Twenty-five years ago, Andrea Kinloch, now 60, who has a history of human papillomavirus (HPV), a sexually transmitted disease, was told by her gynecologist that her Pap smear was abnormal. The doctor sent a sample for biopsy, which came back negative for cancer, but because she thought Kinloch was at high risk, she suggested a hysterectomy.
Kinloch, who was only 35 years old, hadn’t yet had any children and wanted them, so she declined. At that point, her gynecologist sent her to a gynecological oncologist who monitored her and performed a colposcopy (a test to look more closely at the cervix) every three months for several years. Three years later, she was given a clean bill of health and sent back to a regular gynecologist to be followed.
A change in insurance sent her to yet another gynecologist who performed a Pap smear, which came back abnormal. A colposcopy then came back abnormal, and a biopsy indicated she had cervical cancer.
After some digging, she discovered that one of her prior doctors had somehow missed two years of bad Pap smears. Infuriated and with a job that provided better insurance, she sought out the best doctor she could find in the area; that doctor has been treating her ever since with chemotherapy and immunotherapy.
“If you’ve been diagnosed with cervical cancer, you should see a gynecological oncologist, who is a specialist trained in procedures and treatments that gynecologists are not trained in, and whose entire focus is on the disease and cancer,” says Dr. Ritu Salani, a gynecological oncologist at UCLA.
[Read: Where to Go for Cancer Treatment.]
What Is Cervical Cancer?
The cervix is the lower narrow part of the uterus (womb) that connects to the vagina (birth canal) and holds the fetus in place during pregnancy.
Before cancer appears in the cervix, the cells in the cervix have gone through changes known as dysplasia or abnormal growth of cells, which may be precancerous. If these cells aren’t destroyed or removed, they can become cancer cells that multiply and spread to nearby organs — like the uterus and vagina — or to other parts of the body.
Cervical cancer usually develops slowly, and women with early cervical cancer tend not to have symptoms until the cancer becomes larger and grows into the nearby tissue.
In the United States, the American Cancer Society estimates that in 2025 about 13,360 women will be diagnosed with cervical cancer and about 4,320 of them will die from it.
[SEE: Questions to Ask Your Oncologist at Your First Cancer Appointment.]
Cervical Cancer and HPV
HPV is a common sexually transmitted disease caused by skin to skin contact during vaginal, oral or anal sex. In the U.S., about 43 million people are exposed to the virus every year. Certain strains of HPV cause most cases of cervical cancer.
“Almost all cervical cancer cases are caused by HPV, with a small number being caused by factors we don’t know much about,” says Dr. Kathleen Schmeler, professor in the department of gynecologic oncology at MD Anderson Cancer Center.
If you’re infected by a high-risk strain of HPV, it’s likely your immune system will prevent the virus from doing any harm. If your immune system can’t control the infection, it can last for years and over time may turn normal cervical cells into abnormal cells. If these cells aren’t treated, they may become cervical cancer.
The HPV vaccine has been available for almost 20 years and can prevent most cases of cervical cancer.
[READ: When to See a Gynecologist for the First Time and What to Expect]
Risk Factors for Cervical Cancer
While most cervical cancer cases are caused by HPV, the following also increase your risk:
— Multiple sexual partners. The more sexual partners you’ve had and the more sexual partners your sexual partners have had, the greater your risk of getting HPV.
— Early sexual activity. This may increase your number of sexual partners and risk of getting HPV.
— Sexually transmitted diseases. Other sexually transmitted diseases — such as herpes, chlamydia, gonorrhea, syphilis and HIV/AIDS — increase your risk.
— Weakened immune system. If your immune system is weakened from other health conditions and you have HPV, your risk is higher.
— Exposure to diethylstilbestrol (DES). DES is a medicine that pregnant women were prescribed between 1940 and 1971 to prevent miscarriage. Daughters of women who were exposed are at higher risk for cervical cancer.
— Sex without condoms. While condoms don’t cover all potential areas for HPV prevention, they do provide some protection against HPV and other sexually transmitted diseases.
— Oral birth control. Longtime use of oral birth control increases your risk for cervical cancer, but once you stop using it, your risk returns to normal.
— Smoking. Some studies suggest that women who smoke are twice as likely to develop cervical cancer.
Screening for Cervical Cancer
The best way to detect and prevent cervical cancer is to receive the HPV vaccine and to have regular screenings. Early detection can prevent cervical cells from becoming cancer and can improve treatment outcomes.
Routine screening tests include the following:
— Pap test. Your doctor uses a long swab during a pelvic exam to scrape cells from the inside of the cervix and sends that swab to the lab where it’s checked for abnormal cells.
— HPV test. Your doctor takes a small sample of your cervical cells to check for high-risk HPV infections that can cause cancer.
The U.S. Preventive Services Task Force recommends that physicians screen women ages 21 to 29 every three years with a Pap test. For women 30 to 65, they recommend screening with an HPV test every five years. Other options include women 30 to 65 getting a Pap test every three years or to get a combined Pap test and HPV test every five years.
“It’s important for you to know what your screening tests show, to keep up with screening recommendations, to know your results and to know when you need to follow up,” Salani says.
Symptoms of Cervical Cancer
At early stages of cervical cancer, you may have no symptoms, but as the cancer grows, you may experience some of the following:
— Vaginal bleeding after sexual intercourse, between your periods or after menopause
— Menstrual bleeding that is heavier and lasts longer
Symptoms of more advanced cervical cancer include the following:
— Vaginal discharge. Vaginal discharge becomes watery, heavier and more yellow in color as cancer progresses
— Pelvic pain or pain during sexual intercourse. Pelvic pain and pain during sexual intercourse increase as cancer progresses.
— Bowel movements. Painful bowel movements and bleeding from the rectum are signs of more advanced cervical cancer.
— Urination. Pain when urinating or blood in urine are signs of advancing cervical cancer.
— Back pain. Severe, constant dull pain in the lower back is a sign of advancing cancer.
— Swollen legs. As tumors grow, lymph fluid can stop draining, causing swelling in the legs.
— Abdominal pain. Sharp pain or pressure may be a symptom of advancing cervical cancer.
— Fatigue. Exhaustion is a symptom of all advanced cancers.
— Bone fracture. Fractures, especially pelvic bone fractures, can occur when cancer has spread to the bones.
— Unexplained weight loss. Like with other cancers, unexplained weight loss is a symptom of advancing cervical cancer.
Cervical Cancer Diagnosis
All women should see a gynecologist once a year for a pelvic exam during which the doctor looks for the following:
— Masses on the cervix. A mass on the cervix can be a noncancerous growth or a sign of cervical cancer.
— Irregularities on the cervix, uterus, ovaries, vagina and vulva. These organs are checked for irregularities during an annual gynecologic exam.
If cancer is suspected from your gynecologic exam or from a screening result, further diagnostic testing will be ordered to determine how advanced the cancer is. Some of those tests include the following:
— Ultrasound. This imaging technique uses sound waves to create images of your organs.
— CT scan. Creates detailed 3D images
— MRI. Creates detailed images using a magnetic field
— Colposcopy. A lighted magnifying lens is used to view your cervix and vagina.
— Dilation and curettage (D&C). Your cervix is dilated so abnormal cells can be removed from your cervical canal and uterus lining.
— Loop electrosurgical excision procedure (LEEP). A heated wire loop is used to remove cells and tissue.
— Biopsy. A small amount of cervical tissue is removed to be examined under a microscope to look for cancer cells.
— Laparoscopy. A thin lighted tube is inserted through a small incision in your lower abdomen. It sends images to a video monitor to be examined.
— Blood test samples. Blood test samples check to see how well your liver and kidneys are working and to determine if they’re healthy enough to recover from the effects of cancer treatment.
Stages of Cervical Cancer
Staging of cervical cancer determines the extent of the disease or how far cancer has spread in the body.
These are the stages of cervical cancer:
— Stage 0. You have been diagnosed with dysplasia, or precancerous cells are found (carcinoma in situ). Cancer has grown only in the surface layer of the cells lining the cervix. Normally, all that is needed is surgery to remove precancerous areas on the cervix to prevent cancer.
— Stage 1. Cancer cells are confined to the cervix, but the cancer hasn’t spread.
— Stage 2. Cancer cells have spread outside of the cervix to the vagina and other areas just adjacent to it.
— Stage 3. Cancer cells have spread to the lower part of the vagina, the pelvic wall and nearby lymph nodes. Tumors may also be blocking the ureters, the tubes that take urine from the kidneys to the bladder.
— Stage 4. Cancer is advanced and has spread to the pelvis, bladder or rectum, or it has spread to other organs or distant lymph nodes.
“There are various treatments for cervical cancer, with new ones emerging, but treatment for an individual depends on the stage of the cancer,” says Dr. Susan Campos, a gynecological oncologist at Dana-Farber Cancer Institute.
Treatment for Cervical Cancer
Treatment for cervical cancer depends on a variety of factors, including your stage of cancer, your general health, your age, the desire for fertility preservation, the amount of cancer you have and if it’s spread. Early-stage cervical cancer is treated successfully with surgery.
Later stage surgical cancer may include one or a combination of the following:
— Hysterectomy. A surgical procedure to remove the uterus and cervix
— Pelvic lymph node dissection. Lymph nodes are removed from the pelvic area to be closely examined.
— Radiation therapy. To shrink tumors and cancer cells, radiation therapy includes high energy X-rays to kill the cancer cells or to keep them from growing. Radiation may be from a machine or may be implanted in your body.
— Chemotherapy. Medications that kill or shrink cancer cells may come in the form of pills, IV treatment or sometimes both.
— Targeted therapy. Drugs are used to block the growth and spread of cancer cells.
— Immunotherapy. A therapy that uses your own immune cells to fight cancer cells.
Campos notes that tremendous advances have been made in the field of advanced cervical cancer. Based on several key studies, she adds, the addition of immunotherapy to chemotherapy and radiation therapy has been associated with improved survival in women with locally advanced cervical cancer.
In patients with advanced disease (Stage 4), the addition of immunotherapy to chemotherapy has improved overall survival.
“In the management of advanced cervical cancer, new agents called antibody drug conjugates are being developed, and research continues to explore new and novel therapeutics in the management of this disease,” Campos explains.
Cervical Cancer Survival Rates
Survival rates for cervical cancer depend on the stage of cancer, the type of cancer cell (adenocarcinoma or squamous cell carcinoma), your age, general health and whether your cancer is newly diagnosed or if it’s a recurrence.
Five-year relative survival rates are determined by what percentage of people with the same type and stage of cervical cancer are alive five years after diagnosis compared with the overall population. The rates of survival for cervical cancer are as follows:
— Early-stage diagnosis. People with cervical cancer diagnosed at an early stage are 91% as likely as people without cancer to be alive five years after diagnosis.
— Diagnosis when cancer has spread to nearby organs and lymph nodes. The five-year relative survival rate is 60%.
— Diagnosis when cancer has spread to other parts of the body. The five-year relative survival rate is 19%.
— All people with cervical cancer. The five-year relative survival rate for all people with cervical cancer is 67%.
Cervical Cancer Prevention
Cervical cancer is both curable and preventable. Currently, there’s a worldwide effort to eliminate the disease with vaccines, screenings and follow-up.
Here are the ways you can prevent yourself from being infected with cervical cancer:
HPV vaccine
The HPV vaccine protects against high-risk strains of the HPV virus that’s the primary cause of cervical cancer. The vaccine is safe and effective and prevents 90% of cancers from HPV.
Since the vaccine was introduced in 2006, HPV infections from high-risk strains have dropped by 88% in teenagers and 81% in young adult women, according to the Centers for Disease Control and Prevention.
The vaccine is recommended for boys and girls ideally before they become sexually active and exposed to HPV or between the ages of 9 and 26. Women between the ages of 27 and 45 who have not gotten the vaccine or to whom it wasn’t yet available could also benefit.
Regular screenings
Screenings on a specific schedule with routine Pap smears and HPV tests can detect precancerous conditions of the cervix, which can then be monitored to prevent cancer. Follow-up is vital.
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A Patient’s Guide to Cervical Cancer originally appeared on usnews.com
Update 02/27/25: This story was published at an earlier date and has been updated with new information.
