Cervical cancer is a serious but often preventable disease that begins in the cells of the cervix—the lower part of the uterus that connects to the vagina. Most cases result from a persistent infection with high-risk types of human papillomavirus (HPV), a very common virus transmitted through sexual contact. While the immune system clears HPV naturally in most individuals, long-term infections can cause precancerous changes in cervical cells, eventually developing into cervical cancer if left untreated. With the availability of vaccines and screening tests, the burden of cervical cancer can be significantly reduced.

Types of Cervical Cancer

Cervical cancer is categorized based on the type of cell where the abnormal changes begin. These types include:

  • Squamous Cell Carcinoma: The most common form, accounting for about 90% of all cervical cancer cases. It arises in the squamous epithelial cells covering the outer surface of the cervix (ectocervix).
  • Adenocarcinoma: Develops in the glandular cells of the endocervix, the inner part of the cervix that produces mucus. Though less common, its incidence is gradually increasing.
  • Adenosquamous Carcinoma (Mixed Carcinoma): Contains both squamous and glandular cancer cells. It’s relatively rare but can behave more aggressively.
  • Small Cell Neuroendocrine Carcinoma (SCNEC): A rare and highly aggressive type that often spreads quickly and is usually diagnosed at a later stage.

Understanding the type of cervical cancer helps oncologists design the most appropriate treatment plan.

Warning Signs and Symptoms

One of the challenges of cervical cancer is that it often produces no noticeable symptoms in its early stages. This makes regular screening vital for early detection. When symptoms do appear, they can vary depending on the extent of the disease.

Early-stage symptoms may include:

  • Vaginal bleeding after sex, between periods, or post-menopause
  • Watery or bloody vaginal discharge with a foul odor
  • Pelvic pain or pain during intercourse

Advanced-stage symptoms may include:

  • Pain during urination or bowel movements
  • Persistent back, leg, or pelvic pain
  • Swelling in the legs
  • Unintended weight loss or fatigue
  • Difficulty urinating or defecating

While these symptoms can be caused by other conditions, it’s essential to see a healthcare provider for evaluation if they occur.

Causes and Risk Factors

The main cause of cervical cancer is long-lasting infection with high-risk types of HPV, particularly HPV types 16 and 18, which together account for over 70% of cases. HPV is so common that nearly all sexually active individuals are exposed to it at some point, but only a small proportion will develop cancer.

Risk factors that increase the likelihood of persistent HPV infection or progression to cancer include:

  • Multiple sexual partners or having sex with someone who has had many partners
  • Early sexual activity
  • Smoking, which impairs immune function in cervical tissues
  • Long-term use of oral contraceptives (over 5 years)
  • HIV or other conditions that weaken the immune system
  • A history of sexually transmitted infections (e.g., chlamydia, herpes)
  • A family history of cervical cancer
  • Poor access to regular screening and HPV vaccination

HPV alone does not cause cancer; the progression depends on host factors and immune response. Therefore, addressing modifiable risk factors is crucial in prevention.

Screening and Early Detection

Routine cervical cancer screening is one of the most effective ways to detect precancerous changes and prevent cancer development. The two primary tests used for screening are:

  • Pap Smear (Pap Test): Detects abnormal cells in the cervix before they become cancerous. Recommended every 3 years for women aged 21–29 and every 3–5 years for women 30 and older.
  • HPV Test: Identifies high-risk types of HPV. Often used in combination with a Pap test (co-testing) for women over 30.

Both tests are quick, minimally uncomfortable, and can be done during a routine pelvic exam.

Diagnostic Tools

If screening reveals abnormal results, additional tests may be ordered to confirm a diagnosis:

  • Colposcopy: A magnified visual inspection of the cervix using a colposcope. Special stains may highlight abnormal areas.
  • Biopsy: A small sample of cervical tissue is removed and analyzed for cancerous or precancerous changes.
  • Endocervical Curettage: Cells are scraped from inside the cervical canal to examine further.
  • Cone Biopsy: A larger, cone-shaped section of tissue is removed for examination.

These procedures help determine the extent and severity of abnormal changes.

Staging Cervical Cancer

Once cervical cancer is diagnosed, staging determines how far the cancer has spread. Accurate staging is essential for choosing appropriate treatments.

  • Stage 0 (Carcinoma in situ): Abnormal cells are present only in the surface layer of the cervix.
  • Stage I: Cancer is confined to the cervix.
  • Stage II: Cancer has spread beyond the cervix and uterus but not to the pelvic wall or lower vagina.
  • Stage III: Cancer involves the pelvic wall or lower part of the vagina; may block the ureters.
  • Stage IV: Cancer has spread to nearby organs (like the bladder or rectum) or distant organs (lungs, liver).

Treatment Options

Cervical cancer treatment depends on the stage, overall health, age, and desire for fertility preservation. Common treatments include:

1. Surgery:

  • Cryosurgery or Laser Ablation: Used to destroy abnormal cells in early stages.
  • Conization: Removes a cone-shaped sample, which may also treat early-stage cancer.
  • Trachelectomy: Preserves the uterus while removing the cervix (for early cancer in women wishing to have children).
  • Hysterectomy: Removes the uterus and cervix; radical hysterectomy may also include surrounding tissues and lymph nodes.

2. Radiation Therapy:

  • Uses targeted high-energy beams to kill cancer cells.
  • Often used after surgery or in combination with chemotherapy for advanced cancers.

3. Chemotherapy:

  • Uses drugs like cisplatin or paclitaxel to kill or shrink cancer cells.
  • Administered intravenously in cycles, often alongside radiation.

4. Targeted Therapy:

  • Targets specific proteins or pathways in cancer cells, such as angiogenesis (blood vessel growth).
  • Bevacizumab is an example used in cervical cancer.

5. Immunotherapy:

  • Helps boost the immune system to attack cancer cells.
  • Useful in recurrent or metastatic cases, particularly when the cancer expresses PD-L1 proteins.

Some patients may also qualify for clinical trials, offering access to experimental treatments.

Fertility and Cervical Cancer

For younger individuals diagnosed in early stages who wish to preserve fertility, certain surgical options like conization or trachelectomy may be viable. Fertility preservation discussions should take place before treatment begins.

Assisted reproductive technologies may also be considered after treatment, especially in cases where the uterus or ovaries are removed.

Prevention Strategies

Cervical cancer is one of the most preventable cancers. Prevention measures include:

  • HPV Vaccination: Highly effective at preventing infection from high-risk HPV strains. Best given between ages 9–12 but can be administered up to age 26, or age 45 in some cases.
  • Routine Screening: Pap and HPV tests detect changes before they become cancerous.
  • Safe Sexual Practices: Using condoms and limiting sexual partners lowers HPV transmission.
  • Smoking Cessation: Smoking doubles the risk of cervical cancer.

Educating adolescents, parents, and communities about HPV prevention is key to reducing new cases globally.

Living with Cervical Cancer

Receiving a cervical cancer diagnosis is life-changing. Physical, emotional, and social impacts can be profound, especially during treatment and recovery.

Managing life during and after treatment may involve:

  • Coping with fatigue, pain, and side effects
  • Addressing changes in reproductive health and sexuality
  • Dealing with infertility and emotional health
  • Accessing support groups, mental health services, or survivorship programs
  • Ongoing follow-ups to monitor recurrence

Quality of life can often improve significantly with supportive care and tailored rehabilitation programs.

Global Disparities and Awareness

Although cervical cancer is preventable, it remains a major cause of death in low- and middle-income countries due to lack of access to vaccination, screening, and timely treatment.

WHO has launched a global strategy to eliminate cervical cancer as a public health problem by 2030, aiming to:

  • Vaccinate 90% of girls by age 15
  • Screen 70% of women by age 35 and again by 45
  • Treat 90% of women with precancer or cancer

Efforts to raise awareness, expand outreach, and ensure equitable healthcare access are critical to achieving this goal.