Cervical cancer is cancer that starts in the cervix. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina.
Cancer - cervix
Worldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the United States because of the routine use of Pap smears.
Cervical cancer starts in the cells on the surface of the cervix. There are two types of cells on the surface of the cervix, squamous and columnar. Most cervical cancers are from squamous cells.
Cervical cancer usually develops slowly. It starts as a precancerous condition called dysplasia. This condition can be detected by a Pap smear and is 100% treatable. It can take years for dysplasia to develop into cervical cancer. Most women who are diagnosed with cervical cancer today have not had regular Pap smears, or they have not followed up on abnormal Pap smear results.
Almost all cervical cancers are caused by HPV (human papillomavirus). HPV is a common virus that is spread through sexual intercourse. There are many different types (strains) of HPV. Some strains lead to cervical cancer. Other strains can cause genital warts. Others do not cause any problems at all.
A woman's sexual habits and patterns can increase her risk of developing cervical cancer. Risky sexual practices include:
Having sex at an early age
Having multiple sexual partners
Having a partner or many partners who take part in high-risk sexual activities
Having a mother who took the drug diethylstilbestrol (DES) during pregnancy in the early 1960s to prevent miscarriage
Having a weakened immune system
Most of the time, early cervical cancer has no symptoms. Symptoms that may occur include:
Abnormal vaginal bleeding between periods, after intercourse, or after menopause
Vaginal discharge that does not stop, and may be pale, watery, pink, brown, bloody, or foul-smelling
Periods that become heavier and last longer than usual
Cervical cancer may spread to the bladder, intestines, lungs, and liver. Often, there are no problems until the cancer is advanced and has spread. Symptoms of advanced cervical cancer may include:
Bone pain or fractures
Leaking of urine or feces from the vagina
Loss of appetite
Single swollen leg
Exams and Tests
Precancerous changes of the cervix and cervical cancer cannot be seen with the naked eye. Special tests and tools are needed to spot such conditions:
A Pap smear screens for precancers and cancer, but does not make a final diagnosis.
The human papillomavirus (HPV) DNA test may be done along with a Pap test. Or it may be used after a woman has had an abnormal Pap test result. It may also be used as a main test.
If abnormal changes are found, the cervix is usually examined under magnification. This procedure is called colposcopy. Pieces of tissue are removed (biopsied) during this procedure. This tissue is then sent to a lab for examination.
Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. This is why routine Pap smears are so important. There are surgical ways to do this without removing the uterus or damaging the cervix, so that a woman can still have children in the future.
Types of surgery for early cervical cancer include:
Laser therapy -- uses light to burn abnormal tissue
A hysterectomy (surgery to remove the uterus but not the ovaries) is not often done for cervical cancer that has not spread. It may be done in women who have repeated LEEP procedures.
Treatment for more advanced cervical cancer may include:
Radical hysterectomy, which removes the uterus and much of the surrounding tissues, including lymph nodes and the upper part of the vagina.
Pelvic exenteration, an extreme type of surgery in which all of the organs of the pelvis, including the bladder and rectum, are removed.
Radiation may be used to treat cancer that has spread beyond the cervix or cancer that has returned.
Chemotherapy uses drugs to kill cancer. It may be given alone or with surgery or radiation.
You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.
How well the patient does depends on many things, including:
Type of cervical cancer
Stage of cancer (how far it has spread)
Age and general health
If the cancer comes back after treatment
Precancerous conditions can be completely cured when followed up and treated properly. Most women are alive in 5 years (5-year survival rate) for cancer that has spread to the inside of the cervix walls but not outside the cervix area. The 5-year survival rate falls as the cancer spreads outside the walls of the cervix into other areas.
Complications can include:
Risk of the cancer coming back in women who have treatment to save the uterus
Problems with sexual, bowel, and bladder function after surgery or radiation
When to Contact a Medical Professional
Call your health care provider if you:
Have not had regular Pap smears
Have abnormal vaginal bleeding or discharge
Cervical cancer can be prevented by doing the following:
Get the HPV vaccine. The vaccine prevents against most types of HPV infection that cause cervical cancer. Your health care provider can tell you if the vaccine is right for you.
Practice safer sex. Using condoms during sex reduces the risk of HPV and other sexually transmitted infections (STIs).
Limit the number of sexual partners you have. Avoid partners who are active in high-risk sexual behaviors.
Get Pap smears as often as your provider recommends. Pap smears can help detect early changes, which can be treated before they turn into cervical cancer.
Get the HPV test if recommended by your provider. It can be used along with the Pap test to screen for cervical cancer in women 30 years and older.
Committee on Adolescent Health Care of the American College of Obstetricians and Gynecologists: Immunization Expert Work Group of the American College of Obstetricians and Gynecologists. Committee Opinion No. 588: human papillomavirus vaccination. Obstet Gynecol. 2014;123:712-8. PMID: 24553168 www.ncbi.nlm.nih.gov/pubmed/24553168.
Jhingran A, Russell AH, Seiden MV, et al. Cancers of the cervix, vulva, and vagina. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2013:chap 87.
Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.