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OVERVIEW

What is cervical cancer?

Cervical cancer is abnormal growth of cells in a woman’s cervix. The cervix is the lowest part of the uterus (womb). It connects the uterus and the vagina.

Cervical cancer grows slowly. Healthcare providers can often find and treat the problem before it turns into cancer. People should get regular screenings so their healthcare providers can find problems early.

SYMPTOMS

In its early stages, cervical cancer may not have any symptoms. This is the case with many cancers. In later stages, symptoms could include:

• Unusual vaginal bleeding (not during your menstrual cycle).
• Abnormal vaginal discharge.
• Pelvic pain.
• Pain during sex.

These could also be signs of a condition other than cervical cancer. If you experience any of these symptoms, contact your healthcare provider

CAUSES & RISK FACTORS

What causes cervical cancer?

Almost all cervical cancers are caused by HPV. This is a common sexually transmitted virus that can cause infections. There are more than 100 types of HPV. Some types cause no symptoms. Others cause body warts or genital warts. More aggressive kinds can cause cancer in both women and men. Cervical cancer is the most common kind of cancer caused by HPV.

DIAGNOSIS & TESTS

How is cervical cancer diagnosed?

Abnormal results from a routine Pap test (or smear) leads to a cervical cancer diagnosis. During a Pap test, your healthcare provider takes a sample of cells from your cervix. The sample is sent to a lab and checked under a microscope.

An abnormal Pap smear can be a sign of a number of changes in the cells on your cervix, including:

• Inflammation (irritation). This can be caused by an infection of the cervix, including a yeast infection, infection with the human papillomavirus (HPV), the herpes virus, or many other infections.
• Abnormal cells. These changes are called cervical dysplasia. The cells are not cancer cells, but may be precancerous (which means they could eventually turn into cancer).
• More serious signs of cancer. These changes affect the top layers of the cervix but don’t go beyond the cervix.
• More advanced cancer. These cell changes extend into tissues beyond the cervix.

If the results of your Pap smear are abnormal, your healthcare provider may want to do another Pap smear or may want you to have a colposcopy. During this procedure, they will use a magnifying lens to look more closely at your cervix. They can also take a sample of tissue (biopsy) to test for cancer.

Cells of the cervix go through many changes before they turn into cancer. A Pap test can show if your cells are going through these changes. If caught and treated early, cervical cancer is not life threatening. This is why it is so important that you get regular Pap tests.

PREVENTION

Can cervical cancer be prevented or avoided?

In many cases, cervical cancer can be prevented. The best ways to do this are to avoid getting HPV and to get regular Pap tests.  Getting an HPV vaccine can protect young people against the virus.

Other ways to lower your risk of getting HPV include:

• Limit your number of sex partners.
• Use condoms anytime you have sex. (Remember, condoms aren’t 100% effective. HPV is spread by skin-to-skin contact. This makes condoms less reliable for prevention.)

Get regular Pap tests

How often should I have a Pap smear?

Certain things put you at higher or lower risk for cervical cancer. Your healthcare provider will consider these when recommending when you should have your first Pap test and how often you should have a Pap test. Below are general guidelines.  It is recommended you consult with your health care provider to determine what screening is right for you, based on your history.

Nova Scotia

The Nova Scotia Cervical Screening Practice Guidelines recommend:

• Women who have been sexually active should start having a Pap test at the age of 25. Once women begin having Pap tests, they should have them every 3 years.
• Women who become sexually active for the first time after the age of 25 should have a Pap test within three years of the time that they became sexually active.
• Women who have never been sexually active do not need to have Pap tests until such time as they become sexually active.
• If the Pap test results are normal (negative or clear) women should continue to have Pap tests every three years.
• Screening may be discontinued after the age of 70 ONLY if there is an adequate negative screening history in the previous ten years (i.e. three or more negative tests).

Prince Edward Island

HPV (human papillomavirus) testing has replaced Pap tests to screen for cervical cancer on PEI. For more information, see https://www.princeedwardisland.ca/en/information/health-pei/hpv-screening-and-cervical-cancer-prevention

TREATMENT

In many cases, precancerous cells are found before cancer develops. Treatment for these is different than for invasive cancer cells.

Precancerous lesions

Treatment will depend on several factors. These include severity, age, general health, desire to get pregnant in the future, and preference. Options include cryosurgery (freezing), cauterization (burning), or laser surgery. These procedures destroy the abnormal cells without causing much damage to nearby healthy tissue.

Invasive cervical cancer

This means that the cancer has spread from the surface of the cervix. It may spread to tissue deeper within the cervix or to other parts of the body. Treatment options depend on the size of the tumor and how far the cancer has spread. They also may depend on your plans for having children in the future. The most common treatments include:

• Surgery — The cancerous tissue is removed in an operation.
• Radiation —High-energy rays like X-rays shrink or kill the cancerous cells.
• Chemotherapy — Powerful medicines, in pill form or injected into the veins, shrink or kill the cancer.

Treatment of invasive cancer often involves a team of specialists. This could include your primary healthcare provider, a gynecologist, and an oncologist (cancer specialist). You will all work together to develop the best treatment plan for you.

Living with cervical cancer

Cervical cancer is treatable, especially when detected early. Precancerous cells can be removed before they develop into cancer. Early treatment often does not affect your ability to have children. Treatment of more advanced cancers could require removal of the uterus or other reproductive organs. Some women have their eggs frozen for future use before undergoing this kind of surgery.

Cancer treatments can be stressful. Treatments can have different side effects on your body. Take good care of yourself. Eat a healthy diet, get plenty of sleep, and try to keep your energy up by staying mildly active.

Even after your cancer goes into remission, you are at higher risk of cancer returning to your body. You will need to get regular follow-up care and check-ups for years after your treatment.

FOR MORE INFORMATION

Screening Guidelines – Nova Scotia
https://library.nshealth.ca/Cancer/Screening

Health PEI – HPV Screening and Cervical Cancer Prevention
https://www.princeedwardisland.ca/en/information/health-pei/hpv-screening-and-cervical-cancer-prevention