Preventing Cervical Cancer: Risk Factors, Symptoms and Regular Screenings

COURTESY PHOTO

After a certain age, many women stop getting annual cervical exams, taking the view they are beyond the time of bearing children and/or may have experienced menopause.

Due to potential health risks of cervical cancer, this is a viewpoint that warrants a discussion with a physician.

There are guidelines established by the American Cancer Society, but a discussion with a physician regarding medical history, lifestyle and other factors should be taken into account before deciding frequency of cervical screenings.

If a woman has risk factors for cervical cancers, these exams can be key in early diagnosis and effective treatment.

The American Cancer Society forecasted 13,960 cervical cancer cases for 2023, up 2,400 from 2020 as reported by the Centers for Disease Control and Prevention. Of that total, more than 4,000 were expected to die.

There is some understanding as to why women would feel exams are not necessary after a certain age: Most cervical cancers are diagnosed between ages 35 to 44, followed by 45 to 54. Patients 55 and older have a lesser risk, but the possibility exists.

What is Cervical Cancer?

The cervix is the lower part of the uterus that opens into the vagina. The endocervix, the opening of the cervix, contains glandular cells. The exocervix, the outer part seen by a physician during an exam, contains squamous cells.

Where these cells meet is called the transformation zone, and the area can change depending on childbirth and age. Most cervical cancers begin in the transformation zone where normal squamous cells gradually develop abnormal changes over time and can turn into cancer.

Abnormal changes in the cells within the transformation zone are graded on a scale from one to three.

In mild dysplasia or low-grade squamous intraepithelial lesion (SIL), also known as cervical intraepithelial neoplasia 1(CIN1), there is not a large quantity of tissue that looks abnormal, and the cells will go back to their normal state.

In moderate or severe dysplasia or high-grade SIL (CIN2, CIN3), more of the tissue looks abnormal and there is a higher risk that the cells within the tissue will become cancerous.

There are several types of cervical cancer, classified by how they look under a microscope.

The cancer society reports that nine of 10 cervical cancers are squamous cell carcinomas, developing from cells in the exocervix. Squamous cell carcinomas most often begin in the transformation zone.

Most of the other diagnosed cancers are adenocarcinomas. They are carcinomas that form from glandular cells. Cervical adenocarcinomas develop from the mucus-producing gland cells of the endocervix.

Less common cervical cancers have features of squamous cell carcinomas and adenocarcinomas. These are referred to as adenosquamous carcinomas, or mixed carcinomas. Other cancers that develop in the cervix including melanoma, sarcoma and lymphoma.

Not all patients with abnormal cells will develop cancer. But, in some cases, these cells can turn into invasive cancers, so early detection and treatment at any age is key.

There are several factors that may increase the chances of developing cervical cancer:

• Exposure to human papillomavirus (HPV), a common virus passed between individuals during sex causing changes in the cervix that can lead to cancer.
• Family history, including having high-risk sex partners, multiple sex partners or sex at a young age.
• A weakened immune system.
• Having a history of chlamydia, a sexually transmitted disease.
• Long-term use of oral contraceptives.
• Three or more full-term pregnancies.
• Pregnancy at a young age.

How Is It Diagnosed?

The key to prevention, early diagnosis and treatment are screenings. Screenings for cervical cancer include the HPV test and Pap test, both conducted during a cervical exam. A clinician will remove cells from the cervix and send the cells to a lab to be reviewed under a microscope.

Signs and Symptoms

Patients with cervical cancer may have no symptoms, so screenings are important. As the cancer grows, affecting nearby tissue, women may experience the following:

• Abnormal vaginal bleeding after sex, bleeding after menopause, bleeding or spotting between periods, or periods that are longer and heavier than usual.
• Unusual discharge from the vagina, possibly containing blood.
• Pain during sex.

Signs and symptoms experienced during advanced disease can include:

• Swelling of the legs.
• Problems urinating or having bowel movements.
• Blood in the urine.

Treatment Options

Treatment will vary depending on the diagnosis or stage of cancer, other health factors, age and physician recommendations.

Surgery. Surgery is used to diagnose cervical cancer, determine how far the cancer has spread and as a treatment. Surgical options range from ablation to hysterectomy, and lymph node biopsy and mapping. A variety of techniques can be utilized.

Radiation therapy. Depending on the state of the cancer, radiation therapy can be utilized as a main treatment or as a treatment for cancers that have come back and spread to other parts of the body. External beam radiation and brachytherapy (internal radiation) are the most common forms.

Chemotherapy. Anti-cancer drugs are injected, infused or taken orally. With some stages of cervical cancer, both chemo and radiation may be recommended.

Targeted drug therapy. A therapy in which medications target or are directed at the proteins on cervical cancer cells. The drugs work to destroy the cancer cells or slow down their growth.

Immunotherapy. This treatment is the use of medication to boost a person’s immune system to recognize and destroy cancer cells more effectively. Immunotherapy typically works on specific proteins involved in enhancing the immune system. Some immunotherapy drugs work in more than one way to control cancer cells: They may be considered targeted therapy because they can block specific proteins on the cancer cells and keep them from growing.