All your questions about cervical cancer: Answered 

Cervical cancer can most often be successfully treated if diagnosed early. But, first, it is essential to understand what the disease is and get screened for it. 

So, here’s all the most common questions about cervical cancer – answered.

What is cervical cancer? 

This type of cancer occurs in the cells of the cervix. The cervix is the lower portion of your uterus and lies in the upper part of the vagina – forming a connection between your vagina and uterus. Most cervical cancers are caused by some human papillomavirus strains (HPV) – a sexually transmitted infection. 

WHO cancer statistics

As per a study published in the Annals of Global Health, India accounts for about one-fourth of the world’s cervical cancer deaths. This mostly preventable disease is the second most common cause of cancer mortality among Indian women [4] with 60,078 deaths and 96,922 new cases in 2018 [2, 3]. 

What are the signs and symptoms of cervical cancer?

Cervical pre-cancers or cervical cancers do not cause any pain or other symptoms in the early stages, which is why women need to get regular pelvic exams and pap smears to detect the presence of cancer at the earliest stage possible. 

Some of the most common symptoms of cervical cancer are: 

• Abnormal vaginal bleeding, especially after intercourse, between menstrual periods or after menopause. In menstruating women, they may experience heavier than normal bleeding that lasts longer than usual. 

• Pain during intercourse

• Pelvic pain

• Vaginal discharge with a foul odour. 

In some instances, if cervical cancer has spread to other parts of your body, symptoms may include: 

• Blood in urine with/without pain while urinating. 

• Swelling in the legs and dull ache in the back. 

• Pain and bleeding from the rectum on passing motion

• Diarrhea

• Unintended weight loss, loss of appetite and fatigue

• Malaise (general feeling of illness)

• Nausea

• Vomiting

• Constipation

• Swollen abdomen

What treatments exist for cervical cancer?

Cervical cancer is usually very treatable –especially if caught early. Once diagnosed, there are several treatment modalities that can relieve symptoms and help you live longer. 

First, your doctor will determine cancer’s stage and see if it has spread to other parts of the body. The treatment your doctor chooses is based on the results of these tests and other factors, including your age and whether you want to maintain your ability to have children.

Some common treatments include:

• Radiation therapy

• Chemotherapy

• Surgery 

• Targeted therapy.

What is cervical cancer screening?

Screening for cervical cancer is usually part of a regular woman’s health check-up. This test is essential since it helps detect cancerous cells or abnormal cells that are likely to become cancerous later in life. 

Cervical cancer screening includes:

Pap smear: During a pap smear, your doctor will take a few cells from your cervix to be examined in a lab for abnormalities. 

HPV DNA test: This test is also performed by testing cells taken from your cervix for the presence of any types of HPV that might be present. The cells are also tested for any kind of abnormal cells that could lead to cervical cancer.  

How is cervical cancer diagnosed?

If your doctor suspects cervical cancer, he/she is likely first to do a thorough examination of your cervix using a particular magnifying instrument (colposcope) to look for abnormal cells.

During this examination, your doctor will take a sample of your cervical tissue (also known as a biopsy) for laboratory testing. To obtain tissue, your doctor may use any of the following methods: 

• Punch biopsy: A process where a tool is used to pinch off a small sample of cervical tissue.  

• Endocervical curettage: Here a small instrument is used to scrape tissue from the cervix for further laboratory analysis.  

If an analysis of your cervical tissue shows any abnormalities, he/she may perform one of the following tests: 

• Electrical wire loop: Uses a thin, low-voltage electrified wire to get a small tissue sample. 

• Cone biopsy (conization): This procedure helps your doctor gain access to the deeper layers of cervical cells for laboratory testing.

Why does cervical cancer occur?

Cervical cancer is an abnormal mutation of the cells in your cervix, leading to cancer. Modifications can occur due to many reasons, including exposure to HPV (Human Papilloma Virus). This virus is usually spread via sexual contact with a person carrying the virus. 

Is cervical cancer linked to other cancers like breast cancer, ovarian cancer, uterine cancer or colon cancer?

Women who have had cervical cancer might be at a higher risk of suffering from certain cancers, including: 

• Cancer of the throat and mouth

• Cancer of the larynx (voice box) 

• Anal cancer 

• Acute myeloid leukaemia 

• Vaginal and vulvar cancer 

• Lung cancer 

• Bladder and ureter cancer 

• Stomach cancer 

• Pancreatic cancer 

Many of these cancers are linked to smoking and infection with HPV – both of which are linked to cervical cancer. 

AML (acute myeloid leukaemia), cancers of the rectum, bladder and bone have also been linked to radiation treatment.  

Can cervical cancer be cured?

Cervical cancer is very successfully treatable if it’s diagnosed early. If cervical cancer is not curable, treatment can help slow its progression, prolong lifespan and relieve any associated symptoms, such as pain and vaginal bleeding.

Can cervical cancer kill you?

It’s estimated that about 160 million women aged 30-59 years are at risk of developing cervical cancer in India. With nearly 77,300 new cases diagnosed annually and 37,800 deaths, cervical cancer has a fatality rate of 49 per cent.

Can cervical cancer spread (is it communicable)?

Unlike bacterial or viral conditions, cervical cancer cannot spread from person to person either by kissing or exchanging saliva in some way, by sharing utensils or a toothbrush, having sex (protected or unprotected) or by coming into contact with the blood of someone who has cancer.

How fast does cervical cancer spread?

The progression of an HPV infection to cervical cancer is very slow and often takes 10 to 20 years. Once cervical cells begin to undergo abnormal changes, it may take several years to grow into invasive cervical cancer. Statistically, several women experience precancerous changes in the cervix in their 20s and 30s, though the average woman with cervical cancer is diagnosed in her 50s.

How does cervical cancer affect the body?

Some of the common symptoms of cervical cancer:

• Abnormal vaginal bleeding

• Pain during intercourse

• Vaginal discharge with a foul odour

• Pelvic pain

How is cervical cancer transmitted?

Cervical cancer per se, cannot be transmitted from one person to another. The virus (HPV) is a leading cause of cervical cancer mainly transmitted through sexual contact with an infected person. 

Why does cervical cancer cause bleeding and back pain?

Vaginal bleeding is a common symptom of cervical cancer and is caused due to the mutation of cells in the cervix – causing vaginal bleeding. As for back pain, this is another symptom of cervical cancer caused due to the spread of cancer to either your bones, lymph nodes, ureters and bladder.  

Can you get pregnant if you have cervical cancer?

The treatment for cervical cancer can affect your fertility, making it difficult to conceive. But infertility after cervical cancer is not inevitable; some measures can be taken to preserve your fertility. 

Can I get cervical cancer, if I’ve never had sex? 

It is very rare that women who have never had sex develop cervical cancer. Although becoming sexually active at a young age can increase a woman’s risk of developing cervical cancer. 

Can cervical cancer recur?

Cervical cancer has a very low recurrence rate when detected early. But about 35 per cent of patients with invasive cervical cancer do tend to have a recurrence. 

Can cervical cancer be prevented?

Cervical cancer can be prevented by having regular screenings to find any precancers and treat them and receiving the HPV vaccine.

Is cervical cancer hereditary?

Though some female-related cancers, such as breast cancer and ovarian cancer, are passed down from parent to child, cervical cancer is not.

Can men have cervical cancer?

No, men cannot have cervical cancer, but they can be infected with HPV and cause penile cancer and anal cancer.

What is the cervical cancer vaccine?

Your immune system typically prevents the HPV virus from doing any harm when you’re exposed to HPV. However, in some people, the virus survives for years, contributing to some cervical cells to become cancerous [5]. 

This risk can be reduced by having screening tests and getting the HPV vaccine. This vaccine can help protect women and girls before they’re exposed to the virus. 

Dr Ashay Karpe, medical oncologist and haematologist, Sunrise Oncology Centre says, “Ideally the vaccine should be given at least two to three years before expected sexual exposure. This means that any woman who is likely to be sexually active in the next two to three years should get the vaccine. The age of administering the vaccine has changed in India. Earlier it was recommended that a woman be vaccinated after marriage. But, with the change in trends and women becoming sexually active early, it is better to administer the vaccine early. It recommended that the vaccine be administered anywhere between the ages of 12 to 13 years. The maximum age that a woman can take the vaccine is 26 years, after which there isn’t much benefit of the vaccine.”

Should women get the HPV vaccine, and is it effective? 

Dr Ashay Karpe, medical oncologist and haematologist, Sunrise Oncology centre says, “Cervical cancer is only cancer till date, where the use of a vaccine can prevent that. The other being hepatocellular cancer where there is now a recommendation to be vaccinated with the hepatitis B vaccine. But all women should get the HPV as it has been studied to be effective and helps prevent cervical cancer.”

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References

1. 1] HPV vaccine information for clinicians. Centres for Disease Control and Prevention. http://www.cdc.gov/hpv/hcp/clinician-factsheet.html. Accessed April 5, 2019.

2]Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015; 136(5): E359–386. DOI: https://doi.org/10.1002/ijc.29210  

3] Bruni L, Albero G, Serrano B, et al. Human Papillomavirus and Related Diseases Report. Information Centre on HPV and Cancer (HPV Information Centre); 2019. https://hpvcentre.net/statistics/reports/XWX.pdf.  

4]Kadam Y, Dhobale R, Gore A, Tripathi N. Barriers for early detection of cancer amongst Indian rural women. South Asian J Cancer. 2014; 3(2): 122. DOI: https://doi.org/10.4103/2278-330X.130449  

5] Jemal A, Center MM, DeSantis C, Ward EM. Global Patterns of Cancer Incidence and Mortality Rates and Trends. Cancer Epidemiol Biomarkers Prev. 2010; 19(8): 1893–1907. DOI: https://doi.org/10.1158/1055-9965.EPI-10-0437  

1. 5] Cervical cancer treatment — Patient version. National Cancer Institute. http://www.cancer.gov/types/cervical. Accessed July 9, 2016.

6] Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin [Internet]. 2018 Nov;68(6):394–424. Available from: http://dx.doi.org/10.3322/caac.21492 pmid:30207593