Cervical Cancer

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 intercourse, especially 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.

Go to the emergency room if you have vaginal bleeding along with weakness or if you feel faint or light-headed, or pass out.

How Is Cervical Cancer Diagnosed?

The most important advance in cervical cancer screening is broader use of the Papanicolaou test (Pap smear) and high-risk HPV testing. A Pap smear 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.

Other tools can find changes in your cervix. They include:

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 eight to 15 times, to look for unusual cells for biopsy. You can usually have this procedure in your gynecologist's office. You might need another biopsy later if the colposcopy shows signs of invasive cancer.

In the loop electrosurgical excision procedure (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.

Precancerous changes

Unusual changes in cells on the surface of your cervix are usually called squamous intraepithelial lesions (SIL). "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.

Invasive cancer

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) or CT scan to look at your urinary tract; a cystoscopy can check your bladder and urethra
• A colposcopy to look at your vagina
• A proctosigmoidoscopy and barium enema 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.

How Is Cervical Cancer Treated?

Surgery and radiation therapy are the most common treatments for invasive cervical cancer. Others are chemotherapy and biological therapy.

If the cancer is only on the surface of your cervix, your doctor can remove or destroy the cancerous cells with procedures like 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 to 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 uses powerful drugs to kill cancer cells. 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).

Biological therapy or immunotherapy targets “checkpoints” in your immune cells that are turned on or off to set off an immune response. Pembrolizumab (Keytruda) or tisotumab vedotin-tftv (Tivdak) can be used to help block a protein on the cells to shrink tumors or slow their growth.

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:

• Get mild physical activity to keep up your energy level. Make sure it doesn't wear you out.
• Get enough rest at night, and take naps if you need.
• Quit smoking.
• Don't drink alcohol. You may not be able to drink alcohol while taking some medications.

Follow-Up After Cervical Cancer Treatment

Regular pelvic exams and Pap smears are important for every woman but especially 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 to 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 you’ve finished your treatment. You should still get a Pap test every year.

Even if you had a treatment like 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.

Can I Prevent Cervical Cancer?

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 a human papillomavirus (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.
• Women of any age don’t need screening if they’ve had their cervix removed and have no history of cervical cancer or precancerous lesions.
• If you’re sexually active and have a higher risk for STDs, get tests for chlamydia, gonorrhea, and syphilis each year. Take an HIV test at least once, or more often if you’re at high risk.

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 ages 9 to 45. It protects against numerous strains of HPV that cause the great majority of both 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 survival rate is close to 100% when you find and treat precancerous or early cancerous changes. The prognosis for invasive cervical cancer depends on the stage.

• More than 90% of women with stage 0 survive at least 5 years after diagnosis.
• Stage I cervical cancer patients have a 5-year survival rate of 80% to 93%.
• Women with stage II cervical cancer have a 5-year survival rate of 58% to 63%.
• The survival rate for women with stage III cervical cancer is 32% to 35%.
• Sixteen percent or fewer women with stage IV cervical cancer survive 5 years.

Health care providers who treat cancer often use the term "remission" rather than "cure." Many women who have cervical cancer recover completely, but it can still come back.

Are There Support Groups and Counseling 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 also has information about support groups all over 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 of time. 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 fast-growing, or 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 cancers. In some cases, your chances of developing a second cancer could go up. After cervical cancer, you may be more likely to get:

• Lung cancer
• Mouth, throat, or laryngeal cancers
• Stomach, pancreas, bladder, or ureter cancers
• Vulvar, vaginal, colorectal, or anal cancers

If you have a radical hysterectomy or radiation treatment, you won’t be able to become pregnant. But technologies like 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.