Everything about cervical cancer
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What is cervical cancer?
Cervical cancer, known under the moniker cervix carcinoma amongst doctors, is a malignant tumor that forms in the cervix. The cervix is the lowest, narrow part of the uterus. It is sometimes also referred to as the cervix uteri (neck of the uterus). Cervical cancer is a different form of cancer than uterine cancer. Uterine cancer develops in the upper, wider part of the uterus, the uterine body. The malignant tumor often develops in the transitional space of the cervix, where two types of cells meet each other: cylinder cells and squamous cells. These squamous cells are found on the outer side of the cervix and the vagina, while the cylinder cells are on the inner side of the cervix. You can compare it to your lips, the outside feels different than the inside.
Types of cervical cancer
Cervical cancer occurs in various forms. The most common one is squamous cell carcinoma (8 out of 10 cases). If the tumor forms out of the cylinder cells, it’s called an adenocarcinoma. These occur in 2 out of every 10 people with cervical cancer. In both cases, the cancer is caused by a prolonged HPV infection. HPV stands for human papillomavirus, which you can contract through sexual contact. About 80% of all women will be infected with this virus at some point in their life. In most cases, your body manages to get rid of it after 1 to 2 years. If you smoke, it will be more difficult for your body to rid itself of the virus.
In some very rare cases, HPV isn’t the cause of cervical cancer. This can be the case when a ‘DES daughter’ gets adenocarcinoma. That has nothing to do with HPV. DES is a hormone that used to be prescribed to pregnant women+ to prevent miscarriages between 1947 and 1976. Sadly, it has turned out to cause some very troubling side effects.
How common is cervical cancer?
Worldwide, cervical cancer ranks at number four on the list of most common types of cancers in women. It has been estimated that about 600.000 diagnoses of it are made every year (2020) and about 340.000 people die because of it (2020). In more wealthy countries such as the Netherlands, cervical cancer occurs less frequently. In 2021, 947 women in the Netherlands were diagnosed with cervical cancer, while this number tends to be around 3,200 a year in the UK. This is because of the nationwide population screenings that are done to detect HPV (human papillomavirus) and/or (early stages of) cervical cancer. There are also vaccination programs that help your body to get rid of HPV more easily. The vaccine provides you with antibodies that specifically target the different types of HPV. These nationwide programs often don’t exist in middle- and low-income countries, which makes cervical cancer more common there.
What causes cervical cancer?
As said, in 95% of all cases, cervical cancer is caused by the human papillomavirus (HPV). There are two types of HPV, types 16 and 18, which combined cause almost 50% of the early stages of cervical cancer. Squamous cell carcinoma is often caused by HPV type 16. The adenocarcinoma, in turn, is caused by HPV types 16 and 18. In 90% of all cases, the body rids itself of the virus without you even knowing it was there. Sometimes this doesn’t happen, and after a long period of time - think of 15 to 20 years - this can develop into cervical cancer. For individuals with a weak immune system, this may happen more quickly.
pap smear results explained
read moreCervical cancer: the symptoms and stages
It can be the case that you don’t even notice that the cells in your cervix aren’t at ease for the first few years. You often won’t have any symptoms or complaints. The cells in your cervix will change very slowly, and you often won’t notice. Later on in (the preliminary stages of) cervical cancer you can experience some complaints, such as:
Bloody or brown discharge when you’re not menstruation (spotting)
Blood loss during penetrative sex
Bloss loss after perimenopause (during menopause)
There are many different causes for these symptoms, ranging from completely innocuous to cancer. In any case, if you’re having any of these symptoms, it’s a good idea to visit your GP to check them, and to at least have a pap smear done.
Cervical cancer can be divided into two different stages, for which two separate methods are used: the TNM system and the FIGO system. The TNM system looks at the size of the tumor, the metastases in the lymph nodes, and the potential other metastases in the body. These three parts are all assigned a number, which are added together. The higher this number, the more the cancer has spread.
Another method is the FIGO system. This is made up of four stages:
Stage 1: The cervical cancer is only in the cervix.
Stage 2: The cancer cells of the cervix have grown out of the cervix, for example into the top of the vaginal wall or into the suspensory ligaments of the uterus.
Stage 3: There are metastases in the lymph nodes in the pelvic area or along the aorta, or the cancerous cells have spread to the vaginal entrance.
Stage 4: The malignant cells are in the rectum or bladder, or there are metastases in the bones, lungs, or for example in the liver. The cancerous cells can also be found in the blood.
Prevention: population screenings and cervical cancer
In the Netherlands, all individuals with a uterus between the ages of 30 to 60 are invited to partake in the population screening for cervical cancer. In almost all cases, cervical cancer develops as a result of a long-term infection of HPV, which isn’t taken care of by the body itself. Almost everyone gets HPV at some point in their lives, so it’s important to test people for it. Once the pap smear has been done, it will first only be tested for HPV. If you don’t have this, there is no need to look for abnormal cells, since the chance of having them is miniscule without HPV. If HPV is found, then it will be examined whether or not the cells in the cervix are abnormal. This can be done using the same pap smear, so you won’t have to come back for a second one. This way, abnormal cells can quickly be detected before they develop into cervical cancer. There are two ways for you to take part in this screening: by doing an at-home test (which will be sent along with the invitation) or by having a pap smear done by your GP. When you opt for the at-home test, it will only be checked for HPV. If you don’t have HPV, you won’t have to worry about it for the next five years. However, if HPV is found, you’ll still have to go to the GP for a pap smear so that the cervical cells can be examined.
Sadly, the number of women+ who take part in the screening has been dwindling over the past few years. Fear, worry, and a lack of knowledge seem to contribute to the decision not to do a pap smear or to have one done. Even though this is an important thing to do*
In a few European countries, this screening is done starting at the age of 25, as cervical cancer can also occur in people under the age of 30. In those cases, the consequences of it are often more severe. The cancer tends to be more aggressive and grows more quickly. Young people can already be sexually active around the age of 14/15, and can therefore contract an HPV infection. In some very rare cases, HPV can develop into cancer in 10 years. If you’re below the age of 30 and are experiencing symptoms, it’s smart to have it looked into by way of a pap smear!
Besides the population screening, you can also be vaccinated against cervical cancer. Vaccination considerably reduces the risk of cervical cancer. In the Netherlands, children between the ages of 9 and 10 are invited to be vaccinated. It is also possible to be vaccinated as a (young) adult.
Treatment of cervical cancer
The preliminary stage of cervical cancer, which isn’t cancer yet, is very easy to treat. This also applies to the FIGO stages of cervical cancer.
Once cervical cancer has been diagnosed, there are different treatment options available. They’re dependent on the type of cervical cancer you have, your age, the stage, and of course your own wishes and what you can handle. Based on this, a treatment plan will be made for you.
Operation
There are many different kinds of operations, and the one that is selected is dependent on multiple factors. A section of the uterus can be removed (conization). The entire uterus, the ovaries and oviducts, and the lymph nodes in the pelvis can also be removed (radical hysterectomy/hysterectomy with lymphadenectomy). It can also be decided to do a uterus-saving operation, after which you’ll still have a chance of getting pregnant. Usually, this is only done for people who have an early stage of cervical cancer and who have a child-wish. This operation is called a radical trachelectomy, but it can also be done using a conization. After the operation, most people can get pregnant the natural way, though a C-section is always needed.
Radiation (potentially in combination with heat treatment)
In most cases, this will be recommended if the tumor is present outside of the cervix, or if the tumor is too large to operate on.
Chemotherapy
For cervical cancer, chemotherapy can be done before the operation or radiation. In advanced cervical cancer, you will often get a combination of chemotherapy and radiation.
The preliminary stages of cervical cancer, which aren’t cancer just yet, can often be treated very well. This is also true for cervical cancer that hasn’t spread outside of the pelvic area. Once tumors are found in for example the lungs or liver, it is no longer possible to fully treat it. When that happens, the treatment will focus on decreasing or stabilizing the growth of the tumor.
Want to know more? Take a look at the Kanker.nl website *Dutch population screening
