Cervical Cancer – Causes, Diagnosis, and Prevention

Cervical cancer centers on the uterus’ narrow lower end, which connects to the birth canal (vagina). Typically developing slowly, cervical cancer begins in the cells of the cervix. Cell changes are known as dysplasia, with abnormal cells gradually populating the cervical tissue. Not removing or eliminating such cells may spread into deeper portions of the cervix and surrounding tissue.

The cervix has two major parts, with the ectocervix being the outer portion viewable through a gynecologic exam. This is made up of squamous cells, or thin, flat cells. By contrast, the inner endocervix is made up of glandular cells that are column-shaped and produce mucus, and it is this part that connects the vagina with the uterus. Also known as the transformation zone, the squamocolumnar junction forms the border between the endocervix and ectocervix, and most cervical cancers start here.

Around 90 percent of cervical cancers are covered with cell carcinomas, forming within the ectocervix, with most of the remainder known as cervical adenocarcinomas and developing in the endocervix’s glandular cells. In cases of adenosquamous carcinoma (or mixed carcinoma), cervical cancer features both types of cells, and in extremely rare cases, it can develop in other cervical cells.

Preventing cervical cancer starts with administering human papillomavirus (HPV) vaccine, which addresses the HPV types responsible for vaginal, vulvar, and cervical cancers. This FDA-approved vaccine, Gardasil, is administered as early as age nine but is most common in the preteen years of 11 to 12. For those who start before age 15, a two-dose schedule is recommended at six to 12-month intervals. For those to begin after turning 15, a three-shot series is recommended.

If not vaccinated, the HPV vaccine is advisable for all women up to age 26. While some adult women, from age 27 through 45, take the vaccine, its benefits diminish, as a majority of women have already had some exposure to HPV by their late 20s.

Among the steps women can take to minimize HPV risks are delaying sexual intercourse until the late teens (or later), practicing safe sex, and limiting the number of sexual partners. Smoking cessation may also have a positive effect in preventing the disease.

There are three basic tests and procedures that screen for cervical cancer. The HPV test involves removing a sample of cells from the cervix, which are examined for the human papillomavirus linked with the cancer. Often combined with the former procedure, the Pap test involves examining the same sample for cell changes that can potentially develop into cancers.

Finally, visual inspection with acetic acid (VIA) involves applying diluted white vinegar to the cervix. Typically employed in places with limited medical options, this helps identify abnormalities as they turn white with exposure to vinegar.

Treating cervical cancer often involves removing cancerous tissue surgically, with chemotherapy and radiation used in conjunction to shrink or eliminate the tumor. A paper published in Gynecologic Oncology in 2023 points to the immunotherapy drug pembrolizumab, in conjunction with chemotherapy, as an effective way of reducing mortality risks among patients who have metastatic or recurrent cervical cancer. This approach harnesses the immune system’s natural cancer-fighting properties and thus is better tolerated, with fewer side effects, among many patients.