Obstetrics and Gynecology

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Cervical Cancer

What is Cervical Cancer? Cervical cancer is a cancer that starts in the cervix, the lower part of the uterus that opens at the top of the vagina.  What Causes Cervical Cancer? Worldwide, cervical cancer is the third most common type of cancer in women.  It is much less common in the United States because of 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 cervix's surface: squamous and columnar. The majority of cervical cancers are from squamous cells. The development of cervical cancer is very slow. It starts as a pre-cancerous condition called dysplasia. This pre-cancerous condition can be detected by a Pap smear and is very treatable. That is why it is so important for women to get regular Pap smears. Most women that are diagnosed with cervical cancer today have not had regular Pap smears or they have not followed up on abnormal results. Undetected, pre-cancerous changes can develop into cervical cancer and spread to the bladder, intestines, lungs, and liver. It can take years for pre-cancerous changes to turn into cervical cancer. Patients with cervical cancer do not usually have problems until the cancer is advanced and has spread. 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 of HPV, and many do not cause problems. However, only certain strains of HPV actually lead to cervical cancer. (Other strains may cause genital warts.) Other risk factors for cervical cancer include:

  • Having sex at an early age
  • Multiple sexual partners
  • Sexual partners who have multiple partners or who participate in high-risk sexual activities
  • Smoking
  • Women whose mothers took the drug DES (diethylstilbestrol) while pregnant with them in the early 1970's to prevent miscarriage 
  • Long-term use of birth control pills (more than 5 years) may increase adenocarcinoma (a more rare type than squamous)
  • Weakened immune system (HIV, AIDS, medications after transplant)
  • Infections with genital herpes or chronic chlamydia infections
  • Poor economic status (may not be able to afford regular Pap smears)
  • Poor medical follow-up 

What are the Symptoms of Cervical Cancer? Most of the time, early cervical cancer has no symptoms. Symptoms that may occur can include:

  • Continuous vaginal discharge, which may be pale, watery, pink, brown, bloody, or foul-smelling
  • Abnormal vaginal bleeding between periods, after intercourse, or after menopause
  • Periods become heavier and last longer than usual

Symptoms of advanced cervical cancer may include:

  • Loss of appetite
  • Weight loss
  • Fatigue
  • Pelvic pain
  • Back pain
  • Leg pain
  • Single swollen leg
  • Heavy bleeding from the vagina
  • Leaking of urine or feces from the vagina
  • Bone fractures

Cervical Cancer Exams and Tests Available: Pre-cancerous changes of the cervix and cervical cancer can not be seen with the naked eye. Special tests and tools are needed to spot such conditions.

Pap smears screen for pre-cancers and cancer, but do not offer the final diagnosis. If abnormal changes are found, the cervix is usually examined under magnification. This is called colposcopy. Pieces of tissue are surgically removed (biopsied) during this procedure and sent to a laboratory for examination. 

Other tests may include:

  • Endocervical curettage (ECC) to examine the opening of the cervix
  • Cone biopsy (Cold-knife cone, LEEP, or LLETZ)

If the woman is diagnosed with cervical cancer, the gynecologic oncologist will order more tests to determine how far the cancer has spread. This is called staging. Tests may include:

  • CT scan
  • Cystoscopy and proctoscopy
  • Examination under anesthesia
  • MRI
  • Chest x-ray
  • Intravenous pyelogram (IVP)

Cervical Cancer Treatment Options: Treatment of cervical cancer depends on the stage of the cancer, the size and shape of the tumor, the age and general health of the woman, and her desire to have children in the future.

Cervical dysplasia can be cured by removing or destroying the pre-cancerous tissue. There are various 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:

  • LEEP (Loop Electrosurgical Excision Procedure) - uses electricity to remove abnormal tissue
  • Cryotherapy - freezes abnormal cells
  • Laser therapy - uses light to burn abnormal tissue

For very early cancers (<3 mm in depth), occasionally a LEEP or cone may be enough treatment in women still wanting child bearing. In larger lesions, in women still wanting child-bearing, occasionally a radical trachelectomy (radical removal of the cervix) with sparing of the uterus can be performed.

A hysterectomy (removal of the uterus but not the ovaries) is not often performed for cervical dysplasia. It may be done in women who have repeated LEEP or cone procedures. However, in invasive disease, a radical hysterectomy may be performed. This type of hysterectomy removes the uterus and much of the surrounding tissues, including internal lymph nodes and upper part of the vagina. In recurrent or locally advanced disease, a pelvic exenteration may be performed where all of the organs of the pelvis, including the bladder and rectum, are removed.

Radiation therapy (often with chemotherapy) may be used to treat cancer that has spread beyond the uterus, or cancer that has returned. Radiation therapy can be either external or internal. Internal radiation therapy uses a device filled with radioactive material, which is placed inside the woman's vagina next to the cervical cancer. The device is removed when she goes home. External radiation therapy beams radiation from a large machine onto the body where the cancer is located. It is similar to having an x-ray taken.

Chemotherapy uses drugs to kill cancer. Some of the drugs used for chemotherapy for cervical cancer include 5-FU, cisplatin, carboplatin, ifosfamide, paclitaxel, and cyclophosphamide. Sometimes radiation and chemotherapy are used before or after surgery.

Cervical Cancer Prognosis: Many factors influence the outcome of cervical cancer. These include: 

  • The type of cancer
  • The stage of the disease
  • The age and general physical condition of the woman
  • Pre-cancer conditions are completely curable when followed up and treated properly. The chance of being 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 is 92%.
  • However, the 5-year survival rate falls steadily as the cancer spreads into other areas.

Possible complications of treatments:

  • Some types of cervical cancer do not respond well to treatment.
  • The cancer may come back (recur) after treatment.
  • Women who have treatment to save the uterus have a high risk of the cancer coming back (recurrence). 
  • Surgery and radiation can cause problems with sexual, bowel, and bladder function. Radiation complications can occur as late as 15-20 years after receiving radiation. 

When to contact a medical professional: Call your health care provider if you:

  • Are a sexually active woman who has not had a Pap smear in the past year
  • Are at least 20 years old and have never had a pelvic examination and Pap smear
  • Think your mother may have taken DES when she was pregnant with you
  • Have not had regular Pap smears (ask your health care provider how often you should have one performed)

A woman with ovarian cancer or at risk for ovarian cancer should see a gynecologic oncologist (a women’s cancer specialist) for management of her disease.

Cervical Cancer Prevention: A new vaccine to prevent cervical cancer is now available. In June 2006, the U.S. Food and Drug Administration approved the vaccine called Gardasil, which greatly decreases infection caused by the two types of HPV responsible for the majority of cervical cancer cases. Studies have shown that the vaccine appears to prevent early-stage cervical cancer and precancerous lesions. Gardasil is the first approved vaccine targeted specifically to prevent any type of cancer.

Practicing safe sex (using condoms) also reduces your risk of HPV and other sexually-transmitted diseases. HPV infection causes genital warts. These may be barely visible or several inches wide. If a woman sees warts on her partner's genitals, she should avoid intercourse with that person.

To further reduce the risk of cervical cancer, women should limit their number of sexual partners and avoid partners who participate in high-risk sexual activities.

Getting regular Pap smears can help detect pre-cancerous changes, which can be treated before they turn into cervical cancer. Pap smears work very well in spotting such changes, but they must be done regularly. Annual pelvic examinations, including a pap smear, should start when a woman becomes sexually active, or by the age of 20 in a non-sexually active woman. If abnormal changes are seen, a colposcopy with biopsy should be performed.

If you smoke, quit. Cigarette smoking is associated with an increased risk of cervical cancer. Smoking is also associated with an increased risk of recurrent cervical dysplasia.

Cervical Cancer Support:

Last Updated: 4/20/16