Cervical Cancer

What is cervical cancer?

Cervical cancer develops in the cells that line the cervix, a cylinder-shaped connective tissue situated between a woman’s vagina and uterus. The cervix has two parts: the exocervix, which is located at the top of the vagina and covered in squamous cells, and the ectocervic, which is located at the bottom of the uterus and covered in epithelial cells. The connection of the two cell types is known as the transformation zone, which is where the precancerous changes that lead to the development of cervical cancer often occur.

Most cervical cancers develop gradually after healthy cells in the transformation zone undergo harmful changes. Nearly all cervical cancers are caused by human papillomavirus (HPV), a common sexually transmitted infection. Certain strains of HPV can trigger cellular DNA changes in the cervix that lead to the development of a tumor. However, not all precancerous cells in the cervix progress into cervical cancer.

What are the early warning signs of cervical cancer?

Cervical cancer does not have early warning signs. In most cases, noticeable symptoms such as unusual vaginal bleeding or discharge occur only after the tumor has advanced and invaded nearby tissues. However, precancerous and cancerous cells in the cervix can be detected early through routine screening. As a result, cervical cancer can often be prevented or cured.

How can cervical cancer be detected early?

Early detection is key to the effective treatment of cervical cancer, and regular screening is the best tool for this purpose. The most frequently used screening test for cervical cancer is a Pap smear, which is highly effective for detecting precancerous and cancerous cells in the cervix, often before noticeable symptoms occur. Therefore, Pap smears testing every 3 year are recommended for many women between the ages of 21 and 65 and are usually performed at regular intervals determined by a physician. Additionally, because most cervical cancers are caused by an HPV infection, HPV DNA testing every 5 year plays an important role in early detection and may be recommended for some women along with regular Pap smears.

What does cervical cancer feel like?

The cervix is shaped like a tiny donut, and it is possible to feel it by gently inserting one or two fingers about 3 to 5 inches into the vagina. A healthy cervix should feel smooth and firm—like the cartilage at the tip of the nose—with a slight indentation in the center. A possible warning sign of cervical cancer is a rough or bumpy cervix, which should be discussed with a physician. Most bumps on the cervix are benign (noncancerous) growths, such as polyps or cysts. For instance, nabothian cysts are common, harmless bumps that can form when skin cells trap mucus inside the glands in the cervix. Only a physician can determine whether a bump or another cervical abnormality is caused by cancer.

An early-stage cervical tumor cannot be felt from outside the body by pressing on the stomach. However, advanced cervical cancer that has spread to the liver may cause abdominal swelling due to fluid build-up (ascites).

Cervical cancer can sometimes cause a dull backache or vague sensations of pressure or heaviness in the pelvis. However, any discomfort associated with an early-stage tumor may be mild or even unnoticeable. As the cancer progresses and spreads to nearby tissues and organs, more pronounced pain may develop, particularly during urination and sexual intercourse. Over time, the pelvic pain may become continuous.

As a cervical tumor grows, it may begin to press on sensitive nerves in the pelvic wall, which can cause leg pain and swelling. Leg swelling on its own can have many causes unrelated to cancer, but if it is accompanied by persistent leg pain—which may be dull or sharp—it could be a warning sign of cervical cancer.

What are the first symptoms of cervical cancer?

In its earliest and most treatable stages, cervical cancer may not produce noticeable symptoms. Instead, an abnormal Pap test result may be the first warning sign that precancerous or cancerous changes have occurred in the cervix. Usually, these changes progress very slowly over several years.

After abnormal cells in the cervix bind together, form tumors and spread to surrounding tissues, cervical cancer symptoms may begin to become apparent. The first signs might include:

• Abnormal vaginal bleeding, which may occur between menstrual periods or after menopause
• Abnormal vaginal discharge, which may be thick, odorous and/or tinged with blood
• Menstrual periods that are heavier or longer-lasting than usual
• Vaginal bleeding or pain during sexual intercourse
• Vaginal bleeding during a pelvic examination
• Pain in the lower back or pelvic region
• Pain during urination
• Urinary urgency or frequency
• Leg swelling

Any of these symptoms should be reported to your doctor. If these symptoms appear, it is important to talk with your doctor about them even if they appear to be symptoms of other, less serious conditions. The earlier precancerous cells or cancer in the cervix is found and treated, the better the chance that the cancer can be prevented or cured.

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