The fatality rate for cervical cancer has plummeted. Once the deadliest cancer for women, it is now 14th on the list. This incredible success story is rooted in early screening and prevention.
From the Pap smear to the HPV (human papillomavirus) vaccine, Yale Medicine has been at the forefront of developing widely used and incredibly effective diagnostic techniques and treatments for cervical cancer.
The majority of cervical cancer cases are tied to HPV, a sexually transmitted disease that will affect more than 80 percent of women over the course of their lifetime. "But just because you have it does not mean you will develop cervical cancer," says Yale Medicine's Elena Ratner, MD, co-chief of Gynecologic Oncology Program. "So the most important thing is reducing the rate of it is with the new HPV vaccines."
What is cervical cancer?
Cervical cancer occurs when cells inside the cervix grow abnormally or a tumor starts to form. The growth of abnormal cells in the cervix is almost always related to an HPV infection.
While most of these women will not go on to develop cervical cancer, a small percentage will. Getting vaccinated against HPV is the most effective way to protect young women from ever developing the disease.
New vaccines have proven to be 100 percent effective in preventing infections from HPV strains 16 and 18, the two types of HPV responsible for the majority of cervical cancer cases. For women who have already developed the early stages of cervical cancer, regular Pap smears are recommended. The disease progresses slowly and sometimes regresses on its own.
What are the risk factors for cervical cancer?
- HPV infection: This is the most common cause of cervical cancer. However, having HPV does not mean a woman will develop cervical cancer in her lifetime.
- Smoking: Women who smoke more often earlier in life are more likely to develop cervical cancer.
- DES: Another major risk factor is exposure to diethylstilbestrol (DES). DES is a drug that used to be given to pregnant mothers to prevent miscarriage, but this practice ended in 1971 in the United States. Women who were exposed to DES while inside the womb are at risk.
- Contraception and childbirth: Women who have been on oral contraceptives (the pill) for five or more years may be at greater risk for cervical cancer. Additionally, women who have given birth to seven or more children are at greater risk.
What are the symptoms of cervical cancer?
Women with early stages of cervical cancer will often have no symptoms. The disease develops slowly. In advanced stages, women with cervical cancer may experience symptoms that include:
- Abnormal bleeding: If a woman has abnormal bleeding (not related to her period) during sex, she should see her gynecologist. Bleeding after a pelvic exam may also be a sign of advanced cervical cancer.
- Pain during sex: If a woman is experiencing pain during intercourse, it could be a sign of cervical cancer.
How is cervical cancer diagnosed?
A woman's cervix is usually tested for abnormal cells during a routine Pap smear. A Pap smear is a bit like a cheek swab—a doctor will gently insert a simple tool called a speculum inside the vagina to open it slightly, and then use an extra-long swab to scrape cells from the inside of the cervix. These cells will be sent to a lab and tested for signs of abnormal growth.
How is cervical cancer treated?
Treatment options will differ depending on the stage of the cancer and on a woman’s desire to have children. In general, four treatment options are available. Depending on the extent and nature of the tumor and the spread of the disease, surgery might be needed to remove part of the cervix or the entire uterus.
Other treatment options include radiation and chemotherapy. There are also several FDA approved targeted therapies, which involve drugs specifically developed for treating cervical cancer.
What are treatment options if cervical cancer comes back?
If a woman has already been treated for cervical cancer, but the cancer returns, it is still possible to be treated with radiation, chemotherapy, and/or targeted therapy. In addition, a radical surgery called pelvic exenteration removes all the organs from the pelvic cavity. Clinical trials for promising new medications and therapies may also be an option.
What are treatment options during pregnancy?
If cervical cancer is detected during pregnancy, treatment options will vary on the stage of the cancer and the stage of the pregnancy. For early-stage disease, it might be possible to wait to treat the cancer until after the baby is born.
It might be possible to treat more advanced disease during and after pregnancy. However, some late-stage cancer might require immediate action. Pregnant women with advanced disease need to consult with a doctor about ending a pregnancy before being treated.
What makes Yale Medicine's approach to treating cervical cancer unique?
Vaccination and careful screening through periodic Pap smears is the best way to manage the risk of developing cervical cancer. If cervical cancer progresses to a later stage, surgery might be required. At the Gynecologic Oncology Program at Smilow Cancer Hospital, physicians are specially trained to treat cancers that develop in a woman’s reproductive organs.