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.
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 successfully treated when it's found early. It is usually found at a very early stage through
Cervical cancer is one of the most common cancers in women worldwide. But in the United States and other countries where cervical cancer screening is routine, this cancer is not so common.1
Most cervical cancer
is caused by a virus called
human papillomavirus, or HPV. You can get HPV by
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
genital warts, but other types may not cause any
Most adults have been infected with HPV at some time. An infection may go away on its own. But sometimes it can cause genital warts or lead to cervical cancer. That's why it's important for women 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.
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:
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.
The treatment for most
stages of cervical cancer includes:
Depending on how much the cancer has grown, you may have
one or more treatments. And you may have a combination of treatments. If you have a hysterectomy, you won't be able to have children. But a hysterectomy isn't always needed, especially when cancer is found very early.
Finding out that you have cancer can change your life. You may feel like your world has turned upside down and you have lost all control. Talking with family, friends, or a counselor can really help. Ask your doctor about support groups. Or call the American Cancer Society (1-800-227-2345) or visit its website at www.cancer.org.
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's important to follow up with your doctor after any abnormal Pap
test result so you can treat abnormal cell changes. This may help prevent cervical
If you are age 26 or younger, you can get the HPV vaccine, which protects against two types of HPV that cause most cases of cervical cancer.
The virus that causes
cervical cancer is spread through sexual contact. The best way to avoid getting
sexually transmitted infection 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.
Learning about cervical cancer:
Living with cervical cancer:
Health Tools help you make wise health decisions or take action to improve your health.
Cervical cancer is caused by severe
abnormal changes in the cells of the
cervix. Most precancerous or cancerous cell changes
occur in the cervix at the
transformation zone, because these cells normally
undergo constant change. During this natural process of change, some cervical
cells can become abnormal if you are infected with high-risk types of HPV.
may play a role in causing cervical cancer, such as having more than one sex partner or smoking cigarettes.
Abnormal cervical cell changes rarely
cause symptoms. If cervical cell changes progress
cancer, symptoms may include:
The symptoms of advanced cervical cancer may include:
Cervical cancer happens when abnormal cells on the cervix grow out of control. Cervical cancer can often be successfully treated when it's found early. It is usually found at a very early stage through a Pap test.
cervical cancer isn't treated, it may spread from the
cervix to the vagina, and then into deeper tissue layers
of connective tissue around the uterus. As it progresses, it may spread to the
lymph nodes and other pelvic organs.
Advanced-stage cancer may spread to lymph nodes; to
other organs in the pelvis, causing problems with kidney and bowel function; or
to other organs in the body, such as the liver and lungs.
Treatment of cervical cancer depends on the stage of your cancer and if it has spread.
A risk factor for cervical cancer is something that increases your chance of getting this cancer. Having one or more of these risk factors can make it more likely that you will get cervical cancer. But it doesn't mean that you will definitely get it. And many people who get cervical cancer don't have any of these risk factors.
Things that may increase your risk for
cervical cancer include:
Call your doctor if you have:
If you have been diagnosed with
cervical cancer, be sure to follow your doctor's
instructions about calling when you have problems, new symptoms, or symptoms
that get worse.
Health professionals who can evaluate your symptoms
and your risk factors, and who can diagnose cervical cancer include:
Doctors who can manage your cancer treatment
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Pap test is a routine screening test used to find
abnormal cell changes of the
cervix and to screen for
cervical cancer. Regular Pap test screening is the
most important tool in finding and treating cervical cell changes
before they progress to cervical cancer.
The recommended Pap test schedule is based on your age and things that increase your risk. Talk to your doctor about how often to have this test.
If cervical cancer is suspected, your
doctor will ask about your
medical history and do a physical exam, including
pelvic exam and a Pap test.
Tests to confirm a diagnosis of cervical cancer include:
Tests to find the extent (stage) of cervical cancer include:
found in its early stages can be successfully treated.
The choice of treatment and the
long-term outcome (prognosis) of
cervical cancer depend 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:
Additional information about cervical cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/cervical.
When you first find out that you have cancer, you may feel scared or angry. Or you may feel very calm. It's normal to have a wide range of feelings and for those feelings to change quickly. Some people find that it helps to talk about their feelings with family and friends.
If your emotional reactions to cancer get in the way of your ability to make decisions about your health, it's important to talk with your doctor. Your cancer treatment center may offer psychological or financial services or both. And a local chapter of the American Cancer Society can help you find a support group.
Your feelings about your body and your sexuality may
change following treatment for cancer. Managing body image issues may involve talking openly with your
partner about your feelings and discussing your concerns with your doctor. Your
doctor may be able to refer you to organizations that can offer additional
support and information.
Cancer treatment during pregnancy is the same as for nonpregnant women. But when you'll get treatment may depend on the stage of your cancer and what trimester you are in. For example, if you have early-stage cervical cancer and you are in your third trimester, your treatment may be delayed until after you deliver your baby. Treatment may cause problems such as an early
delivery or even the loss of the baby.
After treatment for
cervical cancer, it is important to receive follow-up
care. Your oncologist or
gynecologic oncologist will schedule regular checkups
that will include:2
Follow-up tests that may be recommended by your
oncologist include an
abdominal and pelvic computed tomography (CT) scan. This test is to
see if cancer has spread to other organs in the belly or
can return, or recur, after treatment. 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.
Treatments include surgery and chemoradiation or chemotherapy to relieve symptoms. Your doctor may talk with you about being in a clinical trial. Clinical trials for cervical cancer are studying therapies that target cancer cells.
Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. Palliative care can improve your quality of life by helping you manage your symptoms. It can also help you with other concerns that you may have when you are living with a serious illness.
For some people who have advanced cancer, a time comes when treatment to cure cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But this isn't the end of treatment. You and your doctor can decide when you may be ready for hospice care.
It can be hard to decide when to stop treatment aimed at prolonging your life and shift the focus to end-of-life care.
To learn about supportive care, see the topics:
You can treat early cervical cell changes
(dysplasia), which can reduce your risk for
cervical cancer. You can also reduce your risk for abnormal cell changes.
Women who smoke cigarettes or who breathe in secondhand smoke have a higher risk for cervical cell changes that can lead to cervical cancer.3 Quitting smoking may decrease this risk.
For information about quitting, see the topic Quitting Smoking.
If you are a woman age 26 or younger or a man age 21 and younger, get the HPV vaccine. 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. It is recommended for children age 11 or 12, but can be given as early as age 9. For girls who have not already gotten the vaccine, it is recommended up to age 26. For boys who have not already gotten the shot, the vaccine is recommended up to age 21. Gardasil is used for males. Females can get either vaccine. For more information,
see the topic
STI, including HPV, is easier than treating an infection after it occurs. HPV infection usually doesn't cause symptoms, so
you or your partner may not know that you are infected.
To reduce your risk:
Not having sexual contact is the only certain way to
prevent exposure to STIs. Sexually transmitted infections such as human
papillomavirus (HPV) can be spread to or from the genitals, anus, mouth, or
throat during sexual activities.
The side effects of cancer treatment can be serious. Healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms. Your doctor may also give you medicines to help you with certain side effects.
Other symptoms that can be treated at home include:
Problems after hysterectomy may include:
Having cancer can change your life in many ways. For support in managing these changes, see the topic Getting Support When You Have Cancer.
used to shrink
cervical cancer and decrease tumor growth. It may be used alone or along with radiation
Chemoradiation, compared with radiation alone, improves
survival in early-stage cervical cancer.5 Chemoradiation can be used as the main treatment
or after a hysterectomy.
Chemotherapy may be used to treat cervical cancer that has spread beyond the cervix.
Common chemotherapy medicines used to treat cervical cancer include:
Most chemotherapy will cause some
side effects, such as nausea, vomiting, and hair loss. Your doctor may also give you medicines to control and prevent nausea and vomiting. Home treatment may also help relieve other common side effects of cancer treatment.
Surgery to remove
the cancer depends on the
location and extent of cervical cancer and your desire to be able to have
children. You also may be given
chemotherapy, or a combination of the two (chemoradiation). These
treatments may be given before or after surgery to try to destroy any cancer
cells that may remain or to help control or shrink the tumor.
Surgery for very early stages of cervical cancer may
preserve your ability to have children. Surgeries include:
Surgery for most stages of cervical cancer does not
preserve your ability to have children. Surgeries include:
Side effects from a conization or LEEP include mild cramping during the first few hours, soreness for several days, and vaginal discharge for about a week. These surgeries may be done in your doctor's office.
A hysterectomy is major surgery with general anesthesia. So unless you have laparoscopic surgery, you will be in the hospital for a few days. As soon as you feel strong enough, get up and move around as much as you can. This helps prevent problems after surgery like blood clots, pneumonia, and gas pains.
Other side effects from hysterectomy include:
Fore more information, see the topic Sexual Problems in Women.
Home treatment may help relieve some common after-surgery side effects.
Radiation therapy is used for certain stages of
cervical cancer, often along with
surgery. Chemotherapy may be given at the same time as radiation treatment (chemoradiation) to improve survival rates. Chemoradiation may be used as the main treatment or after a hysterectomy.
Radiation therapy uses high-energy X-rays to
kill cancer cells and shrink tumors. Radiation may come from a machine outside
the body (external radiation therapy). Or it may come from radiation material
(radioisotopes) in thin plastic tubes inserted through the vagina into the
cervical area where the cancer cells are found.
Radiation may cause many
side effects, including diarrhea and irritation of the bladder (radiation
cystitis). Home treatment may help relieve some common side effects of cancer treatment.
Your ability to have or enjoy sexual intercourse may also be
affected. This is 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 help by making the vaginal opening
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
Some women who have
cervical cancer may be interested in taking part in research studies called
clinical trials. Clinical trials are designed to find
better ways to treat cancer patients. They are based on the most up-to-date
information. Women who don't want standard treatments or are not cured using
standard treatments may want to take part in clinical trials. These are
ongoing in most parts of the United States and in some other countries for all
stages of cervical cancer.
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:
These mind-body treatments may help you feel better. They can make it easier to cope with treatment. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any of these therapies. They are not meant to take the place of standard medical treatment.
The American Cancer Society (ACS) conducts educational
programs and offers many services to people with cancer and to their families.
Staff at the toll-free number have information about services and activities
in local areas and can provide referrals to local ACS divisions.
American Congress of Obstetricians and Gynecologists
(ACOG) is a nonprofit organization of professionals who provide health care for
women, including teens. The ACOG Resource Center publishes manuals and patient
education materials. The Web publications section of the site has patient
education pamphlets on many women's health topics, including reproductive
health, breast-feeding, violence, and quitting smoking.
The Centers for Disease Control and Prevention (CDC) is
an agency of the U.S. Department of Health and Human Services. The CDC works
with state and local health officials and the public to achieve better health
for all people. The CDC creates the expertise, information, and tools that
people and communities need to protect their health—by promoting health,
preventing disease, injury, and disability, and being prepared for new health
The Foundation for Women's Cancer provides information about
cancers of the female reproductive tract (ovary, endometrium, cervix, vulva,
and vagina) for women and their families. The foundation's goal is to increase awareness and education, support expanded research and training, and provide knowledge and hope for women who have these cancers.
The Foundation for Women's Cancer is the consolidation of 3 organizations: the Women's Cancer Network, the National Cervical Cancer Public Education Campaign, and the National Race to End Women's Cancer.
The National Cancer Institute (NCI) is a U.S. government
agency that provides up-to-date information about the prevention, detection,
and treatment of cancer. NCI also offers supportive care to people who have cancer
and to their families. NCI information is also available to doctors, nurses,
and other health professionals. NCI provides the latest information about
clinical trials. The Cancer Information Service, a service of NCI, has trained
staff members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
The Office on Women's Health is a service of the U.S. Department of Health and Human Services. It provides women's health information to a variety of
audiences, including consumers, health professionals, and researchers.
Eifel PJ, et al. (2011). Cancer of the cervix, vagina, and vulva. In VT DeVita Jr et al., eds., DeVita, Hellman, and Rosenberg's Cancer: Principles and Practice of Oncology, 9th ed., vol. 2, pp. 1311–1344. Philadelphia: Lippincott Williams and Wilkins.
National Comprehensive Cancer Network (2012). Cervical Cancer, version 1. Available online: http://www.nccn.org/professionals/physician_gls/PDF/cervical.pdf.
National Cancer Institute (2012). Cervical Cancer (PDQ): Prevention—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/prevention/cervical/HealthProfessional.
Winer RL, et al. (2006). Condom use and the risk of genital human papillomavirus infection in young women. New England Journal of Medicine, 354(25): 2645–2654.
Martin-Hirsch PL, Wood NJ (2011). Cervical cancer, search date October 2009. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
Other Works Consulted
American Cancer Society (2011). Cancer Facts and Figures for African Americans 2011–2012. Atlanta. American Cancer Society. Available online: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-027765.pdf.
National Cancer Institute (2011). Cervical Cancer PDQ: Treatment—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/cervical/patient.
National Cancer Institute (2012). Cervical Cancer PDQ: Treatment—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/cervical/HealthProfessional.
U.S. Preventive Services Task Force (2012). Screening for cervical cancer: Summary of recommendations. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm.
August 1, 2012
Anne C. Poinier, MD - Internal Medicine
& Ross Berkowitz, MD - Obstetrics and Gynecology
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