Cervical Cancer and HPV: What You Need to Know

While cervical cancer is one of the most preventable and treatable forms of cancer,  it continues to be a significant health concern worldwide. One of the key factors in the development of cervical cancer is its link to the Human Papillomavirus (HPV), a highly prevalent virus that many people encounter during their lifetime. Despite the availability of vaccines and screening, cervical cancer is still a concerning issue, largely due to misinformation and insufficient proactive healthcare measures. To help bridge the gap, in this article, we’ll explore the finer aspects of cervical cancer and its association with HPV, equipping you with the knowledge to take informed steps for preventing and managing this life-threatening condition. Let’s start with understanding the basics.

What is Cervical Cancer?

Cervical cancer is a type of cancer that originates in the cells of the cervix, the lower, narrow portion of the uterus that connects to the vagina. It typically develops when abnormal cells in the cervix grow uncontrollably, forming a tumour that can invade nearby tissues or spread to other parts of the body if left untreated. 

There are two main types of cervical cancer:

1. Squamous Cell Carcinoma: The most common form, originating in the thin, flat cells lining the outer part of the cervix.

2. Adenocarcinoma: This type is less common and begins in the glandular cells within the cervical canal.

This disease is most commonly linked to high-risk strains of the Human Papillomavirus (HPV), but other factors, such as smoking and a weakened immune system, can also contribute to cervical cancer. Early detection and timely treatment dramatically improve the chances of recovery, highlighting the importance of regular cervical screenings.

Understanding HPV (Human Papillomavirus)

HPV, or Human Papillomavirus, is a common viral infection that affects millions of people worldwide. It is transmitted primarily through skin-to-skin contact during sexual activity and can infect the genital areas, mouth, and throat. There are over 100 different types of HPV, which are categorised into:

1. Low-Risk HPV: These strains may cause benign conditions like genital warts but are not associated with cancer.

2. High-Risk HPV: These strains, particularly HPV 16 and HPV 18, are linked to several cancers, including cervical cancer, anal cancer, and certain throat cancers.

HPV infections are often asymptomatic and temporary, with the body’s immune system clearing the virus naturally within two years in most cases. However, persistent infections with high-risk HPV strains can lead to abnormal cell changes that may progress to cancer over time.

The Link Between HPV and Cervical Cancer

The connection between HPV and cervical cancer is well-established, with research showing that nearly all cases of cervical cancer are caused by persistent infections with high-risk HPV strains. Here’s how the virus contributes to the development of cervical cancer:

• Infection with HPV: The virus is transmitted during intimate contact, often without any visible signs or symptoms.

• Cellular Changes: Persistent high-risk HPV infection can cause abnormal changes in cervical cells, disrupting their normal growth and repair processes.

• Precancerous Lesions: These abnormal changes may progress to precancerous lesions if left untreated.

• Cancer Development: Over time, untreated precancerous lesions can evolve into cervical cancer, typically over a period of years or even decades.

HPV types 16 and 18 are responsible for about 70% of cervical cancer cases worldwide. Despite the potential severity, most HPV infections do not lead to cancer, as the immune system often clears the virus naturally. 

Risk Factors for Cervical Cancer

While infection with high-risk HPV strains is the primary cause of cervical cancer, several other factors can increase an individual's risk. These include:

• Persistent HPV Infection: Prolonged infection with high-risk HPV types is the most significant risk factor.

• Smoking: Tobacco use weakens the immune system and damages cervical cells, making it harder for the body to fight HPV infections.

• Weakened Immune System: Conditions like HIV/AIDS or the use of immunosuppressive medications can reduce the body’s ability to clear HPV infections.

• Early Sexual Activity: Engaging in sexual activity at a younger age increases the risk of acquiring HPV due to prolonged exposure.

• Multiple Sexual Partners: Having multiple partners, or a partner with multiple partners, increases the likelihood of exposure to HPV.

• Inconsistent Screening: Skipping regular cervical screenings can delay the detection and treatment of precancerous changes.

• Prolonged Use of Oral Contraceptives: Long-term use of birth control pills may slightly increase the risk of cervical cancer.

• Multiple Pregnancies: Women who have had three or more full-term pregnancies may face a higher risk of cervical cancer.

• Socioeconomic Factors: Limited access to healthcare and screening services can increase the risk due to delayed diagnosis and treatment.

Symptoms and Warning Signs of Cervical Cancer

Cervical cancer often develops silently, showing no symptoms in its early stages. This makes regular screenings crucial for early detection. However, as the disease progresses, certain warning signs may become evident:

• Unusual Vaginal Bleeding:

• Bleeding between periods

• Bleeding after sexual intercourse

• Postmenopausal bleeding

• Abnormal Vaginal Discharge: Persistent discharge that may be watery, pink, or foul-smelling

• Pain During Intercourse: Discomfort or pain during or after sexual activity

• Pelvic Pain: Persistent or intermittent pain in the lower abdomen or pelvis

• Changes in Menstrual Cycle: Longer, heavier, or more painful periods than usual

• Advanced Stage Symptoms:

• Swelling in the legs

• Difficulty urinating or blood in the urine

• Fatigue, weight loss, or loss of appetite

These symptoms can also be caused by other conditions, so experiencing them does not necessarily mean cervical cancer is present. However, consulting a healthcare professional promptly for evaluation is essential if these signs occur. Early diagnosis can significantly improve treatment outcomes.

Screening and Diagnosis

Regular screening is the cornerstone of cervical cancer prevention, allowing early detection and treatment of abnormal changes in cervical cells before they progress to cancer. Key screening and diagnostic methods include:

1. Pap Smear (Pap Test):

• A procedure where cervical cells are collected and examined for abnormalities.

• Recommended for women starting from their mid-20s or within three years of becoming sexually active.

2. HPV Testing:

• Detects high-risk HPV strains associated with cervical cancer.

• Often performed alongside a Pap smear (co-testing) or as a standalone test for women aged 30 and above.

3. Visual Inspection with Acetic Acid (VIA):

• A low-cost method where the cervix is examined after applying acetic acid to highlight abnormal cells.

• Commonly used in resource-limited settings.

4. Colposcopy:

• A follow-up procedure if screening tests suggest abnormalities.

• Involves using a specialised microscope to closely examine the cervix for suspicious areas.

5. Biopsy:

• A small tissue sample is taken from the cervix for detailed examination.

• May include procedures such as a punch biopsy, endocervical curettage (ECC), or cone biopsy.

6. Imaging for Advanced Diagnosis:

• Techniques like MRI, CT scans, or PET scans are used to assess cancer spread in more advanced cases.

Screening Guidelines:

• Women aged 21–29: Pap smear every three years.

• Women aged 30–65: Pap smear every three years, or co-testing (Pap smear + HPV test) every five years.

• Women over 65: Screening may stop if there is no history of abnormalities and adequate prior screening.

Timely screenings and prompt follow-ups on abnormal results are crucial in preventing cervical cancer or catching it at its earliest, most treatable stage.

Treatment Options for Cervical Cancer

Treatment for cervical cancer depends on the stage of the disease, overall health, and personal preferences. Early diagnosis offers a higher likelihood of successful treatment. Here are the main treatment approaches:

Treatment for Precancerous Lesions

• Cryotherapy: Freezes and destroys abnormal cells.

• Laser Therapy: Uses a focused beam of light to remove or destroy abnormal tissue.

• Loop Electrosurgical Excision Procedure (LEEP): Removes abnormal cells using an electrically charged wire loop.

• Cone Biopsy: Removes a cone-shaped piece of tissue containing abnormal cells from the cervix.

Treatment for Early-Stage Cervical Cancer

• Surgery:

• Conization: Removal of a cone-shaped section of cervical tissue.

• Hysterectomy: Removal of the uterus and cervix, which may be total or radical (includes removal of surrounding tissues and lymph nodes).

• Radiotherapy: High-energy X-rays are used to target and kill cancer cells, sometimes combined with low-dose chemotherapy.

Treatment for Advanced-Stage Cervical Cancer

• Chemoradiation: A combination of chemotherapy and radiation therapy to improve effectiveness.

• Chemotherapy Alone: Administered in cases where cancer has spread extensively.

• Targeted Therapy: Drugs such as bevacizumab (Avastin) block the blood vessels that supply nutrients to cancer cells.

• Immunotherapy: Stimulates the immune system to attack cancer cells, used in certain advanced cases.

Palliative Care for Late-Stage Cancer

• Focuses on relieving symptoms and improving quality of life.

• May include pain management, nutritional support, and psychological counselling.

Follow-Up Care

• Regular follow-up visits to monitor for recurrence or manage side effects of treatment.

Choosing the right treatment involves collaboration with a multidisciplinary team of specialists, considering the patient’s overall health and personal circumstances. Advances in treatment have significantly improved survival rates, particularly with early detection.

When to See a Doctor?

Early detection of cervical cancer significantly improves treatment outcomes, so knowing when to seek medical attention is crucial. Consult a doctor if you experience any of the following:

• Unusual Vaginal Bleeding: Bleeding between periods, after sexual intercourse, or post-menopause.

• Abnormal Vaginal Discharge: Persistent discharge that is watery, bloody, or foul-smelling.

• Pelvic or Abdominal Pain: Ongoing pain or discomfort in the lower abdomen or pelvic region without an obvious cause.

• Pain During Intercourse: Persistent discomfort or pain during or after sexual activity.

• Changes in Menstrual Patterns: Irregular, heavier, or longer-lasting periods than usual.

• Family History or Risk Factors: If you have a family history of cervical cancer or known risk factors, such as persistent HPV infection or smoking, schedule regular screenings even without symptoms.

• Screening Schedule: Follow cervical cancer screening guidelines and see a doctor for routine Pap smears or HPV testing.

Emergency Symptoms

Seek immediate medical attention if you notice:

• Significant vaginal bleeding that doesn’t stop.

• Severe pelvic pain or swelling in the legs.

• Difficulty urinating or blood in the urine.

Regular screenings and prompt consultations for unusual symptoms are vital for early diagnosis and successful treatment. If you are unsure about any symptoms, it’s always better to consult a healthcare professional for reassurance and advice.

Living with and Managing Cervical Cancer

A cervical cancer diagnosis can be overwhelming, but with the right approach, individuals can manage the condition effectively and maintain a good quality of life. Here are key aspects to consider:

• Seek emotional support from family, friends, or professional counsellors.

• Educate yourself about the condition to make informed decisions about your treatment.

• Engage with online or in-person communities for guidance and encouragement.

• Manage common side effects like fatigue, nausea, or pain with medical guidance.

• Use complementary therapies such as yoga, meditation, or acupuncture to reduce stress and discomfort.

• Address anxiety, depression, or fear with therapy or counselling.

• Engage in activities that bring joy and foster a sense of normalcy.

• Follow a balanced diet rich in fruits, vegetables, and lean proteins to boost recovery.

• Stay physically active, as approved by your doctor, to improve overall well-being.

• Schedule regular check-ups to monitor recovery and detect potential recurrences.

• Discuss any lingering side effects or new symptoms with your healthcare provider promptly.

• Openly communicate with your partner about emotional and physical challenges.

• Consult specialists about fertility-preservation options before or after treatment, if relevant.

Living with cervical cancer requires a holistic approach that addresses physical, emotional, and social aspects of well-being. With proper care, many individuals go on to lead fulfilling lives after their diagnosis and treatment.

Prevention of Cervical Cancer

Cervical cancer is highly preventable through proactive measures, early detection, and lifestyle adjustments. Here are the key strategies for prevention:

• HPV Vaccination: Vaccines like Gardasil and Cervarix protect against high-risk HPV strains linked to cervical cancer.

• Regular Cervical Screenings: Routine Pap smears and HPV testing detect abnormal changes early.

• Safe Sexual Practices: Use condoms and limit sexual partners to reduce HPV transmission risk.

• Quit Smoking: Avoid smoking to strengthen the immune system and lower HPV-related risks.

• Healthy Immune System: Maintain a balanced diet, exercise, and manage chronic conditions for immunity.

• Awareness and Education: Learn about cervical cancer and HPV; promote screenings and vaccination in your community.

• Timely Treatment of Precancerous Changes: Follow up on abnormal screenings with treatments like cryotherapy or LEEP.

Conclusion

Cervical cancer is a preventable and treatable condition when addressed early through regular screenings, HPV vaccination, and prompt medical care. Understanding the disease, recognising its symptoms, and taking proactive steps are crucial to safeguarding your health.