Cervical cancer: care with a gynecologic oncologist

What it is

Most people who are sexually active get HPV at some point, and in the vast majority of cases the body clears the virus on its own without causing harm. The problem comes when an infection with a high-risk HPV type persists for years: it can produce changes in the cells of the cervix (precancerous lesions) that, if not found and treated, can turn into cancer.

That process usually takes 10 to 20 years. This is why cervical cancer is largely preventable: there is plenty of time to find these lesions with simple tests and treat them before they progress. When a woman gets her screening tests regularly, it is rare for her to develop invasive cancer.

Risk factors

• Persistent infection with high-risk HPV (mainly types 16 and 18): this is the central factor.
• Never having had a Pap test or an HPV test, or not having had one in many years.
• Becoming sexually active at a young age and having multiple sexual partners (both increase the chance of contact with the virus).
• Smoking.
• A weakened immune system (for example, living with HIV).
• Long-term use of oral contraceptives (a risk that decreases after stopping them).
• Several full-term pregnancies.
• Not being vaccinated against HPV.

Warning signs / common symptoms

Precancerous lesions and early-stage cancer usually cause no symptoms; that is why screening is key. As the disease advances, there may be:

• Vaginal bleeding between periods, after sex, or after menopause.
• Abnormal vaginal discharge, sometimes foul-smelling or containing blood.
• Pain during sex.
• Persistent pelvic pain.

Important: these symptoms can also come from infections or other common, treatable conditions. Only a doctor can evaluate them. If you have any of them, come in for an evaluation.

How it is detected and diagnosed

• Pap test (cytology): a gentle scraping of cells from the cervix; it finds changes before they become cancer.
• HPV test: shows whether an infection with a high-risk type of the virus is present.
• If a result comes back abnormal, the next step is a colposcopy (examining the cervix through a magnifying lens) and, if needed, a biopsy to confirm the diagnosis. The gynecologic oncology consultation, the tests, and the biopsy are part of what the Unidad de Oncología Menonita performs.
• A positive HPV result does not mean you have cancer: most infections go away on their own; it means you need follow-up.

Treatment options

It depends on whether it is a precancerous lesion or an established cancer, and on its stage:

• Precancerous lesions: local procedures that remove or destroy the abnormal tissue; they are usually outpatient, and the unit can perform them or coordinate them.
• Cancer surgery: in early stages, from procedures that preserve the uterus to hysterectomy (removal of the uterus), depending on the case.
• Chemotherapy: used in advanced stages or alongside other treatments.
• Targeted therapy and immunotherapy: options for certain advanced or recurrent cases.
• Palliative care: pain and symptom control at any stage.

Being honest about radiation therapy: in many stages of cervical cancer, standard treatment combines radiation therapy with chemotherapy. The unit does not have radiation therapy; when a case requires it, we refer and coordinate care with centers in Chihuahua City, while medical follow-up continues in Cuauhtémoc.

Early detection / prevention

Screening schedule in Mexico (Secretaría de Salud, NOM-014-SSA2-1994 and the current program):

• HPV vaccine: given free of charge to girls (and now boys as well) in fifth grade of elementary school, or at age 11 if not in school. The vaccine protects against the HPV types that cause most of these cancers and works best when given before sexual activity begins.
• Ages 25 to 34: Pap test; after two consecutive normal yearly results, it is repeated every 3 years.
• Ages 35 to 64: HPV test; with a normal result, it is repeated every 5 years.
• The vaccine does not replace screening: vaccinated women still need their screening tests.
• Using condoms and not smoking reduce the risk.

Frequently asked questions

Does having HPV mean I am going to get cancer? No. Most HPV infections go away on their own within one or two years. A positive result means you need follow-up, not that you have cancer. Come in for an evaluation to define the next steps.

At what age should I start getting Pap tests? In Mexico, screening starts at age 25, or earlier if your doctor recommends it for a particular reason.

If I already got the HPV vaccine, do I still need Pap tests? Yes. The vaccine protects against the most dangerous HPV types, but not all of them. Screening is still necessary.

Related treatments