What is Cervical Cancer?
Some people are confused about the differences between ovarian cancer and cervical cancer, and may even think that they are the same, or similar diseases. While both are gynecologic cancers, they affect different parts of the reproductive system, and have different risk factors, symptoms, treatment and survival rates.
Cervical cancer is found in the cervix, which is the narrow, lower part of the uterus where it connects to the upper end of the vagina; while ovarian cancer often originates in the fallopian tubes or the ovaries, which are reproductive organs on each side of the uterus in the pelvis.
Types of Cervical Cancer
HPV associated cancers: the majority of cervical cancers are associated with HPV infections and are described based on how the cancer cells look microscopically:
- Squamous cell carcinoma develosp in the cells of the ectocervix, or the surface of the cervix, and comprise 9 out of 10 cervical cancer diagnoses
- Adenocarcinomas, which develop from glandular cells of the endocervix, or cervical canal, are less common.
- Adenosquamous carcinomas, sometimes called mixed carcinomas, are cervical cancers with squamous cell and adenocarcinoma features.
Non-HPV cancers: rare tumor types can arise in the cervix that are not associated with HPV infection. These include:
- Neuroendocrine carcinomas (NECC), a rare type of cancer that can arise from multiple sites, including the cervix.
- Small cell carcinoma is a very rare subtype of neuroendocrine cancer that can also arise from the cervix
- Though extremely rare, it is possible for other types of cancers which occur more often in other parts of the body — such as melanoma, sarcoma, or lymphoma — to develop in the cervix.
Commons Symptoms and Signs of Cervical Cancer
Symptoms that may be associated with cervical cancer include:
- Abnormal vaginal bleeding, particularly bleeding after intercourse, bleeding or spotting between periods. People may also experience heavy or irregular periods or post-menopausal bleeding.
- Unusual vaginal discharge, which may contain blood
- Pelvic pain or pain during sexual intercourse
- Leg swelling
- Problems with urination or bowel movements
- Blood in the urine
If you are experiencing these symptoms, see a healthcare professional and tell them your concerns.
Prevention and Screening Tests for Cervical Cancer
Cervical cancer is the only gynecologic cancer with effective prevention and screening tools.
The HPV Test
Cervical cancer prevention: The majority of cervix cancers are caused by the human papilloma virus (HPV). HPV is a virus that can be spread during sexual contact. In many people, the virus may infect cells in the cervix without causing any symptoms. In some people, HPV infection can cause changes in the cells of the cervix that result in the development of pre-cancer and can progress to cancer.
Fortunately, vaccines have been developed that can protect people from infection by the strains of HPV associated with cancer development. These vaccines can be administered to girls and boys as young as 9, and may be administered to adults up to the age of 45. Vaccination against HPV is highly effective at preventing infection and cancer. Learn more about who should be vaccinated, and how the HPV vaccine protects against cervical cancer and other cancers.
The Pap (Papanicolaou) Test
Cervical cancer screening: The Pap test, or Pap smear, is a way to screen for precancerous changes or cancer of the cervix. During a Pap test, a provider uses a speculum to visualize the cervix and collects cells from the surface of the cervix with a special brush. These cells are then examined microscopically to determine whether they show pre-cancerous changes or evidence of cancer. Tests for the presence of the HPV virus can also provide information about a person’s risk of having or developing cervix cancer. These tests have significantly reduced the number of people who develop cervix cancer because they allow providers to treat pre-cancerous changes before a cancer can develop. It is very important that all women over the age of 21 have regular screening tests for cervical cancer.
Importantly, although Pap tests are usually done during a speculum exam, a provider may do a speculum exam for other reasons without collecting a sample for a Pap smear. Also, Pap tests and HPV tests only screen for cervical cancer. Ovarian cancer is not detected with the Pap test, or the HPV test.
Cervical Cancer Diagnosis
If cervical cancer screening tests yield abnormal results that show pre-cancerous or concern for cancerous cells, or if symptoms like abnormal vaginal bleeding or pain during sex are present, a provider may recommend further testing, including:
- A physical exam, which may include a pelvic exam, and possibly an assessment of lymph nodes in the groin, along with further investigation of medical history
- Colposcopy, a procedure involving a speculum examination of the cervix using a colposcope, which allows the doctor to see the surface of the cervix more clearly, spot any areas that appear pre-cancerous or cancerous, and remove a small piece of tissue for biopsy
- Endocervical curettage, or endocervical scraping, may be performed to determine whether abnormal cells are present in the endocervical canal.
- Cone biopsy, or conization, is a procedure in which a cone-shaped area of tissue is removed from the cervix. Sometimes this is called a loop electrosurgical procedure (LEEP), when a device with a heated thin wire loop is used to excise the abnormal area. A LEEP may be done as an office procedure. Cone biopsies are typically done in an outpatient surgical setting.
Cervical Cancer Risk Factors
- Human papillomavirus (HPV) infection is associated with almost all cervix cancers. HPV is commonly transmitted during sexual contact or sexual intercourse. Strains of the virus that are associated with cervical cancer have been identified and are specifically targeted by the HPV vaccines.The HPV vaccine can prevent cervical cancer that stems from HPV infections, and is recommended by the CDC.
- Smoking can increase the risk that an HPV infection may lead to cancerous changes in the cervix.
- A weakened immune system. Because most cervix cancer is caused by a viral infection, conditions or medications that suppress immune function can increase a person’s risk of developing HPV infection and cervix cancer. These include infections like HIV, autoimmune conditions, or medications such as chronic steroid use or the use of immune suppressive medications after an organ transplant.
Cervical Cancer Staging
If a biopsy confirms the presence of cervical cancer, further tests may be ordered to learn the extent of the cancer’s spread, or stage.
- Pelvic exam may be performed under anesthesia, to evaluate the tissue adjacent to the cervix for evidence of tumor spread.
- Cystoscopy is a thin camera that can be placed in the bladder through the urethra to look for any evidence that the cancer has invaded the bladder wall.
- Proctoscopy similarly involves an inspection of the rectum, using a lighted tube, to look for tumor involvement of the rectum.
Imaging tests may also help determine if, or how far, cervical cancer has spread:
- Chest x-ray or CT can show if cervical cancer has spread to the lungs.
- CT scan (computed tomography) or MRI (magnetic resonance imaging) can for evidence of tumor involvement beyond the cervix.
- PET scan (positron emission tomography) uses a labeled sugar substance to identify possible tumor involvement of tissues such as lymph nodes. This substance collects mainly in cancer cells, and shows up in imaging. PET scans are sometimes performed at the same time as CT scans.
- Intravenous pyelogram or IVP, is an x-ray of the urinary system to evaluate for hydronephrosis, or swelling of the kidneys resulting from compression of a pelvic tumor.
Treatment of cervical cancer is determined primarily by the stage at diagnosis. Clinical stage is based on whether metastatic spread is detected using imaging tests, biopsies, and physical exams. Pathologic stage includes information obtained from surgery, including the presence of tumor cells in lymph nodes or other sites.
View the American Cancer Society’s detailed information on cervical cancer stages.
How is Cervical Cancer Treated?
Treatment for cervical cancer will be largely dependent on the stage. In early stages, cervical cancer may be treated with surgery. Sometimes people additionally receive radiation or chemotherapy after surgery. In advanced stages, surgery is not recommended. Instead most people are treated with a combination of radiation and chemotherapy. Recent studies have now demonstrated that immune therapy can also improve outcomes for people with metastatic or recurrent cervix cancer. Read more information about cervical cancer treatments.
Recurrent Cervical Cancer
A recurrence refers to cancer that has come back after treatment. If cervical cancer recurs, a doctor will assess the location of the recurrent disease and make recommendations for treatment. In determining next steps, patients should discuss their goals for care and treatment. For some patients, it may be possible to participate in a clinical trial that evaluates up-and-coming treatments for cervical cancer recurrence.
Cervical Cancer Survival Rates and Incidence
The average 5-year survival rate for cervical cancer varies based the stage at diagnosis. For early stage disease, the 5-year overall survival may be as high as 92%. In people with regional spread to other sites in the pelvis or lymph nodes, the average 5-year survival is 58%. For people with distant spread, it is 18%.
As with every cancer diagnosis, it is important to remember that statistics are a set of trends based on observations of large groups of people, and are not an individual prognosis. If you have been diagnosed with cervical cancer, talk to your medical team about your specific circumstances.
According to the American Cancer Society, in 2022, 14,100 women will find out they have invasive cervical cancer, and 4,280 women will die from cervical cancer.
For detailed information about cervical cancer, visit the American Cancer Society.
Support with Cervical Cancer
OCRA has several support programs available for those with cervical cancer.
Peer support is offered through Woman to Woman, OCRA’s program that matches trained survivor mentors with gynecologic cancer patients. Woman to Woman is offered at sites across the country., and is also available through our virtual national mentoring program. Request a peer mentor through OCRA’s Woman to Woman program.
Those with cervical cancer and all gynecologic cancers are invited to participate in Staying Connected, OCRA’s virtual support series. Sessions are offered on a weekly and monthly basis, and cover a wide range of topics. Registration is required. View the support series schedule and register today.
OCRA’s online support forum through Inspire provides a welcoming space for patients, survivors and loved ones to talk about life with cervical cancer.