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Gynecology

Cervical pathology

15 September 2025

What is it and how is it detected?

1. Prevalence

  • Cervical cancer is the 4th most common cancer in women worldwide.
  • In Spain, thanks to screening with cytology and HPV testing, the incidence has decreased considerably.

2. What is it and how does it originate?

  • It is almost always related to persistent infection with the human papillomavirus (HPV).
  • Not all HPV infections cause cancer, but some strains (the so-called "high-risk" strains) can cause precancerous lesions that, if not detected and treated, eventually progress to cancer.

3. Risk factors

  • HPV infection (main risk factor)
  • Smoking
  • Multiple sexual partners
  • Immunosuppression
  • Early onset of sexual relations
  • History of sexually transmitted infections

4. Symptoms: When to seek medical advice?

In its early stages, cervical cancer may not cause symptoms. That's why preventive screening is crucial. However, you should consult a doctor if you have:

  • Abnormal vaginal bleeding (between periods, after sexual intercourse, after menopause)
  • Foul-smelling or bloody vaginal discharge
  • Persistent pelvic pain
  • Pain during sexual intercourse

5. Detection and Diagnosi

  • Screening tests: Pap smear and HPV test.
  • Diagnosis: If abnormalities are detected, colposcopy (examination of the cervix with a special microscope) and biopsy are performed.

6. Complementary Studies

  • CT, MRI, or PET, depending on each case, to assess the extent of the disease.
  • These tests are essential for correctly staging the disease and designing the best individualized treatment for each patient.

7. Treatment and Prognosis

Cervical cancer treatment requires a multidisciplinary approach within a Tumor Committee, involving various specialists: gynecological surgeons, oncologists, radiation oncologists, radiologists, and pathologists. The patient's age, general health, and stage of the disease are taken into account.

Treatment by stage:

  • Very early lesions: conservative local surgery
  • Early stages: hysterectomy (removal of the uterus)
  • Advanced stages: combination of radiotherapy and chemotherapy

Prognosis: When detected in early stages, cure rates are over 90%, reinforcing the importance of preventive screening

8. Early Detection Program in Spain

Cervical cancer has a latency period of years from the onset of cellular changes until it progresses to cancer. Cytology allows these changes to be detected and treated before they become malignant. The screening program has significantly reduced the incidence and mortality from cervical cancer.

Screening Recommendations:

Public Program (Cost-Effective):

  • Women aged 25 to 65:
    • Between 25 and 34 years: Pap smear every 3 years
    • From 35 years: HPV test every 5 years (more sensitive than Pap smear)

Ideal recommendation from a medical perspective: Annual screening with Pap smear offers greater sensitivity for detecting precursor lesions at earlier stages. Although the public program establishes wider intervals based on population cost-effectiveness criteria, from an individual clinical perspective, annual screening provides greater diagnostic certainty and peace of mind for both the patient and the provider.

The decision about the screening interval should be individualized based on risk factors, personal history, and patient preferences, always under medical supervision.

Cervical Dysplasia and Abnormal Pap Smear

Frequently Asked Questions:

  • My Pap smear was abnormal during my gynecological checkup, and I'm worried. Could I develop cancer?
  • What does it mean to have dysplasia or ASCUS on a Pap smear? Is it serious? What should I do?
  • What happens if I'm infected with HPV?

1. What is cervical dysplasia?

  • It is an abnormal change in the cells of the cervix, almost always caused by HPV infection.
  • It is not cancer, but it can be a precancerous lesion.
  • Most resolve spontaneously without treatment.

2. What does ASCUS mean on a Pap smear?

  • ASCUS = "Atypical Squamous Cells of Undetermined Significance".
  • It means there are mild changes in the cells, but it is unclear whether they are due to infection, inflammation, or another cause.

3. What is the follow-up?

General protocol:

  • Repeat Pap smear or perform HPV testing to confirm.
  • If the HPV test is negative → normal follow-up as per protocol.
  • If the HPV test is positive → colposcopy to better evaluate the cervix.

Reassure yourself: Most of these changes resolve on their own without the need for treatment.

HPV Infection in Women: Repercussions and Follow-up

Frequently Asked Questions:

  • I tested positive for HPV. How did I get infected?
  • If I'm an HPV carrier, what's the risk of developing secondary lesions or cancer?
  • Should I inform my previous partners?
  • Should I always use a condom? What about sexual intercourse?
  • What role does the HPV vaccine play?

1. What is HPV?

  • A very common virus: most people will have it at some point in their lives.
  • It is primarily transmitted through sexual contact (including skin-to-skin contact).
  • There are more than 100 types, but only some are oncogenic.

2. Do all infections cause cancer?

  • No. In most cases, the immune system eliminates it within 1-2 years.
  • Only a minority persists and can cause dysplasia or cervical cancer.
  • The risk of progression to cancer is low with adequate follow-up.

3. What does it mean to be HPV positive?

  • It doesn't mean you have cancer.
  • It means the virus is present in the cervix and requires follow-up care.
  • It's a warning sign to intensify preventive screening.

4. Psychological Repercussions

It can cause anxiety, but it's important to know that:

  • Most types are eliminated spontaneously.
  • There are vaccines that protect against the most dangerous types.
  • Proper follow-up can prevent progression to cancer.

5. Medical Follow-up

  • Regular Pap smears and/or HPV tests.
  • Colposcopy if changes are detected.
  • In some cases, treatment of precancerous lesions is necessary if they don't disappear.

💗 Key message: Having HPV is not a cause for alarm. With proper screening, cervical cancer can be prevented.

6. What about sexual relations?

Having HPV or dysplasia doesn't mean you should stop having sex, but it does require responsibility, caution, and medical follow-up.

Use of condoms

  • Significantly reduces the risk of transmission of HPV and other infections.
  • It doesn't completely eliminate the risk, as HPV is also transmitted through skin-to-skin contact in areas not covered by a condom.
  • Recommendation: Always use a condom, especially during an active infection.

Communication with your partner

  • Informing your current partner allows for responsible decisions and joint follow-up.
  • Open communication about sexual health is essential.

Priority medical follow-up

  • Keep all follow-up appointments for cytology, HPV testing, and colposcopy.
  • Do not cancel checkups out of fear: surveillance is key to preventing progression.
  • Always consult your gynecologist about questions related to your sexual life.

7. Role of the HPV vaccine in infected women

In Spain, the HPV vaccine is included in the vaccination schedule. For infected women who did not participate in the vaccination program:

The vaccine can be administered

  • It does not treat existing lesions, but it protects against other HPV types
  • It reduces the risk of new infections and recurrences
  • It is beneficial even with previous infection or dysplasia

Age and vaccination schedule

  • Most cost-effective before the start of sexual activity
  • It can be administered at any age according to medical indication
  • Usual schedule: 2 or 3 doses depending on age and recommended schedule

Safety and timing of administration

  • Mild side effects: arm pain, redness, mild fever
  • Does not affect fertility or pregnancy
  • Compatible with treatment of cervical lesions

Key message about the vaccine

  • It complements follow-up, not replaces it
  • It does not replace cytology or periodic check-ups
  • Boosts protection against other HPV type

Bibliography and links of interest for patients: