Cervical Cancer
What is Cervical Cancer?
Cervical cancer is a malignant tumor that arises from the cells of the cervix, the lower part of the uterus that connects to the vagina. It develops gradually, often beginning with precancerous changes known as cervical intraepithelial neoplasia (CIN), which may progress to invasive cancer if untreated. The cervix is made up of the exocervix and endocervix. The exocervix is the outer layer observed during a gynecological exam and is made up of flat squamous cells. The endocervix forms the canal connecting the uterus to the vagina and is made up of glandular cells. Cervical cancer cells often form at the junction between these two layers. Cervical cancer is largely preventable through routine screening and vaccination for human papillomavirus (HPV), and early-stage disease is highly treatable.
Synonyms
- Cancer of the cervix
- Cervical carcinoma
Cervical cancer is a malignant tumor that arises from the cells of the cervix, the lower part of the uterus that connects to the vagina. It develops gradually, often beginning with precancerous changes known as cervical intraepithelial neoplasia (CIN), which may progress to invasive cancer if untreated. The cervix is made up of the exocervix and endocervix. The exocervix is the outer layer observed during a gynecological exam and is made up of flat squamous cells. The endocervix forms the canal connecting the uterus to the vagina and is made up of glandular cells. Cervical cancer cells often form at the junction between these two layers. Cervical cancer is largely preventable through routine screening and vaccination for human papillomavirus (HPV), and early-stage disease is highly treatable.
Cervical cancer is one of the most common cancers affecting women worldwide, making up almost 7% of cases of cancer in women. Cases of cervical cancer are particularly common in low- and middle-income countries where access to screening is limited. In the United States, it is less common due to widespread Pap smear screening and HPV vaccination. It most frequently affects individuals between the ages of 30 and 50, though it can occur at any adult age.
| Name | Abbreviation |
|---|---|
| Cancer of the cervix | |
| Cervical carcinoma |
The primary cause of cervical cancer is persistent infection with high-risk (carcinogenic) types of human papillomavirus (HPV), especially HPV types 16 and 18, which account for the majority of cases (about 95%). HPV is a sexually transmitted virus, and most sexually active individuals are exposed at some point. In most cases, the immune system clears the infection, but persistent infection can lead to cellular changes and development of abnormal cells that lead to cancer over time. Additional risk factors include early sexual activity, multiple sexual partners, smoking, long-term oral contraceptive use, immunosuppression, and lack of regular cervical screening.
About 3-8% of cases of cervical cancer arise without the presence of an HPV infection. This is known as HPV-negative cervical cancer, and is generally associated with worse symptoms and prognosis. Thus, additional treatment and care should be placed on those diagnosed with cervical cancer without an HPV infection.
Early-stage cervical cancer is often asymptomatic until it begins to spread, which is why routine screening is critical. As the disease progresses, symptoms may include:
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Abnormal vaginal bleeding, such as bleeding between periods, after sexual intercourse, or after menopause
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Unusual vaginal discharge, which may be watery, bloody, or foul-smelling
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Pelvic pain or pain during intercourse
Advanced disease symptoms, such as leg swelling, back pain, urinary or bowel problems, and fatigue, due to local or distant spread
Cervical cancer is typically diagnosed through screening tests followed by confirmatory diagnostic procedures. Abnormal Pap smear screening results prompt further evaluation to determine the presence and extent of cancer.
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Pap smear (Pap test): Detects abnormal cervical cells and precancerous changes
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HPV testing: Identifies high-risk HPV strains associated with cervical cancer
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Colposcopy: Visual examination of the cervix using magnification
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Cervical biopsy: Confirms the diagnosis by examining tissue under a microscope
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Imaging studies: CT, MRI, or PET scans to assess tumor size, local invasion, and metastasis
Staging procedures: Based on the FIGO staging system, using clinical and imaging findings
Treatment depends on the stage of the disease, tumor size, and patient factors such as age and desire for fertility:
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Early-stage disease: Surgical options, including conization (removal of a cone-shaped sample from the uterine lining), trachelectomy (removal of the cervix; fertility-sparing surgical option), or hysterectomy (removal of the uterus)
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Locally advanced disease: Combination of radiation therapy and chemotherapy
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Advanced or recurrent disease: Chemotherapy, targeted therapy (e.g., bevacizumab), immunotherapy, or palliative care
Prevention: HPV vaccination and routine screening are key strategies to reduce incidence
The prognosis for cervical cancer depends strongly on the stage at diagnosis. When detected early, the 5-year survival rate exceeds 90%. Survival decreases with more advanced stages, particularly if the cancer has spread beyond the pelvis. Access to screening, early treatment, and follow-up care significantly improves outcomes. With continued global efforts in vaccination and screening, cervical cancer is increasingly considered a preventable disease.
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Lee JE, Chung Y, Rhee S, Kim TH. Untold story of human cervical cancers: HPV-negative cervical cancer. BMB Rep. 2022 Sep;55(9):429-438. doi: 10.5483/BMBRep.2022.55.9.042. PMID: 35725012; PMCID: PMC9537028. https://pmc.ncbi.nlm.nih.gov/articles/PMC9537028/
Clinical Trials
CoRDS, or the Coordination of Rare Diseases at Sanford, is based at Sanford Research in Sioux Falls, South Dakota. It provides researchers with a centralized, international patient registry for all rare diseases. This program allows patients and researchers to connect as easily as possible to help advance treatments and cures for rare diseases. The CoRDS team works with patient advocacy groups, individuals and researchers to help in the advancement of research in over 7,000 rare diseases. The registry is free for patients to enroll and researchers to access.
Enrolling is easy.
- Complete the screening form.
- Review the informed consent.
- Answer the permission and data sharing questions.
After these steps, the enrollment process is complete. All other questions are voluntary. However, these questions are important to patients and their families to create awareness as well as to researchers to study rare diseases. This is why we ask our participants to update their information annually or anytime changes to their information occur.
Researchers can contact CoRDS to determine if the registry contains participants with the rare disease they are researching. If the researcher determines there is a sufficient number of participants or data on the rare disease of interest within the registry, the researcher can apply for access. Upon approval from the CoRDS Scientific Advisory Board, CoRDS staff will reach out to participants on behalf of the researcher. It is then up to the participant to determine if they would like to join the study.
Visit sanfordresearch.org/CoRDS to enroll.
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