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Cervical Cancer - Introduction

Approved by the Cancer.Net Editorial Board, 02/2019

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. Use the menu to see other pages. Think of that menu as a roadmap for this complete 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 abnormal cells in the cervix that can become 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 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 stop cancer from developing. Often, the precancerous tissue can be removed or destroyed without harming healthy tissue, but in some cases, a hysterectomy is needed to prevent cervical cancer. A hysterectomy is the removal of the uterus and cervix.

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 preferences of the woman and her doctor

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

About 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 makes up about 80% to 90% of all cervical cancers. These cancers start in the cells on the outer surface covering of the cervix.

  • Adenocarcinoma makes up 10% to 20% of all cervical cancers. These cancers start in the glandular cells that line the lower birth canal.

The squamous and glandular cells meet at the opening of the cervix at the squamocolumnar junction, which is the location at which most cervical cancers start.

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

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with cervical cancer and general survival rates. Use the menu to choose a different section to read in this guide.

Cervical Cancer - Statistics

Approved by the Cancer.Net Editorial Board, 02/2019

ON THIS PAGE: You will find information about the number of women who are diagnosed with cervical cancer each year. You will also read general information on surviving the disease. Remember, survival rates depend on several factors. Use the menu to see other pages.

This year, an estimated 13,170 women in the United States will be diagnosed with invasive cervical cancer. Incidence rates for the disease dropped by more than 50% between 1975 and 2015 due in part to an increase in screening, which can find cervical changes before they turn cancerous.

It is estimated that 4,250 deaths from the disease will occur this year. The death rate dropped by around 50% between 1975 and 2016, partly because the increase in screening resulted in earlier detection of cervical cancer.

Cervical cancer is most often diagnosed between the ages of 35 and 44. About 15% of cervical cancers are diagnosed in women over age 65. It is rare for women younger than 20 to develop cervical cancer.

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 all women with cervical cancer is 66%. However, survival rates can vary by factors such as race, ethnicity, and age. For white women, the 5-year survival rates are 69%, and for black women, the 5-year survival rate is 56%. For white women under age 50, the 5-year survival rate is 78%. For black women age 50 and older, the 5-year survival rate is 47%.

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%. About 45% of women with cervical cancer are diagnosed at an early stage. If cervical cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the 5-year survival rate is 56%. 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 the survival rates for women with cervical cancer are an estimate. The estimate comes from annual data based on the number of women with this cancer in the United States. Also, experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatment available for less than 5 years. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publications, Cancer Facts & Figures 2019 and Cancer Facts & Figures 2018, and the ACS website (January 2019).

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by cervical cancer. Use the menu to choose a different section to read in this guide.

Cervical Cancer - Medical Illustrations

Approved by the Cancer.Net Editorial Board, 02/2019

ON THIS PAGE: You will find a drawing of the main body parts affected by cervical cancer. Use the menu to see other pages.

Illustration of the anatomy of the female reproductive system.

This illustration shows a frontal and sagittal (side) view of a woman’s reproductive system. The frontal section shows the fallopian tubes, 2 small ducts that link the 2 ovaries (1 on each side) to the hollow, pear-shaped uterus. The lower, narrow part of the uterus is called the cervix, which leads to the vagina. The uterus is located in the pelvis, between the bladder and rectum, and the vagina is located behind the urethra, which connects to the bladder. Copyright 2003 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

The next section in this guide is Risk FactorsIt explains the factors that may increase the chance of developing cervical cancer. Use the menu to choose a different section to read in this guide.

Cervical Cancer - Risk Factors

Approved by the Cancer.Net Editorial Board, 02/2019

ON THIS PAGE: You will find out more about the factors that increase the chance of developing cervical cancer. Use the menu to see other pages.

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. 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. HPV is common. Most people are infected with HPV when they become sexually active, and most people clear the virus without problems. There are over 100 different types of HPV. Not all of them are linked to cancer. The HPV types, or strains, that are most frequently associated with cervical cancer are HPV16 and HPV18. Starting to have sex at an earlier age or having multiple sexual partners puts a person at higher risk of being infected with high-risk HPV types.

  • 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. People younger than 20 years old rarely develop cervical cancer. The risk goes up between the late teens and mid-30s. Women past this age group remain at risk and need to have regular cervical cancer screenings, which include a Pap test and/or an HPV test.

  • Socioeconomic factors. Cervical cancer is more common among groups of women who are less likely to have access to screening for cervical cancer. Those populations are more likely to include black women, Hispanic women, American Indian women, and women from low-income households.

  • 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 4-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, including ways to prevent it, 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 health care team if you have concerns about your personal risk of developing cervical 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. Use the menu to choose a different section to read in this guide.

Cervical Cancer - Screening and Prevention

Approved by the Cancer.Net Editorial Board, 02/2019

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

Prevention

Cervical cancer can often be prevented by having regular screenings to find any precancers and treat them, as well as receiving the HPV vaccine.

The HPV vaccine Gardasil is approved by the U.S. Food and Drug Administration (FDA) for prevention of cervical cancer caused by HPV (see Risk Factors) for people between 9 and 45 years old. Gardasil 9 is available in the United States for preventing infection from HPV16, HPV18, and 5 other types of HPV linked with cancer. There were 2 other vaccines previously available in the United States: Cervarix and the original Gardasil. Both of these are no longer available in the United States. However, these vaccines may be in use outside of the United States.

To help prevent cervical cancer, ASCO recommends that girls receive HPV vaccination. Talk with a health care provider about the appropriate schedule for vaccination because it may vary based on many factors, including age and vaccine availability. Learn more about HPV vaccination and ASCO’s recommendations for preventing cervical cancer.

Additional actions people can take to help prevent cervical cancer include:

  • Delaying first sexual intercourse until the late teens or older

  • Limiting the number of sex partners

  • Practicing safe sex by using condoms and dental dams

  • 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

  • Quitting smoking

Screening information for cervical cancer

Screening is used to look for cancer or abnormalities that may become cancerous 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:

  • Reduce the number of people who die from the cancer, or completely eliminate deaths from cancer

  • Reduce the number of people who develop the cancer

Learn more about the basics of cancer screening.

The following tests and procedures may be used to screen for cervical cancer:

  1. HPV test. This test is done on a sample of cells removed from the woman’s cervix, the same sample used for the Pap test (see below). This sample is tested for the strains of HPV most commonly linked to cervical cancer. HPV testing may be done by itself or combined with a Pap test. This test may also be done on a sample of cells collected from a woman’s vagina, which she can collect herself.

  2. Pap test. The Pap test has been 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. It is often done at the same time as a bimanual pelvic exam as part of a gynecologic checkup. A Pap test may be combined with an HPV test.

  3. Visual inspection with acetic acid (VIA). VIA is a screening test that can be done with few tools and the naked eye. During VIA, a dilution of white vinegar is applied to the cervix. The health care provider then looks for abnormalities on the cervix, which will turn white when exposed to vinegar. This screening test is very useful in places where access to medical care is limited.

Screening for cervical cancer can be done during an appointment with a primary care doctor or a gynecologic specialist. In some areas, free or low-cost screening may be available.

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.

ASCO recommends that all women receive at least 1 HPV test to screen for cervical cancer in their lifetime. Ideally, women 25 to 65 years old should receive an HPV test once every 5 years. Women 65 and older or who had a hysterectomy may stop screening if their HPV test results have been mostly negative over the previous 15 years. Sometimes, women who are 65 and older and who have tested positive for HPV may continue screening until they are 70.

Decisions about screening for cervical cancer are becoming increasingly individualized. Sometimes, screening may differ from the recommendations discussed above because of a variety of factors. Such factors include your personal risk factors and your health history. It’s important to talk with your health care team or a health care professional knowledgeable in cervical cancer screening about how often you should receive screening and which tests are most appropriate.

Here are some questions to ask a health care professional:

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

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

  • Why are you recommending these specific tests and screening schedule for me?

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

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

  • Do any recommendations change if I have HIV?

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

  • Do any recommendations change if I am pregnant?

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

  • What happens if the screening shows positive or abnormal results?

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 for women who have an average risk of cervical cancer.

To view different groups’ national recommendations, visit the websites of ASCO, the American Society for Colposcopy and Cervical Pathology, the American Cancer Society, the American Congress of Obstetricians and Gynecologists, Cancer Care Ontario, and the U.S. Preventive Services Task Force, and the World Health Organization. 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 cervical cancer can cause. Use the menu to choose a different section to read in this guide.

Cervical Cancer - Symptoms and Signs

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

Most women do not have any signs or symptoms of a precancer. In many women with early-stage cervical cancer, symptoms do typically appear. In women with advanced and metastatic cancers, the symptoms may be more severe depending on the tissues and organs to which the disease has spread. The cause of a symptom may be a different medical condition that is not cancer, which is why women need to seek medical care if they have a new symptom that does not go away.

Any of the following could be signs or symptoms of cervical 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

  • Increased vaginal discharge

  • Pain during sexual intercourse

  • Bleeding after menopause

  • Unexplained, persistent pelvic and/or back pain

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 figure out the cause of the problem, called a diagnosis.

If cervical cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may be called palliative care or supportive care. It is often started soon after diagnosis and continued throughout treatment. Be sure to talk with your health care team about the 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. Use the menu to choose a different section to read in this guide.

Cervical Cancer - Diagnosis

Approved by the Cancer.Net Editorial Board, 02/2019

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

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 if 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 section describes options for diagnosing this type of cancer. Not all tests listed below will be used for every person. Some or all of these tests may be helpful for your doctor to plan the treatment of your cancer. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and general health

  • The results of earlier medical tests

The following tests may be used to diagnose cervical cancer:

  • Bimanual pelvic examination. In this examination, the doctor will check a woman’s body for any unusual changes in 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 are not visible during this exam, so the doctor will insert 2 fingers of 1 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. A Pap test is often done at the same time.

  • Pap test. During a Pap test, the doctor gently scrapes the outside of the cervix and vagina, taking samples of 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. The sample is preserved, so other tests can be done at the same time, such as the HPV test (see Screening and Prevention).

    • Computer screening, often called AutoPap or FocalPoint, uses a computer to scan the sample for abnormal cells.

  • HPV typing test. An HPV test is similar to a Pap test. 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 types or strains of HPV, such as HPV16 and HPV18, are seen more often in women with cervical cancer and may help confirm a diagnosis. If the doctor says the HPV test is “positive,” this means the test found the presence of HPV. Many women have HPV but do not have cervical cancer, so HPV testing alone is not enough for a diagnosis of cervical cancer.

  • Colposcopy. The doctor may do a colposcopy to check the cervix for abnormal areas. Colposcopy can also be used to help guide a biopsy of the cervix. A special instrument called a colposcope is used. The colposcope magnifies the cells of the cervix and vagina, similar to a microscope. It 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. It 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. Most of them are usually done in the doctor's office, using a local anesthetic to numb the area. There may be some bleeding and other discharge. Some women experience discomfort similar to menstrual cramps.

    • 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). The doctor uses a small, spoon-shaped instrument called a curette to scrape 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. It is done under a general or local anesthetic and may be done in the doctor's office or the hospital.

    If the biopsy shows that cervical cancer is present, the doctor will refer the woman to a gynecologic oncologist, which is a doctor 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 under anesthesia. In cases where it is necessary for treatment planning, the specialist may re-examine the pelvic area while the patient is under anesthesia 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 takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can 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 or liquid to swallow.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can 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 or liquid 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.

If there signs or symptoms of bladder or rectal problems, these procedures may be recommended:

  • Cystoscopy. A cystoscopy is a procedure that allows the doctor to view the inside of the bladder and urethra (the canal that carries urine from the bladder) with a thin, lighted 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.

  • Sigmoidoscopy (also called a proctoscopy). A sigmoidoscopy 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 sigmoidoscopy is used to see if the cancer has spread to the rectum.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cervical 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. Use the menu to choose a different section to read in this guide.

Cervical Cancer - Stages

Approved by the Cancer.Net Editorial Board, 02/2019

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

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. For cervical cancer, the staging system developed by the International Federation of Obstetrics and Gynecology (Federation Internationale de Gynecologie et d'Obstetrique, or FIGO) is used.

FIGO stages for cervical cancer

Doctors assign the stage of the cancer by evaluating the tumor and whether the cancer has spread to other parts of the body.

Staging is based on a the results of a physical exam, imaging scans, and biopsies.

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 other parts of the body. This stage may be divided into smaller groups to describe the cancer in more detail (see below).

  • Stage IA: The cancer is diagnosed only by viewing cervical tissue or cells under a microscope. Imaging tests or evaluation of tissue samples can also be used to determine tumor size.

    • Stage IA1: There is a cancerous area of less than 3 millimeters (mm) in depth.

    • Stage IA2: There is a cancerous area 3 mm to less than 5 mm in depth.

  • Stage IB: In this stage, the tumor is larger but still only confined to the cervix. There is no distant spread.

    • Stage IB1: The tumor 5 mm or more in depth and less than 2 centimeters (cm) wide. A centimeter is roughly equal to the width of a standard pen or pencil.

    • Stage IB2: The tumor is 2 cm or more in depth and less than 4 cm wide.

    • Stage IB3: The tumor is 4 cm or more in width.

Stage II: The cancer has spread beyond the uterus 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 other parts of the body. This stage may be divided into smaller groups to describe the cancer in more detail (see below).

  • Stage IIA: The tumor is limited to the upper two-thirds of the vagina. It has not spread to the tissue next to the cervix, which is called the parametrial area.

    • Stage IIA1: The tumor is less than 4 cm wide.

    • Stage IIA2: The tumor is 4 cm or more in width.

  • Stage IIB: The tumor has spread to the parametrial area. The tumor does not reach the pelvic wall.

Stage III: The tumor involves the lower third of the vagina, and/or has spread to the pelvic wall, and/or causes swelling of the kidney, called hydronephrosis, or stops a kidney from functioning, and/or involves regional lymph nodes. There is no distant spread.

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

  • Stage IIIB: The tumor has grown into the pelvic wall and/or affects a kidney.

  • Stage IIIC: The tumor involves regional lymph nodes. This can be detected using imaging tests or pathology. Adding a lowercase "r" indicates imaging tests were used to confirm lymph node involvement. A lowercase "p" indicates pathology results were used to determine the stage.

    • Stage IIIC1: The cancer has spread to lymph nodes in the pelvis.

    • Stage IIIC2: The cancer has spread to para-aortic lymph nodes. These lymph nodes are found in the abdomen near the base of the spine and near the aorta, a major artery that runs from the heart to the abdomen.

Stage IVA: The cancer has spread to the bladder or rectum, but it has not spread to other parts of the body.

Stage IVB: The cancer has spread to other parts of the body.

Source: Bhatla N, et al. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynecol Obstet 2019; 1–7.

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.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.

Cervical Cancer - Types of Treatment

Approved by the Cancer.Net Editorial Board, 02/2019

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with cervical cancer. Use the menu to see other pages.

This section explains the types of treatments that are the standard of care for cervical cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, you are 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 whether the new treatment 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. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

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 include a variety of other health care professionals, such as physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Descriptions of the common types of treatments used for cervical cancer are listed below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

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. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision making.” Shared decision making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision making is particularly important for cervical cancer because there are different treatment options. 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 ability to have children, called fertility, 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 gynecologic oncologist is a doctor who specializes in treating gynecologic 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 cervical cancer that can only be seen with a microscope, called microinvasive 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 simple or radical. 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. A radical hysterectomy also includes an extensive pelvic lymph node dissection, which means lymph nodes are removed. This procedure can be done using a large cut in the abdomen, called laparotomy, or smaller cuts, called laparoscopy.

  • 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 a hysterectomy.

  • Radical trachelectomy is a surgical procedure in which the cervix is removed, but the uterus is left intact. It includes pelvic lymph node dissection (see above). This surgery may be used for young patients who want to preserve their fertility. This procedure has become an acceptable 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 after radiation therapy (see below). Exenteration is rarely required. It is most often used for some people whose cancer has come back 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. Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have.

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.

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, or schedule, usually consists of a specific number of treatments given over a set period of time that combines external and internal radiation treatments. This combined approach is the most effective to reduce the chances the cancer will come back, called a recurrence.

For early stages of cervical cancer, a combination of radiation therapy and low-dose chemotherapy is often used (see below). The goal of radiation therapy combined with chemotherapy is to increase the effectiveness of the radiation treatment. This combination is given to control the cancer in the pelvis with the goal of curing the cancer without surgery. It may also be given to destroy microscopic cancer that might remain after surgery.

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. Women who have received external-beam radiation therapy will lose the ability to become pregnant, and unless the ovaries have been surgically moved out of the pelvis, premenopausal women will enter menopause.

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 Radiation Oncology’s pamphlet, Radiation Therapy for Gynecologic Cancers (PDF; please note that this link takes you to a separate, external website).

Therapies using medication

Systemic therapy is the use of medication to destroy cancer cells. This type of medication is given through the bloodstream to reach cancer cells throughout the body. Systemic therapies for cervical cancer are given by a gynecologic oncologist or medical oncologist, doctors who specialize in treating cancer with medication.

Common ways to give systemic therapies include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

The types of systemic therapies used for cervical cancer include:

  • Chemotherapy

  • Targeted therapy

  • Immunotherapy

Each of these types of therapies is discussed below in more detail. A person may receive 1 type of systemic therapy at a time or a combination of systemic therapies given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

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. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications. Learn more about your prescriptions by using searchable drug databases.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time. For women with cervical cancer, chemotherapy is often given in combination with radiation therapy (see above).

Although chemotherapy can be given orally (by mouth), all the drugs used to treat cervical cancer are given intravenously (IV). IV chemotherapy is either injected directly into a vein or given 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 after treatment is finished.

Rarely, specific drugs may cause some hearing loss. Others may cause kidney damage. Patients may be given extra fluid intravenously to protect their kidneys. 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.

Targeted therapy (updated 07/2019)

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.

When cervical cancer has come back after treatment, called recurrent cancer, or if cervical cancer has spread beyond the pelvis, called metastatic disease, it is treated with a platinum-based chemotherapy combined with the targeted therapy bevacizumab (Avastin). There are 2 drugs similar to bevacizumab, bevacizumab-awwb (Mvasi) and bevacizumab-bvzr (Zirabev), that have been approved by the FDA to treat advanced cervical cancer. These are called biosimilars.

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

The immune checkpoint inhibitor pembrolizumab (Keytruda) is used to treat cervical cancer that has recurred or spread to other parts of the body during or after treatment with chemotherapy. Some cancer cells express the PD-L1 protein, which binds to the PD-1 protein on T cells. T cells are immune system cells that kill certain cells, like cancer cells. When the PD-1 and PD-L1 proteins bind, the T cell does not attack the cancer cell. Pembrolizumab is a PD-1 inhibitor, so it blocks the binding between PD-1 and PD-L1, which allows the T cells to find and attack the cancer cells.

Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.

Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer 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 and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Treatment options by stage

Radiation therapy alone or surgery is generally used for an early-stage 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, an advanced-stage tumor found only in the pelvis, or if the lymph nodes have cancer cells. Commonly, radiation therapy and chemotherapy are used after surgery if there is 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. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Chemotherapy, immunotherapy, and surgery may be used to treat or remove newly affected areas in both the pelvic area and 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. You and your family are encouraged to talk about how you feel 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 is important to talk with your doctor about the possibility of the cancer returning. An important part of follow-up care is watching for recurrence. 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 returns 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 new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as surgery, systemic therapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may 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. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.

If treatment does not work

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

Women who have advanced cancer and who are expected to live less than 6 months may want to consider 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 talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option 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. Use the menu to choose a different section to read in this guide.

Cervical Cancer - About Clinical Trials

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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. Use the menu to see other pages.

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.

Clinical trials are used for all types and stages of cervical cancer. Many focus on new treatments to learn if a new treatment is safe, effective, and possibly better than the existing treatments. These types of studies evaluate new drugs, different combinations of treatments, new approaches to radiation therapy or surgery, and new methods of treatment.

People who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and the chance that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

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.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some people, a clinical trial is the best treatment option available. Because standard treatments are not perfect, people are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other people volunteer for clinical trials because they know that these studies are a way to contribute to the 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.

Insurance coverage and the costs of clinical trials differ by location and by study. In some programs, some of the expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” When used, 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, people must participate in a process known as informed consent. During informed consent, the doctor should:

  • Describe all of the treatment options, so that she understands how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different from the risks of standard treatment.

  • Explain what will be required of each person in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together.

People who participate in a clinical trial may stop participating at any time for personal or medical reasons. 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 people 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 they choose 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.

PRE-ACT, Preparatory Education About Clinical Trials

In addition, you can find a free video-based educational program about cancer clinical trials in another section of this website.

The next section in this guide is Latest Research. It explains areas of scientific research for cervical cancer. Use the menu to choose a different section to read in this guide.

Cervical Cancer - Latest Research

Approved by the Cancer.Net Editorial Board, 02/2019

ON THIS PAGE: You will read about the scientific research being done to learn more about cervical cancer and how to treat it. Use the menu to see other pages.

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 best diagnostic and treatment options 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 Screening and Prevention section, 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 made either 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. Research continues to focus on improving surgical techniques and finding out which people with cervical cancer can be treated successfully without losing their ability to have children. 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 angiogenesis inhibitors that block the action of a protein called vascular endothelial growth factor (VEGF) have been shown to help women live longer if they have 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 angiogenesis inhibitors is to “starve” the tumor. Learn more about angiogenesis inhibitors and targeted treatments.

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

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

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, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

Cervical Cancer - Coping With Treatment

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ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, emotional, and financial effects of cancer and its treatment. Use the menu to see other pages.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people do not experience the same side effects even when they are 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” or "supportive 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 listed in the Types of Treatment 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.

Talk with your health care team regularly about how you are feeling. It is important to let them know about any new side effects or changes in existing side effects. If they know how you are feeling, they can find ways to relieve or manage your side effects to help you feel more comfortable and potentially keep any side effects from worsening.

You may find it helpful to keep track of your side effects so it is easier to explain any changes with your health care team. Learn more about why tracking side effects is helpful.

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 sadness, anxiety, or anger, or managing your stress level. Sometimes, people find it difficult to express how they feel to their loved ones. Some have found that talking to an oncology social worker, counselor, or member of the clergy can help them develop more effective ways of coping and talking about cancer.

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 the stigma of cervical cancer

Cervical cancer, like other cancers that affect the sex organs, can be difficult or uncomfortable to discuss. People with many different types of cancer, such as testicular, penile, vaginal, and vulvar cancers, can experience feelings of embarrassment when discussing these “sensitive” areas of their bodies. However, this should never stop you from requesting and receiving the emotional support you deserve, and your treatment team will never be embarrassed by discussing these issues with you. Your team can help you feel more comfortable talking about this with others as well.

Because cervical cancer is associated with HPV, patients may feel that they will not receive as much support or help from people around them because they believe that others may think that their behavior caused the disease. Although almost all cervical cancers are caused by HPV, it is important to remember that most genital HPV infections will not cause cancer. Cervical cancer can affect anyone.

Living with this stigma can make patients feel guilty, hopeless, embarrassed, ashamed, and isolated. Patients and their families should tell the health care team if they are affected by any of these emotions. There are resources to help those living with cervical cancer. Some patients feel comfortable discussing their disease and experiences with their doctor, nurse, family, and friends. Other women find help through a support group or other avenues.

Learn more about counseling and finding a support group.

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 of medical care 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. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. 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, including:

  • Providing support and encouragement

  • Talking with the health care team

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to and from 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 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 do not 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. Create a caregiving plan with this 1-page fact sheet that includes an action plan to help make caregiving a team effort. This free fact sheet is available as a PDF, so it is easy to print out.

Looking for More on How to Track Side Effects?

Cancer.Net offers several resources to help you keep track of your symptoms and side effects. Please note that these links will take you to other sections of Cancer.Net:

  • Cancer.Net Mobile: The free Cancer.Net mobile app allows you to securely record the time and severity of symptoms and side effects.

  • ASCO Answers Managing Pain: Get this 36-page booklet about the importance of pain relief that includes a pain tracking sheet to help patients record how pain affects them. The free booklet is available as a PDF, so it is easy to print out.

  • ASCO Answers Fact Sheets: Read 1-page fact sheets on diarrhea and rash that provide a tracking sheet to record the timing and severity of the side effect. These free fact sheets are available as a PDF, so they are easy to print out.

The next section in this guide is Follow-up Care. It explains the importance of checkups after cancer treatment is finished. Use the menu to choose a different section to read in this guide.

Cervical Cancer - Follow-Up Care

Approved by the Cancer.Net Editorial Board, 02/2019

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for women diagnosed with cervical cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. 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 ask specific questions about your health. Some people may have blood tests or imaging tests done 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.

The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. This is sometimes called “scan-xiety.” Learn more about how to cope with this type of stress.

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. 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 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 discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the 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 and with 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. Use the menu to choose a different section to read in this guide.

Cervical Cancer - Survivorship

Approved by the Cancer.Net Editorial Board, 02/2019

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

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 about coping with everyday life.

Survivors may feel some stress when their frequent visits to the health care team end after completing 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 when new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexual health 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

  • 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 place 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.

A new perspective on your health

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

It is important to have recommended medical checkups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation may be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, pregnancy counseling for women who may have had a fertility-preserving treatment option, 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 health care team 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 that 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 free 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 after finishing treatment.

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

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. Use the menu to choose a different section to read in this guide.

Cervical Cancer - Questions to Ask the Health Care Team

Approved by the Cancer.Net Editorial Board, 02/2019

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

Talking often with the health care team 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 a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

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?

  • Will my sex life be affected after treatment?

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

  • If I have questions or problems, who should I contact?

Questions to ask about having surgery

  • What type of surgery will I have? Will lymph nodes be removed? 

  • How long will the operation take? 

  • How long will I be in the hospital? 

  • Can you describe what my recovery from surgery will be like?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term effects of having this surgery?

Questions to ask about having radiation therapy

  • What type of radiation therapy is recommended? 

  • What is the goal of this treatment? 

  • How long will it take to give this treatment? 

  • What side effects can I expect during treatment?

  • Who should I contact about any side effects I experience? And how soon?

  • Will this treatment cause early menopause?

  • Should I avoid sexual intercourse during treatment?

  • How often should I dilate the vagina after radiation therapy? For how long?

  • What are the possible long-term effects of having this treatment? 

  • What can be done to relieve the side effects?

Questions to ask about having therapies using medication

  • What type of medication is recommended?

  • Will this treatment be combined with other treatments?

  • What is the goal of this treatment? 

  • How long will it take to give this treatment? 

  • What side effects can I expect during treatment?

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term effects of having this treatment? 

  • What can be done to relieve the side effects?

Questions to ask about planning follow-up care

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

  • 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 leading 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 that may be helpful to you. Use the menu to choose a different section to read in this guide.

Cervical Cancer - Additional Resources

Approved by the Cancer.Net Editorial Board, 02/2019

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. Use the menu to go back and see other pages.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer 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.

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.