Cervical cancer occurs in the cervix, which is located at the end of the uterus that connects to the vagina.
A slow-developing form of cancer, cervical cancer is generally preceded by dysplasia, which is when abnormal cells appear in the cervical tissue. Before the abnormal cells develop into cancer, they are first considered “atypical.” Sometimes these atypical cells disappear on their own, but sometimes they are precancerous (also called cervical dysplasia). If precancerous cells are found on the cervix through regular Pap tests, the tissue can often be removed without damaging surrounding healthy tissue. Sometimes, a hysterectomy (surgery to remove the uterus and cervix) is required to prevent cervical cancer.
The main types of cervical cancer are:
- Squamous cell carcinoma, which develops in the thin, flat cells lining the cervix
- Adenocarcinoma, which occurs in the cervical cells that make mucus and other fluids
Cervical cancer is the only gynecologic cancer for which there is a screening exam. Talk with your doctor about the frequency at which you need HPV testing and Pap testing (also called a Pap smear) based on your age, personal history and risk factors.
For cervical cancer screening, Sarah Cannon recommends:
- Age 21 to 29: Pap test every three years
- Age 30 to 65: Pap test and HPV test every five years
- Age 65+: Women with normal history should stop testing*
*Women with an abnormal diagnosis should be tested for 20 years following the result, even if testing continues past age 65. A woman whose uterus and cervix have been removed for non-cervical cancer reasons and who has no history of cervical cancer or precancerous changes to the cervix should not be tested.
Most cases of cervical cancer are caused by the sexually transmitted infection (STI) human papillomavirus (HPV). HPV is very common in the United States and typically goes away on its own. But sometimes, it can cause precancerous changes to a woman’s cervix.
Other things can increase your risk of cervical cancer too, including:
- Giving birth three or more times
- Number of sexual partners
- Immune system deficiencies, such as HIV
- Sexually Transmitted Infections (STI) such as herpes, chlamydia, etc.
- Taking birth control pills for five or more years
- Socioeconomic factors that prevent you from getting regular cervical cancer screenings
- Exposure to diethylstilbestrol (DES), a drug given to some pregnant women between 1940 and 1970 to prevent miscarriages
You can reduce your risk of cervical cancer (and vaginal and vulvar cancer) by getting the HPV vaccine at an early age. It’s recommended for girls and boys ages 11 to 12, though it can be given as early as age 9. If you haven’t gotten the HPV vaccine and you’re 26 or younger, it’s recommended that you get vaccinated.
Other ways to reduce your risk of cervical cancer include:
- Limiting how many sexual partners you have
- Using condoms during sex
- Not smoking
- Routine HPV or Pap test (also called a Pap smear)
Cervical precancer often doesn’t cause any symptoms. Early-stage cervical cancer often leads to symptoms. More advanced stages of cervical cancer may cause more severe symptoms.
Warning signs of cervical cancer include:
- Spotting or bleeding between periods
- Heavier and longer bleeding during your period
- Increased or unusual vaginal discharge
- Bleeding after a pelvic exam, intercourse or douching
- Unexplained, frequent back or pelvic pain
- Pain during sexual intercourse
Tell your doctor immediately if you have abnormal vaginal bleeding. Otherwise, seek medical care if you experience any of the other symptoms for two weeks or more. They may be caused by less serious conditions, but it is best to see your doctor if you notice any changes in your body.
The following tests may be used to diagnose cervical cancer:
- Pelvic exam: During this exam, your doctor will check your vulva, vagina, cervix, uterus, ovaries and other surrounding organs for changes. They will also manually feel for changes. If you’re due for a Pap test, it will be done during your pelvic exam.
- Pap test: During this test, your physician will lightly scrape the inner and outer portion of the cervix to take samples of your cells. These cells will be tested to look for precancerous or cancerous changes.
- HPV test: The HPV test is done in a similar manner to the Pap test. It may be done at the same time as your Pap test or afterward if your Pap test shows abnormal results.
- Colposcopy: This test is used to look for abnormal or cancerous cells in the cervix. During this test, your doctor will use an instrument called a colposcope to get a better view of the tissues in your cervix and surrounding areas. The colposcope never goes inside your body; rather, it just gives your doctor a better view of potentially abnormal cells.
- Biopsy: If your doctor believes you may have abnormal or cancerous cells, they may take a small tissue sample through a biopsy. Only a biopsy can tell your doctor for sure if you have precancerous or cancerous changes in the cervix.
If your biopsy shows that you have cervical cancer, you will be referred to a gynecologic oncologist, a doctor who specializes in treating gynecologic cancer. Your gynecologic oncologist may do additional tests, such as:
- Pelvic exam under anesthesia
- Computed tomography (CT) scan
- Magnetic resonance imaging (MRI)
- Positron emission tomography (PET) scan
- Molecular testing of the tumor
If you have signs of bladder or rectal problems, your doctor may recommend additional exams of the bladder and colon.
Once all of your tests are complete, your gynecologic oncologist will go over your results with you. If you have cervical cancer, they will talk to you about the cancer’s stage.
Staging is based on where your cancer started, if or where it has spread, and if or how it’s affecting other areas of the body. Here are the stages of cervical cancer:
- Stage I: The cancer is only located in the uterus and hasn’t spread elsewhere in the
- Stage IA1: The cancerous area is less than 3 millimeters (mm) deep.
- Stage IA2: The cancerous area is 3 to 5 mm deep.
- Stage IB1: The tumor is 5 mm or greater in depth and less than 2 centimeters (cm) wide.
- Stage IB2: The tumor is 2 cm or more in depth and less than 4 cm wide.
- Stage IB3: The tumor is 4 cm or more in width.
- Stage II: Cancerous cells have spread from the uterus to nearby organs, like the vagina,
but are contained inside the pelvic region.
- Stage IIA: The tumor is contained to the upper two-thirds of the
- Stage IIA1: The tumor is less than 4 cm wide.
- Stage IIA2: The tumor is 4 cm or wider.
- Stage IIA: The tumor is contained to the upper two-thirds of the vagina.
- Stage IIB: The tumor has spread to the connective tissue and fat that surrounds the uterus (the parametrium).
- Stage IIIA: The tumor has spread to the lower third of the vagina, but not to the pelvic wall.
- Stage IIIB: The tumor is affecting a kidney and/or has spread to the pelvic wall.
- Stage IIIC: The tumor has spread to the lymph nodes.
- Stage IIIC1: The tumor has spread to the pelvic lymph nodes.
- Stage IIIC2: The tumor has spread to the lymph nodes in the abdomen near the aorta (a major artery that connects the heart to the abdomen).
- Stage IVA: The cancer has spread to the rectum or bladder.
- Stage IVB: The tumor has spread to more distant parts of the body.
Your doctor will use staging to determine what type of treatment is right for you.
Sometimes, cervical cancer will come back, or recur, after treatment. If it recurs, it may affect the pelvic region or other areas of the body, such as the bones, lungs or lymph nodes.
During cervical cancer treatment, you’ll be cared for by a multidisciplinary team. This team may include:
- A gynecologic oncologist
- A medical oncologist
- A radiation oncologist
- A nurse navigator
- Nurse practitioners
- Physician assistants
- Oncology nurses
- Social workers
Treatment for cervical cancer may include:
- Surgery: Your gynecologic oncologist may recommend surgery to remove the tumor and some surrounding healthy tissues. For example, in a LEEP procedure, the surgeon only removes the cancerous portion of the cervix and spares fertility, but in a hysterectomy the entire uterus is removed and does not spare fertility.
- Radiation therapy: This treatment uses high-energy X-rays to kill cancer cells. You may need radiation therapy before surgery to shrink the tumor or instead of surgery.
- Chemotherapy: Chemotherapy uses intravenous or oral medication to destroy cancer cells.
- Targeted therapy: This treatment prevents the growth and spread of cancer cells, while limiting damage to healthy tissue. It targets the cancer’s specific genes, environment and proteins.
- Immunotherapy: This treatment, also known as biologic therapy, helps your immune system use its natural defenses to fight cancer.
Robotic Surgery for Cervical Cancer Treatment
Your gynecologic oncologist may recommend robotic surgery, a type of minimally invasive surgery. Robotic surgery gives your doctor more control, a better view and high-definition 3D vision during the procedure. Because this type of surgery requires just a few small incisions, you may experience:
- Quicker recovery
- Less blood loss and transfusions
- Reduced pain
- Less scarring
- Lower risk of infection
Ask your doctor if you’re eligible for robotic surgery.
If you have cervical cancer, you may be wondering if you’ll still be able to have children after treatment. If you’re pre-menopausal, talk with your physician about possible ways to preserve your fertility. You may be referred to a fertility specialist called a reproductive endocrinologist before you begin cancer treatment. Be sure to ask which fertility treatments (if any) your insurance will cover.
See Sarah Cannon’s blog on fertility preservation for more information.