What you need to know about genital warts and cervical cancer
Jasmin was diagnosed with cervical adenocarcinoma at age 31. At the time, she was a single mother of three: Anton, nine years old; Lisa, six years old; and Anna, four years old.
Jasmin had abnormal Pap smears for six years prior, starting when she was pregnant with her daughter Lisa. She had Pap smears every six months, each revealing abnormal results. And each time, her gynecologist would perform a loop electrosurgical excision procedure (LEEP) to remove the abnormal tissue from her cervix.
This procedure, which takes about 20 minutes, involves using a thin wire loop charged with electric current to excise abnormal cells. Recovery typically takes about four weeks.
During a colposcopy, the doctor magnifies the cervix to examine it for abnormal cells and may take a small tissue sample (biopsy) to test for cancer and other issues.
Cervical cancer develops slowly over time. It may take five to 10 years for HPV-infected cervical cells to develop into precancer and about 20 years to develop into cancer.
Following her recent LEEP, Jasmin experienced abnormal bleeding, which she attributed to a potentially misplaced birth-control device. Concerned, she consulted her gynecologist, who, considering her history of HPV (Human Papilloma Virus) infection, decided to conduct a Pap smear higher up in her cervix.
Unfortunately, the results were abnormal, leading to another colposcopy. A few days before her planned vacation, Jasmin got a call from her gynecologist with distressing news: “Your biopsy results are in. You have cancer. I will refer you to an oncologist.”
The abruptness of the diagnosis was deeply unsettling. Jasmin was informed that she had to undergo a hysterectomy.
Overwhelmed with fear, she hurriedly left work, sat in her car, and began to weep, consumed by the thought of leaving her three children.
Cervical cancer starts in the cells of the cervix. The cervix is the lower, narrow end of the uterus (womb). It connects the uterus to the vagina (birth canal).
Cervical cancer develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia, in which abnormal cells begin to appear in the cervical tissue.
Over time, if not destroyed or removed, the abnormal cells may become cancer cells and start to grow and spread more deeply into the cervix and to surrounding areas.
HPV (Human Papilloma Virus) causes almost all cervical cancers. Once high-risk HPV infects cervical cells, it interferes with the ways in which these cells replicate, divide, and communicate with one another, causing infected cells to multiply in an uncontrolled manner. These infected cells are usually recognized and controlled by the immune system.
However, sometimes the infected cells remain and continue to grow, eventually forming an area of precancerous cells that, if not treated, can be malignant. Although research has focused on how high-risk HPV causes cancer in the cervix, HPV-caused cancers at other sites are likely to arise through similar mechanisms.
Based on research, it may take five to 10 years for HPV-infected cervical cells to develop into precancers and about 20 years to develop into cancer.
When cervical cells are infected with high-risk HPV, several factors increase the chance that the HPV infection will be long-lasting and lead to precancerous cervical cells:
• Having a very aggressive HPV type, particularly HPV 16 or HPV 18.
• Smoking. And since smoking may increase the chance that high-grade dysplasia progresses to cancer, it’s important to quit.
• A weakened immune system or being immunocompromised
• Being infected with HIV.
• Taking medicines—as after an organ transplant, to treat an autoimmune disease, or to treat cancer—that suppress your immune system.
HPV is one of the most common sexually transmitted diseases (STDs) in the United States. It is estimated that there are nearly one million new cases of genital warts diagnosed each year. Condyloma acuminata (HPV-induced genital warts) are clinically apparent in at least one percent of the sexually active population. Approximately two-thirds of individuals who have sexual contact with an infected partner develop genital warts. The exact incubation time is unknown.
Having genital warts because of an HPV infection can result in cervical cancer. Infection with the human papillomavirus (HPV) is the most common sexually transmitted disease afflicting approximately 80% of the population.
HPV infection is an essential factor in cervical carcinogenesis and cervical carcinoma is the second most common cause of cancer among women worldwide.
In addition to cervical cancer, other malignancies such as esophageal, oropharyngeal, and anal cancer have been causally associated with this virus, as determined by the sexual practices of an individual.
Other gender-specific HPV-related cancers include penile, vulvar, and vaginal cancer. HPV-16 is the most common HPV type associated with a malignant phenotype regardless of organ of origin.
HPV-16, together with HPV-18, accounts for approximately 70% of cervical cancers. Other non-cancerous HPV types including HPV types 6 and 11 are associated with over 90% of benign, HPV-related lesions such as genital warts (as not all warts degenerate to cancer) and juvenile respiratory papillomatosis (throat lesions secondary to oral sex).
The highest rates of cervical cancer incidence and mortality are in low- and middle-income countries. This reflects major inequities driven by lack of access to national HPV vaccination, cervical screening and treatment services, and social and economic determinants.
Symptoms
Most people will not have any symptoms from an HPV infection. The immune system usually clears HPV from the body within a year or two with no lasting effects.
Some HPV infections cause small, rough lumps (genital warts) that can appear on the vagina, penis, or anus and rarely, the throat. They may be painful, itchy, bleed, or cause swollen glands.
HPV infection that does not go away on its own can cause changes to cervical cells, which lead to precancers that may become cervical cancer if left untreated. It usually takes 15 to 20 years for cervical cancer to develop after HPV infection.
The early changes in cervical cells and precancers mostly do not cause symptoms. Symptoms of cervical cancer may include bleeding between periods or after sexual intercourse or a foul-smelling vaginal discharge. These symptoms may be due to other diseases. People with these symptoms should consult their healthcare provider.
Being vaccinated is the best way to prevent HPV infection, cervical cancer, and other HPV-related cancers. Screening can detect cervical precancers that can be treated before they develop into cancer.
There is currently no treatment for HPV infection. Treatments exist for genital warts, cervical precancers, and cervical cancer.
Non-cancerous genital warts and precancerous lesions in the cervix, vagina, vulva, anus, or penis can be removed or treated by ablation (freezing or heating) or with surgery.
Currently, cervical cancer is the only HPV-caused cancer for which screening tests are available.
Treatments for cancers caused by HPV (including cervical cancer) are more effective if diagnosed early. Treatment should begin quickly after diagnosis.
