The early stages of cervical cancer usually do not cause symptoms. When cancer progresses to later stages, symptoms arise because the cancerous cells have spread to nearby tissues. These symptoms include:

• Pain during intercourse
• Pain in the pelvic region
• Unusual vaginal discharge between periods or during menopause
• Abnormal bleeding after intercourse, between periods, or during menopause

Advanced stages of cancer will show the following signs and symptoms:

• Problems with urination
• Problems with bowel movements
• Blood in the urine
• Swelling in the legs

The most common type of cervical cancer is squamous cell cancer. Squamous cells are thin, flat cells that make up the epidermis (outermost layer of the skin). Small cell cancer is a very rare type of cancer that arises from neuroendocrine cells, specialized cells of the body that contain both nerve and hormone-secreting cells.

Cervical cancer, like all forms of cancer, is classified according to stages. These include:

Stage 1. Cancer cells are localized in the cervix, or neck of the uterus.

Stage 2. Cancer cells have spread outside of the cervix and into surrounding tissues.

Stage 3. Cancer cells have spread from the cervix, into surrounding tissues, and nearby tissues such as the lymph nodes in the pelvis and abdomen.

Stage 4. Cancer has spread to the bladder and/or the rectum and organs and tissues further from the cervix.

Human cells develop dependent on the information contained in their DNA, the chemical in genes that control how the body’s cells function. Some genes direct the process of a cell’s growth, division, and death. These are known as oncogenes. Other genes, tumor suppressor genes, keep cellular growth in check and make sure cells die at the right time. Cancer can be caused by a genetic alteration in the genes responsible for turning on oncogenes or turning off tumor suppressor genes.

Human papillomaviruses (HPV) are a group of viruses that can cause warts on the skin (i.e., hands, feet, arms, chest) and the mucous membranes of the human body. Mucous membranes line organs and structures of the body that open outside of the body, such as the mouth, throat, stomach, anus, and vagina. Genital HPV is a sexually transmitted disease that has been shown to trigger cervical cancer. There are two proteins in HPV (E6 and E7) that may turn off tumor suppressor genes in the cervical mucous membrane lining. This action causes the cell lining of the cervix to grow abnormally and cancer may develop.

There are other causes of cervical cancer not related to HPV that are related to certain risk factors mentioned in the next section.

• Having HPV
• Smoking
• Having HIV (the virus that causes AIDS)
• Low immunity
• Using birth control (five or more years)
• Multiple births (three or more)

Cervical cancer usually does not show any symptoms until the cancer is well advanced. If you are visiting your doctor because of abnormal vaginal bleeding or painful sex then you will be asked to get tests to rule out if you have cervical cancer. However, most cancers are diagnosed after a pap smear exam or screening test. These tests are the best way to find cervical cancer in its early stages. These include:

HPV screening tests. These screening tests are used to identify the presence of the HPV virus in cells taken from the cervix using a small soft brush. Some pathologists will look for changes in the cervical cells before testing for the presence of HPV. If you test positive for HPV, you most likely will be asked to get a colposcopy, which is an instrument that looks closely at the cervix for changes. If there are no cell changes, you will be asked to get a cervical screening every 12 months.

Papanicolaou (PAP) test. In this procedure, your health care provider will place a speculum (metal or plastic instrument) inside your vagina to keep it open. Next, a sample of cells and mucus is scraped from the outside of the cervix using a brush or small spatula. A cotton-tipped swabbed is then inserted into the inside of the cervical opening to take a sample of cells. The samples are looked at in the lab for abnormal cells or signs of infection. If any abnormalities are detected, you will be asked to go in for further testing.

If your screening tests are abnormal, further tests are needed. Your doctor will first take a thorough medical history and give you a physical exam that includes a pelvic exam and checking your lymph nodes. Tests that may be needed are:

Colposcopy. In this exam, a speculum is placed in the vagina to help your gynecologist see your cervix. Next, your gynecologist will use a colposcope (magnifying instrument) to see your cervix. A weak solution of vinegar-like liquid (acetic acid) is then applied which makes abnormal areas of the cervix show up. If an abnormal area is identified your doctor will take a small sample of it (biopsy) and send it to the lab.

Cervical biopsies. These minimal surgical procedures are used to diagnose cancers and pre-cancers. A colposcopic biopsy uses the colposcope to magnify the cervix as the physician removes a small piece of an abnormal area with biopsy forceps. Another form of cervical biopsy is to scrape the endocervix (inside of the cervix closest to the uterus) with a brush to remove tissue.

Cone biopsy. This involves removing a cone-shaped piece of tissue from the cervix. The two most common types of cone biopsies are the loop electrosurgical procedure (LEEP) and the cold knife cone biopsy. The LEEP biopsy can be done in your doctor’s office using a local anesthetic to remove tissue with a thin wire loop heated by electricity. The cold knife cone biopsy requires anesthesia in the hospital and uses a scalpel or laser to remove tissue.

If tests reveal cervical cancer, you will be referred to a gynecologic oncologist and develop a treatment plan specifically geared towards your age, health, and your personal preferences.

Chemotherapy. These drugs are injected into the vein or taken orally to enter the bloodstream to be distributed throughout the body. Chemotherapy is often used alongside radiation treatment as these anti-cancer drugs help the radiation work better. If cancer has spread or come back after surgery or radiation treatment then chemo may be used. Chemo treatments usually are given in cycles (i.e., weekly, every 3 weeks) depending on how you recover from each treatment. Common side-effects of chemotherapy are loss of appetite, nausea and vomiting, mouth sores, hair loss, and fatigue. Common chemo drugs are:

• Carboplatin
• Cisplatin
• Paclitaxel (Taxol©)
• Topotecan

Radiation therapy. Uses high-energy x-rays to destroy cancer cells. The main types of radiation therapy are external beam radiation therapy (EBRT) and brachytherapy. EBRT aims the x-rays directly at the cancer from outside the body. EBRT is often combined with chemotherapy (concurrent chemoradiation) to make the radiation more effective. Brachytherapy is internal radiation using a device with radioactive material that is placed in the vagina near the cervix. Radiation therapy can cause skin rashes, abnormal vaginal bleeding, nausea, fatigue, and vomiting.

Immunotherapy. Uses medicine that stimulates the immune system to destroy cancer cells. This therapy is often used when cervical cancer spreads or comes back. A common immunotherapy drug is pembrolizumab (Keytruda©). It is given in an intravenous infusion every 3 weeks. Possible side effects of immunotherapy are headache, skin rash, loss of appetite, diarrhea, constipation, and joint/muscle pain.

Surgery. Used to diagnose and stage cervical cancer and as a treatment in early-stage cancers. Two common surgeries are ablation and excisional surgery. Ablation uses extremely cold temperatures (cryosurgery) or a laser (laser ablation) to destroy abnormal cervical tissues. Excisional surgery, or conization, cuts out pre-cancerous tissues and removes them from the cervix.

Targeted therapy. These drugs directly target cancer cells by stopping the formation of blood vessels that feed tumors. The formation of blood vessels is known as angiogenesis. Targeted drugs,or angiogenesis inhibitors, block the protein that is in charge of making new blood vessels for tumors. The most common angiogenesis inhibitor used as a targeted therapy for cervical cancer is called bevacizumab or Avastin©. Common side effects of targeted therapy drugs are high blood pressure, fatigue, and nausea.

Hysterectomy or trachelectomy.  In some cases of invasive cervical cancer, a simple or radical hysterectomy is ordered. A simple hysterectomy involves the removal of the uterus and the cervix without removing the ligaments next to the uterus. In a radical hysterectomy, the surgeon will remove the uterus, the tissues next to the uterus, the cervix, and the upper part of the vagina next to the cervix. A trachelectomy is a procedure that removes the cervix but allows a woman to still have children.

The only treatments that will offer a possible cure for cervical cancer are surgery, chemotherapy, and radiation. There are complementary approaches that can be taken to improve the side effects of treatment and make sure that you are as healthy as possible while you work through your treatment plan with your cancer team. Any supplement or alternative treatment you are considering must be discussed with your health care team to make sure it does not interfere with your treatment. The following are some of these complementary treatments:

Dietary changes. Eat a plant-based diet rich in colored fruits and vegetables or decrease your intake of animal fats, especially red meat and dairy products. Avoid refined sugar and highly-processed carbohydrates.

Acupuncture. Acupuncture may help treat the side effects of chemotherapy, such as nausea and vomiting and help to increase energy and decrease dry mouth.

Mind-body techniques. These include breathing exercises, yoga, tai chi, guided imagery, and mindfulness meditation. Mind-body techniques help to reduce stress and encourage relaxation and strength through mild exercise.

Medical cannabis. Can help to treat nausea, appetite loss, pain, and insomnia that are common side effects of cancer therapies.

Cervical cancer is primarily caused by the sexually transmitted form of HPV. Infection of HPV occurs shortly after someone becomes sexually active. The best way to prevent cervical cancer is to be vaccinated against HPV.

HPV vaccination. According to the World Health Organization, 70% of all cervical cancers worldwide originate with HPV. Females older than age 12 can get a vaccination against the human papillomavirus. It is best to get the vaccine before the possibility of coming into contact with the virus. Women with the vaccination have a reduced risk of abnormal cervical cell changes due to contracting the HPV virus.

Other preventative measures include:

• Do not smoke
• Safe sex
• Limit sexual partners
• Sexuality education
• Regular screening tests

The United States National Library of Medicine has a database devoted to listing privately and publicly funded clinical trials that are being conducted around the world today. There are over 3000 studies found for cervical cancer currently listed on the database. You can access the results of these clinical studies here.

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