Cervical cancer starts in the cells of the cervix, which has two different parts covered with two types of cells. This determines the type of cervical cancer, most often squamous cell carcinomas.
Cervical cancer: learn more
Pre-cancerous cells can be detected early
In many cases human papillomavirus (HPV) plays a role in developing cervical cancer. It can cause gene defects in normal cells of the cervix. The resulting pre-cancerous cells can later develop into cervical cancer. A Pap test can identify these pre-cancerous cells.
Schedule regular screenings at UCHealth
UCHealth specialists use several tests to diagnose cervical cancer. Your doctor will determine the right tests for your case.
Parts and cell types
The cervix is located in lower part of the uterus, so it is also called the uterine cervix.
The part of the cervix closest to the body of the uterus is the endocervix, which is covered with glandular cells. The part next to the vagina is the exocervix or ectocervix, which is covered in squamous cells. These two cell types meet at the transformation zone, which is where most cervical cancer starts.
The cells here do not suddenly change into cancer—the normal cells of the cervix first undergo pre-cancerous changes that develop into cervical cancer, including cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL), and dysplasia. We can detect these changes with Pap tests. In most cases, pre-cancerous cells will go away without any treatment. However, we believe in treating all cervical pre-cancers, as this will prevent cervical cancer in most cases.
Symptoms and risk factors
The most common signs and symptoms of cervical cancer
Symptoms usually do not begin until the cancer becomes invasive and grows into nearby tissue, so we strongly recommend regular screening tests for cervical cancer. See your provider right away if you experience:
- Abnormal vaginal bleeding, such as bleeding after vaginal sexual activity, bleeding after menopause, bleeding and spotting between periods, and having menstrual periods that are longer or heavier than usual.
- An unusual discharge from your vagina, which may contain blood and may occur between your periods or after menopause.
- Pain during sex.
These signs and symptoms can also be caused by conditions other than cervical cancer, but don’t ignore them—if you do have cancer, waiting to get checked can mean it will grow to a more advanced stage and lower your chance for effective treatment.
We know that human papillomavirus, or HPV, is not the only cause—other risk factors can also influence which women exposed to HPV are more likely to develop cervical cancer:
- A diet low in fruits and vegetables.
- A weakened immune system. Human immunodeficiency virus (HIV), the virus that causes AIDS, damages a woman’s immune system and puts them at higher risk for HPV infections. The immune system is important in destroying cancer cells and slowing their growth and spread. In women with HIV, a cervical pre-cancer might develop into an invasive cancer faster than it normally would.
- Being overweight. Overweight women are more likely to develop adenocarcinoma of the cervix.
- Being younger than 17 at your first full-term pregnancy. These women are almost two times more likely to get cervical cancer later in life than women who waited to get pregnant until they were 25 years or older.
- Birth control pills (OCs). Research suggests that the risk of cervical cancer goes up the longer a woman takes OCs, but the risk goes back down again after the OCs are stopped, and returns to normal about 10 years after stopping.
- Chlamydia infection. A relatively common kind of bacteria that can infect the reproductive system, spread by sexual activity.
- Diethylstilbestrol (DES). A hormonal drug that was given to some women between 1940 and 1971 to prevent miscarriage.
- Economic status. Many low-income women do not have easy access to adequate health care services, including Pap tests. This means they may not get screened or treated for cervical pre-cancers.
- Family history. If your mother or sister had cervical cancer, your chances of developing the disease are higher than if no one in the family had it.
- Intrauterine device (IUD). Discuss the possible risks and benefits with your doctor.
- Multiple full-term pregnancies. Women who have had three or more full-term pregnancies have an increased risk. We still don’t know why.
Questions and answers about cervical cancer
A Pap test or Pap smear tells your provider if there are any changes to your cervix. To perform the test, your provider holds your vagina open with a speculum. Then she uses a small brush to get cells from your cervix and vagina. These cells are then examined in a lab. The best time for a Pap test is at least five days after your menstrual period.
No, most often cervical cancer grows and spreads slowly. However, it may spread quickly in some cases depending on the type and other conditions.
If it spreads, it typically spreads to the lymph system, liver, lungs and bones.
Diagnosis and staging
Examinations and tests to diagnose cervical cancer
- Bimanual pelvic examination. Done at your doctor’s office. A Pap test is often done at the same time.
- Biopsy. Your doctor removes a small amount of tissue for examination under a microscope by a pathologist. There are a few different types for cervical cancer:
- Endocervical curettage (ECC).
- A loop electrosurgical excision procedure (LEEP).
- Conization (a cone biopsy).
- Colposcopy. A special instrument called a colposcope magnifies the cells of the cervix and vagina, similar to a microscope. It is not inserted into your body, and the examination is not painful.
- HPV typing test. Similar to a Pap test. Your doctor may test for HPV at the same time as a Pap test, or after Pap test results show abnormal changes to the cervix.
- Pap test. Your doctor takes samples of cells from your cervix for testing.
- Pelvic examination under anesthesia.
- Computed tomography (CT or CAT) scan.
- Magnetic resonance imaging (MRI).
- 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.
Cervical cancer staging
UCHealth uses the staging system developed by the International Federation of Obstetrics and Gynecology (FIGO) for cervical cancer.
Staging is based on a the results of a physical exam, imaging scans, and biopsies.
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:
- 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.
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:
- 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.
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. This stage also has smaller groups:
- 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.
The cancer has spread to the bladder or rectum, but it has not spread to other parts of the body.
The cancer has spread to other parts of the body.
Source: American Cancer Society
Treatments and supportive therapy for cervical cancer
A typical plan, customized for you, includes drug therapy, such as targeted therapy and/or chemotherapy, with or without steroids. You may also need other types of treatments, such as radiation therapy and surgery. Possible treatments include:
Chemotherapy. Drugs that destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. We often use more than one drug at a time for maximum results.
Targeted therapy or novel therapy. Drugs that target the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. In recent years, targeted therapy has proven to be increasingly successful at controlling myeloma and improving a prognosis.
Immunotherapy or biologic therapy. Uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.
Other drug therapy. We may give steroids alone or at the same time as targeted therapy or chemotherapy.
Radiation therapy. High-energy X-rays or other particles that destroy cancer cells.
We might use surgery to treat cervical cancer. There are several types:
Cryosurgery. Kills the abnormal cells by freezing them.
Laser surgery. A focused laser beam, directed through the vagina, is used to vaporize abnormal cells or to remove a small piece of tissue for study.
Pelvic exenteration. A more extensive operation to treat recurrent cervical cancer. In this surgery, we remove all of the same organs and tissues as in a radical hysterectomy with pelvic lymph node dissection, plus we may remove the bladder, vagina, rectum, and part of the colon depending on where the cancer has spread.
Radical hysterectomy. We remove the uterus along with the tissues next to the uterus, and the upper part of the vagina next to the cervix. We do not remove the ovaries and fallopian tubes unless there is some other medical reason to do so. We may also remove some pelvic lymph nodes in procedures such as lymph node dissection, laparoscopically assisted radical hysterectomy with lymphadenectomy, and robot-assisted laparoscopic surgery.
Simple or total hysterectomy. We remove the uterus, but not the structures next to the uterus—parametria, uterosacral ligaments and vagina and pelvic lymph nodes. The ovaries and fallopian tubes are usually left in place unless there is another reason to remove them. There are different types of simple hysterectomy: abdominal hysterectomy, vaginal hysterectomy, laparoscopic hysterectomy, laparoscopic-assisted vaginal hysterectomy and robotic-assisted surgery.
Trachelectomy or radical trachelectomy. Allows women to be treated without losing their ability to have children.
Types of cervical cancer
Squamous cell carcinomas. Makes up nine out of 10 cervical cancers. These cancers develop from squamous cells in the exocervix.
Adenocarcinomas. Most of the remaining cervical cancers. They develop from the mucus-producing gland cells of the endocervix.
Adenosquamous carcinomas or mixed carcinomas. In rare cases, cervical cancers have features of both squamous cell carcinomas and adenocarcinomas.
Causes of cervical cancer
We have made recent progress in understanding how cells of the cervix develop into cancer, plus the main risk factors.
The main cause is gene defects resulting from human papillomavirus (HPV). Genes that help cells grow, divide, and stay alive are oncogenes—genes that help keep cell growth under control or make cells die at the right time are tumor suppressor genes. HPV causes the production of two proteins—E6 and E7—which turn off some tumor suppressor genes. This can allow the cervical cells to grow too much, and to develop changes in additional genes, which in some cases leads to cancer.
Fortunately, most women with HPV don’t develop cervical cancer. If you don’t know if you have HPV, we can give you an HPV test and an HPV vaccine if necessary.
Center for Disease Control and Prevention (CDC). Basic Information About Cervical Cancer (https://www.cdc.gov/cancer/cervical/basic_info/index.htm)
National Cancer Institute (NCI). What Is Cervical Cancer? (https://www.cancer.gov/types/cervical)
MedlinePlus: National Library of Medicine. Cervical Cancer (https://medlineplus.gov/cervicalcancer.html)
National Center for Biotechnology Information (NCBI): National Library of Medicine. Cervical Cancer (https://www.ncbi.nlm.nih.gov/books/NBK431093/)