Cervical Cancer: what you need to know

Each year in the U.S., around 11,500 new cervical cancer cases are diagnosed. We asked Dr. Claire Hoppenot, assistant professor of obstetrics and gynecology and member of the Dan L Duncan Comprehensive Cancer Center at Baylor College of Medicine, to share more about this disease, including risk factors, treatment options and more.

Question: What are some cervical cancer warning signs women need to be aware of?

Answer: The first sign of cervical cancer that someone might notice is abnormal bleeding, usually with spotting or bleeding between normal periods or after sex or any bleeding after menopause. As the cancer gets bigger, it can start causing pain, most commonly in the pelvis or the flank/lower back, and affecting the sensation to urinate. Many early cancers, though, have NO symptoms but can be detected on screening tests such as a pap smear.

Q: Are there different symptoms depending on your age?

A: After menopause, all vaginal bleeding should be evaluated. It is not usually cancer, and if it is cancer, it is more likely to be uterine cancer than cervical cancer, but cervical cancer can present with bleeding after menopause. Otherwise, the symptoms are similar regardless of age.

Q: Who’s most at risk for cervical cancer?

A: The main risk factor for cervical cancer is infection with the human papillomavirus (HPV). HPV causes almost all cervical cancers. HPV is a sexually transmitted infection that most sexually active adults have had at some point in their life. Many will clear the virus completely on their own, but for some people, the HPV virus lingers. Over many years, it can slowly cause more and more cellular changes that can eventually become cervical cancer. Before age 30, we check for HPV only if the pap smear cells are abnormal, but after age 30, we check with every pap smear because the body becomes less likely to clear the virus on its own. Unfortunately, there is no treatment for HPV, and it does not cause symptoms, so keeping a close eye on the cervix is important for everyone, especially if there has been a positive HPV test.

Q: Are there certain factors that make you more vulnerable?

A: Because HPV is the cause of almost all cervical cancers, people who have more trouble clearing the virus will be most vulnerable. This is usually due to a weakened immune system. The most common causes include smoking, which leads to increased persistence of the virus, as well as immunosuppression, such as from autoimmune diseases (e.g. lupus, ulcerative colitis) or for people who have had an organ transplant. HIV also increases the risk of cervical cancer by weakening the immune system. We keep a closer eye on high-risk populations through more frequent pap smears. However, most women who get cervical cancer don’t have these risk factors, and we don’t know why their bodies don’t clear the HPV virus, so screening is important for everyone.

Q: What are the best screening methods? Are there any new methods, or is a Pap smear the best option?

A: Pap smears work very well to screen not only for cervical cancer but also for cervical changes that are not cancer yet (dysplasia) and can be treated to avoid cancer completely. The Pap smear is a gentle scraping of the cervix that takes about 30 seconds and checks two things: (1) whether the cells scraped off the cervix look abnormal (if they have made some changes that are inflammatory or actual steps towards becoming cancer) and (2) the presence of the HPV virus. Follow-up is recommended on any abnormality with a closer look at the cervix, such as through a colposcopy and sometimes biopsies that can evaluate where the abnormal cells are in the cervix (if any). Pap smears require an uncomfortable speculum exam of the vagina, which is intolerable for some people, so there have been developments in vaginal swabs that check for the HPV virus. If the HPV virus is detected on a swab, a speculum exam and possible biopsies still will be required.

Q: How is cervical cancer treated?

A: Cervical cancers that are detected very early can be treated with the removal of a part of the cervix (especially for women who want future pregnancy) or a hysterectomy (where the uterus and cervix are removed). Other early cancers are treated with a more extensive hysterectomy known as a radical hysterectomy. Once the tumor has reached the size of a cherry or a small plum, or if it has spread to lymph nodes in the pelvis, chemotherapy and radiation work well to cure many women. Cancers that have spread further require chemotherapy, and in the past few years, we have been using more and more immunotherapy as well. We also have new and exciting targeted treatments that have been helpful for women with advanced cancers.

Q: Are there ways it can be prevented?

A: Because almost all cervical cancers are caused by the HPV virus, the HPV vaccine can prevent cervical cancer! In 2020, a study from Sweden showed that women under 30 years old who had received the HPV vaccine had half the rate of cervical cancer as those who weren’t vaccinated.

The HPV virus protects against the nine most common strains of HPV in the United States, including the two highest-risk HPV strains, 16 and 18/45. It does not work as well for the treatment of cancer or precancer (dysplasia), so we recommend giving it before starting sexual activity. It is a safe vaccine that has been studied for decades. In sexually active people, condoms can help decrease the risk of getting HPV. However, these are not as effective as the HPV vaccine. The HPV vaccine is usually offered around age 11 during routine pediatric immunizations but can be given up to age 45 through most insurances.

It is important that our young boys get vaccinated, too. Not only will it help decrease the amount of HPV women are exposed to, but HPV can cause other forms of cancer, such as penile cancer (although rare), anal cancer or throat cancer.

Q: What do you wish more people knew about cervical cancer?

A: I wish more people understood that the Pap smear works very well to detect changes in the cervix that can lead to cervical cancer so that they can be monitored and then treated before they turn into cancer. At the same time, the Pap smear does NOT work to detect most uterine or ovarian cancers. And not all vaginal or speculum exams come with a Pap smear; the Pap smear requires an extra scraping that is sent to a pathologist for evaluation, which is not something that occurs when you get a speculum exam in the emergency room.

Even more so, I wish more people knew that the HPV vaccine works to prevent cervical cancer. It is a preventable cancer! While I am very excited about some breakthrough treatments that are helping women with advanced or recurrent cervical cancers live longer and better, I would prefer that nobody have to go through any of these treatments.

By Anna Kiappes