Cervical cancer: Full guide

What is cervical cancer?

Cervical cancer starts in the cervix. The cervix is the lower, narrow part of the uterus (womb) that opens into the vagina.

Almost all cervical cancers are caused by HPV (human papillomavirus). HPV is a very common virus spread by skin contact during sex. Most HPV infections go away on their own. When an infection stays for years, it can slowly cause changes that turn into cancer.

These slow changes are why screening works so well. Pap tests and HPV tests can find precancer, which can be treated before it becomes cancer. The HPV vaccine can prevent most of these cancers.

Smoking and a weak immune system, such as from HIV or an organ transplant, raise the risk. Having HPV is common and is nothing to be ashamed of.

Early cervical cancer often has no symptoms. Later, it can cause bleeding after sex or between periods, unusual discharge, or pelvic pain. Many people are cured, especially when the cancer is found early.

Types

Squamous cell carcinoma

The most common type, about 7 in 10 cases. It starts in the flat cells that cover the outer part of the cervix.

Adenocarcinoma

About 1 in 4 cases. It starts in the gland cells that line the cervical canal. It is treated much like squamous cell cancer.

Adenosquamous carcinoma

A cancer with both squamous and gland-type cells. It is treated the same way as the main types.

Small cell or neuroendocrine carcinoma

A rare type that grows and spreads quickly. It is often treated like small cell lung cancer. Care at an experienced center is important.

Clear cell carcinoma

A rare type of adenocarcinoma. It often needs a specialized team.

Precancer (CIN)

Abnormal cells on the cervix that are not cancer yet. Treating them, often with a small procedure, can prevent cancer.

Tests you may have

Pap test and HPV test

Cells are gently taken from the cervix. A Pap test looks for abnormal cells. An HPV test looks for the virus types that can cause cancer.

Colposcopy

The doctor uses a magnifying tool to look closely at the cervix. Any odd areas can be sampled.

Biopsy

Taking a small piece of tissue to look at under a microscope. This is the only way to know for sure it is cancer.

Cone biopsy (conization)

A cone-shaped piece of the cervix is removed. It helps find out how deep the cancer goes. For very small cancers, it may also be the treatment.

Pelvic exam under anesthesia

A careful exam while you are asleep. It helps the team see how far the cancer has spread in the pelvis.

Pelvic MRI

A scan that uses magnets to make detailed pictures. It shows the size of the tumor and if it has grown into nearby tissue.

PET-CT scan

A scan with a sugar tracer that makes cancer light up. It checks lymph nodes and other parts of the body.

Blood tests

These check blood counts and kidney function. Healthy kidneys matter because the main chemotherapy, cisplatin, can affect them.

PD-L1 and other tumor tests

Tests on the tumor that show if immunotherapy may help. They matter most if the cancer has spread or come back.

What the stage means

The stage tells how big the cancer is and how far it has spread. Doctors use exams, MRI, and PET-CT scans to set the stage.

Cervical cancer uses stages 1 to 4. Lower numbers mean the cancer is smaller and has not spread far.

Stage 1

The cancer is only in the cervix. Very small cancers may be treated with a cone biopsy or simple surgery. Larger stage 1 cancers may get surgery or chemoradiation.

Stage 2

The cancer has grown beyond the cervix into the upper vagina or nearby tissue, but not to the pelvic wall. Chemoradiation is the usual treatment.

Stage 3

The cancer has reached the lower vagina or pelvic wall, blocks a kidney tube, or has spread to lymph nodes. Chemoradiation is the usual treatment, and immunotherapy may be added for many people.

Stage 4

The cancer has grown into the bladder or rectum (stage 4A), or it has spread to distant organs like the lungs or bones (stage 4B). Stage 4A is often treated with chemoradiation and immunotherapy. Stage 4B is often treated with chemotherapy, immunotherapy, and other medicines.

Tumor markers and gene tests

For early cervical cancer, treatment is mostly based on stage. Tumor tests matter most when the cancer has spread or come back. They help choose immunotherapy and other medicines.

HPV

Most cervical cancers test positive for high-risk HPV, most often types 16 and 18. HPV status does not usually change treatment, but it explains the cause.

PD-L1

A protein that can help predict if immunotherapy may work. A positive result can make you eligible for pembrolizumab with chemotherapy.

MMR and MSI

Tests that look for a DNA repair problem in the tumor. If found, immunotherapy may work well.

Tissue factor

A protein found on most cervical cancer cells. The medicine tisotumab vedotin targets it.

NTRK and other gene changes

Rare gene changes that can be treated with targeted pills. Broad tumor testing can find them.

Lymphovascular invasion (LVSI)

When cancer cells are seen in small blood or lymph vessels. It is found on the biopsy or surgery sample and can affect whether more treatment is needed.

Main treatments

Cone biopsy or trachelectomy

For very early cancer, removing part of or the whole cervix may be enough. Trachelectomy removes the cervix but keeps the uterus. These can keep the chance of pregnancy.

Hysterectomy

Surgery to remove the uterus and cervix, plus nearby lymph nodes. A radical hysterectomy also removes tissue around the cervix and the top of the vagina. For small, low-risk cancers, a simple hysterectomy may be enough.

Open surgery

For radical hysterectomy, an open cut in the belly is preferred over a camera (minimally invasive) approach. A large study found better results with open surgery.

Chemoradiation

Radiation given together with weekly cisplatin chemotherapy. The chemotherapy helps the radiation work better. It is the main treatment for larger or more advanced cancers, given with the goal of cure.

Brachytherapy

Internal radiation. A radiation source is placed inside the vagina and cervix for a short time. It gives a strong dose right to the tumor and is a key part of chemoradiation.

Immunotherapy

Medicines that help your immune system attack cancer. Pembrolizumab can be added to chemoradiation for some stage 3 and 4A cancers. It is also used with chemotherapy for cancer that has spread or come back.

Chemotherapy and bevacizumab

For cancer that has spread or come back, chemotherapy is often combined with bevacizumab. This medicine blocks blood vessel growth to the tumor. Immunotherapy may be added.

Antibody-drug conjugates

Tisotumab vedotin carries chemotherapy straight to cancer cells. It is used after other treatments stop working.

Pelvic exenteration

A large surgery that removes pelvic organs, sometimes including the bladder or rectum. It may be offered to carefully chosen people whose cancer comes back in the pelvis after radiation. The goal is cure.

Clinical trials and supportive care

Research studies test new treatments and may be an option at any stage. Palliative care helps with pain and other symptoms along with cancer treatment.

Common side effects and what helps

Fatigue

Feeling very tired is common during chemoradiation. Short walks can help. Rest when you need to and ask others for help.

Diarrhea and bowel changes

Pelvic radiation can irritate the bowel. Drink plenty of fluids and eat low-fiber foods if your team suggests. Medicines can help. Call if it is severe.

Bladder irritation

Radiation can make you need to pee often or cause burning. Drink water and tell your team. They can check for infection.

Nausea

Cisplatin can cause nausea. Anti-nausea medicines work well, so take them as directed. Small meals help.

Kidney and hearing effects

Cisplatin can affect the kidneys and hearing. You will get IV fluids and blood tests. Tell your team about ringing in the ears or hearing changes.

Low blood counts and infection

Chemotherapy can lower blood counts. Wash your hands often and avoid sick people. Call right away if you have a fever.

Vaginal narrowing and dryness

Radiation can make the vagina narrow, short, or dry. Using a vaginal dilator as your team teaches you helps keep it open and makes exams easier. Moisturizers and lubricants help with dryness.

Early menopause

Radiation or surgery can cause menopause. Hot flashes, dryness, and mood changes can happen. Hormone therapy may be safe for many people, so ask your team.

Leg swelling (lymphedema)

Removing lymph nodes can cause swelling in the legs. A lymphedema therapist, compression, and exercise can help. Report new swelling.

Immune and eye side effects

Immunotherapy can inflame healthy organs, so report new rash, cough, or diarrhea. Tisotumab vedotin can cause eye problems. Use eye drops as told and report eye changes.

Living with and after cervical cancer

After treatment, you will have regular checkups with pelvic exams. They are more frequent in the first two years. Scans are done if needed.

If you smoke, quitting helps your healing and your overall health. Ask your team for support.

Treatment can change your sex life and body. Vaginal dryness, narrowing, and early menopause are common. Dilators, moisturizers, and hormone therapy can help. It is okay to bring these up with your team.

Watch for leg swelling, bowel changes, or bladder problems. These can appear months or years after radiation. Your team can help manage them.

Talk with family members about HPV vaccination. Children and young adults can get it to protect them from cervical and other HPV-related cancers. Regular screening is important for the people you love.

It is normal to feel worried, sad, or alone. Some people feel stigma because HPV is spread by sex. No one deserves cancer. Support groups and counselors can help.