Cervical Cancer

Medically Reviewed By William C. Lloyd III, MD, FACS
Was this helpful?
12

What is cervical cancer?

Cervical cancer is a common malignant tumor of the female reproductive system. Cervical cancer is the third most common type of cancer in females. However, the routine use of Pap smear screening has made it far less common in the United States, according to the National Institutes of Health. Just over 14,000 Americans will get cervical cancer this year. This represents 0.8% of new cancer cases for the year. As a comparison, more than 280,000 people will develop breast cancer. Infection with human papillomavirus (HPV) causes nearly all cervical cancers.

The cervix is the structure that provides an opening between the vagina and the uterus. Normally, cervical cells that are old or damaged will stop dividing and die. These cells are replaced by healthy new cells. HPV infection can change cervical cells in a way that allows old or damaged cells to continue to multiply in the superficial layer of the cervix. This is a precancerous stage of cervical cancer called cervical dysplasia. Without treatment, cervical dysplasia can progress and spread into the deeper tissues of the cervix, developing into cervical cancer.

Regular Pap smear screening tests can detect abnormal cells and cervical dysplasia long before it develops into cervical cancer. Cervical dysplasia is 100% treatable. Once cervical cancer develops, the prognosis varies depending on the cancer’s stage of advancement; your age, general health status, and medical history; and other factors.

Cervical cancer causes life-threatening complications in some cases. It can also be fatal, especially if it goes undetected and untreated.

Seeking regular medical care, including Pap tests offers the best chances of discovering cervical cancer in its earliest, most curable stage. An HPV vaccine is available as well. The vaccine can prevent certain types of HPV infections linked to most cervical cancers.

If you have cervical cancer, following your treatment plan may help reduce your risk of serious complications. The good news is that if diagnosed and treated in an early stage of development, cervical cancer is curable in many cases.

Note: Sex and gender exist on spectrums. For the purposes of this article, we use “male” and “female” to refer to a person’s sex assigned at birth.

What are the different types of cervical cancer?

There are different types of cervical cancer including:

  • Squamous cell carcinoma, which begins in the cervical cells closest to the vagina. This is the most common type of cervical cancer, accounting for 90% of cases.

  • Adenocarcinoma, which develops in the cervical gland cells closest to the uterus. It is the second most common form of cervical cancer.

  • Mixed carcinoma, which has features of both squamous cell and adenocarcinoma. It is much less common.

What are the symptoms of cervical cancer?

Cervical cancer generally has no symptoms in its earliest stages. There are also usually no symptoms of cervical dysplasia or human papillomavirus (HPV) infection, which causes most cases of cervical dysplasia and cervical cancer.

When cervical cancer symptoms occur, they may indicate that the cancer has progressed to more advanced stages. Potential cervical cancer warning signs include:

What are the stages of cervical cancer?

Staging tells doctors how widespread cancer is at diagnosis. This helps them plan treatment and predict how successful it will be. The stage of cervical cancer will depend on:

  • The size of the tumor and if it affects other tissues near the cervix
  • The absence or presence of cancer cells in lymph nodes
  • Whether or not the cancer has spread—or metastasized to other organs

There are five cervical cancer stages, with higher numbers indicating more advanced disease:

  • Stage 0: Another name for this stage is carcinoma in situ. The surface of the cervix is the only place doctors can find cancer cells. Surgery to remove the cancer is the main treatment.
  • Stage I: The cancer has grown deeper than the surface, but still remains in the cervix. Surgery is still the main treatment, but it may involve removing the entire uterus with the cervix.
  • Stage II: The cancer has become invasive, but has not spread to the lymph nodes. Early cancers in this stage have invaded the vagina. Later cancers have grown into the tissues surrounding the uterus. Standard treatment is surgery and combination chemotherapy and radiation therapy.
     
  • Stage III: The cancer has spread to nearby lymph nodes, organs, or tissues. This may include the pelvic wall or kidney ureters. Standard treatment is combination chemotherapy and radiation therapy—or chemoradiation.
  • Stage IV: The cancer has spread outside the pelvic area to distant lymph nodes or body sites. This is advanced cervical cancer and is not curable. Treatment usually involves radiation therapy with or without chemotherapy and targeted therapy.

     

In general, early stage cancers tend to have a better outlook because they often respond better to treatment.

What causes cervical cancer?

Cervical cancer is almost always the result of HPV (human papillomavirus) infection. Researchers have found HPV makes two proteins that turn off tumor suppressor genes. These genes are one way the body controls cell growth and death. When they are turned off, affected cells can grow and divide more than they should. HPV infection of the cervix can result in cervical cells growing too much. In some cases, this turns into cancer.

However, the majority of people with HPV infection will not develop cervical cancer. So, there must be other factors to consider in determining if infected cells become cancerous. In addition, there are many types of HPV, some more likely than others to transform cells into cancer cells.

What are the risk factors for cervical cancer?

A number of factors may increase your chances of developing cervical cancer. Not all people with risk factors will develop cervical cancer, and some people who do not have risk factors will develop cervical cancer.

Risk factors include:

  • Family history of cervical cancer, which may indicate a genetic link

  • Long-term use of birth control pills

  • Past or current chlamydia infection

  • Sexual history of having sex before 18 years of age, having multiple sex partners, or having a high-risk sexual partner who has HPV or multiple sex partners

  • Smoking, which doubles the risk compared to people who do not smoke

  • Three or more full-term pregnancies or age less than 17 years at first full-term pregnancy

  • Weakened immune system

Lifestyle factors may also play a role in developing cervical cancer. This includes excess weight and eating a diet low in fruits and vegetables.

How do you prevent cervical cancer?

Cervical cancer is one of the most preventable cancers. Doctors can screen for precancerous changes before cancer develops using a Pap test. They can also test cervical cells for the presence of HPV. These tests can be done as part of a regular gynecologic exam. The frequency of screening will depend on your age, previous screening results, and your medical history.

Children and adults up to age 26 can protect themselves from HPV infection by getting the HPV vaccine. Males can benefit from the vaccine as well. HPV is also responsible for anal and head and neck cancers. Plus, protecting males from infection can help prevent infections in females.

You can lower your risk of cervical cancer by

  • Abstaining from sex

  • Getting vaccinated. It provides protection from the strains of HPV that cause most cervical cancers. However, these vaccines do not prevent all cases of cervical cancer. Routine Pap smears are still recommended for people who have been vaccinated.

  • Having regular Pap smear screening tests within three years of becoming sexually active or no later than age 21.

  • Having regular HPV tests. Cervical cancer screening guidelines for people 30 years and older include the HPV test every five years with or without a Pap smear, or the Pap smear alone every three years. Women 21 to 29 should have the Pap smear, and women older than 65 may not need testing if prior tests have been negative.

  • Having sex only within a monogamous relationship, in which neither partner is infected with a sexually transmitted disease or has been exposed to HPV. It is important to understand that HPV can spread through sexual contact even when there are no symptoms of infection.

  • Not smoking

  • Using a new condom for each sex act

What are the diet and nutrition tips for cervical cancer?

Research suggests that a diet low in fruits and vegetables may be a risk factor for cervical cancer. Conversely, eating a diet rich in these foods may help prevent it. This type of plant-based diet provides antioxidants, carotenoids, flavonoids and folate. These dietary components may help the body fight HPV infection. They may also prevent HPV from turning normal cervical cells into cancerous ones.

Foods that have high levels of beneficial antioxidant compounds include:

  • Carotenoids: carrots, sweet potatoes, pumpkin and squash

  • Flavonoids: apples, asparagus, black beans, broccoli, brussels sprouts, cabbage, cranberries, garlic, lettuce, lima beans, onions, soy and spinach

  • Folate: avocados, chickpeas, lentils, orange juice, romaine lettuce and strawberries

Ask your healthcare provider for guidance before making significant changes to your diet. Do not rely on dietary changes alone to prevent or treat cancer. Diet is one aspect of overall prevention and treatment.

How do doctors diagnose cervical cancer?

Having regular Pap tests is the most effective way of finding cervical cancer early. In fact, Pap tests can find abnormal cells before they become cervical cancer. Doctors find these precancerous changes far more often than actual cervical cancer. If a Pap test is abnormal, additional testing is necessary to diagnose or rule out cervical cancer.

Diagnosing cervical cancer may involve:

  • Colposcopy, which uses a lighted instrument—or colposcope—to examine the cervical cells
  • Biopsy, which takes a sample of tissue from the cervix to examine it for cancer

Questions your doctor may ask include:

  • Are you experiencing any symptoms?

  • Are you sexually active?

  • When was your last Pap test or HPV DNA test?

  • Have you ever had an abnormal Pap test?

  • Have you ever had a sexually transmitted disease?

  • Do you smoke?

  • Have you ever been pregnant?

  • Do you want to have children in the future? (The answer may affect your treatment choices.)

After diagnosing cervical cancer, doctors often use imaging exams to determine the extent or stage of cancer. Cervical cancer treatment depends on the stage. Surgery is usually an option for early cervical cancers. Sometimes, doctors can remove all of very early cancers during a biopsy. In other cases, more radical surgery is necessary to remove the uterus and possibly nearby pelvic structures. Other treatment options include chemotherapy, radiation therapy, and targeted therapy.

What are the treatments for cervical cancer?

The goal of cervical cancer treatment is to permanently cure the cancer or bring about a complete remission of the disease. Remission means that there is no longer any sign of cancer in the body, although it may recur or relapse later. Cervical cancer treatment plans depend on the type of cancer and stage of advancement; your age, medical history, and coexisting diseases or conditions; and other factors.

Common cervical cancer treatments

Doctors base cervical cancer treatment options on the stage of the cancer. Treatment of cervical cancer may include some combination of the following:

  • Chemotherapy

  • Cone biopsy to surgically remove a cone-shaped section of the cervix where abnormal cells are located along with a margin of healthy tissue. This is the preferred treatment for early stage cancers in people who want to preserve fertility.

  • Hysterectomy to remove the uterus and cervix

  • Immunotherapy, which boosts the immune system to fight cancer

  • Participation in a clinical trial to test novel therapies and treatments for cervical cancer

  • Radiation therapy

  • Radical trachelectomy to remove the cervix and nearby lymph nodes. This is another option for early stage cancers in women who want to preserve fertility.

  • Targeted therapy, which targets proteins that cervical cancer cells need to live, grow and spread

Other cervical cancer treatments

Doctors may add other therapies to maintain your physical health and side effects of treatment including:

  • Antinausea medicines

  • Dietary counseling to help people with cancer maintain their strength and nutritional status

  • Pain medications

  • Palliative care to improve the overall quality of life for families and patients with serious diseases

  • Physical therapy to help strengthen the body, increase alertness, reduce fatigue, and improve functional ability during and after cancer treatment

Complementary treatments

Some complementary treatments may help some women to better deal with cervical cancer and its treatments. These treatments, sometimes called alternative therapies, augment medical treatments. They are not a substitute for traditional medical care. Be sure to tell your doctor if you are using alternative therapies. This includes nutritional supplements and homeopathic remedies. They may interact with the prescribed medical therapy.

Complementary treatments may include:

  • Acupuncture

  • Massage therapy

  • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products

  • Yoga

Hospice care

When cervical cancer is in an advanced stage and is not responding to treatment, the goal of cancer care shifts. It is no longer possible to cure the disease. Instead, treatment focuses on managing symptoms and improving quality of life.

The goal of hospice care is to help people in their last phases of an incurable disease to live as fully and comfortably as possible. Hospice care involves medically controlling pain and other symptoms. It also provides psychological and spiritual support, as well as services to support the patient’s family.

How does cervical cancer affect quality of life?

Health-related quality of life (HRQoL) describes how a disease affects a person’s overall well-being. It includes mental, physical and emotional health. It also includes social and sexual functioning and the ability to perform daily functions and roles. Non-health factors, such as finances, can play a role in HRQoL as well.

Cancer of any kind can affect HRQoL and cervical cancer is no exception. It’s not surprising that cervical cancer and its treatment affect a person’s sex life. Research has shown people with cervical cancer tend to have a decreased interest in sex, increased fear of sex, and a negative perception of their sexuality. In people who attribute self-importance to sex, family and social well-being can be very low. Focusing on other aspects of the relationship can help increase HRQoL in this area.

Cervical cancer treatment can also affect a person’s ability to have children. For early stage cancers, there are treatment options to maintain fertility. This is an important quality of life issue for many people. Discuss the potential for infertility with your doctor before deciding on a treatment plan.

Factors associated with a higher HRQoL include:

  • Having a positive self-perceived health status, which was the number one predictor of good HRQoL in one study
  • Living with a spouse or partner
      
  • Not having any coexisting chronic conditions
  • Not smoking
  • Participating in leisure activities

People with these characteristics may have a better HRQoL than those who do not. People who have radiation therapy tend to have lower HRQoL due to treatment-related side effects. These effects can persist after treatment is complete.

What are the potential complications of cervical cancer?

Complications of cervical cancer are life threatening. Complications are caused by an abnormally rapid growth of old or damaged cells in the cervix that can spread to other organs, such as the lungs, bladder, liver and intestines. Over time, the spread of cancer interferes with organ function and vital body processes. Serious complications include:

  • Recurring cervical cancer after treatment

  • Infertility due to cervical cancer treatment

You can best treat cervical cancer and lower your risk or delay the development of complications by following your treatment plan.

What is the survival rate and prognosis for cervical cancer?

Cervical cancer is highly preventable with regular screening and HPV vaccination. It is also very treatable in early stages, when it is still confined to the cervix and uterus.

Cervical cancer survival is described in terms of a 5-year relative survival rate. This rate looks at people with the same type and stage of cancer five years after diagnosis. It compares them to people of the same age and sex in the general population. The comparison shows how much cervical cancer can shorten life.

When cervical cancer is only in the cervix and uterus, the 5-year relative survival is 92%. With regional spread to nearby structures, the rate is 58%. The rate drops to 17% when it has spread to distant sites, such as the bones, liver or lungs.

Keep in mind, these numbers are only statistics. They cannot tell you how long you will live or what your outlook is. Your circumstances are unique. And there are many factors specific to you that affect your prognosis. Your doctor is the best source of information about your future.

Overall, more than 4,000 people will die from cervical cancer this year. This represents a dramatic reduction from the past. The death rate has fallen by more than 50% over the last 40 years, thanks to regular screening. It continues to trend downward, falling by 0.7% per year.

Cervical cancer awareness

January is cervical cancer awareness month. There are several advocacy groups, including the National Cervical Cancer Coalition, Cervivor, and the Cervical Cancer-Free Coalition. These groups promote cervical health and cervical cancer prevention through education about screening and vaccination. Look for the teal and white ribbon signifying cervical cancer awareness.

Was this helpful?
12
Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Dec 14
View All Cancer Articles
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Basic Information About Cervical Cancer. Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/cervical/basic_info/index.htm 
  2. Cancer Stat Facts: Cervical Cancer. National Cancer Institute SEER. https://seer.cancer.gov/statfacts/html/cervix.html 
  3. Cervical Cancer. American Society of Clinical Oncology. http://www.cancer.net/cancer-types/cervical-cancer/overview 
  4. Cervical Cancer Screening. National Cancer Institute. https://www.cancer.gov/types/cervical/patient/cervical-screening-pdq 
  5. Cervical Cancer Stages. American Cancer Society. https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/staged.html 
  6. Do Certain Foods Fight Cervical Cancer? Moffitt Cancer Center. https://moffitt.org/cancers/cervical-cancer/faqs/do-certain-foods-fight-cervical-cancer/ 
  7. Fernandes WC, Kimura M. Health related quality of life of women with cervical cancer. Rev Lat Am Enfermagem. 2010 May-Jun;18(3):360-7.
  8. Human Papilloma (HPV) Vaccines. National Cancer Institute. https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet 
  9. Key Statistics for Cervical Cancer. American Cancer Society. https://www.cancer.org/cancer/cervical-cancer/about/key-statistics.html 
  10. Schiffman M, Castle PE, Jeronimo J, et al. Human papillomavirus and cervical cancer. Lancet 2007; 370:890.
  11. Screening for Cervical Cancer US Preventive Services Task Force Recommendation Statement. JAMA. 2018;320(7):674-686. https://jamanetwork.com/journals/jama/fullarticle/2697704
  12. Survival Rates for Cervical Cancer. American Cancer Society. https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/survival.html 
  13. Tests for Cervical Cancer. American Cancer Society. https://www.cancer.org/cancer/cervical-cancer/detection-diagnosis-staging/how-diagnosed.html 
  14. Tierney LM Jr., Saint S, Whooley MA (Eds.) Current Essentials of Medicine (4th ed.). New York: McGraw-Hill, 2011.
  15. Treatment Options for Cervical Cancer by Stage. American Cancer Society. https://www.cancer.org/cancer/cervical-cancer/treating/by-stage.html 
  16. What Are the Risk Factors for Cervical Cancer? American Cancer Society. https://www.cancer.org/cancer/cervical-cancer/causes-risks-prevention/risk-factors.html 
  17. What Causes Cervical Cancer? American Cancer Society. https://www.cancer.org/cancer/cervical-cancer/causes-risks-prevention/what-causes.html