Understanding Cervical Cancer and
How To Manage It

Your guide to understanding all aspects of cervical cancer

“I have cancer. Cancer doesn’t have me.”
Marco Calderon

Early detection and diagnosis always increase your chances of receiving successful treatment and beating all forms of cancer – especially cervical cancer. Detecting cervical cancer early will significantly boost your odds of survival. Hence, it is important to adhere to the recommended screening protocol for your age group so that you and your physician can detect and test any anomalies or changes.

You can read the section that details the various types of cancer before embarking on the journey to understand cervical cancer better. Read more

Let’s understand
the anatomy first

Gynecological cancer which starts in a woman’s cervix is called cervical cancer. The cervix is the narrow, lower end of the uterus or womb and connects the uterus to the vagina or the birth canal. It is covered with a layer of skin-like cells on its outer surface, which is called the ectocervix. There are glandular cells on the inside of the cervix, which are scattered along the inside of the passage running from the cervix to the womb. This passage is called the endocervical canal and the layer of these cells forms the endocervix that produces cervical mucus.

What is cervical cancer?

Cervical cancer usually develops slowly over time. It begins when healthy cells in the cervix start mutating or changing. Such mutations cause these cells to grow rapidly and prevent cell death. The accumulation of these abnormal cells forms a malignant mass or tumour. Often, the cancer cells invade nearby tissues and may break off from a tumour to spread or metastasize to other parts of the body.

Types of Cervical Cancer

There are two main types of cervical cancer and they are named after the type of cells which become cancerous

Squamous cell cervical cancer

The skin-like cells of the ectocervix may become cancerous and lead to a squamous cell cervical cancer. This is the most common variety of cervical cancer. It is estimated that that between 70 to 80% of all cervical cancers are squamous cell cancers.

Adenocarcinoma of the cervix

The glandular cells of the endocervix may also become cancerous and lead to an adenocarcinoma of the cervix. It is estimated that more than 10% of all cervical cancers are adenocarcinomas.

There are other rarer types of cervical cancer as well:

Adenosquamous cancer

There is a rare type of cervical cancer called adenosquamous cancer, which is a tumour that affects both squamous and glandular cancer cells. This is a rare type of cervical cancer. It is estimated that around 5 to 6% of cervical cancers are this type.

Small cell cancer

Small cell cancer is another very rare type of cervical cancer that affects specialized hormone producing cells called neuroendocrine cells. About 3% of cervical cancers are estimated to be such neuroendocrine cancers.

Cervical cancer occurs more often in women who are over the age of 30 and is the only gynecologic cancer which can be prevented through routine screening tests. The risk of cervical cancer is eliminated in women who have had their cervix removed during a hysterectomy.

What causes CERVICAL cancer?

While it is not always clear what causes cervical cancer, there are several strains of the human papillomavirus (HPV)5 – one of the most common viral infections of the reproductive tract – which may play a role in causing most cervical cancers. There are several types of HPVs and many do not cause any harm. The immune system typically prevents this virus from causing damage and most people with the virus never develop cancer. However, in a small percentage of people, the virus survives for years and may contribute to the mutation of cervical cells, which in turn results in cancer.

What are the Risk Factors?

While most cervical cancers are caused by HPV, there are other factors which may increase your risk

Having a family history of cervical cancer

Presence of sexually transmitted infections (STIs) – such as chlamydia, gonorrhoea and syphilis

Presence of HIV/AIDS – this makes it hard for the body to fight off infections and increases the risk of HPV infections

Having a weakened immune system

Long-term use of oral contraceptives (birth control pills)

Frequent smoking – studies have shown that this can cause certain types of cervical cancer

What Can be Done
to Lower Your Risk of Getting Cervical Cancer?

Based on your age, overall health and personal risk factors for cervical cancer, there are some things that can be done to prevent pre-cancers and conditions that can lead to pre-cancers

Talk to your doctor about getting an HPV vaccine
Practice safe sex
What are the Symptoms?

Women with early-stage cervical cancer may not display any symptoms. Symptoms often do not begin until the cancer grows larger and spreads to nearby tissue. When this happens, you may experience

Abnormal vaginal bleeding (such as bleeding after vaginal sex, bleeding after menopause, bleeding or spotting between periods, or experiencing periods that are longer or heavier than usual)

Abnormal discharge from the vagina

Pelvic pain, or pain during sex

Swelling of the legs

Problems urinating or passing bowel movements

Blood in the urine

Screening for cervical cancer

Cervical cancer occurs only in women. If you experience any of the signs and symptoms listed above, make an appointment with your doctor for prompt evaluation. Screening tests may be done when you have no cancer symptoms at all. 

The main objective of cervical screening is to detect precancerous changes in cervical cells, which if untreated have a potential to develop into cancer. The secondary objective is to find cervical cancer at an early stage, when treatment is usually more successful.

It is important to remember that your physician does not necessarily think you have cancer if he or she suggests a screening test. They could just be following a normal screening protocol for your age group.

Screening tests for cervical cancer
The Pelvic Exam

What to expect

A pelvic exam is a part of a woman’s routine medical check-up. Pelvic exams can help diagnose certain types of cancers, as well as reproductive problems. A Pap test can be done during a pelvic exam , but sometimes a pelvic exam is done without a Pap test. A Pap test is needed to find early cervical cancer or pre-cancers so ask your doctor if you need a Pap test along with your pelvic exam.

A pelvic exam is generally pain-free, unless you have an underlying condition that causes pain to your pelvic area. You can expect some minor discomfort while undergoing the test. It is important that you choose a doctor and clinical team that you are comfortable with to perform your check-up. 

During a pelvic exam: 

  • You will first be asked to undress the lower part of your body and lie on your back on the examination table. Ask for a sheet or blanket to cover yourself while you wait for your doctor.
  • Try to relax your pelvic area, as this will make the exam more comfortable for you.
  • Your doctor will look at your pelvic area and feel your reproductive areas. It is normal for your doctor to insert his/her gloved fingers into your vagina as part of the test.
  • Your doctor may also do routine screening tests for sexually transmitted diseases by taking a swab of cells.
  • The collected samples are then examined in the lab for any abnormalities.
  • The pelvic exam itself should take around 5-10 minutes. If you experience any pain, be sure to inform your doctor.
The Pap Test

What to expect

A Pap (Papanicolaou) test or Pap smear is done to detect abnormal cells in the cervix and cells which may show certain changes, indicating an increased risk of cervical cancer.

A Pap test is generally pain-free, unless you have an underlying condition that causes pain to your pelvic area. You can expect some minor discomfort while undergoing the test. It is important that you choose a doctor and clinical team that you are comfortable with to perform your test. Your clinician may tell you to avoid doing the test during your menstrual period.

How the Pap test is done:

  • You will first be asked to undress the lower part of your body and lie on the examination table. Ask for a sheet or blanket to cover yourself while you wait for your doctor.
  • Try to relax your pelvic area, as this will make the exam more comfortable for you.
  • Your doctor will first place a speculum inside your vaginal opening. The speculum is a metal or plastic instrument that keeps the vagina open so that the cervix can be seen clearly.
  • Your doctor may also do routine screening tests for sexually transmitted diseases by taking a swab of cells.
  • Next, using a small spatula or brush, your doctor will gently scrape a sample cells and mucus from your exocervix.
  • A small brush or cotton-tipped swab is then inserted into the opening of the cervix to take a sample from the endocervix.
  • If your cervix has been surgically removed (during a trachelectomy or hysterectomy), the cells from the upper part of the vagina (known as the vaginal cuff) will be sampled.
  • The collected samples are then examined in the lab for any abnormalities.
  • The test itself should take 5-10 minutes.
HPV DNA test

What to expect

The HPV DNA test involves testing cells collected from the cervix to determine presence of infections attributable to specific HPV types which are associated with a high risk of cervical cancer

Pap / HPV cotest

What to expect

This is a procedure in which an HPV test and a Pap test are done at the same time, to check for cervical cancer. The same cell sample may be used for the HPV test and the Pap test. Cotesting is more likely to detect abnormal cells or cervical cancer than if a Pap test or HPV test is done alone.

Diagnostic tests for cervical cancer

If the screening protocol detects abnormalities, your doctor may recommend further follow-up diagnostic tests to confirm if cancer is present. Refer to this section for more information about diagnostic tests for cervical cancer. Read more

Staging Cervical Cancer

If your doctor confirms that you have cervical cancer, some additional tests may be used to determine

If the disease has spread beyond the cervix (i.e. determine the stage of cancer)

How quickly the cancer will grow

How likely it is to spread through the body

What sort of treatments might work

The likelihood of the cancer to recur (come back)

The stage of your cancer is a key aspect in determining your treatment. Refer to this section to understand your cancer diagnosis and for more information about how cervical cancer is staged. Read more

Treatments for
cervical cancer
Treatment for cervical cancer depends on several factors, like the type and stage of your cancer, or other health problems you may have. Surgery, chemotherapy, radiation, or a combination of all three may be used. Refer to this section to understand the types of cancer treatments and their effects. Read more
Your cancer journey
Everyone deals with a cervical cancer diagnosis and treatment in a different way. Refer to this section, to understand various aspects of your cancer journey and the road to recovery. Read more
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