Cervical Cancer: Symptoms, Prevention and Treatment

What are the rates and frequency of cervical cancer?

Its frequency has dramatically decreased over the years following the introduction of cervical screening programs with cervical smears (Pap tests) and regular gynecological examinations. Screening usually starts at age 21 and continues at regular intervals, set by your gynecologist according to your age and previous results.

 

Cervical cancer is less likely in women over the age of 65 whose most recent Pap tests have been negative.

What is it and how does it develop?

Cervical cancer develops when the normal cells of the cervix transform into cancer cells. This does not happen overnight. The development of cancer takes place over several years. However, this does not mean that one should become complacent, as in some cases cancer can develop over a much shorter period of time. Cervical cancer usually appears in middle age. Half of the women who are diagnosed with cervical cancer are between 35 and 55 years old.

What are the main symptoms?

If cancer is diagnosed early, there is an almost 100% chance of five-year survival. Women with early-stage cancer typically have no symptoms. Symptoms appear only when the cancer has advanced significantly. These symptoms include: unusual vaginal discharge, abnormal bleeding outside the normal menstrual period, and bleeding or pain during sexual intercourse. These symptoms are not unique to cervical cancer; they may also occur in other benign (non-cancerous) conditions. However, if you experience such symptoms, consult your doctor immediately.

What additional tests are required?

Additional examinations that may be needed as part of the investigation include: cystoscopy (examination of the bladder with an endoscope), rectoscopy (examination of the rectum with an endoscope), chest X-ray, and other imaging tests such as computed tomography (CT) and magnetic resonance imaging (MRI).

What is the treatment process?

These tests are used to assess the spread of the cancer to nearby or distant organs and will determine the exact treatment required — surgical treatment, radiotherapy, or a combination of both.

 

The role of HPV

Almost all cervical cancers are caused by persistent infection with high-risk (oncogenic) types of human papillomavirus. Types 16 and 18 are responsible for about seven out of ten cases. HPV infection is very common and in most women it clears on its own within one to two years. The problem arises when the virus persists for years and causes precancerous changes (CIN), which usually take 10 to 15 years to develop into cancer. Read more about genital warts and HPV.

Factors that increase the risk

• smoking,
• a weakened immune system,
• lack of regular screening,
• co-infection with other sexually transmitted infections, such as chlamydia.

Prevention: a cancer that can be prevented

• HPV vaccine: protects against the types that cause the vast majority of cases. Maximum protection is achieved when it is given before a person becomes sexually active.
• Pap test and HPV test: they detect changes years before they become cancer.
• Colposcopy and treatment of precancerous changes when screening is abnormal.
• Condoms and quitting smoking.

How the diagnosis is confirmed

The Pap test is a screening test and is not enough for a diagnosis. The diagnosis is made by biopsy, taken during colposcopy or by cone biopsy (conization). Staging follows, with clinical examination and imaging.

Treatment by stage

• Very early stage: cone biopsy or simple hysterectomy. In women who want children, cone biopsy or trachelectomy preserves the uterus.
• Early stage: radical hysterectomy with lymph node assessment.
• Locally advanced disease: a combination of radiation therapy and chemotherapy.
• Metastatic disease: systemic treatment, with chemotherapy and newer targeted drugs.

The treatment plan is decided by a tumor board, with the participation of a gynecologic oncologist.

Types of cervical cancer

The term “cervical cancer” covers more than one type of tumor, depending on the cell it starts from.

• Squamous cell carcinoma: the most common type, about seven to eight out of ten cases. It starts in the squamous cells on the outer surface of the cervix, usually in the transformation zone.
• Adenocarcinoma: it starts in the glandular cells of the cervical canal. It is harder to detect with cytology because it lies deeper inside. This is where the HPV test offers a significant advantage.
• Adenosquamous and rare types: such as neuroendocrine carcinomas, which behave differently and need different treatment.

The stages of cervical cancer in plain words

Staging uses the FIGO system and describes how far the disease has spread. Treatment and prognosis depend on it.

• Stage I: the tumor is confined to the cervix. In very early forms it is visible only under the microscope.
• Stage II: it extends beyond the cervix, to the upper part of the vagina or the tissues next to the uterus, without reaching the pelvic walls.
• Stage III: it reaches the lower part of the vagina or the pelvic wall, may press on the ureters or may have spread to the lymph nodes.
• Stage IV: it spreads to the bladder or rectum, or to distant organs.

The prognosis depends above all on the stage. In early stages, cure is the rule. That is why the whole prevention strategy aims to find the disease before it causes symptoms.

Why cervical cancer still occurs

Since there is a vaccine and effective screening, why are women still being diagnosed? Studies consistently show the same gaps:

• Women who have never been screened, or not for many years: they make up the largest group of new diagnoses.
• Abnormal results without follow-up: a finding that did not lead to colposcopy or treatment.
• Stopping screening too early: women who stopped screening after menopause without having the necessary negative results.
• Adenocarcinomas: which escape cytology more easily.

If you cannot remember when you were last screened, that alone is a reason to book an appointment. Modern methods, such as ThinPrep liquid-based cytology with an HPV test from the same sample, make screening more thorough.

Fertility and cervical cancer treatment

Many women are diagnosed at an age when they have not completed their family. The conversation about fertility must take place before any treatment, not after.

• Procedures that preserve the uterus: in very early stages and small tumors, cone biopsy or radical trachelectomy leaves the uterus in place. Later pregnancies need close monitoring, because the risk of preterm birth is higher.
• Ovarian transposition: before radiation therapy, the ovaries can be surgically moved out of the radiation field to preserve their hormonal function.
• Cryopreservation: egg freezing or embryo freezing before treatment gives you an extra chance for the future. It usually takes two to three weeks, which is why it is discussed right after diagnosis.

Life after treatment: what to expect

Treatment can leave effects that impact daily life. We can manage most of them effectively, as long as you talk about them.

• Early menopause: pelvic radiation therapy usually stops the ovaries from working. Hot flashes, dryness and mood changes resemble those of natural menopause. Hormone replacement therapy is usually safe after squamous cell carcinoma and is discussed with the oncologist.
• Vaginal narrowing: after radiation therapy the vagina may become narrower and less elastic. Vaginal dilators, used with proper guidance, help maintain elasticity.
• Bladder and bowel: frequent urination, urgency or changes in bowel habits can appear, even years later.
• Lymphedema: swelling in the legs after lymph node removal. Early physical therapy and compression stockings help.
• Sex life: it returns for most women. Lubricants, local estrogen where allowed and pelvic floor physical therapy make a big difference.

Follow-up after treatment

After treatment is complete, regular follow-up follows, usually every three to six months for the first two years and less often up to five years. It includes a clinical examination, history and, depending on the case, cytology, HPV testing and imaging.

Between appointments, tell your doctor about vaginal bleeding, persistent pain in the pelvis or lower back, swelling in one leg, a cough that does not go away or unexplained weight loss.

Cervical cancer in pregnancy

It is rare, but it is one of the cancers most often diagnosed during pregnancy, because the cervix is often checked at the first visit. Colposcopy and biopsy are safe. Management depends on the stage and the gestational age: in some cases treatment can wait until the fetus matures, in others it starts earlier. The decision is always made by a team that includes an obstetrician, a gynecologic oncologist and a neonatologist.

From biopsy to treatment: the steps

The weeks between diagnosis and the start of treatment are often the most stressful. It helps to know what comes next and why.

• Histological confirmation: the biopsy shows the tumor type and, in small lesions, the depth of invasion.
• Pelvic MRI: the main test for the size of the tumor and its spread into surrounding tissues.
• Assessment of lymph nodes and other organs: with CT or PET-CT, depending on the stage.
• Tumor board: a gynecologic oncologist, a radiation oncologist, a medical oncologist and a radiologist discuss the findings and propose the treatment plan.
• Discussion with you: about the options, side effects, fertility and recovery time.

It is perfectly reasonable to ask for a second opinion before you start. A good doctor will not take offense. A delay of a few days for a second opinion usually does not affect the outcome, but ask how much time you have.

Psychological support and family

A cancer diagnosis affects your life far beyond the medical side. Fear, anger, guilt or numbness are normal reactions.

• Ask the treatment team to put you in touch with a psychologist or psycho-oncologist. This support improves quality of life and cooperation during treatment.
• Think about who in your circle will come with you to appointments. A second pair of ears helps you remember the information.
• Keep a notebook with questions, results and dates.
• Patient associations offer practical information and contact with women who have been through the same thing.

Does my partner need to be tested?

Cancer is not contagious. HPV is transmitted, but in a stable relationship partners have usually already shared the virus, and there is no routine test for men. Your partner does not need special testing unless he has symptoms or visible lesions.

Signs you should not blame on age or hormones

Early-stage cervical cancer is silent. But if any of the following appear, do not wait for your next scheduled checkup:

• Bleeding after intercourse: most of the time it has a benign cause, such as cervical ectropion or a polyp, but it must be checked. Read more about bleeding after intercourse.
• Bleeding after menopause: any drop of blood after twelve months without a period needs to be investigated.
• Watery, pink or foul-smelling discharge that persists without an obvious infection.
• Bleeding between periods that recurs for more than one cycle.
• Pain in the pelvis or lower back with no other explanation, especially if it comes with swelling in a leg.

In these cases, the examination includes inspection of the cervix, cytology and an HPV test and, where needed, colposcopy with biopsy, even if your last screening was normal.

For screening or evaluation of an abnormal result, book an appointment with Dr. Panagiotis Polyzos at his office in Athens or Volos.

Frequently Asked Questions

Does an abnormal Pap test mean cancer?

No. In the vast majority of cases it shows inflammation or precancerous changes, which are easily monitored or treated.

If I have HPV, will I get cervical cancer?

Not necessarily. Most infections clear on their own. The risk lies in persistent infections with high-risk types, which is why regular follow-up is needed.

Can I have children after cervical cancer?

In very early stages there are treatments that preserve fertility. Whether this is possible depends on the stage and is discussed before treatment.

Is cervical cancer hereditary?

Not in the way breast cancer can be. It is almost always caused by HPV.

Does the vaccine protect me if I am already sexually active?

Yes, it offers protection against the virus types you have not already been exposed to. Screening continues as usual.

How quickly does a precancerous lesion turn into cancer?

It usually takes many years, often ten or more, to go from persistent HPV infection to invasive cancer. This long window is what makes regular screening so effective.

Can cervical cancer occur after a hysterectomy?

If the cervix was removed along with the uterus, no. But if you had a subtotal (supracervical) hysterectomy that left the cervix, screening continues as usual. Women with a history of precancerous changes need follow-up of the vagina even after a total hysterectomy.

Does screening stop after 65?

It can stop only if you have had consecutive negative results in recent years and no history of precancerous changes. If screening was not done regularly, it should continue. The decision is made with your gynecologist.

Is it worth quitting smoking if I have already been diagnosed?

Yes. Smoking reduces the effectiveness of radiation therapy, increases surgical complications and makes healing harder. Quitting at any stage improves the course of the disease.