Last updated: March 2, 2020
Candice Fraser M.D.
Obstetrics & Gynaecology
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Are you up to date on pap smears? A pap smear is a test that screens for cervical cancer. Pap smears, education and HPV vaccination are key to lowering your risk of developing cervical cancer.
Cervical cancer is the fourth most frequent cancer diagnosed in women worldwide. Cervical cancer is the second most common cause of cancer death in developing nations. Approximately 84% of all cervical cancer cases occur in Africa, Latin American and the Caribbean underdeveloped areas. Around the globe this type of cancer affects approximately almost half a million women each year with about 270,000 women losing their lives. Because of screening, the number of new cases of cervical cancer has dramatically declined in North America.
We asked one of our OBGYNs Dr. Candice Fraser, to lend her medical insights on cervical cancer.
What is the Role of the Cervix?
The cervix is located within the female reproductive system. It is located where the lower part of the uterus meets the vagina.
The cervix is made up of strong muscles and serves several important functions within the female reproductive system. Each month the cervix allows for the passage of menstrual blood from the uterus. It also helps direct sperm into the uterus to allow for successful fertilization.
While the opening of the cervix is normally very narrow, during labor it will dilate to 10 cm to allow delivery of a baby.
What is Cervical Cancer?
The cervix is covered by cells which make up a thin layer of tissue. When cells are healthy, they will grow, divide and be replaced. Cancer causes this healthy behavior to change. The cells begin to divide more rapidly. The cells may also spread to other organs or grow into deeper cell layers. Eventually the cells form a tumor which is a mass of tissue.
Cervical cancer is the change from healthy cells to cancerous cells. Usually cervical cancer is slow growing, but it certain situations it can grow quickly and spread out of control.
The most common cervical cancer originates from the cells that lie on the surface of the cervix called squamous cells. When cancer develops from these cells it is called squamous cell carcinoma. This type of cancer makes up about 80% of all cervical cancers.
The second most common type of cervical cancer comes from the cells that make up the glands in the cervix. This type of cancer is called adenocarcinoma. Since the 1970’s the percentage of this type of cancer has risen, although researchers are unsure why. Rarely, cervical cancer will have characteristics of both squamous and adenocarcinoma cells. This type of cancer is called adenosquamous carcinomas.
How Common is Cervical Cancer?
Around 85% of women who die from cervical cancer reside in developing countries. This may be because of an unavailability of cervical screenings, prevention education, and the HPV vaccination in their countries.
In fact, North America, Europe and Australia have the lowest incidences of cervical cancer. This is likely due to the availability of programs in those continents which promote cervical screenings through pap smears which can identify and treat precancerous cells.
An estimated 1350 Canadian women and 13, 170 US women will be diagnosed with cervical cancer in 2019. An estimated 410 and 4, 250 respectively will die from it.
Symptoms of Cervical Cancer
Most people will not experience symptoms during the early stages of cervical cancer. This is why it is so important to have regular cervical screenings for changes in the cells on the cervix.
It’s better to detect and treat precancerous lesions early. Usually, the symptoms become visible when the cancer cells have grown through the upper part of cervical tissue into the tissue underneath.
This happens when the precancerous cells remain untreated. The condition will worsen into an invasive cervical cancer. Sometimes women mistake these regular symptoms as being harmless and non-cancerous.
- Irregular Bleeding is the most normal and frequent sign of invasive cervical cancer. Bleeding could happen between your monthly periods, or after having sex. It occasionally appears as a blood-streaked vaginal discharge and oftentimes mistaken as just spotting. This could also happen to postmenopausal women who don’t get their periods. So when you suddenly have irregular bleeding, despite already having gone through menopause, consult your doctor immediately.
- Vaginal Discharge aside from irregular bleeding, women may also experience. Abnormal vaginal discharge, which may be white, transparent, watery, brown, fetid or rancid, and blood tainted.
- Advanced Symptoms that are more serious signs are more prominent during the later stages. These are back pain or pelvic pains, problems with going to the bathroom, enlargement of one or both legs, exhaustion, and losing weight.
HPV and Cervical Cancer
One of the most important risk factors for cervical cancer is infection with a virus called Human papillomavirus (HPV). HPV is found in about 99% of cervical cancers. There are over one hundred different types of HPV, most of which are considered low-risk and do not cause cervical cancer.
However, there are high-risk HPV types that may cause cervical cell abnormalities or cancer. Two strains of HPV, HPV-16 and HPV-18 can be attributed to more than 70 percent of cervical cancer cases.
While HPV is associated with most cervical cancer cases, only a small percentage of women with HPV will develop cervical cancer.
HPV is a sexually transmitted infection that is common in the general population. Approximately 79 million Americans are infected with HPV. The majority of those infected are in their late teens and early twenties.
The HPV virus can cause genital warts, anal warts and several types of cancer. In addition to cervical cancer, it can also cause cancer of the vulva, vagina, penis, or anus. It can also cause cancer in the back of the throat, including the base of the tongue and tonsils (called oropharyngeal cancer).
How is HPV Spread?
HPV is a sexually transmitted infection. You can get HPV be having vaginal, anal or oral sex with a person who is infected with the virus. You can be infected with the virus even if your sexual partner has no symptoms.
The transfer takes place when an uninfected person’s skin or mucous membrane (ex. mouth, vagina) gets touched by or exposed to an infected person’s skin or mucous membrane. The infection doesn’t usually exhibit any symptoms. That’s the reason why infected people having sex unknowingly transfer the infection to their partners.
There are more than 40 HPV strains that can be sexually transmitted. Only a few of these HPV strains show manifestations.
Risk Factors for Contracting HPV
- One risk factor for cervical cancer is having a sexually transmitted infection. Any risk factor for developing STIs can also be risk factors for cervical cancer. These include:
- Becoming sexually active at an early age
- Having multiple male sexual partners
- Having multiple male partners who have high risk factors (becoming sexually active at an early age and having multiple male partners)
- Being diagnosed with any other sexually transmitted disease
Any condition that weakens the immune system can also increase your risk for cervical cancer. This includes being HIV positive, Hodgkin’s Disease and receiving an organ transplant.
Smoking can also increase your risk. Smokers are twice as likely to develop cervical tumors than non-smokers. There is also a link between women living in poverty and death from cervical cancer. This link may be from an inability to access proper screening services.
Risk factors are not an accurate prediction of whether or not you are at risk for cervical cancer. Regular screenings is the best defense to protect yourself against cervical cancer.
Preventing HPV and Cervical Cancer
- Screening in the form of Pap tests is the best way of preventing cervical cancer whether or not you had a vaccination against the virus. The test is one of the most dependable cancer-screening tests at hand. What the tests do is detect irregular cells and precancerous changes on a woman’s cervix. Early detection of these deviations paves the way for treatment before these could progress into being a type of cancer. This test can be done while having a pelvic exam. Your doctor will swab the cervix to gather cells that will be examined under a microscope. An HPV test can also be done while having the exam. The gathered cells will be examined for traces of HPV DNA aside from just being under the microscope.
- Vaccination is suggested for everyone up to age 26 and men up to age 22.. This will only be effective on women and men who have not been infected with one of the strains in the vaccine and therefore it is preferable the boys and girls receive the vaccine prior to becoming sexually active.
How can I avoid HPV and the health problems it can cause?
If you are sexually active:
- Use latex condoms the right way every time you have sex. Condoms don’t prevent HPV but they can lower your risk of the infection spreading.
- Be in a mutually monogamous relationship. Your risk is lower if you only have sex with someone who is only having sex with you.
Who should get vaccinated?
HPV vaccination is recommended at age 11 or 12 years (or can start at age 9 years) and for everyone through age 26 years, if not vaccinated already.
It is suggested that you are vaccinated before becoming sexually active. However, some adults 27 through 45 may choose to get vaccinated after speaking to their healthcare provider.
HPV vaccination in this age range provides less benefit as most sexually active adults would already be exposed to the infection. At any age, having a new sex partner is a risk factor for getting a new HPV infection.
How is Cervical Cancer Diagnosed?
Cervical cancer can be detected through a screening tests. Screening tests are able to detect precancerous cells as well as cancerous cells. This allows for an early intervention before the cells become cancerous.
It is generally advised to begin screenings for cervical cancer at age 21.
Screening tests include:
- Pap test During a pap test your doctor places a speculum inside your vagina which allows them to see your cervix. They will then use a long brush and/or tiny spatula to collect cells from your cervix. The cells will be sent to a lab for abnormalities.
- HPV DNA test. The HPV DNA test involves testing cells collected from the cervix for infection. This is used to screen for any of the types of HPV that are most likely to lead to cervical cancer.
What Happens if you Get an Abnormal Pap Smear?
If your doctor suspects you may have cervical cancer, either because of an abnormal pap smear result or through your reported symptoms, you will likely need a pelvic exam. Your doctor will likely need to thoroughly examine your cervix. There is a special magnifying instrument called a colposcope that is used to check for abnormal cells.
Your doctor may also take a cell sample, called a biopsy, for laboratory testing. These samples can be taken through a punch biopsy which uses a sharp tool to remove small samples of tissue. Your doctor may also use a thin, long instrument with a basket on the end, called a curet to scrape a tissue sample from the inner layer of the cervix.
The results of the colposcopy will determine next steps. This may include repeating a pap smear in 1 year or performing a larger biopsy to remove the HPV-infected cells. Women diagnosed with cervical cancer will be referred to a GYN Oncologists for further managment.
Don’t Lose Sleep Over HPV
Do you have questions about HPV or cervical cancer? If you think you may have HPV or experiencing signs or symptoms of cervical cancer, talk to a doctor immediately. Connect with one of our doctors for 24 hour access to medical advice.
Disclaimer: This article provides general information and is not intended to diagnose, treat or cure any disease or medical condition. If you require specific advice, please consult one of our medical professionals through the app. However, in case of an emergency, please call 911.
About Candice Fraser M.D.
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