View All Pages

Cervical Cancer - Introduction

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Cervical Cancer. To see other pages, use the menu. Think of that menu as a roadmap to this full guide.

About the cervix

Cervical cancer starts in a woman's cervix, which is the lower, narrow part of the uterus. The uterus holds the growing fetus during pregnancy. The cervix connects the lower part of the uterus to the vagina and, with the vagina, forms the birth canal.

About precancer and cervical cancer

Cervical cancer begins when healthy cells on the surface of the cervix change and grow out of control, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can spread to other parts of the body. A benign tumor means the tumor will not spread.

At first, the changes in a cell are abnormal, not cancerous. Researchers believe, however, that some of these abnormal changes are the first step in a series of slow changes that can lead to cancer. Some of the abnormal cells go away without treatment, but others can become cancerous. This phase of the disease is called dysplasia, which is an abnormal growth of cells. The abnormal cells, sometimes called precancerous tissue, need to be removed to keep cancer from developing. Often, the precancerous tissue can be removed or destroyed without harming healthy tissue, but in some cases, a hysterectomy (removal of the uterus and cervix) is needed to prevent cervical cancer.

Treatment of a lesion, which is a precancerous area, depends on the following factors:

  • The size of the lesion and the type of changes that have occurred in the cells

  • If the woman wants to have children in the future

  • The woman's age

  • The woman's general health

  • The preference of the woman and her doctor

If the precancerous cells change into true cancer cells and spread deeper into the cervix or to other tissues and organs, then the disease is called cervical cancer.

There are 2 main types of cervical cancer, named for the type of cell where the cancer started. Other types of cervical cancer are rare.

  • Squamous cell carcinoma, which makes up about 80% to 90% of all cervical cancers

  • Adenocarcinoma, which makes up 10% to 20% of all cervical cancers

Normal Cervical Tissue

Normal cervical tissue
Click to Enlarge

Mild Cervical Dysplasia

Mild cervical dysplasia
Click to Enlarge

Invasive cervical squamous cell carcinoma

Invasive cervical squamous cell carcinoma
Click to Enlarge

Adenocarcinoma in situ of endocervix--diseased

Adenocarcinoma in situ of endocervix
Click to Enlarge

These images used with permission by the College of American Pathologists.

Looking for More of an Introduction?

If you would like more of an introduction, explore these related items. Please note these links will take you to other sections on Cancer.Net:

The next section in this guide is Statistics. It helps explain how many people are diagnosed with this disease and general survival rates. Or, use the menu to choose another section to continue reading this guide.   

Cervical Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will find information about how many women are diagnosed with this type of cancer each year. You will also learn some general information on surviving the disease. Remember, survival rates depend on several factors. To see other pages, use the menu.

This year, an estimated 12,990 women in the United States will be diagnosed with cervical cancer.

It is estimated that 4,120 deaths from the disease will occur this year.

The 5-year survival rate tells you what percent of women live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for women with cervical cancer is 68%. The 10-year survival rate is 64%. However, survival rates depend on many factors, including the stage of cervical cancer that is diagnosed.

When detected at an early stage, the 5-year survival rate for women with invasive cervical cancer is 92%. If cervical cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the 5-year survival rate is 57%. If the cancer has spread to a distant part of the body, the 5-year survival rate is 17%.

It is important to remember that statistics on how many women survive this type of cancer are an estimate. The estimate comes from data based on thousands of women with this cancer in the United States each year. So, your own risk may be different. Doctors cannot say for sure how long any woman will live with cervical cancer. Also, experts measure the survival statistics every 5 years. This means that the estimate may not show the results of better diagnosis or treatment available for less than 5 years. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2016.

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by this disease. Or, use the menu to choose another section to continue reading this guide.   

Cervical Cancer - Risk Factors

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. To see other pages, use the menu.

A risk factor is anything that increases a person's chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a woman's risk of developing cervical cancer:

  • Human papillomavirus (HPV) infection. The most important risk factor for cervical cancer is infection with HPV. Research shows that infection with this virus is a risk factor for cervical cancer. Sexual activity with someone who has HPV is the most common way someone gets HPV. There are different types of HPV, called strains.

  • Immune system deficiency. Women with lowered immune systems have a higher risk of developing cervical cancer. A lowered immune system can be caused by immune suppression from corticosteroid medications, organ transplantation, treatments for other types of cancer, or from the human immunodeficiency virus (HIV), which is the virus that causes acquired immune deficiency syndrome (AIDS). When a woman has HIV, her immune system is less able to fight off early cancer.

  • Herpes. Women who have genital herpes have a higher risk of developing cervical cancer.

  • Smoking. Women who smoke are about twice as likely to develop cervical cancer as women who do not smoke.

  • Age. Girls younger than 15 rarely develop cervical cancer. The risk goes up between the late teens and mid-30s. Women over 40 remain at risk and need to continue having regular cervical cancer screenings, which include both a Pap test and HPV test.

  • Race/Ethnicity. Cervical cancer is more common among black women, Hispanic women, and American Indian women.

  • Oral contraceptives. Some research studies suggest that oral contraceptives, which are birth control pills, may be associated with an increase in the risk of cervical cancer. However, more research is needed to understand how oral contraceptive use and the development of cervical cancer are connected.

  • Exposure to diethylstilbestrol (DES). Women whose mothers were given this drug during pregnancy to prevent miscarriage have an increased risk of developing a rare type of cancer of the cervix or vagina. DES was given for this purpose from about 1940 to 1970. Women exposed to DES should have an annual pelvic examination that includes a cervical Pap test as well as a four-quadrant Pap test, in which samples of cells are taken from all sides of the vagina to check for abnormal cells.

Research continues to look into what factors cause this type of cancer and what women can do to lower their personal risk. There is no proven way to completely prevent this disease, but there may be steps you can take to lower your cancer risk. Talk with your doctor if you have concerns about your personal risk of developing this type of cancer.

The next section in this guide is Screening and Prevention. It explains how tests may find precancer and cancer before signs and symptoms appear. Or, use the menu to choose another section to continue reading this guide.  

Cervical Cancer - Screening and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will find out more about screening for this type of cancer, including risks and benefits of screening. You will also learn about some of the things that a woman can do to reduce the risk of this type of cancer. To see other pages, use the menu.

Prevention 

Cervical cancer can often be prevented by preventing precancers and having regular Pap tests to find any precancers so they can be treated. Preventing precancers means controlling possible risk factors, such as:

  • Delaying first sexual intercourse until the late teens or older

  • Limiting the number of sex partners

  • Avoiding sexual intercourse with people who have had many partners

  • Avoiding sexual intercourse with people who are obviously infected with genital warts or show other symptoms

  • Having safe sex by using condoms will reduce the risk of HPV infection. Condoms also protect against HIV and genital herpes.

  • Quitting smoking

In 2006, the FDA approved the first HPV vaccine, called Gardasil, for girls and women between ages 9 and 26. The vaccine helps prevent infection from the 2 HPV strains known to cause most cervical cancer and precancerous lesions called HPV-16 and HPV-18. The vaccine also prevents against 2 low-risk HPV strains that cause 90% of genital warts. In 2009, the FDA approved a second HPV vaccine, called Cervarix, for the prevention of cervical cancer in girls and women ages 10 to 25. These vaccines do not protect people who are already infected with HPV. Doctors still recommend regular Pap tests using the guidelines below for all women. Learn more about HPV vaccination for cervical cancer.  

Screening

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer before signs or symptoms appear. The overall goals of cancer screening are to:

  • Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

  • Lower the number of people who develop the disease

Learn more about the basics of cancer screening.

Screening information for cervical cancer

Bimanual pelvic exam

In this examination, the doctor will check a woman’s body for any unusual changes regarding her cervix, uterus, vagina, ovaries, and other nearby organs. To start, the doctor will look for any changes to the woman’s vulva outside the body and then, using an instrument called a speculum to keep the vaginal walls open, the doctor will look inside the woman’s body. Some of the nearby organs cannot be viewed by the doctor, so the doctor will then insert two fingers of one hand inside the patient’s vagina while the other hand gently presses on the lower abdomen to feel the uterus and ovaries.  This exam typically takes a few minutes and is done in an examination room at the doctor’s office.

Pap test and the HPV test

The Pap test is the most common test for early changes in cells that can lead to cervical cancer. This test is also called a Pap smear. A Pap test involves gathering a sample of cells from the cervix and is often done at the same time as a pelvic exam (see above.)  Researchers have found that combining the Pap test with a test to detect HPV provides the most accurate results. These tests can be done on the same sample of cells removed from the woman’s cervix. In 2003, a U.S. Food and Drug Administration (FDA) panel recommended that Pap tests and HPV tests be used together when screening for cervical cancer in women older than 29. The HPV test and HPV genotyping, which is testing the strain of HPV, are already being used as secondary tests for people with Pap test results that show abnormal cells to help doctors determine a woman’s risk for developing cervical cancer.

Screening recommendations for cervical cancer

Different organizations have looked at the scientific evidence, risks, and benefits of cervical cancer screening. These groups have developed different screening recommendations for women in the United States who have “average risk” of cervical cancer, meaning these women do not have strong risk factors for this disease. 

Decisions about screening for cervical cancer are becoming increasingly individual, with recommendations based on a woman’s age, personal risk factors, and whether she’s had surgery to remove her cervix and uterus called a hysterectomy. It’s important for each woman to talk with her doctor about how often she should receive regular screening tests and exams, and which tests are most appropriate. Here are some questions to ask your doctor:

  • At what age should I start being screened for cervical cancer?

  • Should my screening include a pelvic exam? If so, how often?

  • Should my screening include a Pap test? If so, how often?

  • Should my screening include an HPV test?  If so, how often?

  • At what age could I stop being regularly screened for cervical cancer?

  • Do any of these recommendations change if I have had cervical dysplasia or precancer?

  • Do any of these recommendations change if I have had a hysterectomy?

  • Do any of recommendations change if I have had the HPV vaccine?

All women should talk with their doctors about cervical cancer and decide on an appropriate screening schedule. For women at high risk for developing cervical cancer, screening is recommended at an earlier age and more often than women who have an average risk of cervical cancer.

To view different groups’ national recommendations, visit the websites of the American Cancer Society, the American Congress of Obstetricians and Gynecologists, and the U.S. Preventative Services Task Force. Please note that these links will take you away from this guide to other, independent websites.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems this disease can cause. Or, use the menu to choose another section to continue reading this guide.

Cervical Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu.

Most women do not have any signs or symptoms of a precancer or early-stage cervical cancer. Symptoms usually do not appear until the cancer has spread to other tissues and organs. Or, the cause of a symptom may be another medical condition that is not cancer.

Any of the following could be signs or symptoms of cervical dysplasia or cancer:

  • Blood spots or light bleeding between or following periods

  • Menstrual bleeding that is longer and heavier than usual

  • Bleeding after intercourse, douching, or a pelvic examination

  • Pain during sexual intercourse

  • Bleeding after menopause

  • Increased vaginal discharge

Any of these symptoms should be reported to your doctor. If these symptoms appear, it is important to talk with your doctor about them even if they appear to be symptoms of other, less serious conditions. The earlier precancerous cells or cancer is found and treated, the better the chance that the cancer can be prevented or cured.

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu to choose another section to continue reading this guide.  

Cervical Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find cause of the medical problem. To see other pages, use the menu.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

In addition to a physical examination, the following tests may be used to diagnose cervical cancer:

  • Pap test. A Pap test is when he doctor gently scrapes the outside of the cervix and vagina taking samples of the cells for testing.

    Improved Pap test methods have made it easier for doctors to find cancerous cells. Traditional Pap tests can be hard to read because cells can be dried out, covered with mucus or blood, or clump together on the slide.

    • The liquid-based cytology test (often referred to as ThinPrep or SurePath) transfers a thin layer of cells onto a slide after removing blood or mucus from the sample. Because the sample is preserved, other tests (such as the HPV test mentioned in the Prevention section) can be done at the same time.

    • Computer screening (often called AutoPap or Focal Point) uses a computer to scan the sample for abnormal cells.

  • Pelvic examination. In this examination, the doctor feels a woman’s uterus, vagina, ovaries, fallopian tubes, cervix, bladder, and rectum to check for any unusual changes. A Pap test is often done at the same time.

  • HPV typing. An HPV test is similar to a Pap test, where the test is done on a sample of cells from the patient’s cervix. The doctor may test for HPV at the same time as a Pap test or after Pap test results show abnormal changes to the cervix. Certain strains of HPV, such as HPV-16 and HPV-18, are seen more often in women with cervical cancer and may help confirm a diagnosis. If the doctor says the HPV test is “positive,” that means it found the presence of HPV. Many women have HPV but do not have cervical cancer, so HPV testing alone is not an accurate test for cervical cancer.

If the Pap test showed some abnormal cells, and the HPV test is also positive, the doctor may suggest 1 or more of the following diagnostic tests:

  • Colposcopy. The doctor may do a colposcopy to check the cervix for abnormal areas. A special instrument called a colposcope (an instrument that magnifies the cells of the cervix and vagina, similar to a microscope) is used. The colposcope gives the doctor a lighted, magnified view of the tissues of the vagina and the cervix. The colposcope is not inserted into the woman’s body and the examination is not painful, can be done in the doctor's office, and has no side effects. It can be done on pregnant women.

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. If the lesion is small, the doctor may remove all of it during the biopsy. There are several types of biopsies:

    • One common method uses an instrument to pinch off small pieces of cervical tissue.

    • Sometimes, the doctor wants to check an area inside the opening of the cervix that cannot be seen during a colposcopy. To do this, the doctor uses a procedure called endocervical curettage (ECC). Using a small, spoon-shaped instrument called a curette, the doctor scrapes a small amount of tissue from inside the cervical opening.

    • A loop electrosurgical excision procedure (LEEP) uses an electrical current passed through a thin wire hook. The hook removes tissue for examination in the laboratory. A LEEP may also be used to remove a precancer or an early-stage cancer.

    • Conization (a cone biopsy) removes a cone-shaped piece of tissue from the cervix. Conization may be done as treatment to remove a precancer or an early-stage cancer.

    The first 3 procedures are usually done in the doctor's office using a local anesthetic to numb the area. There may be some bleeding and other discharge and, for some women, discomfort similar to menstrual cramps. Conization is done under a general or local anesthetic and may be done in the doctor's office or the hospital.

    If the biopsy indicates that cervical cancer is present, the doctor will refer the woman to a gynecologic oncologist, who specializes in treating this type of cancer. The specialist may suggest additional tests to see if the cancer has spread beyond the cervix.

  • Pelvic examination. The specialist may re-examine the pelvic area while the patient is under anesthetic to see if the cancer has spread to any organs near the cervix, including the uterus, vagina, bladder, or rectum.

  • X-ray. An x-ray is a way to create a picture of the structures inside of the body using a small amount of radiation. An intravenous urography is a type of x-ray that is used to view the kidneys and bladder.

  • Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow.

  • Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

  • Cystoscopy. A cystoscopy is a procedure that allows the doctor to view the inside of the bladder and urethra (canal that carries urine from the bladder) with a thin, lighted, flexible tube called a cystoscope. The person may be sedated as the tube is inserted in the urethra. A cystoscopy is used to determine whether cancer has spread to the bladder.

  • Proctoscopy (also called a sigmoidoscopy). A proctoscopy is a procedure that allows the doctor to see the colon and rectum with a thin, lighted, flexible tube called a sigmoidoscope. The person may be sedated as the tube is inserted in the rectum. A proctoscopy is used to see if the cancer has spread to the rectum.

  • Laparoscopy. A laparoscopy is a procedure that allows the doctor to see the abdominal area with a thin, lighted, flexible tube called a laparoscope. The person may be sedated as the tube is inserted through an incision in the body.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Or, use the menu to choose another section to continue reading this guide.  

Cervical Cancer - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. For cervical cancer, there are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details on each part of the TNM system for cervical cancer:

Tumor (T)

Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are divided into smaller groups that help describe the tumor in even more detail. The Roman numerals in parentheses are stages used in another widely used staging system from the Federation Internationale de Gynecologie et d'Obstetrique, or FIGO.

TX: The primary tumor cannot be evaluated. More tests may be needed.

T0: There is no primary tumor.

Tis: This stage is called carcinoma (cancer) in situ, which means that the cancer is found only in the layer of cells lining the cervix and has not spread deeper into the cervix.

T1/FIGO I: The carcinoma is found only in the cervix.

T1a/FIGO IA: Invasive carcinoma was diagnosed only by microscopy, which is viewing cervical tissue or cells under a microscope. Note: Any tumor found macroscopically (large enough to be recognized by imaging tests or to be seen or felt by the doctor) is called stage T1b or FIGO IB.

T1a1/FIGO IA1: There is a cancerous area of 3 millimeters (mm) or smaller in depth, and 7 mm or smaller in length.

T1a2/FIGO IA2: There is a cancerous area larger than 3 mm but not larger than 5 mm in depth, and 7 mm or smaller in length.

T1b/FIGO IB: In this stage, the doctor can see the lesion, and the cancer is found only in the cervix, or there is a microscopic lesion (one able to be seen using a microscope) that is larger than a stage T1a2/FIGO IA2 tumor (see above). The cancer may have been found because of a physical examination, laparoscopy, or other imaging methods (see Diagnosis).

T1b1/FIGO IB1: The tumor is 4 centimeters (cm) or smaller.

T1b2/FIGO IB2: The tumor is larger than 4 cm.

T2/FIGO II: The cancer has grown beyond the uterus but not to the pelvic wall or to the lower third of the vagina.

T2a/FIGO IIA: The tumor has not spread to the tissue next to the cervix, also called the parametrial area.

T2a1/FIGO IIA1: The tumor is 4 cm or smaller.

T2a2/FIGO IIA2: The tumor is larger than 4 cm.

T2b/FIGO IIB: The tumor has spread to the parametrial (tissue surrounding the uterus) area.

T3/FIGO III: The tumor extends to the pelvic wall, and/or involves the lower third of the vagina, and/or causes hydronephrosis (swelling of the kidney) or a nonfunctioning kidney.

T3a/FIGO IIIA: The tumor involves the lower third of the vagina, but it has not grown into the pelvic wall.

T3b/FIGO IIIB: The tumor has grown into the pelvic wall and/or causes hydronephrosis or nonfunctioning kidneys.

T4/FIGO IVA: The tumor has spread to the mucosa (lining) of the bladder or rectum and grown beyond the pelvis.

Node (N)

The “N” in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the cervix are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): The tumor has not spread to the regional lymph nodes.

N1/FIGO IIIB: The tumor has spread to the regional lymph node(s).

Metastasis (M)

The "M" in the TNM system indicates whether the cancer has spread to other parts of the body.

M0 (M plus zero): There is no distant metastasis.

M1/FIGO IVB: There is distant metastasis.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications.

Stage 0: The tumor is called carcinoma in situ. In other words, the cancer is found only in the first layer of cells lining the cervix, not in the deeper tissues (Tis, N0, M0). Carcinoma in situ is not considered to be an invasive cancer.

Stage I: The cancer has spread from the cervix lining into the deeper tissue but is still just found in the uterus. It has not spread to lymph nodes or other parts of the body (T1, N0, M0). This stage may be described in more detail (see below).

Stage Ia: T1a, N0, M0

Stage Ia1: T1a1, N0, M0

Stage Ia2: T1a2, N0, M0

Stage Ib: T1b, N0, M0

Stage Ib1: T1b1, N0, M0

Stage Ib2: T1b2, N0, M0

Stage II: The cancer has spread beyond the cervix to nearby areas, such as the vagina or tissue near the cervix, but it is still inside the pelvic area. It has not spread to lymph nodes or other parts of the body (T2, N0, M0). This stage may be described in more detail (see below).

Stage IIa: T2a, N0, M0

Stage IIa1: T2a1, N0, M0

Stage IIa2: T2a2, N0, M0

Stage IIb: T2b, N0, M0

Stage III: The cancer has spread outside of the cervix and vagina but not to the lymph nodes or other parts of the body (T3, N0, M0).

Stage IIIa: The cancer has spread to the lower part of the vagina but not to other parts of the body (T3a, N0, M0).

Stage IIIb: The cancer may have spread as far as the pelvic wall and to lymph nodes but not to other parts of the body (T1, T2, or T3a; N1, M0). If it has spread to the pelvic wall, it is called stage IIIb regardless of whether there is cancer in the lymph nodes (T3b, any N, M0).

Stage IVa: The cancer has spread to the bladder or rectum and may or may not have spread to the lymph nodes, but it has not spread to other parts of the body (T4, any N, M0).

Stage IVb: The cancer has spread to other parts of the body (any T, any N, M1).

Recurrent. Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition published by Springer-Verlag New York, www.cancerstaging.net.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu to choose another section to continue reading this guide.  

Cervical Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of cancer. To see other pages in this guide, use the menu.

This section tells you the treatments that are the standard of care for this type of cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn if it is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Descriptions of the most common treatment options for cervical cancer are listed below. The treatment of cervical cancer depends on several factors, including the type and stage of cancer, possible side effects, and the woman’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Women with cervical cancer may have concerns about if or how their treatment may affect their sexual function and fertility (ability to have children), and these topics should be discussed with the health care team before treatment begins. A woman who is pregnant should talk with her doctor about how treatments could affect both her and the unborn child. Treatment may be able to be delayed until after the baby is born.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. For cervical cancer that has not spread beyond the cervix, these procedures are often used:

  • Conization is the use of the same procedure as a cone biopsy (see Diagnosis) to remove all of the abnormal tissue. It can be used to remove microinvasive cervical cancer.

  • LEEP is the use of an electrical current passed through a thin wire hook. The hook removes the tissue. It can be used to remove microinvasive cervical cancer.

  • A hysterectomy is the removal of the uterus and cervix. Hysterectomy can be either a simple hysterectomy or a radical hysterectomy. A simple hysterectomy is the removal of the uterus and cervix. A radical hysterectomy is the removal of the uterus, cervix, upper vagina, and the tissue around the cervix. In addition, a radical hysterectomy includes an extensive pelvic lymph node dissection, which means the removal of the lymph nodes.

  • If needed, surgery may include a bilateral salpingo-oophorectomy. This is the removal of both fallopian tubes and both ovaries. It is done at the same time as the hysterectomy.

  • Radical trachelectomy is surgery to remove the cervix that leaves the uterus intact with pelvic lymph node dissection. It may be used for young patients who want to preserve their fertility. This procedure has gained acceptance as an alternative to a hysterectomy for some patients.

For cervical cancer that has spread beyond the cervix, this procedure may be used:

  • Exenteration is the removal of the uterus, vagina, lower colon, rectum, or bladder if cervical cancer has spread to these organs following radiation therapy (see below). Exenteration is rarely required. Most commonly it is used for some patients with a recurrence of cancer after radiation treatment.

Complications or side effects from surgery vary depending on the extent of the procedure. Occasionally, patients experience significant bleeding, infection, or damage to the urinary and intestinal systems. Talk with your doctor about what to expect about your specific surgery.

Because these surgical procedures affect a woman's sexual health, women should talk with their doctor about their symptoms and concerns in detail before the surgery. The doctor may be able to help reduce the side effects of surgery and provide support resources on coping with any changes. If extensive surgical procedures have affected sexual function, other surgical procedures can be used to make an artificial vagina. Learn more about the basics of cancer surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. Radiation therapy may be given alone, before surgery, or instead of surgery to shrink the tumor. Many women may be treated with a combination of radiation therapy and chemotherapy (see above).

The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Side effects of internal radiation therapy may include abdominal pain and bowel obstruction, although it is uncommon. Most side effects usually go away soon after treatment is finished. After radiation therapy, the vaginal area may lose elasticity so some women may also want to use a vaginal dilator, which is a plastic or rubber cylinder that is inserted into the vagina to prevent narrowing. 

Sometimes, doctors advise their patients not to have sexual intercourse during radiation therapy. Women may resume normal sexual activity within a few weeks after treatment if they feel ready.

Learn more about the basics of radiation therapy or read the American Society for Therapeutic Radiology and Oncology’s pamphlet, Radiation Therapy for Gynecologic Cancers.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.

Cervical cancer is often treated along with radiation therapy (see above). The goal of chemotherapy when given with radiation therapy is to increase the effectiveness of the radiation treatment. It can also be given to destroy cancer that is remaining after surgery, also called adjuvant therapy, or treat cervical cancer it has come back. The addition of bevacizumab (Avastin) to combination chemotherapy in patients with later stages of cervical cancer showed improvement in outcome.

Although chemotherapy can be given orally (by mouth), most drugs used to treat cervical cancer are given intravenously (IV). IV chemotherapy is either injected directly into a vein or through a thin tube called a catheter, which is a tube temporarily put into a large vein to make injections easier.

The side effects of chemotherapy depend on the woman and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

Other possible long-term side effects include the inability to become pregnant and early menopause. Rarely, specific drugs may cause some hearing loss. Others may cause kidney damage. Patients may be given extra fluid intravenously for kidney protection. Talk with your doctor about the possible short-term and long-term side effects based on the drugs and dosages you’ll be receiving.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a woman’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. Women often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care

Treatment options by stage

Radiation therapy alone or surgery is generally used for a small tumor. These treatments have been shown to be equally effective at treating early stage cervical cancer. Chemoradiation (a combination of chemotherapy and radiation therapy) is generally used for women with a larger tumor or if the lymph nodes are found to have cancer cells. Commonly, radiation therapy and chemotherapy are used after surgery when the patient is at a high risk for the cancer coming back or if the cancer has spread.

Metastatic cervical cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your treatment plan chosen.

Chemotherapy and surgery may be used to treat or remove newly affected areas both within the pelvic area and in other parts of the body. Palliative care will also be important to help relieve symptoms and side effects, especially with radiation therapy to relieve pain and other symptoms.

For most women, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED. 

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer does return after the original treatment, it is called recurrent cancer. Recurrent cancer may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above such as chemotherapy and radiation therapy but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

Women with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and advanced cancer is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Women who have advanced cancer and who are expected to live less than 6 months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Or, use the menu to choose another section to continue reading this guide.  

Cervical Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for women with cervical cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Women who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

Deciding to join a clinical trial

Women decide to participate in clinical trials for many reasons. For some women, a clinical trial is the best treatment option available. Because standard treatments are not perfect, women are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other women volunteer for clinical trials because they know that these studies are the only way to make progress in treating cervical cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with cervical cancer.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” However, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, women must participate in a process known as informed consent. During informed consent, the doctor should list all of the woman's options, so that she understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends. 

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for cervical cancer, learn more in the Latest Research section.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research. It explains areas of scientific research currently going on for this type of cancer. Or, use the menu to choose another section to continue reading this guide.    

Cervical Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu.

Doctors are working to learn more about cervical cancer, ways to prevent it, how to best treat it, and how to provide the best care to women diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

  • Improved detection and screening methods. Because cervical cancer is highly treatable when detected early, researchers are developing better ways to detect precancer and cervical cancer. For example, fluorescent spectroscopy is the use of fluorescent light to detect changes in precancerous cervix cells.

  • HPV prevention. As discussed in the Prevention section, the HPV vaccines help prevent infection from the HPV strains that cause most cervical cancer. Gardasil is also approved by the FDA for boys and men ages 9 through 26 to prevent genital warts. Researchers are looking at the impact of the HPV vaccine on boys to reduce the risk of HPV transmission.

  • Immunotherapy. Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight the cancer. It uses materials either made by the body or in a laboratory to improve, target, or restore immune system function. For women who already have cervical cancer, a therapeutic vaccine is being developed. These vaccines help "train" the immune system to recognize cervical cancer cells and destroy them. Learn more about immunotherapy.

  • Fertility-preserving surgery. There is continued interest in improving surgical techniques and finding out which patients with cervical cancer can be treated successfully without the loss of fertility. Learn more about fertility preservation.

  • Targeted therapy. Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. Drugs called anti-angiogenesis inhibitors that block the action of a protein called vascular endothelial growth factor (VEGF) have been shown to increase the cancer’s response to treatment and survival in women with cervical cancer that has spread to other parts of the body. VEGF promotes angiogenesis, which is the formation of new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogensis therapies is to “starve” the tumor. Learn more about targeted treatments.

  • Combination therapy. Some clinical trials are exploring various combinations of immunotherapy, radiation therapy, and chemotherapy.

  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current cervical cancer treatments to improve patients’ comfort and quality of life.

Looking for More About Latest Research?

If you would like additional information about the latest areas of research regarding cervical cancer, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. Or, use the menu to choose another section to continue reading this guide.  

Cervical Cancer - Coping With Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people don’t experience the same side effects even when given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for cervical cancer are described within the Treatment Options section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as anxiety or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in return.

Patients and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Learn more about managing financial considerations, in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with cervical cancer. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers take care of:

  • Providing support and encouragement

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they are likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

The next section in this guide is Follow-up Care and it explains the importance of check-ups after cancer treatment is finished. Or, use the menu on the side of your screen to choose another section to continue reading this guide.  

Cervical Cancer - Follow-Up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will read about your medical care after cancer treatment is completed, and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

Care for women diagnosed with cervical cancer doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years.

Learn more about the importance of follow-up care.

Watching for recurrence 

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will also ask specific questions about your health. Some people may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors including the type and stage of cancer originally diagnosed and the types of treatment given.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Or, use the menu to choose another section to continue reading this guide.  

Cervical Cancer - Survivorship

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will read about how to with challenges in everyday life after a cancer diagnosis. To see other pages, use the menu.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain of how to cope with everyday life.

Survivors may feel some stress when frequent visits to the health care team end following treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing,

  • Thinking through solutions,

  • Asking for and allowing the support of others, and

  • Feeling comfortable with the course of action you choose.

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

Women recovering from cervical cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

In addition, it is important to have recommended medical check-ups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation may also be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The booklet is available as a PDF, so it is easy to print out.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including for survivors in different age groups.

The next section offers Questions to Ask the Doctor to help start conversations with your cancer care team. Or, use the menu to choose another section to continue reading this guide.  

Cervical Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

Questions to ask about prevention

  • Should I receive the HPV vaccine?

  • Should I be tested for HPV infection? What does this mean?

  • How often should I have a Pap test?

Questions to ask after a diagnosis of cervical cancer or precancer

  • What is my diagnosis, and what does it mean?

  • What is the stage of the precancer or cancer? What does this mean?

  • Can you explain my pathology report (laboratory test results) to me?

Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options?

  • What clinical trials are available for me? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • Who will be part of my health care team, and what does each member do?

  • Who will be leading my overall treatment?

  • What are the possible side effects of this treatment, both in the short term and the long term?

  • Will this treatment affect my ability to become pregnant in the future? Should I talk with a fertility expert before starting treatment?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • If I’m worried about managing the costs of cancer care, who can help me?

  • Should I stop have sex during treatment?

  • Will my sex life be affected after treatment?

  • What can I do to stay healthy as possible during and after treatment?

Questions to ask about planning follow-up care

  • What is the risk of the cancer returning? Are there signs and symptoms I should watch for?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need, and how often will I need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be coordinating my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu to choose another section to continue reading this guide.

Cervical Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2016

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Cervical Cancer. To go back and review other pages, use the menu.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Cervical Cancer. Use the menu to select another section to continue reading this guide.