Health Library Cervical CancerFrom Healthwise
Topic Contents
Cervical Cancer
Topic Overview
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This topic talks about the testing, diagnosis, and treatment of cervical cancer. For general information about abnormal Pap test results, see the topic Abnormal Pap Test.
What is cervical cancer?
Cervical cancer occurs when abnormal cells on the cervix grow out of control. The cervix is the lower part of the uterus that opens into the vagina. Cervical cancer can often be cured when it's found early. It is usually found at a very early stage through a Pap test.
What causes cervical cancer?
Most cervical cancer is caused by a virus called human papillomavirus, or HPV. You can get HPV by having sexual contact with someone who has it. There are many types of the HPV virus. Not all types of HPV cause cervical cancer. Some of them cause genital warts, but other types may not cause any symptoms.
You can have HPV for years and not know it. It stays in your body and can lead to cervical cancer years after you were infected. This is why it is important for you to have regular Pap tests. A Pap test can find changes in cervical cells before they turn into cancer. If you treat these cell changes, you may prevent cervical cancer.
What are the symptoms?
Abnormal cervical cell changes rarely cause symptoms. But you may have symptoms if those cell changes grow into cervical cancer. Symptoms of cervical cancer may include:
- Bleeding from the vagina that is not normal, or a change in your menstrual cycle that you can't explain.
- Bleeding when something comes in contact with your cervix, such as during sex or when you put in a diaphragm.
- Pain during sex.
- Vaginal discharge that is tinged with blood.
How is cervical cancer diagnosed?
As part of your regular pelvic exam, you should have a Pap test. During a Pap test the doctor scrapes a small sample of cells from the surface of the cervix to look for cell changes. If a Pap test shows abnormal cell changes, your doctor may do other tests to look for precancerous or cancer cells on your cervix.
Your doctor may also do a Pap test and take a sample of tissue (biopsy) if you have symptoms of cervical cancer, such as bleeding after sex.
How is it treated?
Cervical cancer that is caught early can usually be cured. If the cancer is caught very early, you still may be able to have children after treatment.
The treatment for most stages of cervical cancer removes the cancer and makes you unable to have children. These treatments include:
- A hysterectomy and removal of pelvic lymph nodes with or without removal of both ovaries and fallopian tubes.
- Radiation therapy.
- Chemotherapy.
Depending on how much the cancer has grown, you may have one or more treatments. And you may have a combination of treatments.
It's common to feel scared, sad, or angry after finding out that you have cervical cancer. Talking to others who have had the disease may help you feel better. Ask your doctor about support groups in your area. You can also find people online who will share their experiences with you.
Can cervical cancer be prevented?
The Pap test is the best way to find cervical cell changes that can lead to cervical cancer. Regular Pap tests almost always show these cell changes before they turn into cancer. It is important to follow up with your doctor after any abnormal Pap test result to treat abnormal cell changes. This may help prevent cervical cancer.
If you are age 26 or younger, you can get the HPV shot. The vaccines Cervarix and Gardasil protect against two types of HPV that cause cervical cancer. Gardasil also protects against two types of HPV that cause genital warts. Three shots are given over 6 months. The series of shots is recommended for girls age 11 or 12 and can be given to females ages 9 to 26.
The virus that causes cervical cancer is spread through sexual contact. The best way to avoid getting a sexually transmitted disease is to not have sex. If you do have sex, practice safer sex, such as using condoms and limiting the number of sex partners you have.
Frequently Asked Questions
Learning about cervical cancer: | |
Being diagnosed: | |
Getting treatment: | |
Living with cervical cancer: | |
End-of-life issues: |
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Treatment Overview
Cervical cancer detected in its early stages can be cured with treatment and close follow-up. Treatment choices for cervical cancer may include one or more of the following therapies:
- Surgery to remove the cancer
- Radiation therapy to treat the cancer itself or other organs affected by the cancer
- Chemotherapy to help make the cancer more sensitive to radiation therapy and to treat cancer that has spread (metastasized)
Your quality of life becomes a critical issue when considering treatment options. Be sure to discuss your personal preferences with your oncologist when he or she recommends treatment.
Initial treatment
The choice of treatment and the long-term outcome (prognosis) of cervical cancer depends on the type and stage of cancer. Your age, overall health, quality of life, and desire to be able to have children must also be considered. Treatment choices for cervical cancer may be a single therapy or a combination of therapies, such as:
- Surgery to remove the cancer.
- Cone biopsy to remove the cancer
- Radical trachelectomy to remove the cervix, part of the vagina, and the pelvic lymph nodes (lymph node dissection) but not the uterus
- Simple hysterectomy to remove the uterus and cervix
- Modified radical hysterectomy and lymph node dissection to remove the cancer
- Radiation therapy, which uses high-dose X-rays or implants in the vaginal cavity to kill cancer cells.
- Chemotherapy, which uses medicines to kill cancer cells.
When you have a hysterectomy, your doctor may also remove your fallopian tubes and your ovaries. This is called a salpingo-oophorectomy (say "sal-PING-oh oh-uh-fuh-REK-tuh-mee").
Surgery to remove the uterus and cervix (hysterectomy) may be done through an incision in the belly. For early-stage cervical cancer, laparoscopic surgery may be possible. This is done with several small incisions in the belly for a tiny camera and special instruments.
Robotic-assisted laparoscopic surgery uses robotic arms that translate the surgeon's hand motions into finer and more precise movements. This surgery requires specially trained doctors.
Chemotherapy may be given at the same time as radiation therapy (chemoradiation). Compared with radiation alone, chemoradiation improves survival. It is usually used as the primary therapy or after a hysterectomy.
Most treatments for cervical cancer cause side effects. Side effects may differ, depending on the type of treatment used and your age and overall health. Your doctor can talk to you about your treatment choices and the side effects associated with each treatment.
- Side effects of chemotherapy may include loss of appetite, nausea, vomiting, diarrhea, mouth sores, or hair loss.
- Side effects of radiation therapy may include fatigue, skin irritation, or changes in your bowel or urinary habits.
- Side effects of surgery depend on the surgery used to treat the stage of your cancer.
Home treatment measures may help relieve some common side effects of cancer treatment. For more information, see the Home Treatment section of this topic.
If you have recently been diagnosed with cervical cancer, you may experience a wide variety of emotions in reaction to your diagnosis. Most women will feel some denial, anger, and grief. There is no "normal" or "right" way to react to a diagnosis of cancer. You can take steps, though, to manage your emotional reactions to learning that you have cervical cancer. Some women find that talking with family and friends is comforting, while others may need to spend time alone to understand their feelings about their disease.
If your emotions are interfering with your ability to make decisions about your health and to move forward with your life, it is important to talk with your doctor. Your cancer treatment center may offer counseling services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other women who have had similar feelings after a diagnosis such as yours can help you accept and deal with your disease.
Treatment for pregnant women
Recommended treatments are the same for pregnant women as for nonpregnant women. Treatment for early-stage cervical cancer may be delayed until after delivery if the pregnancy is in the third trimester. A vaginal delivery may be possible.
For all stages of cervical cancer, treatment will be managed by a team of doctors specializing in cancer and high-risk pregnancies. Treatment for cervical cancer may cause problems such as an early delivery or even the loss of the baby. Treatment will consider the recommendations for the specific stage of cancer, the development of the baby, and the mother's preferences.
What to think about during initial treatment
Depending on the extent (stage) of your cancer, surgery may be combined with radiation therapy and chemotherapy. Radiation or chemotherapy given after a surgery is called adjuvant therapy.
Some women with cervical cancer may be interested in participating in research studies called clinical trials. Clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Women who do not want standard treatments or are not cured using standard treatments may want to participate in clinical trials. These are ongoing in most parts of the United States and in some other countries for all stages of cervical cancer.
For more information about specific cervical cancer treatments, see the topics:
- Cervical Cancer—Health Professional Information [NCI PDQ].
- Cervical Cancer—Patient Information [NCI PDQ].
Ongoing treatment
After initial treatment for cervical cancer, it is important to receive follow-up care. Your emotional reactions may continue throughout the course of your treatment depending on your prognosis, the treatment methods used, and your quality-of-life decisions.
Your oncologist or gynecologic oncologist will schedule regular checkups that will include:2
- A pelvic exam and Pap test every 3 to 6 months for the first 2 years.
- After the first 2 years, a pelvic exam and Pap test every 6 months for another 3 to 5 years.
- After 5 years, a pelvic exam and Pap test every year.
Follow-up tests that may be recommended by your oncologist include an abdominal and pelvic computed tomography (CT) scan to monitor whether cancer has spread to other organs in the abdomen or pelvis.
If respiratory symptoms are present, a chest X-ray may be done to determine whether cancer has spread to the lungs.
Treatment if the condition gets worse
Cervical cancer can return after treatment. About 35% of women with cervical cancer will have persistent or recurrent disease.3 The chance that your cancer will return depends on the stage of the initial cancer: cancer found early is less likely to come back than cancer found at a later stage.
Your long-term outcome (prognosis) for recurrent cervical cancer depends greatly on how much the cancer has spread when the recurrence is diagnosed.
The goal of treatment of advanced-stage cervical cancer that has spread outside the pelvis is to control symptoms, reduce complications, and increase comfort (palliative care). It is not intended to cure the disease. Palliative care may include:
- Radiation therapy.
- Chemotherapy medicines.
- Medicines for symptoms such as nausea or pain.
Complementary therapies
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the therapies that may be helpful include:
- Acupuncture. It can relieve pain and may help you deal with nausea and vomiting from chemotherapy.
- Meditation or yoga. These mind-body treatments relieve stress. They may help you feel better and cope with treatment.
- Light massage (not deep tissue or intense pressure) or biofeedback. These can ease tension.
- Breathing exercises or aromatherapy. They can help you relax and feel less anxious.
These types of therapies also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Complementary therapies are not a substitute for the standard treatment recommended for cervical cancer. Before you try any of these therapies, discuss their possible benefits and side effects with your doctor. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.
End-of-life issues
Some women with advanced-stage disease that is not curable may choose not to have cancer treatment because the time, costs, and side effects of treatment may be greater than the benefits. Making the decision about when to stop cancer treatment aimed at prolonging life and shift the focus to best supportive care can be difficult. For more information, see the topics:
Talk to your doctor about an advance directive, which includes a living will and a medical power of attorney. In a living will, you describe the kind of care you want if something happens to you and you cannot speak for yourself. In a medical power of attorney, you choose a person to make medical decisions for you if you cannot speak for yourself. Be sure to share your wishes with your family or close friends.
You can get forms from Caring Connections (www.caringinfo.org or 1-800-658-8898) or Aging With Dignity (www.agingwithdignity.org or 1-888-594-7437).
Prevention
You can treat early cervical cell changes (dysplasia), which can reduce your risk for cervical cancer. You can also reduce your risk factors for abnormal cell changes.
Have regular Pap test screening
The recommended Pap test schedule is based on your age and things that increase your risk. For most women, it is best to have a Pap test every 1 to 3 years. Talk to your doctor about when to have your first Pap test and how often to have this test.
Quit smoking
Women who smoke cigarettes or who breathe in secondhand smoke have a higher risk of developing cervical cell changes that can lead to cervical cancer.4Quitting smoking may decrease this risk.
Vaccine
If you are age 26 or younger, you can get the HPV shot. The vaccines Cervarix(What is a PDF document?) and Gardasil(What is a PDF document?) protect against two types of human papillomavirus (HPV) that cause cervical cancer. Gardasil also protects against two types of HPV that cause genital warts. Three shots are given over 6 months. The series of shots is recommended for girls age 11 or 12 and can be given to females ages 9 to 26. You can get either vaccine. For more information, see the topic Immunizations.
Reduce your risk of a sexually transmitted disease (STD)
Sexually transmitted diseases (STDs) often cause abnormal Pap tests and can lead to other serious health problems. Preventing an STD is easier than treating an infection after it occurs. The most common cause of cervical cancer is infection with a high-risk type of the HPV. Since the HPV virus may remain in body cells for life, abnormal cervical cell changes that cause cervical cancer can be the result of either you or your partner having had an HPV infection years earlier. HPV infection usually does not cause symptoms, so you or your partner may not be aware of a current or past HPV infection.
To reduce your risk:
- Talk with your partner about STDs before beginning a sexual relationship. Find out if he or she is at risk for an STD. Remember that it is quite possible to be infected with an STD without knowing it. Some STDs, such as HIV, can take up to 6 months before they are detected in the blood.
- Be responsible.
- Avoid sexual contact if you have symptoms of an STD or are being treated for an STD.
- Avoid all intimate sexual contact with anyone who has symptoms of an STD or who may have been exposed to an STD.
- The fewer sex partners you have in your lifetime, the better it is for your health. Your risk for an STD increases if you have several sex partners, or if your sex partner has more than one partner.
- Use male or female condoms to reduce the risk of getting an STD. Using male condoms when you have sex has been shown to reduce your risk of getting HPV.5 Female condoms may help also, although there has been less study of this type of protection.
Not having sexual contact is the only certain way to prevent exposure to STDs. Sexually transmitted diseases such as human papillomavirus (HPV) can be spread to or from the genitals, anus, mouth, or throat during sexual activities.
Home Treatment
During medical treatment for any stage of cervical cancer, you can use home treatment to help manage the side effects of cervical cancer or cancer treatment. Home treatment may be all that is needed to manage the following common problems. If your doctor has given you instructions or medicines to treat these symptoms, be sure to follow them. In general, healthy habits such as eating a balanced diet and getting enough sleep and exercise can help control your symptoms.
Home treatment for:
- Nausea or vomiting includes watching for and treating early signs of dehydration, such as a dry mouth, sticky saliva, and reduced urine output with dark yellow urine. Older adults can quickly become dehydrated from vomiting. Nausea and vomiting caused by chemotherapy usually require medical treatment. Your doctor may also prescribe medicines to control nausea and vomiting. For more information on how to deal with these side effects, see:
- Diarrhea includes resting your stomach and being alert for signs of dehydration. Check with your doctor before using any nonprescription medicines for your diarrhea.
- Constipation includes making sure that you drink enough fluids and include fruits, vegetables, and fiber in your diet each day. Do not use a laxative without consulting your doctor.
Other issues that may arise include:
- Sleep problems. If you find you have trouble sleeping, some tips for managing sleep problems may be helpful, such as having a regular bedtime, getting some exercise during the day, and avoiding caffeine late in the day.
- Fatigue. If you feel as though you do not have any energy and tire easily, try some measures to manage fatigue, such as getting extra rest, eating a balanced diet, and reducing your stress.
- Urinary problems, which can be caused by both cervical cancer and its treatment. It may help to eliminate caffeinated drinks from your diet and to establish a schedule of urinating every 3 to 4 hours, regardless of whether you feel the need.
- Hair loss. Hair loss may be unavoidable, but using mild shampoos and avoiding damaging hair products will reduce irritation of your scalp.
Many women with cervical cancer face emotional issues as a result of their disease or its treatment.
- Finding out that you have cancer and going through treatment is stressful. Managing stress may include expressing your feelings to others. Learning relaxation techniques may also be helpful. Relaxation techniques, such as meditation, and support groups may be helpful.
- Your feelings about your body and your sexuality may change following treatment for cancer. It may help to talk openly with your partner about your feelings and to discuss your concerns with your doctor. Your doctor may be able to refer you to organizations that can offer additional support and information.
Not all forms of cancer or cancer treatment cause pain. If pain occurs, many options are available to relieve it. If your doctor has given you instructions or medicines to treat pain, be sure to follow them. Home treatment for pain such as a nonsteroidal anti-inflammatory drug (NSAID) or an alternative therapy like biofeedback may improve your physical and mental well-being. Be sure to discuss with your doctor any home treatment you use for pain. For more information on how to deal with pain from cancer or cancer treatment, see:
Some women with advanced-stage disease may choose not to have treatment because the time, costs, and side effects of treatment may be greater than the benefits. Making the decision about when to stop medical treatment aimed at prolonging life and shift the focus to end-of-life care can be difficult. For more information, see the topics:
Other Treatment
Radiation therapy is the standard treatment for certain stages of cervical cancer and often is used in combination with surgery.
Radiation therapy is the use of high-energy X-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from radiation material (radioisotopes) in thin plastic tubes inserted through the vagina into the cervical area where the cancer cells are found (intracavitary brachytherapy).
The two forms of brachytherapy used to treat cervical cancer include low-dose-rate (LDR) brachytherapy and high-dose-rate (HDR) brachytherapy. LDR brachytherapy has been used the most in the past, but HDR brachytherapy takes less time and can be done on an outpatient basis. Both LDR and HDR appear to work about the same.7
Chemotherapy may be given at the same time as radiation treatment (chemoradiation) to improve survival rates. Chemoradiation may be used as primary therapy or after a hysterectomy.
What to think about
Radiation may cause many side effects, including diarrhea and irritation of the bladder (radiation cystitis). Your ability to have or enjoy sexual intercourse may also be affected, because radiation may cause changes to the cells lining the vagina (mucosa), making intercourse difficult or painful. A series of vaginal dilators, starting with a small one and progressing to a larger size, may be used after radiation therapy. Using the dilators can make the vaginal opening larger and help make sex less difficult or painful.
Radiation to treat cervical cancer may thin the bone and increase the risk of fractures in the pelvic area, including hip fractures. You can take steps to prevent thinning of the bone (osteoporosis), such as getting enough calcium and vitamin D. Also, try to prevent falls, which can lead to fractures. For more information, see the topic Osteoporosis.
Radiation therapy may also be used to manage the symptoms that occur with incurable cervical cancer. This is called palliative care.
Other Treatment Choices
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the therapies that may be helpful include:
- Acupuncture. It can relieve pain and may help you deal with nausea and vomiting from chemotherapy.
- Meditation or yoga. These mind-body treatments relieve stress. They may help you feel better and cope with treatment.
- Light massage (not deep tissue or intense pressure) or biofeedback. These can ease tension.
- Breathing exercises or aromatherapy. They can help you relax and feel less anxious.
These types of therapies also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Complementary therapies are not a substitute for the standard treatment recommended for cervical cancer. Before you try any of these therapies, discuss their possible benefits and side effects with your doctor. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.
Last Revised: February 22, 2011
Author: Healthwise Staff
Medical Review: Adam Husney, MD, MD - Family Medicine & Ross Berkowitz, MD - Obstetrics and Gynecology
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