Many women are reluctant to talk about vaginal spotting, unusual discharge or physical discomfort during sex. However, if you have symptoms like these, don’t hesitate to speak up — they could be early signs of cervical cancer. Your gynecologist or primary care provider will listen carefully as you describe your symptoms, ask follow-up questions, do a thorough exam and proceed with testing as needed.
If cervical cancer is found early, most women do well with surgical treatment. Having awareness of symptoms is crucial. But don’t rely on physical symptoms alone as cancer warning signs. Some women with early cervical cancer may not have any symptoms that could prompt a timely discussion with their doctors.
Regular screening with methods like Pap tests can detect cancerous or even precancerous changes much sooner. Here’s what you should know about the earliest signs of cervical cancer.
Early Cervical Cancer Warning Signs
If you experience any of these symptoms, let your doctor know:
— Light bleeding or blood spots between menstrual periods.
— Vaginal discharge changes: watery, foul-smelling or more discharge than usual.
— Pain or discomfort during sexual intercourse.
— Bleeding during or after sex, or after a pelvic exam.
— Increased or extended menstrual bleeding.
— Pelvic or unexplained back pain.
— Postmenopausal bleeding.
“For the vast majority of women, if they have symptoms, it’s the early symptoms of discharge, bleeding and spotting,” says Dr. Jennifer Mueller, a surgeon who specializes in caring for women with gynecologic cancers, including cervical cancer, at Memorial Sloan Kettering Cancer Center in New York City. Whether women have symptoms or not, she says, “There’s the power and importance of the screening test — the Pap smear.”
About Your Cervix
The cervix is part of a woman’s reproductive anatomy. The cervix is the narrow opening between the vagina and uterus (or womb). During labor, the cervix widens, or dilates, to allow the baby to pass through the vagina.
The cervix is made up of three main sections. The ectocervix, or lower portion, extends downward into the vagina. The endocervix, the upper portion, comprises the cervical canal connecting the vagina to the uterus. The transformation zone of the cervix, or T-zone, is where the upper and lower portions meet.
The T-zone contains two types of cervical cells: glandular cells of the endocervix and squamous cells of the ectocervix. The T-zone is where cervical cells are most likely to gradually develop precancerous changes, which could potentially lead to cervical cancer.
Your Pelvic Exam
During a pelvic exam, your gynecologist or other provider uses a speculum to visualize your vagina and cervix. That also allows the clinician to use a swab to collect a sample for a Pap test or an HPV test to help detect cervical cancer.
Colposcopy is a procedure using an instrument that provides a magnified view of the cervix during a pelvic exam. Biopsy involves removing a small sample of cervical tissue. A cone biopsy, which is more extensive, removes a cone-shaped tissue section from the cervix. In some cases, a cone biopsy can be used as a treatment to entirely remove precancers or very early cancers from the cervix.
Cervical Cancer Risk Factors
Most cervical cancers are caused by the human papilloma virus. HPV is the most common sexually transmitted infection, according to the Centers for Disease Control and Prevention. Both males and females can be infected with HPV.
HPV can cause genital warts and several types of cancer, including anal cancer, throat cancer and cancer of the penis. Any woman who has been sexually active is at risk for HPV infection and cervical cancer.
Women with conditions affecting the immune system, such as HIV/AIDS, are at higher risk of cervical cancer. Smoking increases the risk of cervical cancer, as well.
Cervical cancer risk rises from late adolescence to a woman’s mid-30s. Risk still exists for women in their 40s and beyond.
Access to screening has an impact on the odds of developing cervical cancer. Black, Hispanic and American Indian women may be at higher risk for that reason.
Crucial Cervical Cancer Screening
Routine screening for cervical cancer really works. Screening catches abnormal cells or malignancies sooner, enabling timely, effective treatment and saving women’s lives.
If you’ve being proactive with recommended screenings for cervical cancer, you will either receive a Pap smear, an HPV test or, in some cases, a combination of the two.
When Should You Get Cervical Cancer Screening?
These are the current recommendations on cervical cancer screening from the U.S. Preventive Services Task Force, an influential panel of medical experts. They apply to healthy women at average risk for cervical cancer.
— Women ages 21 to 29 should be screened every three years with a Pap test alone.
— Women ages 30 to 65 should either have a Pap test alone every three years; HPV testing alone every five years or both tests combined every five years.
— Women over 65 who’ve previously had adequate screening and aren’t otherwise at high risk for cervical cancer do not need screening.
— Women younger than 21 do not need screening.
— Women who’ve had a hysterectomy with removal of the cervix do not need screening.
Early detection of cervical cancer is “extremely important,” says Paul Reiter, an associate professor in the division of health behavior and health promotion at the College of Public Health at The Ohio State University. “Most cases of cervical cancer can be prevented with regular screening, and then follow-up if any abnormal tests come back, with women receiving appropriate follow-up care,” says Reiter, whose research is focused on cancer prevention and control through screening and vaccination.
Which Screening Test Should You Have?
Although both screen for cervical cancer, the HPV and Pap tests reveal two different things. The Pap test detects abnormal cells in the cervix that could become cancerous if untreated, as well as cancer cells. The HPV test detects the presence of high-risk types of the virus in cervical cells.
Both the HPV and Pap tests are effective, Reiter says. HPV has been moving to the screening forefront in the last decade or so, he says, and is being increasingly used in conjunction with, or in place of, Pap testing.
Mueller explains that the recommendation for younger women to receive only Pap screening is meant to avoid overtreatment. In some cases, a young woman might have a normal Pap smear but show positive findings on her HPV test. “Young women are more likely to have what we call transient HPV infection,” she says. “So they’re young, they’re healthy and their immune systems will clear that virus.”
Cervical Cancer Prevention
Many cases of cervical cancer can now be prevented thanks to medical advances. A vaccine called Gardasil 9 helps protect against HPV infection and related cancers. Gardasil vaccination is recommended for both girls and boys, starting at 9 years old. With the HPV types it covers, Reiter says, “Gardasil 9 has the potential to prevent about 80 percent of all cervical cancers.” The vaccine can also prevent genital warts.
In October 2018, the Food and Drug Administration expanded its Gardasil 9 approval to include adults ages 27 to 45. Gardasil 9 vaccination is now indicated for females and males from 9 to 45 years old, using a two- or three-dose schedule.
Women who receive Gardasil need to continue screening for cervical cancer, Reiter emphasizes. “The vaccine protects against the most dangerous, high-risk HPV types, but not all of them,” he says. “So (although) they’re vaccinated, they still need to talk with their health provider to make sure they’re getting screened as they get older.”
If Your Screening Test Is Positive
It’s concerning to receive a positive Pap or HPV test, but this is vital health information to act on. The next step is working with your health care provider to get a complete examination and follow-up to determine whether precancerous cells are present or make a cervical cancer diagnosis. If cervical cancer is found in early stages, cure rates are excellent with appropriate treatment.
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