Cervix Cancer
The cervix is the lower part of the womb (uterus). The uterus has two parts — the upper part (body) where a baby grows, and the lower part (cervix). The cervix connects the body of the uterus to the vagina (birth canal).
Cervical cancer, or cancer of the cervix, begins on the surface of the cervix. As per Globocan 2020 cervical cancer is the fourth most common cancer among females worldwide and second most common cancer among females in India. There are two main types of cancer of the cervix — squamous cell carcinomas and adenocarcinomas. About 80% to 90% are squamous cell carcinomas, 10%-20% are adenocarcinomas and other varieties are rare.
Various strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cervical cancer. When exposed to HPV, a woman's immune system typically prevents the virus from doing harm. In a small group of women, however, the virus survives for years, contributing to the process that causes some cells on the surface of the cervix to become cancer cells.
Cervical Cancer – Causes
HPV Infection
This is the leading cause of cervical cancer.
High-risk HPV types (especially HPV-16 and 18) are commonly linked.
HPV spreads through sexual contact.
Multiple Sexual Partners
Increases the risk of HPV transmission.
More exposure = higher chance of acquiring a high-risk HPV type.
Early Sexual Activity
Having sex at a young age increases HPV risk.
Immature cervical cells are more vulnerable to infection.
Weakened Immune System
HIV/AIDS or long-term use of immunosuppressants reduces HPV defense.
Smoking
Tobacco by-products can damage cervical cells.
Smokers with HPV are more likely to develop cancer.
Long-term Use of Birth Control Pills
Using oral contraceptives for over 5 years may slightly increase the risk.
Poor Genital Hygiene
Especially in low-resource settings, poor hygiene increases infection risk.
Not Getting Regular Pap Tests
Regular Pap smears detect early abnormal cervical changes.
Skipping tests allows issues to go unnoticed.
Family History of Cervical Cancer
Genetics can contribute to risk.
Having a close relative with cervical cancer increases your risk.
How Is Cervical Cancer Diagnosed?
Cervical cancer is typically diagnosed through a combination of screening tests, physical examinations, and lab procedures:
1. Pap Smear (Pap Test)
A routine screening tool to detect precancerous or cancerous cells on the cervix.
A sample of cervical cells is collected and examined under a microscope.
2. HPV Test
Often done along with a Pap test (co-testing), it checks for the presence of high-risk HPV types.
If HPV is detected, further monitoring or testing is recommended.
3. Colposcopy
If the Pap smear shows abnormal results, a colposcopy is done.
A special magnifying instrument (colposcope) is used to closely examine the cervix. Areas that look suspicious may be biopsied.
4. Cervical Biopsy
A small sample of tissue is removed for detailed analysis.
Types of biopsies include punch biopsy, LEEP, or cone biopsy, depending on how deep the sample needs to be.
5. Imaging Tests (if cancer is confirmed)
Once cervical cancer is diagnosed, imaging like CT scans, MRI, PET scans, or chest X-rays help determine the stage and spread of the disease.
Rare Types of Cervical Cancer
Adenosquamous Carcinoma
This type contains both squamous cells and glandular cells, making it a mix of two types of cervical cancer. It tends to be more aggressive than squamous cell carcinoma.
Small Cell Carcinoma
A rare and highly aggressive form of cervical cancer that arises from neuroendocrine cells. It often spreads quickly and requires intensive treatment.
Clear Cell Adenocarcinoma
This rare cancer type is associated with exposure to diethylstilbestrol (DES) before birth and tends to occur in younger women. It originates from glandular cells.
Other Rare Types
Other less common types include sarcomas and lymphomas, which originate from different tissues than typical cervical cancers and require specialized care.
Signs and Symptoms of Advanced Cervical Cancer
Early-stage cervical cancer generally produces no signs or symptoms.
Signs and symptoms of more-advanced cervical cancer include:
- Vaginal bleeding after intercourse, between periods or after menopause
- Watery, bloody vaginal discharge that may be heavy and have a foul odor
- Pelvic pain or pain during intercourse
Main Types of Cervical Cancer
- Squamous cell carcinoma. This type of cervical cancer begins in the thin, flat cells (squamous cells) lining the outer part of the cervix, which projects into the vagina. Most cervical cancers are squamous cell carcinomas.
- Adenocarcinoma. This type of cervical cancer begins in the column-shaped glandular cells that line the cervical canal.
Sometimes, both types of cells are involved in cervical cancer. Very rarely, cancer occurs in other cells in the cervix.
Risk Factors for Cervical Cancer
- Many sexual partners. The greater your number of sexual partners — and the greater your partner's number of sexual partners — the greater your chance of acquiring HPV.
- Early sexual activity. Having sex at an early age increases your risk of HPV.
- Other sexually transmitted infections (STIs). Having other STIs — such as chlamydia, gonorrhea, syphilis, and HIV/AIDS — increases your risk of HPV.
- A weak immune system. You may be more likely to develop cervical cancer if your immune system is weakened by another health condition and you have HPV.
- Smoking. Smoking is associated with squamous cell cervical cancer.
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