General Information About Cervical Cancer

Cervical cancer is a disease in which malignant (cancer) cells form in the tissues of the cervix.

The cervix is the lower, narrow end of the uterus (the hollow, pear-shaped organ where a fetus grows). The cervix leads from the uterus to the vagina (birth canal).

Anatomy of the female reproductive system. The organs in the female reproductive system include the uterus, ovaries, fallopian tubes, cervix, and vagina. The uterus has a muscular outer layer called the myometrium and an inner lining called the endometrium.

Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia , in which cells that are not normal begin to appear in the cervical tissue. Later, cancer cells start to grow and spread more deeply into the cervix and to surrounding areas.

Cervical cancer in children is rare. For more information, see the PDQ summary on Unusual Cancers of Childhood.

Human papillomavirus (HPV) infection is the major risk factor for development of cervical cancer.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor.

Infection of the cervix with human papillomavirus (HPV) is the most common cause of cervical cancer. Not all women with HPV infection, however, will develop cervical cancer. Women who do not regularly have a Pap smear to detect HPV or abnormal cells in the cervix are at increased risk of cervical cancer.

Other possible risk factors include the following:

• Giving birth to many children.
• Having many sexual partners.
• Having first sexual intercourse at a young age.
• Smoking cigarettes.
• Usingoral contraceptives("the Pill").
• Having a weakenedimmune system.

There are usually no noticeable signs of early cervical cancer but it can be detected early with yearly check-ups.

Early cervical cancer may not cause noticeable signs or symptoms . Women should have yearly check-ups, including a Pap smear to check for abnormal cells in the cervix. The prognosis (chance of recovery) is better when the cancer is found early.

Possible signs of cervical cancer include vaginal bleeding and pelvic pain.

These and other symptoms may be caused by cervical cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

• Vaginalbleeding.
• Unusual vaginaldischarge.
• Pelvicpain.
• Pain during sexual intercourse.

Tests that examine the cervix are used to detect (find) and diagnose cervical cancer.

The following procedures may be used:

• Pap smear: A procedure to collect cells from the surface of the cervix and vagina. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under amicroscopeto find out if they are abnormal. This procedure is also called a Pap test.
  
  Pap smear. A speculum is inserted into the vagina to widen it. Then, a brush is inserted into the vagina to collect cells from the cervix. The cells are checked under a microscope for signs of disease.
• Human papillomavirus (HPV) test : Alaboratory test used to checkDNA (geneticmaterial) for certain types of HPV infection. Cells are collected from the cervix and checked to find out if an infection is caused by a type of human papillomavirus that is linked to cervical cancer. This test may be done if the results of a Pap smear show certain abnormal cervical cells. This test is also called the HPV DNA test.
• Colposcopy : A procedure in which acolposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas. Tissue samples may be taken using acurette(spoon-shaped instrument) and checked under a microscope for signs of disease.
• Biopsy : If abnormal cells are found in a Pap smear, the doctor may do a biopsy. A sample of tissue is cut from the cervix and viewed under a microscope by apathologist to check for signs of cancer. A biopsy that removes only a small amount of tissue is usually done in the doctor's office. A woman may need to go to a hospital for a cervicalcone biopsy(removal of a larger, cone-shaped sample of cervical tissue).
• Pelvic exam : An exam of the vagina, cervix, uterus,fallopian tubes ,ovaries , andrectum . The doctor ornurse inserts one or two lubricated, gloved fingers of one hand into the vagina and places the other hand over the lowerabdomen to feel the size, shape, and position of the uterus and ovaries. Aspeculumis also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test of the cervix is usually done. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
  
  Pelvic exam. A doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and presses on the lower abdomen with the other hand. This is done to feel the size, shape, and position of the uterus and ovaries. The vagina, cervix, fallopian tubes, and rectum are also checked.
• Endocervical curettage: A procedure to collect cells or tissue from the cervical canal using a curette (spoon-shaped instrument). Tissue samples may be taken and checked under a microscope for signs of cancer. This procedure is sometimes done at the same time as a colposcopy.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on the following:

• The patient's age and general health.
• Whether or not the patient has a certain type of human papillomavirus.
• Thestage of the cancer (whether it affects part of the cervix, involves the whole cervix, or has spread to thelymph nodesor other places in the body).
• The type of cervical cancer.
• The size of thetumor.

Treatment options depend on the following:

• The stage of the cancer.
• The size of the tumor.
• The patient's desire to have children.
• The patient's age.

Treatment of cervical cancer during pregnancy depends on the stage of the cancer and the stage of the pregnancy. For cervical cancer found early or for cancer found during the last trimester of pregnancy, treatment may be delayed until after the baby is born.

Stages of Cervical Cancer

After cervical cancer has been diagnosed, tests are done to find out if cancer cells have spread within the cervix or to other parts of the body.

The process used to find out if cancer has spread within the cervix or to other parts of the body is called staging . The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

• Chest x-ray : Anx-ray of theorgansand bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. Adye may beinjected into avein or swallowed to help the organs ortissuesshow up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• Lymphangiogram : A procedure used to x-ray thelymph system . A dye is injected into thelymph vessels in the feet. The dye travels upward through thelymph nodesand lymph vessels, and x-rays are taken to see if there are any blockages. This test helps find out whether cancer has spread to the lymph nodes.
• Pretreatment surgical staging:Surgery (an operation) is done to find out if the cancer has spread within the cervix or to other parts of the body. In some cases, thecervical cancer can be removed at the same time. Pretreatment surgical staging is usually done only as part of aclinical trial.
• Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called asonogram.
• MRI(magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Fine-needle aspiration (FNA) biopsy : The removal of tissue orfluid, using a thin needle.

The results of these tests are viewed together with the results of the original tumor biopsy to determine the cervical cancer stage.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

• Throughtissue . Cancerinvadesthe surrounding normal tissue.
• Through thelymph system . Cancer invades the lymph system and travels through thelymph vesselsto other places in the body.
• Through theblood . Cancer invades theveins andcapillariesand travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis . The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The following stages are used for cervical cancer:

Carcinoma in Situ (Stage 0)

In carcinoma in situ (stage 0) , abnormal cells are found in the innermost lining of the cervix . These abnormal cells may become cancer and spread into nearby normal tissue.

Stage I

Millimeters (mm). A sharp pencil point is about 1 mm, a new crayon point is about 2 mm, and a new pencil eraser is about 5 mm.

In stage I, cancer is found in the cervix only. Stage I is divided into stages IA and IB, based on the amount of cancer that is found.

• Stage IA: A very small amount of cancer that can only be seen with amicroscope is found in thetissues of thecervix . Stage IA is divided into stages IA1 and IA2, based on the size of thetumor.
  • In stage IA1, the cancer is not more than 3millimetersdeep and not more than 7 millimeters wide.
  • In stage IA2, the cancer is more than 3 but not more than 5millimetersdeep, and not more than 7 millimeters wide.
• Stage IB is divided into stages IB1 and IB2.
  • In stage IB1:
    • the cancer can only be seen with amicroscope and is more than 5millimetersdeep and more than 7 millimeters wide; or
    • the cancer can be seen without a microscope and is 4centimetersor smaller.
  • In stage IB2, the cancer can be seen without a microscope and is larger than 4 centimeters.

Stage II

In stage II, cancer has spread beyond the cervix but not to the pelvic wall (the tissues that line the part of the body between the hips) or to the lower third of the vagina. Stage II is divided into stages IIA and IIB, based on how far the cancer has spread.

• Stage IIA: Cancer has spread beyond thecervix to the upper two thirds of thevagina but not totissues around theuterus . Stage IIA is divided into stages IIA1 and IIA2, based on the size of thetumor.
  • In stage IIA1, the tumor can be seen without amicroscope and is 4centimetersor smaller.
  • In stage IIA2, the tumor can be seen without a microscope and is larger than 4 centimeters.
• Stage IIB: Cancer has spread beyond thecervix to thetissues around theuterus.

Stage III

In stage III , cancer has spread to the lower third of the vagina , and/or to the pelvic wall , and/or has caused kidney problems. Stage III is divided into stages IIIA and IIIB, based on how far the cancer has spread.

• Stage IIIA : Cancer has spread to the lower third of thevagina but not to thepelvic wall.
• Stage IIIB:
  • Cancer has spread to thepelvic wall; and/or
  • thetumor has become large enough to block theureters (the tubes that connect thekidneys to thebladder). This blockage can cause the kidneys to enlarge or stop working.

Stage IV

In stage IV , cancer has spread to the bladder , rectum, or other parts of the body. Stage IV is divided into stages IVA and IVB, based on where the cancer is found.

• Stage IVA : Cancer has spread to nearbyorgans , such as thebladder orrectum.
• Stage IVB : Cancer has spread to other parts of the body, such as theliver ,lungs , bones, or distantlymph nodes.

Recurrent Cervical Cancer

Recurrent cervical cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the cervix or in other parts of the body.

Treatment Option Overview

There are different types of treatment for patients with cervical cancer.

Different types of treatment are available for patients with cervical cancer . Some treatments are standard (the currently used treatment), and some are being tested in clinical trials . A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Three types of standard treatment are used:

Surgery

Surgery (removing the cancer in an operation) is sometimes used to treat cervical cancer. The following surgical procedures may be used:

• Conization : A procedure to remove a cone-shaped piece oftissue from thecervix and cervical canal. Apathologist views the tissue under amicroscope to look for cancercells . Conization may be used todiagnose or treat a cervicalcondition. This procedure is also called a cone biopsy.
• Total hysterectomy : Surgery to remove theuterus , including the cervix. If the uterus and cervix are taken out through thevagina , the operation is called avaginal hysterectomy. If the uterus and cervix are taken out through a largeincision (cut) in theabdomen , the operation is called a totalabdominal hysterectomy. If the uterus and cervix are taken out through a small incision in the abdomen using alaparoscope, the operation is called a total laparoscopic hysterectomy.
  
  Hysterectomy. The uterus is surgically removed with or without other organs or tissues. In a total hysterectomy, the uterus and cervix are removed. In a total hysterectomy with salpingo-oophorectomy, (a) the uterus plus one (unilateral) ovary and fallopian tube are removed; or (b) the uterus plus both (bilateral) ovaries and fallopian tubes are removed. In a radical hysterectomy, the uterus, cervix, both ovaries, both fallopian tubes, and nearby tissue are removed. These procedures are done using a low transverse incision or a vertical incision.
• Radical hysterectomy : Surgery to remove the uterus, cervix, part of the vagina, and a wide area of ligaments and tissues around theseorgans . Theovaries ,fallopian tubes , or nearbylymph nodesmay also be removed.
• Modified radical hysterectomy: Surgery to remove the uterus, cervix, upper part of the vagina, and ligaments and tissues that closely surround these organs. Nearby lymph nodes may also be removed. In this type of surgery, not as many tissues and/or organs are removed as in a radical hysterectomy.
• Bilateral salpingo-oophorectomy: Surgery to remove both ovaries and both fallopian tubes.
• Pelvic exenteration : Surgery to remove the lowercolon ,rectum , andbladder . In women, the cervix, vagina, ovaries, and nearby lymph nodes are also removed. Artificial openings (stoma ) are made forurine andstool to flow from the body to a collection bag.Plastic surgerymay be needed to make an artificial vagina after this operation.
• Cryosurgery : A treatment that uses an instrument to freeze and destroyabnormal tissue, such ascarcinoma in situ. This type of treatment is also called cryotherapy.
• Laser surgery : A surgical procedure that uses alaser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surfacelesion such as atumor.
• Loop electrosurgical excision procedure(LEEP): A treatment that uses electrical current passed through a thin wire loop as a knife to remove abnormal tissue or cancer.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds , wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy ). When chemotherapy is placed directly into the cerebrospinal fluid , an organ , or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

See Drugs Approved to Treat Cervical Cancer for more information.

New types of treatment are being tested in clinical trials.

Information about clinical trials is available from the NCI Web site.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment Options by Stage

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Carcinoma in Situ (Stage 0)

Treatment of carcinoma in situ (stage 0) may include the following:

• Loop electrosurgical excision procedure(LEEP).
• Laser surgery.
• Conization.
• Cryosurgery.
• Total hysterectomyfor women who cannot or no longer want to have children.
• Internal radiation therapy for women who cannot havesurgery.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage 0 cervical cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Stage IA Cervical Cancer

Treatment of stage IA cervical cancer may include the following:

• Total hysterectomy with or withoutbilateral salpingo-oophorectomy.
• Conization.
• Modifiedradical hysterectomy and removal oflymph nodes.
• Internal radiation therapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IA cervical cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Stage IB Cervical Cancer

Treatment of stage IB cervical cancer may include the following:

• A combination ofinternal radiation therapy andexternal radiationtherapy.
• Radical hysterectomy and removal oflymph nodes.
• Radical hysterectomy and removal of lymph nodes followed byradiation therapy pluschemotherapy.
• Radiation therapy plus chemotherapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IB cervical cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Stage IIA Cervical Cancer

Treatment of stage IIA cervical cancer may include the following:

• A combination ofinternal radiation therapy andexternal radiation therapy pluschemotherapy.
• Radical hysterectomy and removal oflymph nodes.
• Radical hysterectomy and removal of lymph nodes followed byradiation therapyplus chemotherapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IIA cervical cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Stage IIB Cervical Cancer

Treatment of stage IIB cervical cancer may include internal and external radiation therapy combined with chemotherapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IIB cervical cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Stage III Cervical Cancer

Treatment of stage III cervical cancer may include internal and external radiation therapy combined with chemotherapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage III cervical cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Stage IVA Cervical Cancer

Treatment of stage IVA cervical cancer may include internal and external radiation therapy combined with chemotherapy.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IVA cervical cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Stage IVB Cervical Cancer

Treatment of stage IVB cervical cancer may include the following:

• Radiation therapy aspalliative therapy to relievesymptoms caused by thecancer and improvequality of life.
• Chemotherapy.
• Clinical trials of new anticancerdrugsor drug combinations.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with stage IVB cervical cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Treatment Options for Recurrent Cervical Cancer

Treatment of recurrent cervical cancer may include the following:

• Pelvic exenteration followed byradiation therapy combined withchemotherapy.
• Chemotherapy aspalliative therapy to relievesymptoms caused by thecancer and improvequality of life.
• Clinical trials of new anticancerdrugsor drug combinations.

Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent cervical cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

To Learn More About Cervical Cancer

For more information from the National Cancer Institute about cervical cancer, see the following:

• Cervical Cancer Home Page
• What You Need to Know About™ Cancer of the Cervix
• Cervical Cancer Prevention
• Cervical Cancer Screening
• Unusual Cancers of Childhood
• Drugs Approved to Treat Cervical Cancer
• Cryosurgery in Cancer Treatment: Questions and Answers
• Lasers in Cancer Treatment
• Understanding Cervical Changes: A Health Guide for Women
• HPV (Human Papillomavirus) Vaccines for Cervical Cancer
• Cervical Cancer: What You Can Do to Protect Yourself

For general cancer information and other resources from the National Cancer Institute, see the following:

• What You Need to Know About™ Cancer
• Understanding Cancer Series: Cancer
• Cancer Staging
• Chemotherapy and You: Support for People With Cancer
• Radiation Therapy and You: Support for People With Cancer
• Coping with Cancer: Supportive and Palliative Care
• Questions to Ask Your Doctor About Cancer
• Cancer Library
• Information For Survivors/Caregivers/Advocates

Changes to This Summary (04 / 04 / 2012)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

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PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

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Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

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A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

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Last Revised: 2012-04-04

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