Cervical Cancer

What is cervical cancer?

Cervical cancer, also known as cervical carcinoma, is a type of cancer that develops in the cells of the lower part of the uterus (the cervix). It occurs when these cells begin to multiply uncontrollably.

Most cases of cervical cancer are linked to infection with the human papillomavirus (HPV), which has a high prevalence in Brazil. For this reason, it is the most common gynecological tumor among the Brazilian population.

According to estimates from the National Cancer Institute (INCA), between 2023 and 2025, more than 17,000 new cases of the disease are expected, representing approximately 15.38 cases per 100,000 women.
 

Symptoms

The symptoms of cervical cancer can vary depending on the stage of the disease. In the early stages, it may not present any visible symptoms. As the disease progresses, the following symptoms may appear:

• abnormal vaginal bleeding: bleeding between menstrual periods, after sexual intercourse, or after menopause. This is one of the most common symptoms of cervical cancer
• abnormal vaginal discharge: discharge that may be watery, bloody, or have a foul odor
• pelvic pain: persistent pain in the lower abdomen, especially during sexual intercourse
• pain during urination: pain or discomfort while urinating, which may be caused by the tumor pressing on the bladder
• back or leg pain: may occur when the cancer spreads to surrounding tissues
• unexplained weight loss: weight loss without an apparent reason, which may occur in more advanced stages of cancer

It is important to note that these symptoms can also be related to other health conditions. Therefore, if any of these symptoms appear, it is essential to consult a healthcare professional for proper evaluation and diagnosis

Causes

Cervical cancer is primarily caused by infection with the human papillomavirus (HPV). However, there are other risk factors that may contribute to the development of this type of cancer:

• sexual behavior: having multiple sexual partners or initiating sexual activity at an early age increases the risk of HPV exposure and, consequently, cervical cancer
• smoking: tobacco use increases the risk of developing cervical cancer. The chemicals in tobacco can damage cervical cells and make them more susceptible to HPV infection
• weakened immune system: women with weakened immune systems due to conditions such as HIV/AIDS infection, prolonged use of immunosuppressive medications, or organ transplants have an increased risk of developing cervical cancer

Diagnosis

Methods for identifying cervical cancer are essential for detecting the disease in its early stages (when it may not yet cause symptoms) and for reversing lesions that could potentially become cancerous (pre-malignant)

These are the main screening methods used:

• pap smear (Papanicolaou test): the most common method for identifying cervical cancer. During the exam, the doctor collects cells from the cervix and surrounding area to be examined in a laboratory
• HPV test: checks for the presence of DNA from the human papillomavirus (HPV), the main cause of cervical cancer. The HPV test can be used as a primary screening method in women over 30 years old or as a complementary test alongside the Pap smear
• pelvic exam: the healthcare provider manually examines the pelvic organs to detect any abnormalities in the cervix, uterus, ovaries, and vagina. This exam does not replace the Pap smear but may be part of a general gynecological evaluation
• colposcopy: a procedure in which the healthcare provider uses a colposcope (an instrument with a magnifying lens) to closely examine the cervix. It is often performed if the Pap smear shows abnormal cells or if there is suspicion of serious changes in the cervix

It is important for women to discuss with their healthcare providers which screening methods are most appropriate for them based on age, medical history, risk factors, and public health guidelines

Treatment

The treatment for cervical cancer depends on the stage of the disease (whether it is localized in the cervix or has spread to nearby or distant organs), as well as the patient’s overall health and desire to become pregnant

Treatment options include:

• surgery: a procedure that involves removing the tumor and, if necessary, surrounding tissues and organs
• radiation therapy: uses high-energy radiation to destroy cancer cells or stop them from growing
• immunotherapy: a treatment that helps the body’s immune system fight the cancer

Einstein’s Oncology and Hematology department offers comprehensive care from diagnosis through treatment. Learn more

Prevention

The primary way to prevent cervical cancer is through HPV vaccination

In Brazil’s public healthcare system (SUS), the quadrivalent vaccine (which protects against HPV types 6, 11, 16, and 18) is available for boys and girls aged 9 to 14. As of 2024, the vaccination is administered in a single dose, with eligibility extended to adolescents up to 19 years old who have not yet been vaccinated

Additionally, in the public system, the quadrivalent vaccine is also available for immunocompromised men and women up to 45 years old (those with weakened immune systems due to illness, medication, or medical procedures) and for victims of sexual violence

In the private healthcare sector, men and women aged 9 to 45 can receive the nonavalent vaccine, which protects against 9 HPV subtypes and offers up to 90% protection against cervical cancer

Besides HPV vaccination, other preventive measures should be encouraged, such as maintaining a healthy immune system, not smoking, and regularly undergoing preventive screenings

References

BRITO-SILVA, Keila et al. Integralidade no cuidado ao câncer do colo do útero: avaliação do acesso. Revista de Saúde Pública, v. 48, p. 240-248, 2014

NAKAGAWA, Janete Tamani Tomiyoshi; SCHIRMER, Janine; BARBIERI, Márcia. Vírus HPV e câncer de colo de útero. Revista Brasileira de Enfermagem, v. 63, p. 307-311, 2010

SILVA, Mikaela Luz et al. Conhecimento de mulheres sobre câncer de colo do útero: uma revisão integrativa. Brazilian Journal of Health Review, v. 3, n. 4, p. 7263-7275, 2020

NATIONAL CANCER INSTITUTE – INCA. Cervical Cancer, 2023.

By Einstein Editorial Board