Ask the Expert: Cervical Cancer 

Dr. Yi-Chun Lee, gynecologic oncologist and system chair of Women’s Health Services at Catholic Health, answers commonly asked questions about cervical cancer.

What is cervical cancer?

Cervical cancer occurs in the cervix, which is the lower part of the uterus or womb. This type of cancer typically develops slowly from HPV-related precancerous conditions over a long period of time. Approximately 14,000 women are diagnosed with cervical cancer each year in the United States. Cervical cancer is most frequently diagnosed among women over the age of 35 and rarely occurs in women younger than 20. If found early, cervical cancer is highly treatable. 

What causes cervical cancer?

The human papillomavirus (HPV) causes more than 90% of cervical cancer cases and is transmitted through sexual activities. It is rare for cervical cancer to be caused by other non-HPV related etiology. (A few examples are small cell neuroendocrine tumor, adenoid cystic and adenoid basal carcinoma, or rhabdomyosarcoma of the cervix.) Additionally, there can be other types of cancer that metastasize or spread to the cervix such as from the uterine cancer or lymphoma.
 

Are there symptoms of cervical cancer?

There are usually no symptoms of cervical cancer in its early stage. Therefore, early cervical cancer is often diagnosed by Pap smear or pelvic examination and not by the presenting symptoms. In the advanced stages, cervical cancer symptoms can include painful intercourse, pelvic pain, bleeding after sex, or bloody, foul smelling vaginal discharge. 

How is cervical cancer treated?

Early-stage cervical cancer can be treated surgically, especially among young women, whereas advanced stage cervical cancer is treated with chemo-radiation. The type and stage of cervical cancer will determine the exact treatment plans. Surgical treatment of cervical cancer includes cervical conization, simple hysterectomy, radical hysterectomy, and typically limited to stage I disease. For any cervical cancer above stage I, whole pelvic radiotherapy with concurrent low-dose chemotherapy is the standard of care. 

How is cervical cancer detected? 

Pap smear screenings identify abnormal cells on the cervix. During a Pap smear, a physician collects cells from the cervix. The cells are examined by a cytologist under a microscope to look for any precancerous changes that suggest cancer might develop in the future. 

Regular high-risk HPV testing can also identify women at risk of developing cervical cancer. Several types of HPV, such as types 16 and 18, can lead to cervical cancer and hence are high-risk. HPV testing is typically conducted on women over the age of 25 and repeated every five years.

How often should women have Pap smears?

According to the American Society for Colposcopy and Cervical Pathology guidelines, women should have a Pap smear every three years beginning at age 21. 

Between the ages of 30-65, women can have a cervical cancer screening by either Pap smear alone or together with high-risk HPV testing (co-test). If women have a negative Pap smear and HPV testing, they can repeat the tests every five years. If a woman has a negative Pap smear alone without HPV testing, it should be repeated every three years.

After the age of 65, women can stop cervical cancer screening as long as they have 20 years history of regular cervical cancer screening and never had a high-grade abnormal pap smear and never had a positive HPV testing. If they don’t meet these strict criteria, they should continue having Pap smears on a regular schedule. 

Women who have had total hysterectomies (cervix removed) should continue regular screenings if they don’t meet the above criteria. HPV infection can occur in the vagina and cause vaginal cancer in a similar fashion. Women who had partial or subtotal hysterectomies still have their cervix and should follow the same screening guidelines as those without hysterectomies. 

Women should see their gynecologists every year for pelvic examination. The examination will ensure the uterus and cervix look and feel normal between Pap smears and will also evaluate the pelvis.

How can cervical cancer be prevented?

Preventing HPV infections can prevent cervical cancer. HPV is very common with 43 million cases most recently reported in 2018. The virus has no symptoms and spreads through any type of sexual activity. The HPV vaccination can prevent HPV infections that lead to cervical cancer. Both males and females should receive the vaccine. 
 

Find Care at Catholic Health

The gynecologic cancer experts at Catholic Health Cancer Institutes across Long Island provide comprehensive care from screenings to diagnosis and customized treatment plans designed to achieve the best possible outcomes.

Call 844-86-CANCER (844-862-2623) for more information. Learn more about our gynecologic cancer services.