The fatality rate for cervical cancer has plummeted. Once the deadliest cancer for women, it is now 14^th on the list. This incredible success story is rooted in early screening and prevention.

From the Pap smear to the HPV (human papillomavirus) vaccine, Yale Medicine has been at the forefront of developing widely used and incredibly effective diagnostic techniques and treatments for cervical cancer.

Cervical cancer occurs when abnormal cells inside the cervix grow in an uncontrolled manner. These abnormal cells can form tumors and may spread to other tissues in the body. The growth of abnormal cells in the cervix is almost always related to an HPV infection.

While most women who have an HPV infection will not go on to develop cervical cancer, a small percentage will. Getting vaccinated against HPV is the most effective way to protect young women from ever developing the disease.

New vaccines have proven effective in preventing infections from HPV strains 16 and 18, the two types of HPV responsible for the majority of cervical cancer cases. For women who have already developed the early stages of cervical cancer, regular Pap smears are recommended. The pre-cancerous disease progresses slowly and sometimes regresses on its own.

• HPV infection: This is the most common cause of cervical cancer. An HPV infection, however, does not mean a woman will develop cervical cancer in her lifetime.
• Smoking: Women who smoke are more likely to develop cervical cancer.
  
• DES: Another major risk factor is exposure to diethylstilbestrol (DES). DES is a drug that used to be given to pregnant mothers to prevent miscarriage. This practice ended in 1971 in the United States. Women who were exposed to DES while inside the womb are at risk of developing cervical cancer.
  
• Contraception and childbirth: Women who have been on oral contraceptives (the pill) for five or more years may be at greater risk for cervical cancer. Additionally, women who have given birth to seven or more children are at greater risk.
  
• Weakened Immune System: Women whose immune systems are weakened are at increased risk of developing cervical cancer. Various medications such as chemotherapy can suppress immune function, as can certain infections such as HIV.
  

Women with early stages of cervical cancer will often have no symptoms. The disease develops slowly. In advanced stages, women with cervical cancer may experience symptoms that include:

• Abnormal bleeding: If a woman has abnormal bleeding (not related to her period), for instance after sexual intercourse, she should see her gynecologist.
• Vaginal Discharge: Abnormal vaginal discharge, which may be watery, may indicate cervical cancer.
• Pain during sexual intercourse: If a woman is experiencing pain during intercourse, it could be a sign of cervical cancer.

Some women experience pelvic pain, and in cases in which the disease has become more advanced, may have lower back pain, swelling of the legs, and bowel and urinary problems such as constipation, incontinence, and hematuria (blood in the urine).

A woman's cervix is usually tested for abnormal cells during a routine Pap smear. A Pap smear is a bit like a cheek swab—a doctor will gently insert a simple tool called a speculum inside the vagina to open it slightly, and then use an extra-long swab to scrape cells from the inside of the cervix. These cells will be sent to a lab and tested for signs of abnormal cells.

If the Pap smear results indicate the presence of abnormal cells, a doctor will recommend further work up, including a colposcopy and biopsy of cervical tissue. During a biopsy, the physician removes a tiny piece of tissue, which is later analyzed for signs of cancerous cells in a laboratory.

In the case of a diagnosis of cervical cancer, the physician will order more tests to evaluate the location and extent of the disease. This usually entails imaging studies such as a CT scan, MRI, and/or a positron emission tomography (PET) scan.

Treatment options will differ depending on the stage of the cancer and on a woman’s desire to have children. In general, four treatment options are available. Depending on the extent and nature of the tumor and the spread of the disease, surgery might be needed to remove part of the cervix or the entire uterus. Radical hysterectomy, a procedure that removes the uterus, cervix, some tissue around the cervix, and a portion of the vagina, may be done.

Other treatment options include radiation and chemotherapy. There are also several FDA approved targeted therapies, which involve drugs specifically developed for treating cervical cancer.

In some cases, these treatments do not fully eliminate the cancer—or the cancer recurs. In selected cases, a doctor may opt for a surgery called pelvic exenteration, a procedure that removes all the organs from the pelvic cavity and possibly other organs and tissues.

If cervical cancer is detected during pregnancy, treatment options will vary, depending on the stage of the cancer and of the pregnancy. For early-stage disease, it might be possible to wait to treat the cancer until after the baby is born.

It might be possible to treat more advanced disease during and after pregnancy. However, some late-stage cancers might require immediate action.

Vaccination against HPV and careful screening through periodic Pap smears is the best way to manage the risk of developing cervical cancer. If cervical cancer progresses to a later stage, surgery and other treatments might be required. At the Gynecologic Oncology Program at Smilow Cancer Hospital, physicians are specially trained to treat cancers that develop in a woman’s reproductive organs.

“Yale gynecologic oncology physicians are nationally and internationally recognized for their excellent surgical skills, techniques, research, and contribution to the management of gynecologic cancer, including pre-invasive and invasive cervical cancer,” says Masoud Azodi, MD, the director of minimally invasive and robotic surgery for Yale Medicine Obstetrics, Gynecology & Reproductive Sciences. “Smilow Cancer Hospital offers collaborative, patient-centered care, with a multidisciplinary approach to the management of cervical cancer that incorporates the latest medical innovations and advances, as well as offering multiple protocols for treatment of advanced or recurrent cervical cancer. In addition, the Yale gynecologic oncology section has several ongoing research studies to help advance our understanding of the disease and ways to improve treatment and care of patients with cervical cancer.”