Cancer - cervix; Cervical cancer - HPV; Cervical cancer - dysplasia
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.
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 2 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:
Other risk factors for cervical cancer include:
Worldwide, cervical cancer is the third most common type of cancer in women. Luckily, it's much less common in the United States due to women receiving recommended routine Pap smears, the test designed to find cervical cancer sometimes even before abnormal cells turn to cancer. Cervical cancer starts in the cells on the surface of the cervix, the lower portion of the uterus. There are two types of cells on the surface of the cervix, squamous and columnar. Most cervical cancers come from these squamous cells.The cancer usually starts very slowly as a condition called dysplasia. This precancerous condition can be detected by Pap smear and is 100% treatable. Undetected, precancerous changes can develop into cervical cancer and spread to the bladder, intestines, lungs, and liver. It can take years for these precancerous changes to turn into cervical cancer. However, patients with cervical cancer do not usually have problems until the cancer is advanced and has spread.Most of the time, early cervical cancer has no symptoms. Symptoms of advanced cancer may include back pain, bone fractures, fatigue, heavy vaginal bleeding, urine leakage, leg pain, loss of appetite, and pelvic pain.If after having a Pap smear, the doctor finds abnormal changes on the cervix, a colposcopy can be ordered. Using a light and a low-powered microscope, the doctor will view the cervix under magnification. The doctor may remove pieces of tissue, called a biopsy, and send the sample to a laboratory for testing. If the woman is diagnosed with cervical cancer, the doctor will order more tests to determine how far the cancer has spread. This is called Staging. Treatment will depend on the stage of the cancer, the size and shape of the tumor, the woman's age and general health, and her desire to have children in the future.Early cervical cancer can be treated with surgery just to remove abnormal tissue, freeze abnormal cells, or burn abnormal tissue. Treatment for more advanced cervical cancer may include radical hysterectomy, removal of the uterus and much of the surrounding tissue, including lymph nodes and the upper part of the vagina. Radiation may be used to treat cancer that has spread beyond the pelvis, or if cancer returns. The woman may also have chemotherapy to kill cancer cells.Almost all cervical cancers are caused by human papilloma virus, or HPV. This common virus is spread through sexual intercourse. HPV vaccines can prevent infection against the two types of HPV responsible for about 70% of cervical cancer. Practicing safe sex also reduces the risk of getting HPV.But, keep in mind most women diagnosed with cervical cancer have not had their regular Pap smears. Because Pap smears can find precancerous growths that are 100% treatable, it's very important for women to get Pap smears at regular intervals.
Most of the time, early cervical cancer has no symptoms. Symptoms that may occur include:
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:
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:
If cervical cancer is diagnosed, the health care provider will order more tests. These help determine how far the cancer has spread. This is called staging. Tests may include:
Treatment of cervical cancer depends on:
Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. This is why routine Pap smears are so important to prevent cervical cancer. 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:
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 had repeated LEEP procedures.
Treatment for more advanced cervical cancer may include:
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 person does depends on many things, including:
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:
Call your provider if you:
Cervical cancer can be prevented by doing the following:
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;123:712-718. PMID: 24553168
Hacker NF. Cervical dysplasia and cancer. In: Hacker NF, Gambone JC, Hobel CJ, eds. Hacker and Moore's Essentials of Obstetrics and Gynecology. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 38.
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; 2013:chap 87.
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines): cervical cancer. Version 1.2016.
U.S. Preventive Services Task Force. Screening for Cervical Cancer: U.S. Preventive Services Task Force recommendation statement. AHRQ Publication No. 11-05156-EF-2, March 2012.
Last reviewed on: 12/4/2015
Reviewed by: 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.