Cervical cancer is a type of cancer that occurs in the cells of the cervix — the lower part of the uterus that connects to the vagina. Various strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cases of cervical cancer.

When exposed to HPV, a woman's immune system typically prevents the virus from doing harm. In a small group of women, however, the virus survives for years, contributing to the process that causes some cells on the surface of the cervix to become cancer cells.

You can reduce your risk of cervical cancer by undergoing screening tests and receiving a vaccine that protects against HPV infection.

You may not experience any cervical cancer symptoms — early cervical cancer generally produces no signs or symptoms. As the cancer progresses, the following signs and symptoms of more advanced cervical cancer may appear:

  • Vaginal bleeding after intercourse, between periods or after menopause
  • Watery, bloody vaginal discharge that may be heavy and have a foul odor
  • Pelvic pain or pain during intercourse

When to see a doctor

Make an appointment with your doctor if you have any signs or symptoms that worry you.

Cervical cancer begins when healthy cells acquire a genetic mutation that turns normal cells into abnormal cells. Healthy cells grow and multiply at a set rate, eventually dying at a set time. Cancer cells grow and multiply out of control, and they don't die. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can break off from an initial tumor to spread elsewhere in the body (metastasize).

What causes cervical cancer isn't clear. However, it's certain that the sexually transmitted infection called human papillomavirus (HPV) plays a role. While HPV is a very common virus, most women with HPV never develop cervical cancer. This means other risk factors — such as your genetic makeup, your environment or your lifestyle choices — also determine whether you'll develop cervical cancer.

Types of cervical cancer

The type of cell where the initial genetic mutation occurred determines the type of cervical cancer you have. The type of cervical cancer you have helps determine your prognosis and treatment. The main types of cervical cancer are:
  • Squamous cell carcinomas. These begin in the thin, flat cells (squamous cells) that line the outer portion of the cervix, which projects into the vagina. This type accounts for the great majority of cervical cancers.
  • Adenocarcinomas. These occur in the glandular cells that line the cervical canal. These cancers make up a smaller portion of cervical cancers.

Sometimes both types of cells are involved in cervical cancer. Very rare cancers can occur in other cells in the cervix.

These factors may increase your risk of cervical cancer:

  • Many sexual partners. The greater your number of sexual partners — and the greater your partner's number of sexual partners — the greater your chance of acquiring HPV.
  • Early sexual activity. Having sex at an early age increases your risk of HPV.
  • Other sexually transmitted infections (STIs). If you have other STIs — such as chlamydia, gonorrhea, syphilis or HIV/AIDS — you have an increased risk of having HPV.
  • A weak immune system. Most women who are infected with HPV never develop cervical cancer. However, if you have an HPV infection and your immune system is weakened by another health condition, you may be more likely to develop cervical cancer.
  • Cigarette smoking. Smoking and an HPV infection may work together to cause cervical cancer.

Make an appointment with your doctor if you have any signs or symptoms that worry you. If you're thought to have cervical cancer, you may be referred to a doctor who specializes in treating gynecologic cancers (gynecologic oncologist).

Here's some information to help you get ready for your appointment and what to expect from your doctor.

What you can do

  • Write down your medical history, including other conditions with which you've been diagnosed.
  • Note any personal history that increased your risk of sexually transmitted infection, such as early sexual activity, multiple partners or unprotected sex.
  • Make a list of your medications. Include any prescription or over-the-counter medications you're taking, as well as all vitamins, supplements and herbal remedies.
  • Write down questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.

Questions to ask your doctor can include:

  • Do I have cervical cancer?
  • Has my cancer spread?
  • What treatment approach do you recommend?
  • What are the possible side effects or complications of this treatment?
  • Am I at risk of this condition recurring?
  • How often will I need follow-up visits after I finish treatment?
  • Are there brochures or other printed material that I can take with me? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

  • What are your symptoms?
  • When did you first notice these symptoms?
  • Have your symptoms changed over time?
  • Have you had regular Pap tests since you became sexually active?
  • Have you ever had abnormal Pap test results in the past?
  • Have you ever been treated for a cervical condition in the past?
  • Have you been diagnosed with any sexually transmitted infections?
  • Have you been diagnosed with any other medical conditions?
  • Have you ever taken medications that suppress your immune system?
  • Do you or did you smoke? How much?
  • Do you want to have children in the future?

When cervical cancer is detected in its earliest stages, treatment is more likely to be successful. Most guidelines suggest beginning screening for cervical cancer and precancerous changes at age 21. Screening for cervical cancer includes:

  • Pap test. During a Pap test, your doctor scrapes and brushes cells from your cervix — the narrow neck of the uterus — and sends the sample to a lab to be examined for abnormalities. A Pap test can detect abnormal cells in the cervix, including cancer cells and cells that show changes (dysplasia) that increase the risk of cervical cancer.
  • HPV DNA test. If you are age 30 or older, your doctor may also use a lab test called the HPV DNA test to determine whether you are infected with any of the types of HPV that are most likely to lead to cervical cancer. Like the Pap test, the HPV DNA test involves collecting cells from the cervix for lab testing.

Diagnosis

If you experience signs and symptoms of cervical cancer or if a Pap test has revealed cancerous cells, you may undergo further tests to diagnose your cancer. To make a diagnosis, your doctor may:

  • Examine your cervix. During an exam called colposcopy, your doctor uses a special magnifying instrument (colposcope) to examine your cervix for abnormal cells. If your doctor identifies unusual areas, he or she may take a small sample of cells for analysis (biopsy).
  • Take a sample of cervical cells. During a biopsy procedure, your doctor removes a sample of unusual cells from your cervix using special biopsy tools.
  • Remove a cone-shaped area of cervical cells. A cone biopsy (conization) — so called because it involves taking a cone-shaped sample of the cervix — allows your doctor to obtain deeper layers of cervical cells for laboratory testing. Your doctor may use a scalpel, laser or electrified wire loop to remove the tissue.

Staging

If your doctor determines that you have cervical cancer, you'll undergo further tests to determine the extent (stage) of your cancer. Your cancer's stage is a key factor in deciding on your treatment. Staging exams include:

  • Imaging tests. Tests such as X-rays, computerized tomography (CT) scans, magnetic resonance imaging (MRI) and positron emission tomography (PET) help your doctor determine whether your cancer has spread beyond your cervix.
  • Visual examination of your bladder and rectum. Your doctor may use special scopes to see inside your bladder (cystoscopy) and rectum (proctoscopy).

Your doctor then assigns your cancer a stage — typically a Roman numeral. Stages of cervical cancer include:

  • Stage I. Cancer is confined to the cervix.
  • Stage II. Cancer at this stage includes the cervix and vagina but hasn't spread to the pelvic side wall or the lower portion of the vagina.
  • Stage III. Cancer at this stage has moved beyond the cervix to the pelvic side wall or the lower portion of the vagina.
  • Stage IV. At this stage, cancer has spread to nearby organs, such as the bladder or rectum, or it has spread to other areas of the body, such as the lungs, liver or bones.

Treatment for cervical cancer depends on several factors, such as the stage of the cancer, other health problems you may have and your preferences about treatment. Treatment options may include:

  • Surgery. Surgery to remove the uterus (hysterectomy) is typically used to treat the early stages of cervical cancer. A simple hysterectomy involves the removal of the cancer, the cervix and the uterus. Simple hysterectomy is typically an option only when the cancer is at a very early stage — invasion is less than 3 millimeters (mm) into the cervix.

    A radical hysterectomy — removal of the cervix, uterus, part of the vagina and lymph nodes in the area — is the standard surgical treatment when there's invasion greater than 3 mm into the cervix.

    A hysterectomy can cure early-stage cervical cancers and prevent cancer from coming back, but removing the uterus makes it impossible to become pregnant.

  • Radiation. Radiation therapy uses high-powered energy to kill cancer cells. Radiation therapy can be given externally using external beam radiation or internally (brachytherapy) by placing devices filled with radioactive material near your cervix.

    Both methods of radiation therapy can be combined. Radiation therapy can be used alone, with chemotherapy, before surgery to shrink a tumor or after surgery to kill any remaining cancer cells. Premenopausal women may stop menstruating as a result of radiation therapy and begin menopause.

  • Chemotherapy. Chemotherapy uses drugs to kill cancer cells. Chemotherapy drugs, which can be used alone or in combination with each other, are usually injected into a vein, and they travel throughout your body killing rapidly growing cells, including cancer cells. Low doses of chemotherapy are often combined with radiation therapy, since chemotherapy may enhance the effects of the radiation. Higher doses of chemotherapy are used to control advanced cervical cancer that may not be curable. Certain chemotherapy drugs may cause infertility and early menopause in premenopausal women.

No one can be prepared for a cancer diagnosis. You can, however, try to manage the shock and fear you're feeling by taking steps to control what you can about your situation. Every woman deals with a cervical cancer diagnosis in her own way. With time, you'll discover what helps you cope. Until then, you can start to take control by attempting to:

  • Learn enough about cervical cancer to make decisions about your care. Write down your questions and ask them at the next appointment with your doctor. Get a friend or family member to come to appointments with you to take notes. Ask your health care team for further sources of information.
  • Create a support network. Don't face your diagnosis alone. Friends and family are likely feeling helpless and afraid, too. They want to help, so take them up on their offers.

    Ask loved ones to take over daily tasks such as cooking, household chores or child care. Talk with close friends and family when you're feeling overwhelmed.

  • Connect with other cancer survivors. Other people with cancer can offer unique emotional support during your diagnosis and treatment. Connect with cancer survivors through support groups in your community and on the Web. Ask your health care team about support groups in your community, or contact your local chapter of the American Cancer Society.
  • Take time for yourself. Take care of yourself during cancer treatment. It's OK to tell friends and family that you need some time for yourself. Writing in a journal, listening to music or going for walks can all be beneficial ways to reduce stress and cope with your emotions.

You may reduce your risk of cervical cancer if you:

  • Use a condom every time you have sex
  • Delay first intercourse
  • Have fewer sexual partners
  • Avoid smoking
  • Get vaccinated against HPV

Get vaccinated against HPV

Vaccines can protect against the most dangerous types of HPV — the virus that plays a role in causing most cervical cancers. Vaccination is available for girls and women ages 9 to 26. The vaccine is most effective if given to girls before they become sexually active.

Boys and young men can also receive a vaccine against HPV. In males, HPV infection increases the risk of penile cancer, anal cancer and genital warts. In theory, vaccinating boys against HPV may also help protect girls from the virus.

Have routine Pap tests

Routine Pap tests can detect precancerous conditions of the cervix so they can be followed or treated in order to prevent cervical cancer. Work with your doctor to determine the best schedule for Pap tests. Most medical organizations suggest women begin routine Pap tests at age 21 and repeat them every few years. Talk with your doctor about what's best for you.

  • Teamwork. At Mayo Clinic, gynecologic oncologists, radiation oncologists and medical oncologists work as a multidisciplinary team to treat cervical cancer. Other professionals are included as needed.
  • Experience. Mayo Clinic doctors have extensive experience treating many cases of cervical cancer, including rare types of cervical cancer.
  • A full range of treatment options to consider. Mayo Clinic doctors will work with you to review all of your treatment options and choose the treatment that best suits your needs and goals.

    The range of treatments offered to women with cervical cancer includes chemotherapy, radiation therapy and many types of surgical procedures, such as simple hysterectomy, radical hysterectomy, robotic hysterectomy, sentinel lymph node biopsy and fertility-sparing procedures.

  • Comprehensive cancer center. The Mayo Clinic Cancer Center meets strict standards for a National Cancer Institute comprehensive cancer center, which recognizes scientific excellence and a multidisciplinary approach to cancer prevention, diagnosis and treatment.

Mayo Clinic in Rochester, Minn., is ranked among the Best Hospitals for cancer by U.S. News & World Report. Mayo Clinic in Jacksonville, Fla., and Mayo Clinic in Scottsdale, Ariz., are ranked high performing for cancer by U.S. News & World Report.

At Mayo Clinic, we assemble a team of specialists who take the time to listen and thoroughly understand your health issues and concerns. We tailor the care you receive to your personal health care needs. You can trust our specialists to collaborate and offer you the best possible outcomes, safety and service.

Mayo Clinic is a not-for-profit medical institution that reinvests all earnings into improving medical practice, research and education. We're constantly involved in innovation and medical research, finding solutions to improve your care and quality of life. Your doctor or someone on your medical team is likely involved in research related to your condition.

Our patients tell us that the quality of their interactions, our attention to detail and the efficiency of their visits mean health care — and trusted answers — like they've never experienced.

Why Choose Mayo Clinic

What Sets Mayo Clinic Apart

Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

At Mayo Clinic in Arizona, specialists in gynecologic oncology work with experts in gynecology, medical oncology and radiation oncology to care for women with cervical cancer.

For appointments or more information, call the Central Appointment Office at 800-446-2279 (toll-free) 8 a.m. to 5 p.m. Mountain Standard Time, Monday through Friday or complete an online appointment request form.

At Mayo Clinic in Florida, specialists in gynecologic oncology work with experts in gynecology, medical oncology and radiation oncology to care for women with cervical cancer.

For appointments or more information, call the Central Appointment Office at 904-953-0853 8 a.m. to 5 p.m. Eastern time, Monday through Friday or complete an online appointment request form.

At Mayo Clinic in Minnesota, gynecologic oncologists who specialize in gynecologic surgery work with experts in gynecology, medical oncology and radiation oncology to care for women with cervical cancer.

For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.

See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.

Mayo Clinic doctors and researchers are studying new ways to diagnose and treat cervical cancer.

Cancer research is conducted in coordination with the Mayo Clinic Cancer Center. The Mayo Clinic Cancer Center receives funding from the National Cancer Institute and is designated as a comprehensive cancer center — recognition for an institution's scientific excellence and multidisciplinary resources focused on cancer prevention, diagnosis and treatment.

Women's Cancer Program

The Women's Cancer Program at Mayo Clinic brings together doctors and researchers in breast and gynecologic surgery, medical and radiation oncology, medical genetics, pathology, and other specialties to develop new therapies for women's cancers. As part of the Mayo Clinic Cancer Center, the Women's Cancer Program offers access to potential new therapies through clinical trials. The Women's Cancer Program also provides emotional and social support classes, a resource center, and educational programs for women and their families.

Publications

See a list of publications by Mayo Clinic authors on cervical cancer on PubMed, a service of the National Library of Medicine.

Jun. 28, 2013