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Cervical cancer develops in the cells of the cervix, the lower part of the uterus that opens into the vagina. It usually develops over several years through precancerous changes associated with persistent infection with certain high-risk types of human papillomavirus (HPV), although the rate of progression varies.
Early cervical cancer may cause no symptoms, which is why appropriate cervical screening is important for detecting high-risk HPV infection and precancerous changes.
Dr. Nikita Kulkarni, Consultant Obstetrician and Gynaecologist, emphasises appropriate cervical cancer screening and HPV vaccination as important measures for cervical cancer prevention and early detection of precancerous changes.
Understanding the symptoms of cervical cancer, possible risk factors, and available tests allows women to take timely action and seek appropriate medical care when needed.
What is Cervical Cancer and Why Does it Develop?
Cervical cancer develops when abnormal cells in the cervix acquire malignant changes and grow uncontrollably. In most cases, cervical cancer develops gradually through precancerous changes associated with persistent high-risk HPV infection.
The cervix refers to the lower part of the uterus which leads to the vagina. Most HPV infections clear spontaneously and do not progress to cervical cancer. Other factors can increase the risk and may affect how the disease develops.
Some factors that may increase the risk include:
- HPV infection – Persistent high-risk HPV infection is the principal risk factor.
- Smoking – Smoking can harm the cervix and make it harder to clear HPV.
- Immunosuppression – A weak immune system can make it harder for the body to fight HPV.
- Sexual activity at a young age – Earlier onset of sexual activity may increase the likelihood of HPV exposure.
- Multiple full-term pregnancies (High parity) – Women having multiple full-term pregnancies may have been associated with Cervical cancer particularly in women with persistent high-risk HPV infection. It is mainly due to hormonal and other bodily changes associated with pregnancy.
- Inadequate/irregular cervical Screening – Inadequate screening does not itself cause cervical cancer, but not having regular cervical screening can delay the detection of HPV infection and precancerous cervical changes, increasing the risk of cervical cancer being diagnosed at a later stage. Thus, the condition can remain undetected and untreated.
However, regular cervical screening can help detect abnormal changes in the cervix before they develop into cervical cancer.
What Symptoms of Cervical Cancer Should You Be Aware Of?
Early cervical cancer may have no symptoms. Any unusual or persistent symptoms should not be ignored and should be evaluated by a doctor.
Some of the commonly observed symptoms are as follows:
- Abnormal vaginal bleeding – This includes bleeding in between periods, after sex, after menopause, excessively heavy periods or menstrual bleeding that is unusual for that woman .
- Unusual vaginal discharge – Persistent watery, blood-stained, foul-smelling or otherwise unusual vaginal discharge should be medically evaluated.
- Painful intercourse – Pain during sex can sometimes be a symptom of cervical cancer. Persistent pain should not be ignored and needs to be checked by a doctor.
- Pelvic pain – Persistent or unexplained pelvic pain should be medically evaluated.
- Contact Bleeding: Bleeding after intercourse or cervical examination may occur with cervical abnormalities, although benign causes are more common. Medical evaluation is needed to determine the cause.
Symptoms That May Occur With More Advanced Cervical Cancer
Potentially include:
- Persistent pelvic/lower back pain
- Unexplained weight loss
- Fatigue/symptoms related to anaemia
- Urinary or bowel symptoms
- Leg swelling.
Understanding cervical cancer symptoms can help you identify potential warning signs and seek appropriate treatment. These symptoms do not necessarily mean that a woman has cervical cancer. They can occur with many benign gynaecological conditions. However, persistent, recurrent or unexplained symptoms should be evaluated rather than attributed to a common cause without examination.
When Should You Consult a Doctor?
Consult a gynaecologist if you experience unexplained bleeding after intercourse, bleeding between periods, postmenopausal bleeding, persistent unusual vaginal discharge, unexplained pelvic pain or other persistent gynaecological symptoms. Abnormal cervical screening results also require appropriate follow-up, while urinary or bowel symptoms, unexplained weight loss or leg swelling warrant evaluation to determine their cause.
How Is Cervical Cancer Screened For?
- HPV testing;
- Cervical cytology/Pap testing
- Co-testing where appropriate
Screening recommendations vary by age/medical history/previous results/guidelines. The appropriate screening interval also varies according to these factors. Symptomatic women need evaluation even if screening is “up to date”. Cervical screening is intended for women without symptoms. Women with symptoms such as unexplained postcoital bleeding, intermenstrual bleeding or postmenopausal bleeding require clinical evaluation even if their previous cervical screening result was normal.
How Is Cervical Cancer Diagnosed?
If screening results are abnormal or the cervix appears abnormal during examination, further evaluation may include colposcopy and biopsy. Histopathological examination of a biopsy is required to establish a diagnosis of cervical cancer.
Some common tests performed by doctors are listed below:
- Colposcopy – Colposcopy uses a magnifying instrument called a colposcope to examine the cervix more closely.
- Biopsy – A sample of the cervical tissue is taken for examination in the lab.
Colposcopy helps identify abnormal areas of the cervix from which a biopsy may be taken. Histopathological examination of the biopsy confirms whether precancerous or cancerous changes are present.
What Are the Different Stages of Cervical Cancer?
Cervical cancer is staged after diagnosis according to the extent of disease. Staging may involve clinical examination and imaging, and helps guide treatment. Detailed staging should be discussed with the treating gynaecologic oncology team.
| Stage | What It Means |
| Stage I | Cancer is present only in the cervix |
| Stage II | Cancer has spread outside the cervix but has not reached the pelvic wall |
| Stage III | Cancer has spread to the lower third of the vagina, pelvic wall, or nearby lymph nodes, and may affect the kidneys or ureters. |
| Stage IV | Cancer has spread to nearby pelvic organs, such as the bladder or rectum, or to distant parts of the body. |
The stage, along with other clinical and pathological factors, helps guide treatment planning.
How Can Cervical Cancer Be Prevented?
HPV vaccination and appropriate cervical screening are the main strategies for cervical cancer prevention. Smoking cessation and measures that reduce HPV exposure may further reduce risk.
Some effective preventive measures include:
- Routine screening – Cervical cancer screening helps detect abnormal cervical changes before they become cancerous.
- HPV vaccine – HPV vaccination significantly reduces the risk of infection with HPV types linked to most cervical cancers. It is most effective before HPV exposure and does not replace regular cervical screening.
- Stop smoking – Smoking is associated with an increased risk of cervical cancer, particularly in women with high-risk HPV infection.
- Safe sex practices – Safe sex practices like condom usage (although not completely eliminated) and having fewer sexual partners can decrease the chances of getting cervical cancer by reducing HPV transmission.
Can Cervical Cancer Be Detected Before Symptoms Develop?
Yes. Cervical cancer screening is designed to identify high-risk HPV infection and precancerous cervical changes before invasive cervical cancer develops. Detecting and appropriately treating precancerous lesions can prevent many cases of cervical cancer.
Does an Abnormal Pap Smear Mean Cancer?
Most abnormal cervical screening results do not mean that a woman has cervical cancer. An abnormal Pap/cytology result may indicate changes in cervical cells, while a positive HPV test indicates the presence of a high-risk HPV type. Depending on the result, repeat testing, colposcopy or treatment may be recommended.
Conclusion
Early cervical cancer may not cause symptoms, which is why HPV vaccination and appropriate cervical cancer screening among women are important for prevention and early detection of precancerous changes. Symptoms such as unexplained bleeding after intercourse, bleeding between periods, postmenopausal bleeding, or persistent unusual vaginal discharge should be medically evaluated even if previous cervical screening results were normal.
Dr. Nikita Kulkarni, Consultant Obstetrician and Gynecologist in Thane, provides cervical cancer screening, evaluation of abnormal cervical screening results and colposcopy as clinically indicated. Women can consult her for individualised guidance regarding cervical screening and preventive gynaecological care.
Women seeking cervical cancer screening in Thane or evaluation of abnormal cervical screening results can consult Dr. Nikita Kulkarni for individualised guidance and care.
