A type of cancer caused by abnormal growth of cells in the cervix, usually because of infection with HPV.
This article is pending medical review.
Contributors
Written by Alessandra Papitto
Reviewed by Carolin Becker, Katarzyna Przybył, Sophie Oppelt
Edited by Juliëtte Gossens
Cervical cancer is a type of cancer caused by abnormal growth of cells in the cervix. The cervix is the lower end of the uterus that opens into the vagina. Most cervical cancers begin when somebody is infected with a virus, the human papilloma virus (HPV). HPV is a very common infection and is spread mainly via sexual activity (1). You can read more about the HPV virus here.
What we're covering
What is cervical cancer?
Cervical cancer is the 4th most common type of cancer worldwide in women and people with a cervix, according to the World Health Organization (WHO). In 2020, 84% of cases were found in people from countries with few resources (2). In those regions, cervical cancer was even the 2nd most common type of cancer in women. And in Africa and Central America, cervical cancer is the main cause of death related to cancer in women.
How old are most people who get cervical cancer?
Most cases occur in people in middle age, when they’re around 60 (2). Cervical cancer is very rare in young people. For example, in the United States, researchers found that in 2019, about 19 per 100,000 women between 60 and 64 years of age were diagnosed with cervical cancer (that’s 0.02% of all women aged 60 to 64 in 2019). This was only 4 per 100,000 women between the ages of 25 and 29 (that’s 0.004% of all women aged 25 to 29 in 2019).
Fortunately, cervical cancer is one of the most preventable cancers, thanks to an HPV vaccine and early detection with Pap tests and HPV tests (1). Unfortunately, these ways to prevent cervical cancer are not very accessible in the regions where cervical cancer causes the most deaths (2). Cervical cancer is caused by changes in the tissue of the cervix. This tissue is composed of two main cell types:
Flat squamous cells on the outside of the cervix (also known as the “ectocervix”, ecto = outside)
Column-shaped glandular cells on the inside of the cervix (also known as the “endocervix”, endo = inside)
Even though both types of cells can develop into cancer, squamous cells are much more likely to lead to cancer – it’s the cell type involved in about 75% of cervical cancers (2, 3). The border between these two cell types, also called “transformation zone”, is the area where cells of the cervix are most likely to develop into cancer (4).
The International Federation of Gynecology and Obstetrics (FIGO) came up with a scoring system for cervical cancer, including 4 different stages. This was done to help standardize diagnosis and treatment (13, 14). Click below to see what these different stages mean.
Stages of cervical cancer
How does HPV cause cervical cancer?
Almost all cases of cervical cancer, except for a few rare types, are caused by the human papilloma virus (HPV). This is the most common viral infection of the reproductive tract (1, 5). HPV infection is a sexually transmitted disease (STD). It can be transmitted through skin-to-skin contact, or through contact of the skin with a mucosa (such as the lining of the vagina or the head of the penis). This most commonly involves the skin and mucosa of the genital area, but it could also spread through skin in other places (5, 6). There are more than 40 different types (strains) of the HPV virus that can infect the genital area, but not all of them can cause cancer (6). Many are not dangerous at all (benign) and can only cause warts on the skin. Types 16 and 18 are most associated with cervical cancer (1). You can read more about the different types of HPV here.
The response to HPV depends on our immune system. Usually, the immune system attacks virus particles to clear them out of the body. This is what happens in the majority (over 90%) of cases (1). But in some cases, the immune system can‘t get rid of the infection. The infection is then said to be chronic. If you were infected with a strain of HPV capable of causing cancer, this can cause damage to your cells, especially those in the transition zone of the cervix. Eventually, over the span of up to 20 years, this can lead to cervical cancer (1, 7). Importantly, if you’re infected with HIV as well, you can develop cancer due to HPV much quicker (1, 7). Having HPV could also increase your risk to become infected with HIV (5), so the relationship between HPV and HIV might go both ways.
Other forms of cancer are also caused by HPV, such as cancer of the penis, anus, vulva, throat and mouth (5, 7).
When an HPV virus particle infects a cell, it starts producing proteins that interact with regular proteins in the infected cell. These regular proteins normally function as cancer protection: they make sure the cell doesn’t grow too fast and doesn’t grow when it’s not supposed to. They also make sure that the cell repairs any damage to its DNA before it continues growing. If the cell can’t repair itself, these proteins make it die off via apoptosis. But the proteins produced by the HPV virus interfere with the functions of these normal cell proteins or stop them from working altogether. The cell can then start growing and dividing without restriction, even if its DNA is damaged. That leads to cancer (6).
What are risk factors for developing cervical cancer?
There are several factors that could contribute to the development of cervical cancer. Some of them are associated with getting an HPV infection, and some of them are related to developing the cancer itself (2, 7).
HPV-related risk factors
Having multiple partners
Starting having sex when you’re young
Having a sex partner who has a high risk of HPV infection (for example somebody who has had multiple sex partners or who has had STDs in the past)
Having a history of STDs, such as chlamydia or genital herpes
Having unprotected sex: using a condom makes passing on an HPV infection up to 70% less likely (8)
If you were young (under 20) when you had your first child
If you’ve had three or more children
If you’ve had cancer in the vulva or the vagina before
If you have a suppressed immune system (for example, if you have an HIV infection)
More about these risk factors
The risk factors that refer to how old you were when you started having sex or when you had children depend on several facts (9): first, if you were sexually active from a younger age, you’ve probably been sexually active for a longer time in total than those who started when they were older. So, you’ve had more time to be infected with HPV. Young people are also more likely to have sex without protection (such as a condom), which also increases your risk of infection. But there’s something else at play, too: younger people with a cervix are more sensitive to HPV infection, because their cervix produces less discharge (mucus) and their cells are more vulnerable to damage.
If your sex partners have had their penis circumcised, you may be at a lower risk of having an HPV infection. That’s because a circumcised person has a lower risk of becoming infected with HPV and a lower risk to pass an infection to somebody else (10).
Risk factors related to developing the cancer itself
Smoking cigarettes: this habit gives a higher risk of squamous cell cancer of the cervix (the most commonly involved cell type in cervical cancer)
Having a weakened immune system (for example, if you have an HIV infection or if you take medication that suppresses your immune system)
Long term use of oral contraceptives (the birth control pill): some evidence (2, 11, 12) suggests that people who have used oral contraceptives for longer than 5 years may be at higher risk of cervical cancer. That’s because the estrogen in the pills is thought to help the HPV virus infect cells in the cervix.
If you have a family history of cervical cancer (which means your genes might make you more likely to develop cervical cancer, though there is little evidence of genes that may be involved)
If you are less wealthy or live in a region with fewer healthcare resources: that’s because your access to healthcare may be restricted in some way, which means your cancer might not be detected in its early stages and your access to HPV prevention (including birth control and HPV screening services) may also be lower.
What are symptoms of cervical cancer?
Cervical cancer in its early stages is usually hard to detect unless you participate in a screening program. That’s because there are typically no symptoms of cervical cancer until it’s in its later stages (see section Stages of cervical cancer). Usually, symptoms occur when the cancer grows into nearby tissues (2, 15). The most common symptoms are:
Abnormal bleeding from the vagina
Heavier periods
Pain during sex or bleeding after sex
Your vaginal discharge having a strong odor
Your vaginal discharge having a different consistency
Being fatigued
Losing weight when you didn’t mean to
A persistent backache or pain in your legs or pelvis
Peeing is painful or you have blood in your urine
How is cervical cancer diagnosed?
There are several steps to getting diagnosed with cervical cancer.
1. First, your doctor listens carefully to any symptoms you’re having. We’ve listed some common symptoms above. They will also ask questions about any type of cancer you’ve had in the past, and cancer your family members have had. If you’ve gotten screened for cervical cancer before, your doctor will also take note of those results.
2. After asking you questions, your doctor will probably want to do a physical examination. The most important examination is the pelvic examination. During a pelvic exam (also known as a gynecological exam), you’ll be sitting in a chair or lying on an examination table with your feet up and your legs spread. You will have to undress your lower body, so your doctor can inspect your vulva, vagina, and cervix. They will probably use a speculum to look at your cervix and the walls of your vagina. Use of a speculum can be a bit uncomfortable, because it’s often cold and it (temporarily) stretches out your vaginal walls.
3. During this bit, your doctor might want to take a biopsy of any abnormal tissue they’re seeing (2). Just because it looks abnormal doesn’t necessarily mean it’s cancer – it could be a sexually transmitted disease, a different infection, or something benign (growth that isn’t cancerous).
4. If they don’t see anything but suspect there might be cancer based on your symptoms or any screening results, your doctor might want to perform a colposcopy (16). To do a colposcopy, your doctor will use a microscope (called a colposcope) to magnify your cervix. Any abnormal tissue that they couldn’t see with the naked eye, they might be able to see with the microscope. If they see anything, they can take a biopsy of tissue in that area.
It’s good to know that a biopsy of the cervix might be painful, but it’s not common to inject something numbing in the area because that’s about just as painful. If your doctor performed a biopsy, they will send this tissue to a lab so its characteristics can be inspected. This is necessary to make a definitive diagnosis.
Are there any risks to doing a biopsy?
There are two main risks of doing a biopsy (16). First, it’s possible that the area or tissue from which a sample was taken starts bleeding. This typically resolves quickly, but in rare cases, the bleeding is severe. That’s a risk especially if the biopsy was taken from a visible cancerous growth on the cervix, because tumors like that have a lot of blood vessels inside them. There is a higher risk of bleeding if you’re taking blood thinners or if you’re pregnant. In rare cases, your doctor has to stuff your vagina with gauzes to apply pressure to the cervix to stop the bleeding.
The second main risk is infection. Your doctor will do their best to work as sterile as possible (meaning there are no bacteria or other pathogens on the tools they use or on their gloves), but there’s always a risk. If the place where the biopsy was taken has become infected, you could develop pain in the days following the biopsy, your discharge could be different (of a different color or a bad smell), or you could have bleeding. Contact your doctor if you think you might have an infection. In case you do, you’ll probably be prescribed antibiotics to fight the infection.
5. Your doctor may also want to use their fingers to feel inside the vagina. This is called the bimanual examination. During this bit, they can test if any movements of your cervix inside your vagina are painful. They can also feel for your uterus and ovaries with the fingers of one hand inside the vagina and the other hand on your belly. In some cases, your doctor might also want to perform a rectal exam, during which they insert a finger inside your anus. That’s because the vagina and the rectum (the last bit of bowel before your anus) are right next to each other, so it could give your doctor more information about anything abnormal they might have seen or felt during the rest of the examination.
6. Lastly, it’s likely your doctor will feel for any enlarged lymph nodes in your groin (in the folds between your upper legs and your pubic area).
It’s completely normal to feel nervous or anxious about this examination. Especially for those who have experienced sexual trauma in the past, allowing somebody to feel around in your genitals can be very uncomfortable. It’s important to let your doctor know beforehand how you’re feeling about it, so they can help guide you through the process. It might also be possible to request that you’re examined by a female doctor, depending on how things work in your hospital or clinic. Asking never hurts!
Can cervical cancer be prevented?
Cervical cancer is one of the most preventable cancers due to the development of screening tests, such as the Pap test and the HPV DNA test (1, 8). This way, abnormal cells can be detected and treated early, before they develop into cancer.
During a Pap test, your doctor takes a few cells from your cervix using a small brush. The test is done during a pelvic examination, which we’ve described earlier. These cells are then sent to a lab and examined under a microscope. If they show changes, your doctor can take biopsy of your cervix to make sure there’s no cancer. For an HPV test, your doctor also collects a small sample, in the same way as for a Pap test. The sample is then tested to see if they’re infected with HPV. If they are, a Pap test can be done. It’s important to keep in mind that these screening tests don’t give a diagnosis. To diagnose cervical cancer, you need a biopsy.
Lastly, but importantly, there is a vaccine for HPV. If you get vaccinated early, you’re much less likely to catch an HPV infection, and you’re also less likely to transmit it to somebody else.
You can read more about the Pap test and the HPV test here. You can read about the vaccine in more detail here.
Depending on where you live, your country may have a national screening program that automatically invites those who should get screened. In other countries, you have to take the initiative to contact your doctor yourself.
Importantly, if your country sends invites, make sure to check whether you’ll be included automatically if you have a cervix but aren’t registered as female with your government. You might also receive invites if you’re registered as female but don’t have a cervix (anymore). In that case, you might still need screening if you’ve had an abnormal test result in the past. Some countries keep track of these things, but others don’t. Contact your GP or primary care doctor to make sure things are in order for you.
Does my country have a screening program?
We’ll only discuss countries with English as their primary language here. Choose the language spoken in the country where you live in the upper left corner (on desktop) or in the menu (on mobile) to learn more about screening in your country.
Disclaimer: we do our best to present up-to-date information, but it’s possible things have changed since we last reviewed this article. That’s why this information is for educational purposes only. Always contact your own healthcare provider (or check your country’s guidelines online) if you have questions about your health and what applies to you.
England: yes, England has a national cervical cancer screening program. In England, you receive an invitation every 3 to 5 years (depending on your age) between the ages of 25 and 64. Everyone registered as female with their GP receives a letter, unless they don’t have a cervix anymore. If you’re registered as male with your GP but you have a cervix, talk to them about getting tested.
Wales: yes, Wales has a national cervical cancer screening program. In Wales, you’re invited every 5 years between the ages of 25 and 64 (this used to be more often in young women but has recently been changed to 5-year intervals). Everybody registered as female or unspecified with their GP receives an invitation. If you’re registered as male but you have a cervix, contact your GP.
Scotland: yes, Scotland has a national cervical cancer screening program. In Scotland, you receive an invitation every 5 years between the ages of 25 and 64. Everyone with a cervix is invited. If you don’t identify as female but have a cervix, and you haven’t changed your Community Health Index (CHI) number or changed it after 14 June 2015, you will receive an invitation. If you changed it before this date, contact your GP.
Northern Ireland: yes, Northern Ireland has a national cervical cancer screening program. In Northern Ireland, you receive an invitation every 3 to 5 years (depending on your age) between the ages of 25 and 64. You will receive an invitation if you’re registered as female with your GP. If you’re not, but you have a cervix, contact your GP.
Ireland: yes, Ireland has a national cervical cancer screening program. Ireland works with a register (the CervicalCheck register) of women with a PPS number between the ages of 25 and 65. If you’re on it, you’ll be sent a letter when your test is due (every 3-5 years, depending on your age). You can also check the register yourself to see when you should be getting tested next. If you’re not on the register, you can fill out a form or book an appointment at a GP or a clinic to have a test. If you get a test, you’ll be added to the register automatically. If you have a cervix but are registered as male with the Department of Social Protection, you won’t receive letters. In that case, you should contact your GP to get screened.
Australia: yes, Australia has a national cervical cancer screening program. In Australia, you receive an invitation every 5 years between the ages of 25 and 74. You can check the National Cancer Screening Register to see when you’re due next. You can get screened by a healthcare professional, or you can ask them about collecting your sample yourself. If you’re registered as female under Medicare, you’ll be added to the register automatically when you turn 25. This is also true if you’re not registered as female but you’ve had a screening test at some point in your life. But if you’ve never had a screening test and you’re registered as male with Medicare, you’re not added to the register when you turn 25. So, if this applies to you but you have a cervix, talk to your GP or a different clinician about getting screened.
New Zealand/Aotearoa: yes, New Zealand/Aotearoa has a national cervical cancer screening program in place. From the age of 25 to 69, you will be invited by your healthcare provider to take part in screening. At the time of writing, this is a Pap smear every 3 years. In July 2023, this will be changed to an HPV test every 5 years. Self-testing will then also become an option.
United States: no, the United States don’t have a nation-wide automatic cervical cancer screening program. But you can get screened by your primary care doctor or your gynecologist, or at a sexual health clinic (including Planned Parenthood). The American Cancer Society recommends that everyone with a cervix get screened with an HPV test every 5 years between the ages of 25 and 65.
Canada: no, Canada does not have a nation-wide cervical cancer screening program. But many provinces do. Only Nunavut, Quebec, and Yukon don’t have any screening program in place. Because the programs in the provinces differ slightly from each other, we won’t discuss each of them separately here. But in general, the Canadian Cancer Society recommends getting a Pap test every 1-3 years from the age of 21. Check your province’s screening program or contact your primary care doctor to see if you’ll be invited or if you have to take the initiative to get screened yourself.
Screening programs for cervical cancer are well-developed mainly in high-resource countries (2). People in those countries typically also have more access to necessary medical treatment. That’s why women in countries with scarce resources die from cervical cancer much more commonly than women in wealthy countries, tragically (1). This is also true for underserved communities within wealthy countries. The global mortality from cervical cancer is therefore still high.
How can cervical cancer be treated?
Your treatment will depend on the stage your cancer is in: how big is it? Has is spread to other places? How far are those places from the cervix? We’ve explained the different stages of cervical cancer above. We’ve summarized the main treatment options for your below.
For very small tumors that haven’t grown into any other tissues (stage 1 cervical cancer), it’s often enough to remove a portion of the cervix. This is called conization. This tissue can then be used for biopsies (which confirms the diagnosis again), and the procedure treats the cervical cancer at the same time. Your surgeon can perform conization with either a scalpel (a cold knife), a laser, or through a loop heated with electrical current, called electrosurgical loop (17). An electrosurgical loop can cut tissue and stop bleeding at the same time (18).
In other cases, especially for more advanced cancer, different forms of treatment are needed. These options include:
Surgery
Radiation therapy (which uses radiation to kill cancer cells)
Chemotherapy (which uses chemicals to kill cancer cells)
Immunotherapy (which uses antibodies to kill cancer cells)
Your doctor will discuss all the options available to you. If you’re wondering about certain ways to treat cancer that they haven’t spoken to you about, there’s no harm in asking! What options would work for you depend on many different factors, most notably the extent of the cancer (8).
Getting screened for cervical cancer can be scary. But it’s your best bet to prevent having to get intensive treatment for cervical cancer. It can save your life!
We acknowledge that access to screening is limited in a lot of areas around the world. But we’re optimistic about efforts to increase access for every woman and every person with a cervix!
References
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Please note: the information we provide to you here is for educational purposes only. If you’re experiencing any discomfort or have any complaints or questions about your health, please contact your doctor or other relevant health professional. We don’t provide medical advice.