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Cervical cancer

Cervical cancer arises from the cervix due to abnormal cell growth that can invade or spread to other parts of the body. Early stages often present no symptoms, but later stages may include abnormal vaginal bleeding, pelvic pain, and pain during sexual intercourse.

Causes and Risk Factors

Human papillomavirus (HPV) infection is the primary cause of cervical cancer, responsible for over 90% of cases. HPV types 16 and 18 are particularly high-risk, causing around 75% of global cases. Other contributing factors include smoking, a weak immune system, long-term use of birth control pills, starting sexual activity at a young age, and having multiple sexual partners.

In most cases, cells infected with the HPV heal on their own. In some cases, however, the virus continues to spread and becomes an invasive cancer.
In most cases, cells infected with the HPV heal on their own. In some cases, however, the virus continues to spread and becomes an invasive cancer.

Signs and Symptoms

Early stages of cervical cancer often lack symptoms. As the disease progresses, symptoms may include:

  • Vaginal bleeding, especially after sexual intercourse
  • Pelvic pain
  • Pain during sexual intercourse
  • Vaginal discharge

Advanced stages may present with symptoms such as loss of appetite, weight loss, fatigue, back pain, leg pain, swollen legs, heavy vaginal bleeding, and even leakage of urine or faeces from the vagina.

Diagnosis

Diagnosis typically begins with cervical screening methods like the Pap test or HPV DNA testing. If abnormalities are detected, a biopsy is performed through colposcopy, which involves a magnified visual inspection of the cervix. Imaging techniques like MRI, CT scans, and ultrasounds are used to assess the spread of the cancer.

Cervical cancer seen on a T2-weighted sagittal MR image of the pelvis
Cervical cancer seen on a T2-weighted sagittal MR image of the pelvis

Treatment

Treatment varies based on the stage of cancer and includes surgery, chemotherapy, radiation therapy, and immunotherapy. Early-stage cancer (IA1) may be treated effectively by surgical techniques like loop electrical excision procedure or cone biopsy. Advanced stages (IIB-IVA) are often treated with radiation therapy and cisplatin-based chemotherapy.

Cervical cryotherapy
Cervical cryotherapy

Prognosis

Prognosis largely depends on the stage at diagnosis. Early-stage cervical cancer has a five-year survival rate of about 92%, whereas the overall survival rate across all stages is approximately 66%. Survival rates decrease significantly for advanced stages.

Prevention

Screening

Regular cervical screening has dramatically reduced the incidence and mortality of cervical cancer. Pap tests can detect precancerous changes, allowing for early intervention. In the UK, cervical screening is recommended every three years for women aged 25-49 and every five years for women aged 50-64.

Cervical screening test vehicle in Taiwan
Cervical screening test vehicle in Taiwan

HPV Vaccination

HPV vaccines like Gardasil and Cervarix can prevent infection with high-risk HPV strains. These vaccines are most effective when administered before the onset of sexual activity, typically between ages 9 to 26.

Epidemiology

Worldwide, cervical cancer is the fourth most common type of cancer and the fourth leading cause of cancer-related deaths in women. In 2018, about 570,000 new cases were diagnosed, with over 300,000 deaths. It is most prevalent in developing countries due to limited access to screening and vaccination.

Age-standardised death from cervical cancer per 100,000 inhabitants in 2004
Age-standardised death from cervical cancer per 100,000 inhabitants in 2004

Self-assessment MCQs (single best answer)

What is the primary cause of cervical cancer?



Which HPV types are considered high-risk, causing around 75% of global cervical cancer cases?



What is a common symptom of advanced-stage cervical cancer?



Which diagnostic method is commonly used to obtain a visual inspection of the cervix?



What is the five-year survival rate for early-stage cervical cancer (IA1)?



Which treatment is often combined with radiation therapy for advanced cervical cancer stages (IIB-IVA)?



How often is cervical screening recommended for women aged 25-49 in the UK?



At what age range are HPV vaccines most effective?



What is the global prevalence ranking of cervical cancer among women?



Which of the following contributes significantly to the higher prevalence of cervical cancer in developing countries?



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