What is cervical cancer?

Cervical cancer is one of the most common forms of gynecologic cancer (cancer that starts in a woman’s reproductive system). It occurs when abnormal cells develop and invade a woman’s cervix (the lowest part of the uterus). 

Cervical cancer and HPV 

Most cervical cancers are caused by an infection of the human papilloma virus (HPV). HPV is the most common sexually transmitted infection. Everyone is at risk for HPV infection, no matter your gender or sexual orientation. 

For most individuals, HPV goes away on its own and does not cause problems. For others, it can persist and lead to problems over time, including genital warts or cancers of the vulva, vagina, cervix, anus, or throat. While nearly all cervical cancers are caused by HPV infection, not everyone with HPV will get cervical cancer.

There are multiple strains of HPV. Some strains are known as “high-risk” because they can transform normal cervical cells into pre-cancerous and cancerous cells. The transformation takes years to develop, which is why screening is an important tool. 

Signs and symptoms of HPV infection

There are no signs or symptoms when one gets infected with HPV. In this way it is a silently transmitted infection. The outward sign of HPV infection, though, are warts that occur anywhere in the body, including in the genital area. 

Signs and symptoms of cervical cancer

Cervical cancer rarely has signs or symptoms in its early stages, however abnormal vaginal bleeding or discharge may occur. The majority of signs and symptoms in cervical cancer usually appear in the more advanced stages of the disease when nearby structures are also affected. Those symptoms may include:

  • pelvic or back pain
  • abnormal heavy vaginal bleeding (spontaneous or after intercourse)
  • abnormal vaginal discharge
  • blood in urine or stool, or leakage of urine or stool

Screening for cervical cancer

Cervical cancer is one of only a few types of cancer with tools that allow us to detect abnormal cells before cancer develops or cancer in the early stages when it can be best treated and potentially cured. 

Tests for cervical cancer include the Papanicolaou smear (pap), high-risk HPV testing, and co-testing (both pap smear and HPV assessment). When available HPV-based testing is preferred because it is more sensitive and specific than a pap smear alone. We know that regular screening has reduced the incidence of and deaths from cervical cancer among women. 

Diagnosing cervical cancer 

Regular screening can help identify pre-cancerous cells or cancer in its earliest stages when it is most treatable. For women who do not have routine screening, cervical cancer is usually diagnosed in its later stages, after symptoms develop or a tumor is found. Once diagnosed, imaging studies are used to help determine the extent of disease and a care plan for the individual patient. 

How often should you have screenings?

For most healthy individuals, cervical cancer screening should begin at age 21, with repeat screening as follows:

  • Healthy patients ages 21 to 29: pap smear every three years, or primary high-risk HPV based testing every 5 years starting at age 25. 
  • Patients ages 30-65: pap test cytology every 3 years or co-testing every 5 years or primary HPV testing every 5 years. 
  • If screening identifies any abnormalities, your physician may recommend additional procedures or a repeat co-test in one year depending on the result. 
  • Patients with HIV or other immunocompromised states: screening starts at age 21 but also includes annual physical exam, follow-up, and more frequent screenings throughout the patient's lifetime due to an increased risk of cervical cancer.
  • In patients with no history of cervical disease and negative HPV testing, screening is usually discontinued at age 65, however, can be continued if risk factors are present.

It’s important to note, however, that screening recommendations for cervical cancer vary by age, risk factors and past medical history. Talk with your doctor about a screening schedule that is right for you. 

The stages of cervical cancer

Cervical cancer has four stages, which are based on where the disease is located. In its early stages, the cancer is confined to the cervix. In more advanced stages, the disease spreads to nearby structures such as the vagina, bladder, pelvic sidewalls, and rectum. It can also spread to more distant sites beyond the pelvis, through a process known as metastasis.

Can you prevent cervical cancer?

Appropriate screening and regular visits to your doctor can identify abnormal lesions that are pre-cancerous. These lesions can be removed or treated to prevent the development of cervical cancer. Additionally, we know high-risk HPV is necessary for cervical cancer to develop. Preventing infection of high-risk HPV is key to preventing cervical cancer. 

Can you prevent HPV?

Yes! We can prevent HPV today through HPV vaccination. There is evidence the vaccine reduces the precancerous changes in cells due to HPV. That means it is our best chance at preventing cervical cancer from ever developing. 

Both boys and girls are eligible for vaccination and it is recommended by many medical societies, including the American Academy of Pediatrics. It’s important to understand that even if you are vaccinated against HPV, screening for cervical cancer is still important. 

Don S. Dizon, MD, and Tarra Evans, MD

Dr. Don S. Dizon is an oncologist who specializes in women's cancers. He is the director of women's cancers at Lifespan Cancer Institute and director of medical oncology at Rhode Island Hospital.

Dr. Tarra Evans is a gynecologic oncologist at the Center for Gynecologic Cancers at the Women’s Medicine Collaborative.