Dr. Tariq Jagnarine
Family Medicine, Endocrinology/Diabetes

Cervical cancer is a type of cancer that starts in the cervix. Most cervical cancers begin in cells on the surface of the cervix. Cervical cancer used to be a leading cause of death, but that’s changed since screening tests became widely available.
Most cases will be diagnosed in people with a cervix between the ages of 35 and 44. Hispanic, Indigenous and African women are the ethnic groups most likely to get cervical cancer. The death rate from cervical cancer has dropped over the years. From 2002 to 2016, the number of deaths was 2.3 per 100,000 women per year. In part, this decline has been due to improved screening.

HPV is the biggest risk for cervical cancer. Other factors that can increase the risk include:

• Chlamydia
• Smoking
• Obesity
• Family history of cervical cancer
• Diet low in fruits and vegetables
• Birth control pills
• Three or more full-term pregnancies
• Younger than 17 when you got pregnant for the first time

Even if persons have one or more of these factors, they’re not destined to get cervical cancer.

Most cervical cancer cases are caused by the sexually transmitted human papillomavirus (HPV). This is the same virus that causes genital warts. There are about 100 different strains of HPV. Only certain types cause cervical cancer. The two types that most commonly cause cancer are HPV-16 and HPV-18.
Being infected with a cancer-causing strain of HPV doesn’t mean people will get cervical cancer. The immune system eliminates the vast majority of HPV infections, often within 2 years.
HPV can also cause other cancers in women and men. These include:

Vulvar cancer
Vaginal cancer
Penile cancer
Anal cancer
Rectal cancer
Throat cancer

Many women with cervical cancer don’t realize they have the disease early on, because it usually doesn’t cause symptoms until the late stages. When symptoms do appear, they’re easily mistaken for common conditions like menstrual periods and urinary tract infections (UTIs).
Typical cervical cancer symptoms are:
• Unusual bleeding, like in between periods, after sex, or after menopause
• Vaginal discharge that looks or smells different than usual
• Pain in the pelvis
• Needing to urinate more often
• Pain during urination

After being diagnosed, the doctor will assign the cancer a stage. The stage tells whether the cancer has spread, and if so, how far it’s spread. Staging cancer can help with the right treatment.
Cervical cancer has four stages:
Stage 1: The cancer is small. It may have spread to the lymph nodes. It hasn’t spread to other parts of the body.
Stage 2: The cancer is larger. It may have spread outside of the uterus and cervix, or to the lymph nodes. It still hasn’t reached other parts of the body.
Stage 3: The cancer has spread to the lower part of the vagina or to the pelvis. It may be blocking the ureters, the tubes that carry urine from the kidneys to the bladder. It hasn’t spread to other parts of the body.
Stage 4: The cancer may have spread outside of the pelvis to organs like the lungs, bones, or liver.

Cervical cancer is very treatable, once diagnosed early. The four main treatments are:

Radiation therapy
Targeted therapy

Sometimes these treatments are combined to make them more effective.
• Surgery
The purpose of surgery is to remove as much cancer as possible. Sometimes the doctor can remove just the area of the cervix that contains cancer cells. For cancer that’s more widespread, surgery may involve removing the cervix and other organs in the pelvis.
• Radiation therapy
Radiation kills cancer cells using high-energy X-ray beams. It can be delivered through a machine outside the body. It can also be delivered from inside the body using a metal tube placed in the uterus or vagina.
• Chemotherapy
Chemotherapy uses drugs to kill cancer cells throughout the body. Doctors give this treatment in cycles. They will get chemo for a period of time, then stop the treatment to give the body time to recover.
• Targeted therapy
Bevacizumab (Avastin) is a newer drug that works in a different way from chemotherapy and radiation. It blocks the growth of new blood vessels that help cancer grow and survive. This drug is often given together with chemotherapy.

• Cervical cancer test
A Pap smear is a test doctors use to diagnose cervical cancer. To perform this test, the doctor collects a sample of cells from the surface of the cervix. These cells are then sent to a lab to be tested for precancerous or cancerous changes. If these changes are found, doctors may suggest a colposcopy, a procedure for examining the cervix. During this test, the doctor might take a biopsy, which is a sample of cervical cells.
The U.S. Preventive Services Task Force recommends the following screening schedule for women by age:
• Ages 21 to 29: Get a Pap smear once every 3 years.
• Ages 30 to 65: Get a Pap smear once every 3 years, get a high-risk HPV (hrHPV) test every 5 years, or get a Pap smear plus hrHPV test every 5 years.
For cervical cancer that’s caught in the early stages, when it’s still confined to the cervix, the 5-year survival rate is 92 percent. Once cancer has spread within the pelvic area, the 5-year survival rate drops to 56 percent. If cancer has spread to distant parts of the body, survival is just 17 percent.
Routine testing is important for improving the outlook of women with cervical cancer. When this cancer is caught early, it’s very treatable.

One of the easiest ways to prevent cervical cancer is by getting screened regularly with a Pap smear or hrHPV test. Screening picks up precancerous cells, so they can be treated before they turn cancerous.
HPV infection causes most cervical cancer cases. The infection is preventable with the vaccines Gardasil and Cervarix. Vaccination is most effective before a person becomes sexually active. Both boys and girls can be vaccinated against HPV.
Here are a few other ways you can reduce the risk of HPV and cervical cancer:
• Limit the number of sexual partners.
• Always use a condom or other barrier method when having vaginal, oral, or anal sex
• An abnormal Pap smear result indicates that precancerous cells may be in the cervix.