as possible. Other than this, some symptoms should be closely observed and need immediate medical assistance. These are; abnormal vaginal bleeding and discharge, after sexual intercourse, pain in the lower back, unexplained weight loss, lack of appetite, and many more.

FAQ

Is cervical cancer curable?

Cervical cancer is one of the few preventable and treatable cancers that affect women in their reproductive ages. Regular screening and on-time diagnosis can improve the chances of survival.

What are the early warning signs of cervical cancer?

Some of the early warning signs of cervical cancer are:

  • Vaginal bleeding
  • Dyspareunia
  • Abnormal vaginal bleeding and discharge
  • Weight loss
  • Painful and swollen legs

How do you get cervical cancer?

The most common cause of cervical cancer is human papillomavirus infection which is a sexually transmitted infection.

Last medically reviewed on August 14, 2021.