Cervical cancer is a malignant tumor that begins in the cells of the cervix: the lower, narrow part of the uterus that opens into the vagina. The disease develops slowly, and long before a tumor forms, the cervical cells look abnormal — which is why regular screening allows for earlier intervention.
What cervical cancer is
Medical texts use the term "cervical carcinoma" — it is the same malignant neoplasm in the cervical area. Cells that have not yet become cancerous are called preinvasive carcinoma (Tis, FIGO stage 0): the tumor does not grow into the underlying tissues. When tumor cells grow into the cervical stroma, it is called invasive cervical cancer. Without treatment, such cells grow uncontrollably and spread throughout the body.
Causes and risk factors
Almost all cases are associated with long-standing human papillomavirus (HPV) infection. The highly oncogenic serotypes 16 and 18 are responsible for 65–75% of cases. The virus is transmitted through close skin contact, most often sexually. Infection occurs in 75% of cases upon contact with a carrier, but in about 90% the immune system clears the virus within one to two years. If it does not, the infection persists for years and gradually alters the epithelial cells of the cervix.
The risk is higher if sexual activity began before age 16, if partners changed frequently (more than two or three per year), with smoking and inhalation of tobacco smoke, with weakened immunity (HIV, immunosuppressive medications), use of hormonal contraceptives, and obesity. The disease is more often detected after age 30, with a peak at 35–55 years, and in one in five patients — after 65.
Signs of cervical cancer
In the early stages, there are usually no symptoms. The signs that do appear are nonspecific: bleeding that is unusual for the woman — after sexual intercourse, douching, or a gynecological examination; changes in the character and duration of menstruation; bloody discharge after menopause. There may be watery discharge with a strong odor or with blood, pelvic pain, and pain during sexual intercourse.
As the tumor spreads, painful defecation or blood from the rectum, painful urination or blood in the urine, dull back pain, leg swelling, fatigue, increasing weakness, rapid weight loss, prolonged low-grade fever up to 37.5 °C, anemia, and elevated ESR appear. The conclusion is made not based on a symptom but on examination.
Types: squamous cell carcinoma and adenocarcinoma
There are two main types: cervical squamous cell carcinoma and cervical adenocarcinoma. The tissue type is determined from a sample obtained by biopsy.
Stages, cervical screening, and diagnosis
The stage is described using the TNM system and the FIGO classification. The first stage is a tumor confined to the cervix: microscopic forms are measured in millimeters of depth and extent, clinically visible ones — in centimeters.
- Stage I (T1) — tumor confined to the cervix.
- Stage II (T2) — tumor extends beyond the uterus but does not reach the pelvic wall or the lower third of the vagina.
- Stage III (T3) — pelvic wall or lower third of the vagina, impaired kidney function.
- Stage IV (T4, M1) — bladder or rectal mucosa, extension beyond the pelvis, or distant metastases.
Cervical screening consists of two tests using a cervical cell sample: cytology (Pap smear) looks for abnormal cells, and an HPV test detects oncogenic types of the virus. If results are abnormal or there are complaints, an examination, colposcopy, and biopsy are performed. Ultrasound is not included in this list: the diagnosis is confirmed by biopsy.
When to see a doctor
A reason to visit a gynecologist is bleeding that does not resemble your usual menstruation, discharge with odor or blood, pelvic pain, and pain during sexual intercourse. The absence of complaints is also a reason: in the early stages there are no symptoms, and changes are found during examination with screening. At the appointment, you can ask which screening tests are right for you, what an abnormal result means, and what examinations follow.
Cervical cancer itself or its possible signs are not a reason to call emergency services; 103/112 — for a life-threatening condition when a person suddenly becomes severely unwell.
This material is for reference and does not replace a doctor's consultation: the decision on further examination is made at the appointment.
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This content is for reference and does not replace a doctor's consultation. Medical disclaimer