Understanding Cervical Cancer
Cervical cancer affects the cervix, or the lower part of the uterus (womb), in a woman’s reproductive system. Like other types of cancer, cervical cancer involves abnormal changes to cells. In the cervix, it begins with “pre-cancerous” changes that can be detected with a screening test.
Pre-cancerous cells don’t always become malignant (cancerous), but it’s best to detect and treat them early. According to the Canadian Cancer Society, most women with pre-cancerous changes to the cervix are treated successfully and do not develop cancer. It’s also important to note that not all changes to cervical cells are pre-cancerous or cancerous. Benign (non-cancerous) tumours, such as polyps, fibroids and cysts, can also develop.
Cervical cancer rates have decreased greatly since 1992, when screening programs became widely available. Cervical cancer now accounts for 1.5% of new cases of cancer in Canadian women. An estimated 1,500 Canadian women will be diagnosed with cervical cancer in 2016, and an estimated 400 will die from it. Cervical cancer rates are expected to decline over the next two decades, with moderate to high HPV vaccination rates in girls.
Are you at risk?
Certain factors increase a woman’s risk of cervical cancer. Known risks include:
Human papillomavirus (HPV): HPV is a group of more than 100 viruses. More than 40 of them are transmitted through sexual contact, and about 25 are linked to cancer. Most sexually active people will have an HPV infection at some point; most don’t know since there are often no physical symptoms. HPV is the leading cause of cervical cancer. Having HPV doesn’t mean you’ll have cancer – only certain “high-risk” types cause changes to cervical cells, which can develop into cancer if not treated early.
Smoking: Cigarettes contain cancer-causing substances. Smoking also makes it harder for the immune system to fight HPV. A prolonged HPV infection can develop into pre-cancerous conditions and cervical cancer.
Giving birth more than once: A woman’s risk of cervical cancer increases with each child she gives birth to.
Sexual activity: Sexually active women are at higher risk of cervical cancer because of potential exposure to HPV.
Weakened immune system: Women with a weakened immune system (for example, due to immune-suppressing medications or HIV infection) can have a higher risk of HPV infections. It’s also more difficult for a weakened immune system to fight HPV, and there’s a higher chance that pre-cancerous changes will develop into cancer.
Socio-economic status: Women with lower incomes are less likely to have regular Pap tests, which detect changes to cervical cells.
Diethylstilbestrol: Diethylstilbestrol (DES) is a synthetic form of estrogen, used between 1940 and 1971 to prevent miscarriage. Women whose mothers took DES during pregnancy have a higher risk of clear cell carcinoma, a rare type of cervical cancer, and possibly pre-cancerous changes to cervical cells and squamous cell carcinoma.
Oral contraceptives: Taking birth control pills for several years may raise the risk of HPV developing into cervical cancer. The risk decreases once women stop taking the pill.
Prevention and Screening
Women can take steps to reduce their risk of cervical cancer:
Pap smears: The Pap smear (or Pap test) is a screening test that detects pre-cancerous changes in cervical cells. The test involves gently scraping the cervix to remove a small amount of cells and then viewing them with a microscope. Sexually active women should begin having Pap smears by age 21. Screening is repeated every one to three years, depending on previous test results. Women at higher risk of cervical cancer (such as women who have a weakened immune system) may need more frequent screening. Women who aren’t sexually active and women over age 69 should talk to their physicians about when and how often they should be screened.
Quitting smoking: This can help reduce the risk of cervical cancer and other diseases. To access free, confidential help for smoking cessation, visit smokershelpline.ca.
Preventing HPV infections: Condoms do not completely protect against HPV, but they help reduce the risk (as well as the risk of HIV and some other sexually transmitted infections).
HPV vaccines: In Canada, three HPV vaccines are available. They are meant to prevent HPV infections; they do not treat existing HPV infections or cervical cancer. The Canadian Cancer Society recommends that girls and women aged 9 to 45 should be vaccinated. Talk to your physician about your options. Women who have been vaccinated should continue to have Pap smears.
Signs and Symptoms
In the early stages of cervical cancer, there may not be any signs or symptoms. Often, symptoms don’t appear until the cancer has spread into surrounding tissues
If you notice any of these symptoms, the Canadian Cancer Society recommends seeing your physician to find out what might be causing them.
• Pale, watery, pink, brown or bloody vaginal discharge between periods
• Unusually long or heavy periods
• Bleeding after sexual intercourse
• Bleeding or bloody discharge from the vagina after menopause
• Bleeding after a pelvic exam or vaginal douching
• Pain during sexual intercourse
• Increased amount of vaginal discharge
• Foul-smelling vaginal discharge
If you notice problems related to urination or bowel movements (such as difficulty urinating or blood in the stool) or other unusual symptoms such as bone pain, weight loss, swelling in the legs or pain in the pelvic area, consult your physician.
Diagnosing and treating cervical cancer
If a Pap test indicates there may be a problem with the cervix, your physician will investigate further. They might ask about symptoms and order bloodwork or other tests. If cancer is diagnosed, a specialist will determine how much it has progressed and discuss your treatment options.They may involve surgery, medication and/or radiation therapy, as well as follow-up care.
Life after cervical cancer
Regular check-ups and cancer screening are important for survivors. A wellness plan, developed with healthcare professionals, can help women regain strength, cope with side effects and stress, and reduce the risk of cancer recurrence.
For more information and support, contact the Canadian Cancer Society or visit CancerConnection.ca. Professional counselling can also provide support.
To read more signup for the quarterly Navigator Newsletter below.