What Is Cervical Cancer?
Cervical cancer happens when cells change in the cervix, which connects the uterus and vagina. This cancer can affect the deeper tissues of the cervix and spread to other parts of the body (metastasize), often the lungs, liver, bladder, vagina, and rectum.
Most cases of cervical cancer are caused by infection with human papillomavirus (HPV), which is preventable with a vaccine.
Cervical cancer grows slowly, so there’s usually time to find and treat it before it causes serious problems. It kills fewer people with female anatomy each year, thanks to improved screening through Pap tests.
Those with female anatomy aged 35-44 are most likely to get it. More than 20% of new cases are in women over age 65, especially those who haven’t been getting regular screenings.
Types of Cervical Cancer
Cervical cancer can exist in more than one form, including:
What Causes Cervical Cancer?
Cervical cancer begins with unusual changes in your tissue. Most cases are linked to infection with HPV. Different types of HPV can cause skin warts, genital warts, and other skin disorders. Others are linked to cancers involving the vulva, vagina, penis, anus, tongue, and tonsils.
Most people who are sexually active will get infected with HPV at some point. Most of the time, it clears up on its own. But if the infection doesn't go away, it can lead to cervical cancer.
Cervical Cancer Risk Factors
You might be at higher risk of cervical cancer if you:
- Started having sex before age 18 or within a year of starting your period
- Have multiple sexual partners, which increases exposure to HPV
- Take birth control pills, especially for longer than 5 years
- Smoke cigarettes
- Have a weakened immune system , so your body is less able to fight infections
- Have a sexually transmitted disease (STD)
- Haven't been vaccinated against HPV
- Have had three or more pregnancies
- Were exposed in the womb to DES, a drug given to some women between 1948 and 1971 to prevent miscarriage; a rare risk factor
- Are obese, which may make it harder to diagnose cervical cancer
- Have low income or are without medical insurance, which means you may not be screened for cervical cancer
Cervical Cancer Symptoms
You might not notice symptoms of cervical cancer until it’s far along. Early signs of cervical cancer include:
- Pain when you have sex
- Unusual vaginal bleeding, such as after sex, between periods, after menopause, or after a pelvic exam
- Unusual vaginal discharge that is watery, bloody, and/or has a strong odor
After it has spread, the cancer can cause:
- Pelvic pain
- Trouble peeing
- Swollen legs
- Kidney failure
- Bone pain
- Weight loss and lack of appetite
- Stomach pain
When to call your doctor
Bleeding after menopause is never normal, so talk to your doctor as soon as possible if you have it.
Tell your doctor if you have very heavy periods or often bleed between periods.
Some women have bleeding after vigorous sex. It’s probably nothing to worry about. But you might want to let your doctor know, especially if it happens a lot.
Cervical Cancer Screening
Screening tests for cervical cancer include the Papanicolaou test (Pap smear) and the HPV DNA test.
- Pap smear. This is part of a woman’s regular pelvic exam. Your doctor collects cells from the surface of your cervix, and a technician looks at them under a microscope. If they spot anything unusual, your doctor will take out a bit of cervical tissue in a procedure called a biopsy.
- HPV DNA test. Your doctor takes cells from your cervix, and a technician looks at them to see if they are infected with any of the types of HPV that may lead to cervical cancer. The DNA test may be done at the same time as the Pap smear or afterward, in case of abnormal Pap test results.
How Is Cervical Cancer Diagnosed?
If your Pap test and/or HPV DNA tests show signs of cells that might have cancer, the doctor has to run more tests to confirm that you do have cervical cancer. Here are the main tests:
Colposcopy. A colposcopy is like a pelvic exam. Your doctor may use it if a Pap smear finds unusual cells. They stain your cervix with a harmless dye or acetic acid so the cells are easier to see. Then, they use a microscope called a colposcope, which magnifies your cervix by 8-15 times, to look for unusual cells for biopsy. You can usually have this procedure in your gynecologist's office. You might need a biopsy later if the colposcopy shows signs of cancer.
Biopsy. Your doctor removes a tissue sample from the cervix and checks it under a microscope for signs of cancer. There are several types of biopsies including a punch biopsy, loop electrosurgical excision procedure (LEEP), endocervical curettage, and cone biopsy.
In a punch biopsy, small tissue samples are taken using a sharp circular instrument. This is done in the doctor's office.
With the endocervical curettage, a narrow instrument called a curette collects tissues from the cervical canal connecting the vagina to the uterus. This procedure is done when the colposcopy doesn't show any cancerous cells. And it takes place in your doctor's office.
In a LEEP, your doctor uses an electrified loop of wire to take a sample of tissue from your cervix. You might have this in your gynecologist's office.
Your doctor can do a conization (removal of part of your cervix) in the operating room while you’re under anesthesia. They might use a LEEP, a scalpel (cold knife conization), or a laser. These are usually outpatient procedures, so you can go home the same day.
LEEP and cold knife conization procedures give your doctor a better look at the types of unusual cells in your cervix and whether they’ve spread.
Unusual changes in cells on the surface of your cervix are usually called squamous intraepithelial lesions (SIL). A “lesion” means an area of unusual tissue; “intraepithelial” means these cells are only in the surface layer.
These are precancerous cells. They might not become cancerous or invade deeper layers of tissue for months or years.
If a biopsy shows cancer that’s further along, your doctor will probably do more tests to see whether it’s spread and how far. They include:
- A chest X-ray to check your lungs
- Blood tests to see whether it’s spread to your liver; you might have a CT scan to refine the results
- An intravenous pyelogram (IVP, a type of X-ray) or CT scan to look at your urinary tract; a cystoscopy can check your bladder and urethra (the area where pee leaves your body)
- A colposcopy to look at your vagina
- A rectal exam and barium enema (X-ray of the digestive system) to check your rectum
- CT, MRI, or PET scans of your lymph nodes
Your doctor uses these tests to “stage” the cancer according to how big the lesions are, how deep they go, and how far they’ve spread. Cervical cancer ranges from stage 0 (least severe) to stage IV (metastatic disease, the most severe).
How Are Precancerous Lesions Treated?
If you have a low-grade lesion, you may not need treatment, especially if your doctor took out the area during a biopsy. Get regular checkups to watch for problems later on.
Your doctor might use LEEP conization, cold knife conization, cryosurgery (freezing), cauterization (burning, also called diathermy), or laser surgery to destroy the precancerous area with little damage to nearby healthy tissue.
In cryocautery, a steel tool that’s cooled to subzero temperatures freezes cells on the surface of your cervix. They die and fall off, to be replaced by new cells.
Laser ablation uses a laser beam to destroy cells in areas or layers of cervical tissue, leaving healthy cells in their place.
You’ll need a follow-up exam and Pap smear after cryocautery or laser ablation to make sure all the precancerous cells are gone.
You could also have a hysterectomy, in which your doctor removes your uterus. It will keep you from getting cervical cancer. But because it takes out your reproductive organs, you can’t become pregnant afterward.
Treatment for Cervical Cancer
There are different treatments for cervical cancer depending on how advanced it is, and you may need more than one form of treatment. If the cancer is only on the surface of your cervix, your doctor can remove or destroy cancerous cells with procedures such as LEEP or cold knife conization.
If cancerous cells have passed through a layer called the basement membrane, which separates the surface of your cervix from underlying layers, you’ll probably need surgery. If the disease has invaded deeper layers of your cervix but hasn’t spread to other parts of your body, you might have an operation to take out the tumor.
If it’s spread into your uterus, your doctor will probably recommend a hysterectomy. Talk with them about the pros and cons.
Radiation therapy (or radiotherapy) uses high-energy rays to damage cancer cells and stop their growth. As with surgery, the radiation affects cancer cells only in the treated area. Your treatments might be external, internal, or both.
External radiation comes from a large machine that aims a beam of radiation at your pelvis. You’ll probably get treatments, which take only a few minutes, 5 days a week for 5-6 weeks. Finally, you may have an extra dose of radiation called a “boost.”
Internal radiation (also called implant radiation or brachytherapy) comes from a capsule containing radioactive material, which your doctor puts into your cervix. The implant puts cancer-killing rays close to the tumor while sparing most of the healthy tissue around it.
Chemotherapy (chemo) uses powerful drugs to kill cancer cells. You get this via injections to your vein. Doctors often use it for cervical cancer that’s locally advanced or has spread to other parts of the body.
Chemotherapy happens in cycles of intensive treatment followed by recovery periods. Most people have it as an outpatient (in an outpatient clinic at the hospital, at the doctor's office, or at home).
Targeted therapy uses a variety of medicines to attack the proteins on cervical cancer cells to kill these cells or slow their growth. Some are taken as pills.
Biological therapy or immunotherapy targets “checkpoints” in your immune cells that are turned on or off to set off an immune response. Immunotherapy drugs boost your immune system so that it can destroy the cancer cells better. Doctors use it if chemo isn’t working or if the cancer has spread. You’ll get it through a vein (called intravenous, or IV) every 3 weeks.
Tips for Caring for Cervical Cancer at Home
Certain things can ease the physical and mental stresses of cervical cancer and treatment.
One of the best things you can do is get the right nutrition. You may lose your appetite or have trouble eating during treatment. But if you get enough calories and protein, you’ll have more strength and energy, and you’ll be able to handle treatment better. You might want to work with a nutritionist to keep up your calorie and protein intake. They may suggest you eat smaller portions more often.
Other lifestyle changes may help keep you stronger and more comfortable during treatment:
Follow-Up After Cervical Cancer Treatment
Regular pelvic exams and Pap smears are important for every woman, especially for those who’ve had precancerous cells or cervical cancer. After treatment, you need to have regular follow-up appointments.
There’s no single recommended schedule, but you should have physical exams every 3-4 months for 2 years, then every 6 months for the next few years, and then once a year after that. How often you have follow-up appointments will depend on your specific situation and how long it’s been since the completion of your treatment. You should still get a Pap test every year.
Even if you had a treatment such as a hysterectomy that removed your cervix, you can still have cervical cells. And cervical cancer treatment may have side effects many years later. Because you have a history of cervical cancer, you will likely need to continue having screenings for years after your treatment. Be sure to tell your doctor about any health problems.
Cervical Cancer Prevention
The key to preventing invasive cervical cancer is to detect cell changes early, before they become cancerous. Regular pelvic exams and Pap tests are the best way to do this. Experts recommend this schedule:
- If you’re 25 to 65, you should get an HPV test every 5 years. Beyond that age, you may be able to stop testing if your doctor says you’re at low risk.
- If HPV alone isn't available, you can get a combined HPV and Pap test every 5 years or a Pap test alone every 3 years.
- If you’re sexually active and have a higher risk for STDs, get tested for chlamydia, gonorrhea, and syphilis each year. Take an HIV test at least once, or more often if you’re at high risk.
- You don’t need screening if you’ve had your cervix removed and have no history of cervical cancer or precancerous lesions.
Avoiding HPV is also important. Steps to prevent infection include:
- Use a barrier, like a condom, if you have sex.
- Get the HPV vaccine. The FDA has approved Gardasil--9 for males and females aged 9-45. It protects against numerous strains of HPV that cause the great majority of genital warts, as well as cervical and other HPV-caused cancers.
- Because cigarette smoking also raises your odds of having cervical cancer, quitting can lower your risk.
What Is the Outlook for Cervical Cancer?
The cervical cancer survival rate is close to 100% when you find and treat precancerous or early cancerous changes. If it's not caught so early, then the rate depends on the stage. Survival rates come from the Surveillance, Epidemiology, and End Results (SEER) database, kept by the National Cancer Institute. It groups cancers by localized, regional, and distant stages, rather than by stages 0 to IV.
- Those with localized cancer (which hasn't spread outside the cervix or uterus) have a 92% survival rate after 5 years.
- Those with cancer at the regional stage (which has spread beyond the cervix and uterus to nearby tissues or lymph nodes) have a 60% survival rate.
- Those with cancer at the distant stage (which has spread to organs or distant parts of the body) have a 17% chance of survival.
The overall survival rate, combining all stages, is 67% after 5 years.
Are Support Groups and Counseling Available for Cervical Cancer?
Living with cervical cancer can present new challenges for you and your loved ones.
You might worry about how it will affect your everyday life. Many people feel anxious or depressed, and some are angry and resentful. Talking about your feelings and concerns can help.
Your friends and family members can be supportive. If you want to talk, let them know. They may be waiting for a cue from you.
Some people don't want to “burden” their loved ones, or they prefer talking about their concerns with a more neutral professional. A social worker, counselor, or member of the clergy can help.
Many people get a boost from talking with others with similar experiences. Your hospital or medical center might have support groups. The American Cancer Society and the National Cervical Cancer Coalition also have information about support groups across the U.S.
What Else Should I Know About Cervical Cancer?
If you’ve been diagnosed with cervical cancer, you’re sure to have a lot of questions. Maybe you just found out you have it, or maybe you’ve already been through treatments and don’t know what comes next.
Knowing the answers to these common questions can help you better understand your situation and make the best choices.
Can my cervical cancer come back?
In a lot of cases, treatment works and the cancer never comes back. But sometimes, it does, even if your doctor hasn’t detected any signs of it for a long period. This is called recurrence.
It’s impossible for your doctor to know how likely it is that your cancer will come back. But if it’s a fast-growing, advanced, or widespread cancer, the chances are high. And it may be harder to treat.
If your cancer doesn’t go away after your first treatment, you may have to get regular treatments, such as chemotherapy and radiation, to keep the cancer under control. Your doctor will discuss your options with you.
Am I more likely to get other cancers?
Even if you’ve been treated for cervical cancer, that doesn’t necessarily mean you can’t get other types of cancer. In some cases, your chances of developing a second cancer could go up. After cervical cancer, you may be more likely to get:
If you were treated with radiation, your odds of getting stomach, vagina, vulva, rectum, and urinary bladder cancers are higher. And you may have an increased risk of certain other cancers such as acute myeloid leukemia and bone cancer.
Continue to see your doctor for regular checkups, even if you’re finished with treatment. This can help you stay aware of symptoms. Eating a healthy diet, exercising, limiting alcohol, and avoiding tobacco products can help reduce your risks.
Will I be able to have kids?
Your ability to get pregnant after getting cervical cancer will depend on the stage of your cancer and the type of treatment you have.
If you have early-stage cancer, you may be able to have less aggressive treatments, so you’ll still be able to have children. You’ll probably have to wait 6-12 months before you can try to get pregnant so you can heal.
But you could still have problems having a baby because the treatments can affect your fertility. If you do get pregnant, your doctor will need to monitor you closely because you may be more likely to have a miscarriage or early delivery.
If you have a radical hysterectomy or radiation treatment, you won’t be able to become pregnant. But technologies such as egg preservation or embryo preservation prior to getting treatment mean you can likely still have a biological child with the help of a surrogate. Talk to your doctor about all your options and concerns.
Can I pass cervical cancer on to my daughter?
It’s possible to pass an increased risk of cervical cancer to your daughter, but it’s not likely. Most cervical cancers are caused by HPV, not genetic mutations.
Doctors do think, however, that cervical cancer may run in some families. So if you have it, your daughter is two to three times more likely to have it than someone whose mother did not. This could be because women in the same family are more likely to have a condition that makes it harder for them to fight HPV.
Will cervical cancer change my sex drive?
A lot of cancers can affect your libido, but when you’re being treated for cervical cancer, you’ll almost definitely notice changes. Chemotherapy and radiation can cause loss of sexual desire, pain, and vaginal dryness. And they could prompt early menopause, which makes the walls of your vagina thinner and less stretchy.
A radical hysterectomy also can cause vaginal dryness and lack of sex drive.
You can use lubricants or vaginal moisturizers to help relieve some of the dryness and other symptoms. Your doctor might also talk to you about hormonal therapy, but this will depend on your age and other factors. Don’t be afraid to talk to your doctor or your partner about any sexual problems or other side effects you’re having after treatment.