Oncologist-approved cancer information from the American Society of Clinical Oncology

Cervical Cancer


Last Updated: August 29, 2011

This section has been reviewed and approved by the Cancer.Net Editorial Board,  07/11

Overview

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.

Cervical cancer begins when normal cells on the surface of the cervix change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body).

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 (an abnormal growth of cells). The precancerous tissue needs 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 (a precancerous area) depends on the following factors:

  • How big the lesion is 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 two 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

Find out more about basic cancer terms used in this section.

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Statistics

This year, an estimated 12,710 women in the United States will be diagnosed with cervical cancer. It is estimated that 4,290 deaths from the disease will occur this year.

The one-year survival rate (percentage of women who survive at least one year after the cancer is detected, excluding those who die from other diseases) of women with cervical cancer is 87%. The five-year survival rate (percentage of women who survive at least five years after the cancer is detected, excluding those who die from other diseases) for all stages of cervical cancer is 70%. When detected at an early stage, the five-year survival rate for women with invasive cervical cancer is 91%.

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a woman how long she will live with cervical cancer. Because survival statistics are often measured in multi-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2011.

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Risk Factors

A risk factor is anything that increases a person's chance of developing cancer. Although risk factors can 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. This virus is most commonly passed from person to person during sexual activity. There are different types, or strains, of HPV, and some strains are more strongly associated with certain types of cancers. Learn more about HPV and cancer.

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 transplantations, treatments for other types of cancer, or from human immunodeficiency virus (HIV), 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 Pap test screenings (see below).

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

Oral contraceptives. Some research studies suggest that oral contraceptives (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 cervical cancer. 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.

Prevention

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

  • 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 AIDS.

  • Quitting smoking

The Pap test is the most common test for cervical cancer. Researchers have found that combining it with a test to detect HPV provides the most accurate results. 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 (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.

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 two HPV strains known to cause most cervical cancers and precancerous lesions. The vaccine also prevents against two 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.

In 2009, the American College of Obstetricians and Gynecologists updated its guidelines for cervical cancer to recommend the following screening schedule:

  • Starting at age 21, women should have Pap tests every two years.

  • After three normal Pap tests in a row, women 30 and older may have Pap tests every 3 years. Women with specific medical conditions, such as a history of abnormal Pap tests, infection with HIV, a weakened immune system, or exposure to DES, should be screened more often.

  • Women 30 and older may be tested for HPV with the Pap test. If both are normal, the tests are not needed for another three years.

  • Starting at age 65 to 70, women can stop screening if they have had three normal Pap tests in a row in the previous 10 years. However, they should continue screening if they are sexually active, have had multiple sexual partners, or have a history of abnormal Pap tests.

The American Cancer Society and the U.S. Preventive Task Force recommend the following screening guidelines:

  • All women should begin having yearly Pap tests within three years of beginning vaginal sexual intercourse, but no later than age 21.

  • Women should be screened yearly with a conventional Pap test or every two years with liquid-based tests. Women 30 and older who have had normal test results in a row can receive screening every two to three years. Women older than 30 may also have a Pap test and the HPV test every three years.

  • Women 70 or older can stop screening if their previous three Pap tests were normal and there were no abnormal test results within the previous 10 years.

  • Screening after a hysterectomy (removal of the uterus and cervix) is not necessary unless the surgery was done to treat cervical cancer or precancer. Women who have had a hysterectomy without removal of the cervix should continue screening until age 70.

Symptoms and Signs

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. These symptoms may also be caused by a 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 six symptoms should be reported to the 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.

Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a diagnosis. This may include how long you’ve been experiencing the symptom(s) and how often.

If cancer is diagnosed, relieving symptoms and side effects 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.

Diagnosis

Doctors use many tests to diagnose cancer and find out if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition

  • Type of cancer suspected

  • Severity of symptoms

  • Previous test results

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

Pap test. The doctor gently scrapes the outside of the cervix and vagina and takes 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. If the doctor finds abnormal changes to the cervix during a pelvic examination and a Pap test, the doctor may test for HPV. An HPV test is similar to a Pap test, where the test is done on a sample of cells from the patient’s cervix. Certain strains of HPV, such as HPV 16, are seen more often in women with cervical cancer and may help confirm a diagnosis. Many women carry HPV, 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 one 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. The sample removed from the biopsy is analyzed by a pathologist (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 three 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 organs near the cervix, including the uterus, vagina, bladder, and rectum.

X-ray. An x-ray is a picture of the inside of the body. For instance, a chest x-ray can help doctors determine if the cancer has spread to the lungs. 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 three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture.

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body. This substance is absorbed mainly by organs and tissues 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. This procedure 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). This procedure 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. This procedure 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.

Learn more about what to expect when having common tests, procedures, and scans.

After these 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. Learn more about the first steps to take after a diagnosis of cancer.

Staging

Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and whether it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine 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 (chance of recovery). There are different stage descriptions for different types of cancer.

One tool that doctors use to describe the stage is the TNM system. This system judges three factors: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to the rest of the body. The results are combined to determine the stage of cancer for each person. 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.

TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:

  • How large is the primary tumor and where is it located? (Tumor, T)

  • Has the tumor spread to the lymph nodes? (Node, N)

  • Has the cancer metastasized to other parts of the body? (Metastasis, M)

Tumor. 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 (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 3.0 millimeters (mm) or smaller in depth, and 7.0 mm or smaller in length.

T1a2/FIGO IA2: There is a cancerous area larger than 3.0 mm but not larger than 5.0 mm in depth, and 7.0 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.

T1b1/FIGO IB1: The tumor is 4.0 centimeters (cm) or smaller.

T1b2/FIGO IB2: The tumor is larger than 4.0 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 4.0 cm or smaller.

T2a2/FIGO IIA2: The tumor is larger than 4.0 cm.

T2b/FIGO IIB: The tumor has spread to the parametrial 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. The “N” in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the site of the cancer 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).

Distant metastasis. 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 comes back after treatment. It may come back in the cervix or in another place. If there is a recurrence, the cancer may need to be staged again (re-staging) using the system above.

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 (2010) published by Springer-Verlag New York, www.cancerstaging.net.

Treatment

This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Current 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.

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 patient’s preferences and overall health. 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 and whether treatment can be delayed until after the baby is born.

Surgery

Surgery is the removal of the tumor and surrounding 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, which is the removal of the uterus and cervix, or a radical hysterectomy which 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 (removal of the lymph nodes).

  • If needed, a bilateral salpingo-oophorectomy (the removal of both fallopian tubes and both ovaries) is done at the same time as the hysterectomy.

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

For cervical cancer that has spread beyond the cervix, one of these procedures may be used:

  • Radical hysterectomy

  • Exenteration: the removal of the uterus, vagina, lower colon, rectum, or bladder if cervical cancer has spread to these organs following radiation therapy.

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.

If extensive surgical procedures have affected sexual function, other surgical procedures can be used to make an artificial vagina. 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. Learn more about cancer surgery.

Radiation therapy

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

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. Most side effects usually go away soon after treatment is finished.

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 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 kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. 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. The goal of chemotherapy can be to destroy cancer remaining after surgery (also called adjuvant therapy), slow the tumor's growth, reduce side effects, or treat recurrent cervical cancer (cancer that has come back after original treatment).

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 individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, 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.

Learn more about 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.

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. Sometimes, radiation and chemotherapy are used after surgery when the patient is at a high risk for a recurrence or if the cancer has spread.

Recurrent cervical cancer

Once your treatment is complete and there is a remission (absence of cancer symptoms; also called “no evidence of disease” or NED), talk with your doctor about the possibility of the cancer returning. Many survivors feel worried or anxious that the cancer will come back. Learn more about coping with this fear.

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 therapies described above (such as chemotherapy and radiation therapy) but 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.

People 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.

Metastatic cervical cancer

If cancer has spread to another location in the body, it is called metastatic cancer.

Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

Your health care team may recommend a treatment plan that includes a combination of palliative treatment with radiation therapy to relieve pain and other symptoms. 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.

In addition to treatment to slow, stop, or eliminate the cancer (also called disease-directed treatment), an important part of cancer care is relieving a person’s symptoms and side effects. It includes supporting the patient with his or her physical, emotional, and social needs, an approach called palliative or supportive care. People often receive disease-directed therapy and treatment to ease symptoms at the same time.

If disease-directed treatment is not successful, this may also be called advanced cancer. This diagnosis is stressful, and it may be difficult to discuss. 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. Learn more about advanced cancer care planning.

Find out more about common terms used during cancer treatment.

About Clinical Trials

Doctors and scientists are always looking for better ways to treat women with cervical cancer. To make scientific advances, doctors create research studies involving people, called clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. 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.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and managing the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

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, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. 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.

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. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find clinical trials.

For specific topics being studied for cervical cancer, learn more in the Current Research section.

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. 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 trials ends, and/or if the patient chooses to leave the clinical trial before it ends.

Side Effects

Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects occur.

Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatment you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and your overall health. Common side effects for each treatment option are described in detail within the Treatment section.

Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health care team. Also, be sure to communicate with the doctor about side effects you experience during and after treatment. Care of a patient’s symptoms and side effects is an important part of a person’s overall treatment plan; this is called palliative or supportive care. It helps people with cancer at any stage of illness be as comfortable as possible. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them.

Be sure to talk with your doctor about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with cervical cancer. Learn more about caregiving.

In addition to physical side effects, there may be psychosocial (emotional and social) effects are well. For many patients, a diagnosis of cervical cancer is stressful and can bring difficult emotions. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies. Learn more about the importance of addressing such needs, including concerns about managing the cost of your medical care.

A side effect that occurs more than five years after treatment is called a late effect. Treatment of late effects is an important part of survivorship care. Learn more about late effects or long-term effects by reading the After Treatment section or talking with your doctor.

After Treatment

After treatment for cervical cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests, such as pelvic examinations and Pap tests, to monitor your recovery in the coming months and years. Women treated for cervical need surveillance to make sure that the tumor is not recurring, but the risk of recurrence declines over time.

ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

Women recovering from cervical cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. For women who smoke, quitting smoking can help recovery and reduce the risk of cancer recurrence. Learn more about tobacco. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes.

Find out more about common terms used after cancer treatment is complete.

Current Research

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 people 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 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 vaccine helps prevent infection from the two HPV strains that cause most cervical cancers. 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 bolster, 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 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) are being tested for women with cervical cancer. VEGF promotes angiogenesis (the formation of new blood vessels), which is necessary for tumor growth and metastasis. Learn more about targeted treatments.

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

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

Learn more about common statistical terms used in cancer research.

Looking for More about Current Research?

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

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Questions to Ask the Doctor

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.

Prevention/before a diagnosis of cervical cancer

  • Should I receive the HPV vaccine?

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

  • How often should I have a Pap test?

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?

  • What are my treatment options?

  • What clinical trials are open to me?

  • What treatment plan do you recommend? Why?

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

  • Who will be coordinating my overall treatment and follow-up care?

  • 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 related to my cancer care, who can help me with these concerns?

  • Should I stop have sex during treatment?

  • Will I be able to resume my sex life after treatment?

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

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

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

Patient Information Resources

In addition to Cancer.Net, there are other sources of information about this type of cancer available online. Cancer.Net maintains a list of national, not-for-profit organizations that may be helpful in finding additional information, services, and support. As always, be sure to talk with your doctor about questions you may have about information you find about this disease.

View organizations that offer information on this specific type of cancer.