What Is Cervical Cancer?

Cervical cancer appears in the lower, narrow portion of the uterus, known as the cervix. It’s almost always caused by long-lasting infection with human papillomavirus (HPV). HPV is a common virus that’s passed during sex. However, only 10% of people assigned female at birth who have HPV will develop a lasting infection that puts them at risk for cervical cancer.

Cervical cancer usually doesn’t have symptoms in the early stages, making it hard to detect. When symptoms do occur, they may include vaginal bleeding and pain during sex. Once cervical cancer has spread to other parts of the body, it can cause symptoms such as leg swelling and pain during urination and bowel movements.

Getting vaccinated against HPV and having regular screening tests can help prevent cervical cancer. Meanwhile, finding cervical cancer early will improve the chances of successful treatment. It also often allows for more treatment options.

Types of Cervical Cancer

Cervical cancer can develop in different parts of the cervix. The main types of cervical cancer are named after the cell where the cancer started. They include squamous cell carcinoma, adenocarcinoma, and mixed carcinoma (also called adenosquamous carcinoma). 

Squamous Cell Carcinoma

Up to 90% of cervical cancers are squamous cell carcinomas. This type develops in the thin, flat cells (squamous cells) in the outer part of the cervix (ectocervix).

Adenocarcinoma

While rare, some cervical cancers are adenocarcinomas. These develop in the glandular cells that make mucus in the inner part of the cervix (endocervix).

Mixed Carcinoma or Adenosquamous Carcinoma

Sometimes, cervical cancer is both squamous cell carcinoma and adenocarcinoma, or mixed carcinoma.

Small Cell Neuroendocrine Carcinoma (SCNEC)

Small cell neuroendocrine carcinoma of the cervix, also called small cell cervical cancer, is extremely rare, representing only about 2% of cases. It is an aggressive form of cancer that is usually found in the late stage because it tends to spread to distant areas of the body.

Cervical Cancer Symptoms

Cervical cancer often carries specific symptoms. The symptoms can vary depending on how advanced your cervical cancer has become. 

Early-Stage Symptoms

Unfortunately, early-stage cervical cancer usually doesn’t have symptoms, making it hard to detect.

When symptoms do occur, they may include:

• Vaginal bleeding after sex, during menopause, or in between periods
• Vaginal discharge that’s watery and has a strong odor
• Pelvic pain or pain during sex

Later-Stage Symptoms

Symptoms typically appear once cancer has spread beyond the cervix to other parts of the body. These symptoms may include those of early-stage cervical cancer, as well as:

• Painful urination or bowel movements
• Dull backache
• Leg swelling
• Abdominal pain
• Fatigue

Causes

The most common cause of cervical cancer is long-lasting infection with HPV, a virus passed through sex. There are more than 40 HPV types, with 13 known to cause cervical cancer.

Most people who get HPV don’t know they have it, and their immune system usually gets rid of it within two years. However, if the immune system can’t get rid of HPV, the virus can turn normal cells into cancer cells over time. Researchers still aren’t sure why some people with HPV develop cervical cancer, but behaviors and health conditions that weaken the immune system may play a role.

Risk Factors

Anyone with a cervix who is sexually active is at risk for cervical cancer. However, your risk increases if you have more sexual partners or one partner who’s considered high-risk (someone with HPV or who has had many sexual partners). Smoking, a weakened immune system, long-term oral contraceptive use, a family history of cervical cancer, and sexually transmitted infections (STIs) can also increase your risk.

Diagnosis

In addition to taking your medical history, your healthcare provider may perform the following diagnostic tests:

• Colposcopy: The healthcare provider inserts an instrument known as a speculum to gently widen the opening of the vagina and look for abnormal spots on the cervix.  
• Biopsy: During a colposcopy, the healthcare provider removes a tissue sample from the cervix so a pathologist (a doctor who specializes in examining body tissue as part of the diagnostic process) can view it under a microscope to check for cancer.

Stages of Cervical Cancer

If diagnostic tests reveal that you have cervical cancer, your healthcare provider (likely an oncologist, or a doctor who specializes in cancer) will stage the disease. Identifying the stage helps determine how severe the cancer is and how to best treat it.

• Stage 1: Cancer cells have developed in the cervix but haven’t spread to other areas of the body. 
• Stage 2: The cancer has grown beyond the cervix and uterus. However, it hasn’t spread to the pelvic walls or the lower part of the vagina. 
• Stage 3: Cancer cells are present in the lower part of the vagina or pelvic walls. Cancer may have spread to nearby lymph nodes. 
• Stage 4: The cancer has spread to other areas of the body.

Treatments for Cervical Cancer

Cervical cancer treatments aim to cure the disease. However, later-stage cervical cancer may not be curable. At this point, the goal of treatment is to slow cancer growth or help relieve symptoms. 

Your cervical cancer care team will recommend treatment based on the cancer stage and your general health, age, and preferences. 

Surgery

There are several surgeries used to treat cervical cancer. 

In the early stages of the disease, cervical cancer may be cured by removing cancerous tissue. Procedures to remove cancer cells include laser ablation, which burns away cancer cells, and cryosurgery, which freezes them off. Conization is an excisional surgery that removes a cone-shaped section of the cervix where early cervical cancer tends to start.

In later stages, surgery may be used to remove areas affected by cancer, such as the cervix (trachelectomy) or uterus (hysterectomy). 

Radiation Therapy 

Radiation therapy uses high-energy X-rays to kill cancer cells. It may be used alone, after surgery, or in addition to chemotherapy. Radiation therapy can also be used if cervical cancer comes back after treatment.

Chemotherapy 

Also known as chemo, this treatment uses drugs that are injected through your veins or taken by mouth to kill cancer cells. Chemo may be used alone or with other types of treatment.

Targeted Drug Therapy 

Targeted drug therapy involves using drugs to destroy cancer cells without harming healthy cells. Some of these drugs may also be considered immunotherapy because of how they affect the immune system.

Immunotherapy

Immunotherapy uses drugs to help your immune system fight cervical cancer. The medicine prompts your immune system to recognize and destroy cancer cells.

Prevention

You can prevent cervical cancer by getting vaccinated against HPV. The HPV vaccine prevents new infections but doesn’t treat existing ones. So, it’s best to get vaccinated as early as possible, before you may be exposed to HPV.

Screening tests can also help prevent cervical cancer by finding abnormal cells before they turn into cancer. The Pap test, or smear, is the most common screening method. It involves collecting cells from your cervix to check for abnormal cells. Doctors generally recommend getting a Pap test once every three years. Or, you can test every five years if you also get HPV testing. 

The procedure for HPV testing is the same as for a Pap smear. However, the HPV test only tells you if you have HPV—not if you have cancer. 

It’s also essential to practice safe sex methods, such as wearing a condom. This helps prevent cervical cancer by preventing HPV infection.

Living With Cervical Cancer

The earlier cervical cancer is diagnosed, the better the outcome. About 92 out of 100 people (92%) are still alive after five years when their cervical cancer is diagnosed at an early stage. But if it’s diagnosed after the cancer has spread to a distant part of the body, the 5-year survival rate is only 17%.

However, it can take several years to see the effects of newer, better treatments reflected in survival statistics. The outlook for people with late-stage cervical cancer is improving over time and with new research.