What to Know About Cervical Cancer
If you missed sex ed day in school, the cervix is basically a one-inch, tunnel-like organ between the uterus (the hollow organ in the pelvis) and the vagina. Approximately three to six inches into the vaginal canal, it's a spongy barrier you might feel if you, uh, finger yourself deep enough. In fact, deep penetration can bruise your cervix; not visually, but it feels like a bruise.
The cervix is involved in a lot: Period blood, sperm and babies all go through it. Interestingly, it's involved in fertility, too. During ovulation, the cervical mucus is thinner and less acidic, which helps sperm pass through. Additionally, the cervix gets bigger during birth.
And, unfortunately, it's another organ where cancer can develop.
The types of cervical cancer
There are two main types of cervical cancer: squamous cell carcinoma and adenocarcinoma. Most cases of cervical cancer involve squamous cell carcinoma. Adenocarcinoma is also associated with HPV, though it has been known to also occur rarely without HPV infection, said Aldene Zeno, M.D., a urogynecologist who sees patients at the OB-Gyn & Incontinence Center in Glendale and Arcadia, California.
However, there are other types of cervical cancer.
"Occasionally, we see a mixed adenosquamous cell cancer and, even more rarely, we may see a lymphoma, sarcoma, melanoma or small cell carcinoma of the cervix," said Clare Bertucio, M.D., a radiation oncologist in Alaska and CEO of Medicine Mama's Apothecary, based in California.
The two main types are often found in different parts of the cervix, according to Bertucio. She said squamous cell carcinomas develop in the exocervix (the outer part of the cervix), while a small subset of adenocarcinomas develop in the endocervix (the inner part).
Other than getting a Pap smear every three years once you turn 25, unfortunately, you probably won't be able to detect any signs in the early stages of cervical cancer. As it becomes more advanced, however, you may experience pelvic pain or other types of pain during sex, abnormal vaginal bleeding (after sex, between periods or after menopause) or discharge that's watery, bloody, heavy or foul-smelling.
By the numbers
Statistically, an estimated 14,000 people are expected to be diagnosed with invasive cervical cancer in 2023, and about 4,300 people will die from it. Most people are diagnosed between ages 35 and 44.
Cervical cancer is one of the most common causes of cancer-related deaths in American women, though early detection through Pap smears has reduced the rate. Similar to other diseases—and likely due to disparities in healthcare—Hispanic people have the highest rates of cervical cancer, and Black people have the highest rates of dying from it.
The link between HPV and cervical cancer
While smoking, herpes, age, HIV and a weakened immune system are all risk factors for cervical cancer, the main cause is HPV, which accounts for over 95 percent of cases.
HPV (human papillomavirus) is a sexually transmitted infection (STI), though it can be spread through skin-to-skin contact with an HPV wart (the most common symptom), too.
HPV vaccines—Gardasil, Gardasil 9 and Cervarix—can help prevent the development of cervical cancer. Countries that don't have these vaccines, or easy access to Pap smear testing, have higher rates of this cancer.
So how can the virus lead to cervical cancer?
"The HPV virus infects the cells of the cervix, and over time, if the virus is not cleared by the body, [it] causes changes in the DNA of the cells that lead to abnormal and uncontrolled growth," explained Jill H. Tseng, M.D., a gynecologic oncologist with Providence St. Joseph Hospital in Orange, California.
HPV doesn't always lead to cervical cancer, however.
"While it is believed that up to 90 percent of HPV infections may be cleared or become inactive within 12 to 24 months of exposure, the high-risk variants tend to persist and then progress to cancer," Bertucio added.
While there are more than 12 types of HPV that can lead to cervical cancer and are considered high risk, Tseng said, the most common are subtypes 16 and 18.
Again, HPV isn't the sole cause of cancer.
"A small number of cervical cancers—for example, small cell or neuroendocrine types—are not HPV-related, and we don't know exactly why these develop," Tseng said.
What diagnosis and treatment look like
Pap smears can detect cervical cancer, so while they aren't fun, they're important.
"One of the greatest risks for cervical cancer is inadequate screening," Zeno said.
During a Pap smear, a doctor inserts a swab inside your vaginal canal and tests for precancerous cells on your cervix. Otherwise, getting diagnosed usually means getting a biopsy.
It's important to note that Pap smears aren't always the final step in the diagnosis process.
"Sometimes the cervix can be so abnormal that the Pap smear might diagnose cervical cancer," said Laura Purdy, M.D., a physician in Tennessee and the chief medical officer of Wisp, a healthcare provider. "However, sometimes the Pap smear is only slightly suggestive of abnormalities, and an actual biopsy of the cervix is required to give the diagnosis of cervical cancer."
It's essential to get diagnosed as soon as possible. When diagnosed early, the five-year relative survival rate is 92 percent. After the cancer has spread to other tissues, organs or regional lymph nodes, the rate drops to 59 percent.
After the diagnosis, treatment depends on the stage of the cancer, but it may include a hysterectomy, radiation, chemotherapy, a trachelectomy or possibly immunotherapy, according to Tseng.
It is important to know the risks and precautions to take. And while a cancer diagnosis can seem bleak, treatment is available and there is hope.