Don't Ignore These Cervical Cancer Warning Signs

The American Cancer Society estimates nearly 14,000 new cases of cervical cancer were diagnosed in 2023, and just over 4,300 women died from the disease. These numbers are staggering, especially when cervical cancer is one of the most preventable cancers in women. Fortunately, the death rate from cervical cancer has decreased by more than 50% over the last 40 years due to increased use of the Pap test and human papillomavirus (HPV) vaccination. Abby Sexton, DO, UnityPoint Health, lists the signs of cervical cancer and why knowing them, along with regular screenings, can save your life.

Cervical Cancer Signs

Cervical cancer usually doesn’t have any symptoms until the cancer becomes more advanced. The most important risk factor for cervical cancer is infection with the types of HPV that lead to cancer. The following factors can increase your risk of becoming infected with HPV:

• Smoking
• Multiple sexual partners
• History of sexually transmitted infection (STI) 
• HIV
• Organ transplant
• Sexual intercourse before the age of 18
• A family history of cervical cancer
• Problems with the immune system

“Cervical cancer can occur at any age,” Dr. Sexton says. “It occurs more often after age 40, but it can happen at younger ages, too. It rarely occurs before age 21, which is why we recommend starting Pap smear screening at this age and not before.”

Once cervical cancer is more advanced, women may start to notice the following warning signs.

Abnormal Vaginal Bleeding

Dr. Sexton says the most common cervical cancer symptom is abnormal vaginal bleeding. Although women often think bleeding is normal, it's important to see your doctor if you experience:

• Bleeding between menstrual periods
• Heavier menstrual periods
• Longer menstrual periods
• Bleeding after sexual intercourse
• Bleeding after menopause
• Bleeding after a pelvic exam
• Bleeding resulting in anemia-causing fatigue, dizziness

Foul-Smelling Vaginal Discharge

As tumor cells die, they may create a foul-smelling vaginal discharge, which serves as another sign of cervical cancer. This continuous discharge may be pale, watery, brown or mixed with blood.

Pain During Sexual Intercourse

Women with advanced cervical cancer may experience pain during sexual intercourse because of tumor growth throughout tissues and reproductive organs.

Low Back, Pelvic or Appendix Pain

Low back pain or pelvic pain can be linked to problems with reproductive organs, such as the cervix. A sign of cervical cancer is pelvic pain, especially continuous pain. Pelvic pain near the appendix doesn't usually occur unless the cancer is in the advanced stages. There will typically be other cervical cancer red flags before pelvic pain occurs.

Leg Pain

As the cancer grows and becomes more advanced, it may start to press against nerves in the pelvic wall, resulting in leg pain and sometimes swelling. While swelling could be a symptom of a number of medical problems, if accompanied by leg pain, this could be a warning sign of cervical cancer.

Loss of Appetite or Unexplained Weight Loss

As with many other cancers, a sign of cervical cancer is unexplained weight loss or loss of appetite. Sometimes, regardless of how much food is consumed, weight loss continues to be a problem for women with cervical cancer.

Prevention & Early Detection

To protect yourself against cervical cancer, Dr. Sexton outlines the following prevention measures.

Pap Test

Cervical cancer screening in the form of Pap tests (Pap smears) looks for abnormal cells or changes in the cells of the cervix. Regular Pap smears are the best method for both prevention of cervical cancer and for catching cervical cancer in the earliest stages, which is why they're strongly recommended.

“Because of effective screenings, cervical cancer is seen less in the United States,” says Dr. Sexton.

The American Cancer Society guidelines recommend:

• Women start regular Pap tests at age 21
• From 21 to 29, women should get a regular Pap test every three years
• Women between 30 and 65 should receive a Pap test every five years, along with HPV testing. If HPV testing is not done, then this same age group should continue receiving Pap smears every three years.

Dr. Sexton says these screening guidelines remain the same for women who have had a partial hysterectomy, where the cervix is left intact. However, women who’ve had a total or complete hysterectomy, where both the uterus and cervix are removed, usually don’t need to have a Pap test or HPV test.

Pap Test Results

“If a woman is told her Pap test is abnormal, and/or the HPV testing is positive, her doctor will counsel her about next steps based on the result. This may include repeating the Pap test in six months to a year, or further testing and treatment, if needed. Further testing may include a colposcopy, a safe procedure that more closely examines the cervix, with a possible biopsy,” Dr. Sexton says.

“In countries where screenings are done regularly, like the U.S., only 5 to 10% of Pap smears or HPV testing come back as abnormal. And, if immunization is done with the HPV vaccine, then the possibility of having an abnormal test is even less likely,” Dr. Sexton says.

HPV Self-Collection Test

A new HPV self-sampling test was approved by the Food and Drug Administration in May 2024 for women ages 25 and up. The test screens for up to 14 types of high-risk HPV strains that can lead to cervical cancer.

HPV Self-Collection Instructions

Individuals are given a Q-tip to insert and swab the vagina. Similar to urine samples, the swab is placed behind a collection door in the clinic bathroom and recovered for analysis at a lab.

If the sample comes back normal, it’s recommended to screen again for HPV in five years. If it’s abnormal, your doctor will discuss next steps with you.

HPV tests with self-collection gives patients in rural communities, or those uncomfortable having a full pelvic exam, access to life-saving screenings.

Kits should be available at local health clinics or in primary care offices. Check with your OBGYN provider as well.

While the majority of cervical cancers are caused by HPV, two to five percent are not. That’s why the combination of a pelvic exam and traditional Pap smear is still considered the gold standard. In a pelvic exam, providers examine the vulva, vagina, cervix, ovaries and uterus. Additionally, some studies show higher false positive rates with self-collection — which could mean follow-up tests, including a pelvic exam.

HPV self-collection, however, has the potential to make screening more accessible and available to patients. People who may otherwise decline a traditional pelvic exam and pap screening may be open to a self-collection option, making it an acceptable alternative for cervical cancer screening.

HPV (Human papillomavirus) Vaccine

The most common cause of cervical cancer is the human papillomavirus (HPV), and Dr. Sexton says receiving the HPV vaccine is the best way to prevent cervical cancer. It’s important both males and females receive all doses of the HPV vaccine. The Centers for Disease Control and Prevention recommends the following HPV vaccine schedule:

•  All kids ages 9-14 should get the HPV vaccine
• A two-dose series is given for patients under the age of 14; an initial dose followed by a second dose in 6-12 months
• Patients between the ages 15-45, as well as immunocompromised patients, will receive a three-dose series: an initial dose followed by a second dose in two months and a third dose six months later
• If children and teenagers don’t receive the vaccine when they’re younger, it's recommended both men and women get vaccinated until the age of 45
• Vaccination works best when it’s done before a person becomes sexually active and exposed to HPV. However, HPV vaccination can still reduce the risk of getting HPV for people who are already sexually active
• If a person has never received the vaccination and already has a diagnosis of HPV, it’s recommended they get vaccinated to help prevent getting a new infection in the future.

Does HPV Go Away?

The body uses its immune system to help get rid of HPV, and the infection usually goes away by itself. In a small number of cases, HPV does not go away. The longer HPV is present, and the older you are, the greater the risk the virus will damage the cervical cells.

In addition to early screenings and the HPV vaccine, Dr. Sexton offers these steps to reduce your risk of cervical cancer:

• Practice safe sex by consistently using condoms, especially if you’ve had, or plan to have, multiple partners
• Avoid sexually transmitted infections (STIs) by discussing sexual health history with your partner
• Stop smoking

“Carcinogens associated with smoking can lead to early progression of cervical cancer, and other cancers, too. Smoking causes DNA damage that increases the likelihood of cancerous cell changes and reduces the ability of the immune system to clear HPV from the body. That’s why it’s so important to seek help and break the habit as soon as possible,” Dr. Sexton says.

If cervical cancer is diagnosed, more tests, like blood work and scans of the abdomen and pelvis, will allow your cancer team to form a treatment plan. Treatment is very effective if caught in the early stages, with higher survival rates at five years (more than 90 percent) after the cancer is diagnosed.

Talk to your doctor about a cervical cancer screening schedule and ensuring you, and any children you may have, are vaccinated against HPV.