Cervical Cancer

Symptoms & Risks

Cervical cancer occurs when cells begin to grow abnormally in the cervix. The two types of cervical cells are: squamous, located on the outside of the cervix, and glandular, which are located inside the cervix. Almost all cervical cancer is caused by the Human Papillomavirus or HPV.

Early on, cervical cancer usually doesn’t have symptoms, making it hard to detect. Symptoms usually begin after the cancer has spread.

When symptoms of early-stage cervical cancer do occur, they may include:

vaginal bleeding after sex
vaginal bleeding after menopause
vaginal bleeding between periods or periods that are heavier or longer than normal
vaginal discharge that is watery and has a strong odor or that contains blood
pelvic pain or pain during sex

Symptoms of advanced cervical cancer (cancer has spread beyond the cervix to other parts of the body) may include the symptoms of early-stage cervical cancer.

difficult or painful bowel movements or bleeding from the rectum when having a bowel movement
difficult or painful urination or blood in the urine
dull backache
swelling of the legs
pain in the abdomen
feeling tired

These symptoms may be caused by many conditions other than cervical cancer. The only way to know is to see a health professional. If it is cervical cancer, ignoring symptoms can delay treatment and make it less effective.[1]

Knowing your personal risk factors for getting cervical cancer is very important. Some risk factors can be changed, others cannot. For those risk factors that cannot be changed, prevention and screening are particularly important. Cervical cancer can be cured if detected early.

Infection by the human papillomavirus (HPV) is the most important risk factor for cervical cancer.
Age: Most cases of cervical cancer occur between ages 20 and 50.
Personal or family history of cervical cancer. Some studies show that having a mother or sister who has had cervical cancer increases your risk for the disease. And if you've had cervical cancer before, you have a higher chance of getting it again.
Sexual history. Sexual activity at a young age (18 years old or younger), having multiple sex partners, and having sex with a high-risk partner can all increase your risk for exposure to high-risk HPV.
A weak immune system. Having HIV (the virus that causes AIDS) or taking medicines that weaken the immune system makes it hard to fight off HPV infections.
Long-term use of birth control pills. Your risk may go down after you stop taking the pills. This is mainly due to the synthetic estrogen and progesterone in birth control pills. These may stimulate the development and growth of some cancers.
Some pregnancies. People who have three or more full-term pregnancies are at increased risk for cervical cancer. So are people who had their first full-term pregnancy when they were younger than 20. Those people are more likely to have cervical cancer later when compared with people who had their first full-term pregnancy when they were age 25 or older.
Your birth parent took DES while pregnant with you. Between the years 1940 and 1971, doctors prescribed the medicine DES (Diethylstilbestrol) to pregnant people to prevent miscarriages, premature labor, and complications of pregnancy. Most people whose birth parents took DES don't get cervical cancer. But they are still at risk for an abnormal type of cervical cancer called DES-related clear cell adenocarcinoma and cervical precancers. [2]
Chlamydia infection. Some studies have seen a higher risk of cervical cancer in women whose blood tests and cervical mucus showed evidence of past or current chlamydia infection. Certain studies show that the Chlamydia bacteria may help HPV grow in the cervix, which may increase the risk of cervical cancer.
Smoking. When someone smokes, they and those around them are exposed to many cancer-causing chemicals that affect organs other than the lungs. These harmful substances are absorbed through the lungs and carried through the bloodstream to the rest of the body. Women who smoke are about twice as likely to get cervical cancer as those who don't. Tobacco by-products have been found in the cervical mucus of women who smoke. Researchers believe that these substances damage the DNA of cervical cells and may contribute to the development of cervical cancer. Smoking also makes the immune system less effective in fighting HPV infections. [3]

[1] “Cervical Cancer Symptoms “originally published by the National Cancer Institute

[2] U Mass Memorial “Who is at Risk for Cervical Cancer.”

[3] American Cancer Society “Risk Factors for Cervical Cancer.”

Reducing Your Risk

Using condoms can reduce your risk of getting HPV.
The HPV vaccine can also greatly reduce your risk of HPV and cervical cancer. The Centers for Disease Control recommends that males and females aged 9–26 get vaccinated. Adolescents under 15 years of age should receive two doses of the vaccine, spaced 6 to 12 months apart. People who are 15 years of age or older need three doses of the vaccine administered at 0, 1-2, and 6 months. After 26, people have a smaller benefit from the vaccine, because they typically have already been exposed to HPV. However, those between 27-45 can speak with their provider regarding the benefits of getting vaccinated against HPV.

Screening for Cervical Cancer depends on several factors, such as age and results from previous tests. Cervical cancer screening can be performed using a Pap test (smear) or HPV testing. Cervical cancer screening should start at age 21, according to the American College of Obstetrics and Gynecology guidelines. If you have abnormal results, your doctor may recommend additional evaluation.

Doctors use two tests to initially screen for cervical cancer during a gynecologic exam:

The Pap smear. A Pap smear involves sampling cervical cells with a brush and spatula. The laboratory will look for abnormal cells. Typically, it’s not a painful procedure.
The HPV test. This test uses the same cells collected during a pap smear to look for HPV infection. This type of test is typically recommended for those ages 30-64. [1]

Screening

Following screening guidelines for cervical cancer can also reduce your risk.

Ages 21–29: It is recommended to have a Pap test every 3 years. HPV testing is not recommended for this age group unless necessary for follow-up of abnormal Pap results.

Ages 30–65: The preferred options are an HPV test alone every 5 years or co-testing (HPV test + Pap test) every 5 years. A Pap test alone every 3 years is also acceptable.

Over 65: No screening is needed if previous tests were consistently normal.

HPV Vaccinated: Women who received the HPV vaccine should still follow these screening guidelines.

Screening Methods include:

Pap Test (Pap Smear): Looks for precancerous cell changes on the cervix.
HPV Test: Looks for high-risk human papillomavirus (hrHPV) that can cause cell changes.
Co-testing: Using both HPV and Pap tests together.
Self Collected: Self-collection should only be done using tests and collection devices approved by the US Food and Drug Administration (FDA). These are only available through your health care provider.

Individuals with certain risk factors may need more frequent screening, including those who are HIV-positive, have a weakened immune system, or have had abnormal results previously.

Key Recommendations include:

Do not screen before age 21.
Annual screening is not recommended.
Vaccination is recommended at age 11-12, but can start at 9. [2],[3],[4],[5]

If you have a low income or do not have insurance, you may be able to get a free or low-cost cervical cancer screening test through the National Breast and Cervical Cancer Early Detection Program. To learn more, call 800-CDC-INFO or visit www.cdc.gov/cancer/nbccedp.

Testing, Types & Treatment

Early diagnosis is crucial for effective treatment of cervical cancer. If your doctor says that you have cervical cancer, ask to be referred to a gynecologic oncologist—a doctor who has been trained to treat cancers like this. This doctor will work with you to create a treatment plan. Studies have shown improved outcomes for people who are treated by Gynecological Oncologists compared to those who are cared for by general gynecologists or doctors. [6]

The Society for Gynecologic Oncology (SGO) has a Specialist Finder Tool on its website that you can use to easily find a Gynecological Oncologist near you. The link for it is below.

SGO Specialist Finder Tool

Once Cervical Cancer is suspected, after an abnormal Pap or HPV test, your health care provider may recommend:

Colposcopy: During a colposcopy, your doctor inserts a speculum to gently open the vagina and see the cervix. A vinegar solution is applied to the cervix to help show abnormal areas. Your doctor then places an instrument called a colposcope close to the vagina. It has a bright light and a magnifying lens and allows your doctor to look closely at your vagina and cervix for abnormal areas. A colposcopy usually includes a biopsy, so that the cells or tissues can be checked under a microscope for signs of disease, including cervical cancer.
Cervical biopsy: A biopsy is a procedure used to remove cervical cells or tissue to be checked under a microscope for abnormal cervical cells, including cancer. In addition to removing a sample for further testing, some types of biopsies may be used as treatment to remove abnormal cervical tissue or lesions. Talk with your doctor to learn what to expect during and after your biopsy procedure. Bleeding and/or discharge after a biopsy may occur. Some people have pain that feels like cramps during menstruation.[7]

Types

Knowing the type of cancer you have helps your doctor decide on which treatment you need.

Squamous cell carcinoma: Squamous cells are the flat, skin-like cells covering the cervix's outer surface
Adenocarcinoma: Adenocarcinoma is a cancer that starts in the gland cells that produce mucus. The cervix has glandular cells scattered along the inside of the passage that runs from the cervix to the uterus.
Adenosquamous carcinoma: Adenosquamous cancers are tumors that have both squamous and glandular cancer cells. This is a rarer type of cervical cancer.
Small cell cancer: Small cell cancer of the cervix is a very rare type of cervical cancer. Small cell cancers tend to grow quickly and are treated differently from the more common types of cervical cancer.

Stage & Grade

The Stage and Grade give your doctor an idea of how the cancer might behave and what treatment you need. The grade of a cancer tells you how much the cancer cells look like normal cells.

Grade 1: Look most like normal cells. Low grade.
Grade 2: Look a bit like normal cells.
Grade 3: Look very abnormal and not like normal cells. High grade. [8]

A cancer stage describes the extent of cancer in the body, especially whether the cancer has spread from where it first formed to other parts of the body. It is important to know the stage of cervical cancer in order to plan the best treatment.

Stage 1: cervical cancer has formed and is found in the cervix only.
Stage 2: cervical cancer has spread to the upper two-thirds of the vagina or to the tissue around the uterus.
Stage 3: In stage III, cervical cancer has spread to the lower third of the vagina and/or to the pelvic wall, and/or has caused kidney problems, and/or involves lymph nodes.
Stage 4: cervical cancer has spread beyond the pelvis or has spread to the lining of the bladder or rectum, or has spread to other parts of the body. [9]

Treatment options may include:

Surgery
- Cervical conization: the surgical removal of just the cancerous (or precancerous in many cases) part of the cervix. Conization is an option only for the earliest cancers, the ones that are microscopic. This is the preferred treatment for birthing people with very small cancers who wish to preserve fertility.
- Abdominal hysterectomy: the uterus and cervix are removed through an incision on the abdomen. In the less common vaginal hysterectomy, these organs are removed through the vagina.
- Laparoscopic hysterectomy: this involves the removal of the uterus and cervix in a procedure that is performed through several (3 to 5) very small incisions on your abdomen, and the uterus and cervix are brought out through the vagina. This procedure allows for quicker recovery than abdominal hysterectomy.
- Robotic hysterectomy: this procedure is essentially the same as a laparoscopic hysterectomy using several small incisions, but in this procedure your surgeon uses the assistance of a robotic technology (robot) that s/he is in control of at all times.
- Radical hysterectomy: this procedure can be performed abdominally (with an incision), laparoscopically, or robotically. Open surgery is often recommended for radical hysterectomy, as cancer outcomes have been shown to be better with this approach. The word radical means that the uterus and the tissue between the uterus and pelvic wall, as well as part of the upper vagina, are removed. Lymph nodes in the pelvis are also removed and examined to determine if the cancer has spread (radical pelvic lymphadenectomy). In some cases, both ovaries and both fallopian tubes must be removed. This procedure is called a bilateral salpingo-oophorectomy.
- Radical trachelectomy: in this surgery, your cervix and surrounding tissues are removed, but the upper uterus is preserved for future pregnancy. This operation is only available for carefully selected people and is dependent on several factors.
Chemotherapy
- Chemotherapy for cervical cancer is usually given intravenously (injected into a vein). You may be treated in the doctor’s office or the outpatient part of a hospital. The drugs travel through the bloodstream to reach all parts of the body. This is why chemotherapy can be effective in treating cervical cancer that has spread beyond the cervix.
Radiation Therapy: Radiation therapy can be an effective treatment for early-stage cervical cancers. However, in early cervical cancer, it is more commonly used as extra treatment after surgery for patients at highest risk for recurrence of their cancer—such as when the tumor might have spread beyond the cervix. Radiation is also used to treat larger or higher-stage cancers where it actually works better than surgery. Your need for radiation therapy will be determined using information from your staging tests, examinations and surgery if an operation was performed based on findings at the time of your evaluation. Two types of radiation therapy are used to treat cervical cancer. Radiation therapy for cervical cancer is most often given in combination with chemotherapy.
- External radiation therapy: uses a machine that directs the radiation toward a precise region of the body. The therapy is usually given daily, Monday through Friday, for about six weeks. Radiation does not hurt during the treatment and only takes a few minutes each day. You can be treated at a clinic, hospital, or radiation oncology office, and typically you return home each day after treatment.
- Internal radiation therapy (also called brachytherapy): involves placing a small capsule of radioactive material inside the vagina or near the cervix. This procedure can sometimes be performed on an outpatient basis and other times requires hospitalization for a night or two. Medication is given to alleviate the discomfort from these procedures. During the time the radiation capsules are in, your family may be allowed only limited time next to you, but the radiation capsules are removed prior to going home.
Immunotherapy is an approved treatment for some patients with cervical cancer. It is typically used with chemotherapy, or as a maintenance therapy after chemotherapy is completed.
Clinical Trials There are many ongoing clinical trials studying new and better ways to treat cervical cancer. Many treatment options are available today because women diagnosed with cervical cancer were willing to participate in prior clinical trials. Clinical trials are designed to test some of the newest and most promising treatments for cervical cancer. [10]

Find a clinical trial using Ovarian Cancer Project on Carebox Connect

Disclaimer: The information on this website is designed to aid people in making decisions about appropriate gynecologic care and does not substitute for evaluations with qualified medical professionals familiar with you.

[1] Columbia University Herbert Irving Cancer Comprehensive Center “Cervical Cancer.”

[2] “Screening for Cervical Cancer” Centers for Disease Control

[3] “Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement” JAMA

. 2018 Aug 21;320(7):674-686. doi: 10.1001/jama.2018.10897.

[4] “Screening Recommendations and Considerations Referenced in Treatment Guidelines and Original Sources” Center for Disease Control

[5] “Prevent Cervical Cancer” Center for Disease Control

[6] Minig, L., Padilla-Iserte, P., & Zorrero, C. (2016). The Relevance of Gynecologic Oncologists to Provide High-Quality of Care to Women with Gynecological Cancer. Frontiers in oncology, 5, 308. https://doi.org/10.3389/fonc.2015.00308

[7] “HPV and Pap Test Results: Next Steps after an Abnormal Cervical Cancer Screening Test” originally published by the National Cancer Institute

[8] “Types and grades of cervical cancer” Cancer Research UK

[9] “Cervical Cancer Stages” originally published by the National Cancer Institute

[10] “Cervical Cancer Treatment Options” Foundation for Women's Cancer