Cervical cancer occurs in the cervix, the part connecting the uterus to the vagina, and almost all cases are linked to persistent infection with human papillomavirus (HPV). It is one of the few cancers with a clear cause and can be effectively prevented through a "dual defense" of vaccination and screening.
From HPV infection to precancerous changes and then to cancer usually takes more than ten years—this long window is exactly where screening makes a difference. Women who have regular Pap smears can greatly reduce their risk of cervical cancer.
Causes and Risk Factors
HPV is a very common virus; most people who have had sexual experience will be infected at some point in their lives, and the vast majority clear the virus naturally through the immune system. Only persistent infection with high-risk types (such as HPV 16 and 18) may gradually lead to changes in cervical cells.
Other factors that increase risk include: starting sexual activity at a young age, having multiple sexual partners, smoking (which weakens local immunity), weakened immunity (such as HIV infection or long-term use of immunosuppressants), long-term use of birth control pills, and never having or stopping Pap smear screening.
Common Symptoms and Warning Signs
Precancerous lesions and early cervical cancer usually have no symptoms and can only be found through screening. More common warning signs include: vaginal bleeding between periods, bleeding after intercourse, postmenopausal bleeding, and abnormal vaginal discharge (which may be bloody or foul-smelling).
Symptoms of more advanced disease include: pelvic or lower back pain, difficulty urinating or blood in the urine, swelling in the legs, and weight loss. Any abnormal vaginal bleeding should prompt a prompt visit to a gynecologist—do not delay because of embarrassment.
Diagnosis and Staging Concepts
The cervical smear (Pap test) is the classic screening method, and in recent years HPV DNA testing has also been widely adopted, with higher sensitivity. If the smear is abnormal, the doctor will use a colposcope to magnify the cervix and take a tissue sample for testing. Precancerous lesions (CIN) can be removed with a simple outpatient procedure to prevent cancer.
After cancer is confirmed, MRI, CT scans, and other tests are used to assess the extent. Cervical cancer is staged using the FIGO system: Stage I is confined to the cervix, Stage II extends to the tissues next to the uterus or the upper part of the vagina, Stage III reaches the pelvic wall or the lower part of the vagina, and Stage IV invades the bladder, rectum, or has distant spread.
Overview of Treatment Options
Early cervical cancer is mainly treated with surgery, removing the cervix, uterus, and nearby lymph nodes depending on the stage; for very early-stage patients who wish to preserve fertility, uterus-sparing surgical approaches may be considered. Some patients still need radiation or chemoradiation after smaller surgeries to reduce the risk of recurrence.
For locally advanced disease (Stage IIB and above), the standard treatment is concurrent radiation therapy plus chemotherapy, which is effective. For metastatic or recurrent cervical cancer, treatment is based on chemotherapy plus targeted therapy (anti-angiogenic drugs); patients who are PD-L1 positive may also receive immunotherapy; newer drugs such as ADCs also offer new options for patients with recurrence.
Clinical Trials: One More Treatment Option
For recurrent or metastatic cervical cancer, clinical trials of new immunotherapy combinations and ADC drugs are ongoing, offering new opportunities for patients for whom standard treatment has failed.
The CancerLink platform can screen for gynecologic cancer clinical studies recruiting in Hong Kong based on cancer type, stage, and genetic mutations. After successful matching and enrollment, study-related treatment costs are fully covered. When needed, it is worth including clinical trials as an option to discuss with your doctor.
Two actions for all women: First, get the HPV vaccine (the best time is before any sexual experience, but vaccination in adulthood still provides some protection); Second, have regular Pap smears after becoming sexually active. Cervical cancer is a preventable cancer—don't let being busy become an excuse for delay.