Can cervical cancer be fully cured?

Cervical cancer was once one of the most common causes of cancer death for American women. But over the last 60 years, the cervical cancer death rate has gone down by more than 50%. The main reason for this change was the increased use of the Pap test. This screening procedure can find changes in the cervix before cancer develops. It can also find cervical cancer early − in its most curable stage.

What is cervical cancer screening?

Cervical cancer screening is used to find abnormal changes in the cells of the cervix that could lead to cancer. Screening includes the Pap test and, for some women, testing for a virus called human papilloma virus (HPV) (see Can cervical cancer be prevented?). The Pap test (or Pap smear) looks for pre-cancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately.

The Pap test is simple, quick, and painless; it can be done in a doctor’s office or clinic. A sample of cells is collected from the cervix and sent to a lab for examination under a microscope. It is usually done during a pelvic exam, after the speculum is placed in the vagina.

When should screening start?

Cervical cancer screening should start at age 21. Women under 21 should not be tested.

How often should the Pap test be done?

Women between the ages of 21 and 65 should get a Pap test every 3 years. However, a woman with certain risk factors such as human immunodeficiency virus (HIV) infection, organ transplant, or exposure to the drug DES may need to be screened more often. Talk to your doctor about how often you should have a Pap test based on your personal history.

Why is the Pap test important?

The Pap test looks for cell changes on the cervix that might become cervical cancer if they are not treated appropriately. The test can find these cell changes early, when they’re easier to treat and before they turn into cervical cancer. Treating these pre-cancers can prevent almost all cervical cancers. Pap tests can also detect cervical cancer early, when it’s small and easier to cure.

The Pap test itself does not prevent cancer − it’s just a screening test. But cervical cancer deaths have gone down greatly in the last 50 years because Pap testing became routine.

What determines my risk of cervical cancer?

Certain types of the human papilloma virus (HPV) cause the cell changes that can lead to cervical cancer and other cervical cell changes. HPV is passed from one person to another during sex. So a woman’s risk of getting HPV (and cervical cancer) rises with:

  • The number of sex partners she has had – the more partners, the higher her risk
  • A partner who has had many sex partners or female partners who’ve had cervical cancer or pre-cancers
  • Early age at first intercourse (before age 17)
  • Multiple births (having given birth 3 or more times)

Women who smoke are about twice as likely as non-smokers to get cervical cancer. Smoking also makes the cancer grow and spread faster. Studies suggest smoking may limit the ability of the immune system to fight HPV infection and cancer growth.

HIV infection, also known as AIDS, damages the body’s immune system and puts women at increased risk for HPV infections that increase the risk of cervical cancer. HPV causes AIDS-related cancers, including cervical cancer.

What determines my risk of getting cervical pre-cancer?

Women who have had the risk factors listed above are more likely to develop pre-cancers, but many women with pre-cancers do not have any known risk factors. Although most women diagnosed with cervical pre-cancer have never had (or don’t have) cervical cancer, they are at increased risk for getting cervical cancer in the future.

What if my Pap test is abnormal?

Your doctor will let you know if your Pap test results are abnormal. Don’t assume that your test is normal until you get the results – ask your doctor or nurse. If your test results are abnormal, your doctor will explain what this means to you. The most common abnormal Pap test results are:

  • Atypical squamous cells of undetermined significance (ASC-US) – the squamous cells do not look completely normal, but doctors are uncertain about what the cell changes mean.
  • Squamous intraepithelial lesion (SIL) – refers to abnormal changes in the cells on the surface of the cervix. Changes in these cells are divided into 2 categories:
    • Low-grade SIL – considered mild dysplasia: slightly abnormal cells are found on the surface of the cervix. They may become cancer over time
    • High-grade SIL – considered moderate or severe dysplasia: more abnormal cells are found on the surface of the cervix. They are more likely to become cancer if not treated
  • Atypical glandular cells – glandular cells do not look normal but do not look like they are pre-cancerous. Glandular cells are mucus-producing cells found in the endocervical canal or in the lining of the uterus (endometrium).

Your doctor will explain what treatment, if any, is needed to follow up on the abnormal test results. Most of the time, abnormal changes will go away on their own. If not, the cells may need treatment because they could become cancer if left alone. This will depend on the result of your Pap test.

If I have an abnormal Pap test, what happens next?

What happens next depends on the result of your Pap test. Here are some possibilities:

  • Repeat Pap test: If your Pap test result is ASC-US or is unclear, your doctor may repeat the Pap test at your next routine exam, which is typically in a year.
  • HPV testing: If you are age 30 or older, your doctor may test the sample from your Pap test for HPV types that are most often linked to cervical cancer. If the HPV test is negative, you will most likely need only routine Pap tests for the next 3 years.
  • Colposcopy: In this procedure, the doctor uses a special magnifying device to look at your cervix. A vinegar solution is sprayed on the cervix, which causes abnormal areas to turn white. These areas are then biopsied (a small sample is removed). The biopsy sample is sent to a lab, where it is looked at under a microscope for pre-cancer cells or cancer cells.
  • Loop electrosurgical excision procedure (LEEP): The abnormal area on the cervix is removed with a thin wire loop that acts like a scalpel. A local anesthetic is used to numb the cervix. The procedure takes about 10 minutes. It may cause mild cramping like menstrual cramps and light bleeding afterward.
  • Cone biopsy: A cone-shaped sample of the cervix that contains the abnormal cells is removed for examination (biopsy). This is done using a surgical or laser knife (cold knife cone biopsy) or using a thin wire heated by electricity (the loop electrosurgical, LEEP or LEETZ procedure). Afterward, the cervix is packed with gauze to control bleeding. The biopsy sample is sent to a lab for examination.

If I have cervical cancer, what are the treatment options?

Here are some common treatment options for cervical cancer:

  • Surgery: Early cervical cancers can often be cured with surgery to remove the cancer. A hysterectomy removes the uterus and cervix. Often, the upper part of the vagina near the cervix is also removed. The surgeon may also remove lymph nodes in the pelvis (lymph node dissection) to look for cancer spread.
  • Radiation therapy: Radiation may be used alone or with chemotherapy to treat cervical cancer. It can be used to destroy cancer cells and shrink early stage cervical cancers before surgery. Radiation may be used after surgery to destroy any cancer cells that may have been left behind. It can also help control advanced cervical cancer.
  • Chemotherapy: Chemotherapy uses anti-cancer drugs that are injected into a vein or given by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancer that has spread to organs beyond the pelvis.

The stage and size of the cancer helps determine what treatments are needed. Stages 0, IA, and IB1 cervical cancers are often treated with surgery alone. More advanced cancers often need radiation therapy and chemotherapy. Your doctors will discuss with you the best treatment options based on your particular situation.

What determines my prognosis (chance of recovery) with cervical cancer?

The prognosis for cervical cancer varies depending on the extent of the disease. Early detection improves the prognosis significantly. The cure rate for women with Stage IA cervical cancer exceeds 80%. The percentage of women cured decreases as the stage increases, but treatments can often extend life even at later stages of the disease.

Factors that affect prognosis include:

  • The stage and size of the tumor
  • Whether the cancer has spread to lymph nodes or other places in the body
  • The tumor’s histology (what the cells look like under the microscope)
  • The woman’s age and general health

Even if your cancer is advanced and a cure is no longer possible, you should know that treatment can often shrink the tumor, relieve pain, and help keep you more comfortable. Newer treatments help many women with cervical cancer maintain a good quality of life for a substantial period of time.

Can cervical cancer be prevented?

The Pap test and HPV testing find changes in the cervix before they turn into cancer. This can prevent most, but not all, cases of cervical cancer. If and when cancer does occur, these tests make it possible to find the cancer early, when treatment is most effective.

Cervical cancer is caused by human papilloma virus (HPV) infection. HPV vaccines (Gardasil and Gardasil 9) provide long-lasting protection against the major cancer-causing HPV types. The vaccines work best when given at a younger age, before a person is exposed to HPV. The CDC and major medical groups now recommend that all children ages 11 to 12 get 2 doses of HPV vaccine 6 to 12 months apart. Adolescents and young adults up through age 26 should also be vaccinated if they were never vaccinated. Vaccines do not get rid of existing HPV infections.

Lifestyle changes that promote good health in general are also thought to lower cervical cancer risk. Women should not smoke and should limit their number of sexual partners. While condoms cannot fully protect against HPV infection, they may reduce the risk of cervical cancer development.

Can cervical cancer be cured?

Many cases of cervical cancer can be cured if found early and treated properly. When cervical cancer is found early, more than 9 out of 10 women will live for at least 5 years after diagnosis. Thanks to screening tests like the Pap test, most cervical cancers in the United States are found at an early stage, before cancer has spread. The 5-year survival rate for women with stage 1 cervical cancer is 92%. But women with stage 2 cervical cancer have a 57% 5-year survival rate. At stage 3, survival declines to 35%, and stage 4 survival is only 16% at 5 years.

Even cancers that have spread to other organs can sometimes be controlled with surgery, radiation therapy, chemotherapy, targeted therapy, or some combination of these. If a cure is not possible, treatment may still help by shrinking the cancer and improving cancer-related symptoms.

Conclusion

Cervical cancer was once a major cause of cancer deaths in American women. But death rates from cervical cancer have decreased significantly over the past several decades thanks to widespread use of the Pap test. Screening with the Pap test can find changes in the cervix before they turn into cancer. It can also find cervical cancer early − in its most curable stage. Treatment is more effective when cervical cancer is detected early.

HPV vaccines help prevent cervical cancer by protecting against HPV infection. This infection is the main cause of cervical cancer. The HPV vaccine is recommended for preteens and young adolescents.

Although it may still develop in a small number of women, cervical cancer is one of the most preventable types of cancer. Early detection through Pap tests and HPV co-testing for women 30 and over, and HPV vaccination can help prevent the vast majority of cervical cancer cases.

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