The cervix is the lower, narrow end of the uterus (the organ
where a fetus grows). The cervix leads from the uterus to the vagina
(birth canal).
The main types of cervical cancer are squamous cell carcinoma
and adenocarcinoma. Squamous cell carcinoma begins in the thin, flat
cells that line the cervix. Adenocarcinoma begins in cervical cells
that make mucus and other fluids.
Long-lasting infections with certain types of human
papillomavirus (HPV) cause almost all cases of cervical cancer.
Vaccines that protect against infection with these types of HPV can
greatly reduce the risk of cervical cancer. Having a Pap test to check
for abnormal cells in the cervix or a test to check for HPV can find
cells that may become cervical cancer. These cells can be treated
before cancer forms.
Cervical cancer can usually be cured if it is found and
treated in the early stages.
General Information About Cervical Cancer
Key Points
Cervical cancer is a disease in which malignant (cancer)
cells form in the tissues of the cervix.
Human papillomavirus (HPV) infection is the major risk
factor for cervical cancer.
There are usually no signs or symptoms of early cervical
cancer but it can be detected early with regular check-ups.
Signs and symptoms of cervical cancer include vaginal
bleeding and pelvic pain.
Tests that examine the cervix are used to detect (find) and
diagnose cervical cancer.
Certain factors affect prognosis (chance of recovery) and
treatment options.
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 abnormal
cells begin to appear in the cervicaltissue. Over time,
the abnormal cells may become cancer cells and start to grow and spread
more deeply into the cervix and to surrounding areas.
Cervical cancer in
children is rare.
See the following PDQ summaries for more
information about cervical cancer:
Cervical Cancer Prevention
Cervical Cancer Screening
Unusual Cancers of Childhood Treatment
Human
papillomavirus (HPV) infection is the major risk factor for cervical
cancer.
Anything
that increases your chance 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. Talk to your doctor if you
think you may be at risk for cervical
cancer.
Risk
factors for cervical cancer include the following:
Being infected
with human papillomavirus
(HPV). This is the most important risk factor for cervical cancer.
Being exposed to the drugDES
(diethylstilbestrol) while in the mother's womb.
In women
who are infected with HPV, the following risk factors add to the
increased risk of cervical cancer:
Giving birth to many children.
Smoking cigarettes.
Using oral
contraceptives ("the Pill") for a long time.
There
are also risk factors that increase the risk of HPV infection:
Having a weakened immune
system caused by immunosuppression.
Immunosuppression weakens the body's ability to fight infections and
other diseases. The body's ability to fight HPV infection may be
lowered by long-term immunosuppression from:
being infected with human
immunodeficiency virus (HIV).
taking medicine
to help prevent organ
rejection after a transplant.
Being sexually active at a young age.
Having many sexual partners.
Older
age is a main risk factor for most cancers. The chance of getting
cancer increases as you get older.
There
are usually no signs or symptoms of early cervical cancer but it can be
detected early with regular check-ups.
Early cervical cancer
may not cause signs
or symptoms. Women
should have regular check-ups, including tests to check for human papillomavirus (HPV)
or abnormal cells in the cervix. The prognosis
(chance of recovery)
is better when the cancer is found early.
Signs
and symptoms of cervical cancer include vaginal bleeding and pelvic
pain.
These and other signs
and symptoms may be caused by cervical cancer or by other conditions. Check with your
doctor if you have any of the following:
Vaginal
bleeding (including bleeding after sexual intercourse).
Unusual vaginal discharge.
Pelvic
pain.
Pain during sexual intercourse.
Tests
that examine the cervix are used to detect (find) and diagnose cervical
cancer.
The following procedures
may be used:
Physical
exam and history: An exam of the body to check general signs of
health, including checking for signs of disease, such as lumps or
anything else that seems unusual. A history of the patient's health
habits and past illnesses and treatments will also be taken.
Pelvic
exam: An exam of the vagina, cervix,
uterus, fallopian tubes,
ovaries, and rectum. A speculum is 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 one or two lubricated, gloved fingers
of one hand into the vagina and places the other hand over the lower abdomen to feel the size,
shape, and position of the uterus and ovaries. 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.
Pap test: 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 a microscope to find out if
they are abnormal. This procedure is also called a Pap smear.
Pap test. 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: A laboratory test used to
check DNA or RNA for certain types of HPV
infection. Cells
are collected from the cervix and DNA or RNA from the cells is checked
to find out if an infection is caused by a type of HPV that is linked
to cervical cancer. This test may be done using the sample of cells
removed during a Pap test. This test may also be done if the results of
a Pap test show certain abnormal cervical cells.
Endocervical
curettage: A procedure to collect cells
or tissue from the cervical canal using a curette
(spoon-shaped instrument). Tissue samples are taken and checked under a
microscope for signs of cancer. This procedure is sometimes done at the
same time as a colposcopy.
Colposcopy: A procedure in
which a colposcope
(a lighted, magnifying instrument) is used to check the vagina and
cervix for abnormal areas. Tissue samples may be taken using a curette
(spoon-shaped instrument) or a brush and checked under a microscope for
signs of disease.
Biopsy: If abnormal cells are found in a Pap test, the
doctor may do a biopsy. A sample of tissue is cut from the cervix and
viewed under a microscope by a pathologist
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 cervical cone
biopsy (removal of a larger, cone-shaped sample of
cervical tissue).
Certain
factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of
recovery) depends on the following:
The stage
of the cancer (the size of the tumor
and whether it affects part of the cervix or the whole cervix, or has
spread to the lymph nodes
or other places in the body).
The type of cervical cancer.
The patient's age and general health.
Whether the patient has a certain type of human
papillomavirus (HPV).
Whether the patient has human
immunodeficiency virus (HIV).
Whether the cancer has just been diagnosed or has recurred (come back).
Treatment options depend
on the following:
The stage of the cancer.
The type of cervical cancer.
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. For more information, see the section on Cervical Cancer
During Pregnancy.
Recurrent Cervical Cancer
Recurrentcervical
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
Key Points
There are different types of treatment for patients with
cervical cancer.
Four types of standard treatment are used:
Surgery
Radiation therapy
Chemotherapy
Targeted therapy
New types of treatment are being tested in clinical trials.
Patients may want to think about taking part in a clinical
trial.
Patients can enter clinical trials before, during, or after
starting their cancer treatment.
Follow-up tests may be needed.
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.
Four
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 of tissue
from the cervix
and cervical
canal. A pathologist
views the tissue under a microscope
to look for cancer cells.
Conization may be used to diagnose
or treat a cervical condition.
This procedure is also called a cone biopsy.
Conization may be
done using one of the following procedures:
Cold-knife
conization: A surgical procedure that uses a scalpel
(sharp knife) to remove abnormal
tissue or cancer.
Loop
electrosurgical excision procedure (LEEP): A surgical
procedure that uses electrical current passed through a thin wire loop
as a knife to remove abnormal tissue or cancer.
Laser
surgery: A surgical procedure that uses a laser
beam (a narrow beam of intense light) as a knife to make bloodless cuts
in tissue or to remove a surface lesion
such as a tumor.
The type of
conization procedure used depends on where the cancer cells are in the
cervix and the type of cervical cancer.
Total
hysterectomy: Surgery to remove the uterus,
including the cervix. If the uterus and cervix are taken out through
the vagina,
the operation is called a vaginal
hysterectomy. If the uterus and cervix are taken out through a large incision
(cut) in the abdomen,
the operation is called a total abdominal
hysterectomy. If the uterus and cervix are taken out through a small
incision in the abdomen using a laparoscope,
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 these organs.
The ovaries,
fallopian
tubes, or nearby lymph
nodes may 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.
Radical
trachelectomy: Surgery to remove the cervix, nearby tissue
and lymph nodes, and the upper part of the vagina. The uterus and
ovaries are not removed.
Bilateral
salpingo-oophorectomy: Surgery to remove both ovaries and
both fallopian tubes.
Pelvic
exenteration: Surgery to remove the lower colon,
rectum,
and bladder.
The cervix, vagina, ovaries, and nearby lymph nodes are also removed.
Artificial openings (stoma)
are made for urine
and stool
to flow from the body to a collection bag. Plastic
surgery may be needed to make an artificial vagina after
this
operation.
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. Certain ways of giving radiation therapy
can help keep radiation from damaging nearby healthy tissue. This type
of radiation therapy includes the following:
Intensity-modulated
radiation therapy (IMRT): IMRT is a type of 3-dimensional
(3-D) radiation therapy that uses a computer to make pictures of the
size and shape of the tumor. Thin beams of radiation of different
intensities (strengths) are aimed at the tumor from many angles. This
type of external radiation therapy causes less damage to nearby healthy
tissue.
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. External and internal radiation therapy
are used to treat cervical cancer, and may also be used as palliative
therapy to relieve symptoms
and improve quality
of life.
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 for Cervical Cancer for more information.
Targeted
therapy
Targeted
therapy is a type of treatment that uses drugs or other
substances to identify and attack specific cancer cells without harming
normal cells.
Monoclonal
antibody therapy is a type of targeted therapy that uses antibodies
made in the laboratory from a single type of immune
system cell. These antibodies can identify substances on
cancer cells or normal substances that may help cancer cells grow. The
antibodies attach to the substances and kill the cancer cells, block
their growth, or keep them from spreading. Monoclonal antibodies are
given by infusion.
They may be used alone or to carry drugs, toxins,
or radioactive material directly to cancer cells.
Bevacizumab
is a monoclonal antibody that binds to a protein
called vascular
endothelial growth factor (VEGF) and may prevent the
growth
of new blood
vessels that tumors need to grow. Bevacizumab is used to
treat cervical cancer that has metastasized
(spread to other parts of the body) and recurrent
cervical cancer.
See Drugs
Approved for Cervical Cancer for more information.
New
types of treatment are being tested in clinical trials.
Information about
clinical trials is available from the NCI
website.
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.
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.
Your doctor will ask if
you have any of the following signs
or symptoms, which may mean the cancer has come back:
Pain in the abdomen, back, or leg.
Swelling in the leg.
Trouble urinating.
Cough.
Feeling tired.
For cervical cancer,
follow-up tests are usually done every 3 to 4 months for the first 2
years, followed by check-ups every 6 months. The check-up includes a
current health history
and exam of the body to check for signs and symptoms of recurrent
cervical cancer and for late
effects of treatment.
Treatment Options by Stage
Carcinoma in Situ (Stage 0)
Treatment of carcinoma
in situ (stage 0) may include the following:
Conization,
such as cold-knife
conization, loop
electrosurgical excision procedure (LEEP), or laser
surgery.
Hysterectomy
for women who cannot or no longer want to have children. This is done
only if the tumor
cannot be completely removed by conization.
Internal
radiation therapy for women who cannot have surgery.
Check the
list of NCI-supported 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. Talk with your
doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI
website.
Stage IA Cervical Cancer
Stage
IA cervical cancer is separated into stage IA1 and IA2.
Treatment for stage IA1
may include the following:
Conization.
Total
hysterectomy with or without bilateral
salpingo-oophorectomy.
Treatment for stage IA2
may include the following:
Modified radical
hysterectomy and removal of lymph
nodes.
Radical
trachelectomy.
Internal
radiation therapy for women who cannot have surgery.
Check the
list of NCI-supported 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. Talk with your
doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI
website.
Stages IB and IIA Cervical Cancer
Treatment of stage
IB and stage
IIA cervical cancer may include the following:
Radiation
therapy with chemotherapy
given at the same time.
Radical
hysterectomy and removal of pelviclymph
nodes with or without radiation therapy to the pelvis,
plus chemotherapy.
Radical
trachelectomy.
Chemotherapy followed by surgery.
Radiation therapy alone.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage
IB cervical cancer and 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. Talk with your
doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI
website.
Stages IIB, III, and IVA Cervical Cancer
Treatment of stage
IIB, stage
III, and stage
IVA cervical cancer may include the following:
Radiation
therapy with chemotherapy
given at the same time.
Surgery
to remove pelviclymph
nodes followed by radiation therapy with or without
chemotherapy.
Internal
radiation therapy.
A clinical
trial of chemotherapy to shrink the tumor
followed by surgery.
A clinical trial of chemotherapy and radiation therapy
given at the same time, followed by chemotherapy.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with stage
IIB cervical cancer, stage
III cervical cancer and 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. Talk with your
doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI
website.
Stage IVB Cervical Cancer
Treatment of stage
IVB cervical cancer may include the following:
Radiation
therapy as palliative
therapy to relieve symptoms
caused by the cancer
and improve quality
of life.
Chemotherapy
and targeted
therapy.
Chemotherapy as palliative therapy to relieve symptoms
caused by the cancer and improve quality of life.
Clinical
trials of new anticancer drugs
or drug combinations.
Treatment Options for Recurrent Cervical Cancer
Treatment of recurrentcervical
cancer may include the following:
Radiation
therapy and chemotherapy.
Chemotherapy and targeted
therapy.
Chemotherapy as palliative
therapy to relieve symptoms
caused by the cancer
and improve quality
of life.
Pelvic
exenteration.
Clinical
trials of new anticancer drugs
or drug combinations.
Cervical Cancer During Pregnancy
General Information About Cervical Cancer During Pregnancy
Treatment Options for Cervical Cancer During Pregnancy
Carcinoma in Situ (Stage 0) During Pregnancy
Stage I Cervical Cancer During Pregnancy
Stage II, III, and IV Cervical Cancer During Pregnancy
General Information About Cervical
Cancer During Pregnancy
Treatment of cervical cancer during pregnancy depends on the stage of the cancer and how long the
patient has been pregnant. A biopsy
and imaging tests
may be done to determine the stage of the disease. To avoid exposing
the fetus to radiation, MRI (magnetic resonance
imaging) is used.
Treatment Options for Cervical Cancer
During Pregnancy
Carcinoma in Situ (Stage 0) During
Pregnancy
Usually, no treatment is
needed for carcinoma in situ
(stage 0) during pregnancy.
A colposcopy may be
done to check for invasive cancer.
Stage I Cervical Cancer During Pregnancy
Pregnant women with
slow-growing stage I cervical
cancer may be able to delay treatment until the second
trimester of pregnancy or after delivery.
Pregnant women with
fast-growing stage I cervical cancer may need immediate treatment.
Treatment may include:
Conization.
Radical
trachelectomy.
Women should be tested
to find out if the cancer
has spread to the lymph nodes.
If cancer has spread to the lymph nodes, immediate treatment may be
needed.
Stage II, III, and IV Cervical Cancer
During Pregnancy
Treatment for stage II, stage III, and stage IV cervical cancer
during pregnancy
may include the following:
Chemotherapy
to shrink the tumor
in the second or third trimester of pregnancy. Surgery or radiation therapy may be
done after delivery.
Radiation therapy plus chemotherapy. Talk with your doctor
about the effects of radiation
on the fetus. It
may be necessary to end the pregnancy before treatment begins.
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