This section will take you through the basics of what you need to know about cervical cancer. It will introduce you to the people who may be part of your treatment team. Also, it will identify the different types of treatments for cervical cancer. Hopefully, this information will help prepare you to talk with your treatment team and to feel more confident about your treatment plan.
Cervical cancer overview
Cancer occurs when cells in an area of the body grow abnormally. Cervical cancer is a cancer that begins in the cervix, the part of the uterus or womb that opens into the vagina. It is the part of the uterus that dilates and opens fully to allow a baby to pass into the birth canal. The normal cervix has two main types of cells: squamous (or flat) cells, which protect the outside of the cervix, and glandular cells which are mostly inside the cervix, and produce the fluid and mucus commonly seen during ovulation.
Cervical cancer is caused by abnormal changes in either of these cell types in the cervix, and is the only gynecologic cancer that can be prevented by regular screening and preventive vaccination.
Cervical cancer symptoms
Cervical precancers usually have no symptoms. That is why it is important to have a Pap test. A woman usually does not have any signs until the cells turn into cancer and invade the deepest parts of the cervix or other pelvic organs.
These symptoms include:
- Vaginal discharge
- Abnormal vaginal bleeding
- Vaginal odor
These symptoms may be caused by cancer or by other health problems. It is important for a woman to see her doctor if she is having any of these symptoms.
Medical evaluation and diagnosis
When a woman experiences concerning symptoms, a pelvic exam (including a rectovaginal exam) and a general physical should be performed. If the exam is abnormal, the woman might be advised to undergo an HPV test, a colposcopy (observing the cervix through a magnifying scope) and a biopsy, depending on the results of the colposcopy.
If cervical cancer is suspected or diagnosed, it is important to seek care first from a gynecologic oncologist—medical doctors with specialized training in treating gynecologic cancers who can manage your care from diagnosis to completion of treatment. Use our Seek a Specialist tool to find a gynecologic oncologist in your area.
During your treatment, you will come in contact with many health care professionals—these people make up your treatment team. They will work with each other and you to provide the special care you need. Learn more about your treatment team.
When cervical cancer is diagnosed, it is vital to determine if the cancer has spread. Your treatment team may do more tests to determine this. Additionally, specific procedures during surgery may be performed to determine the extent of disease. This process is called staging. Staging helps to determine the exact extent of your cancer and what treatment plan is best for you.
Following surgery, your cancer will be categorized into Stage I, II, III, or IV, illustrated below. The cancer will also be assigned a grade. Grade refers to how abnormal the cells appear under a microscope. Low grade tumors, also called grade 1, have features that resemble normal cervical cells. In contrast, in high grade tumors (grade 3) the microscopic appearance is greatly altered from normal.
It is important that your surgery be performed by a gynecologic oncologist, a physician with special training in the care of women’s reproductive cancers. Studies show that patients treated by gynecologic oncologists at high-volume centers have improved outcomes.
Cervical cancer stages
Stage I: The cancer is found only in the cervix.
Stage II: The cancer has spread from the cervix to the upper part of the vagina or the tissue around the uterus. It has not spread to the pelvic wall—the muscle and connective tissues that line the insides of the pelvic bones. Cancer cells may also be found in the lymph nodes in the pelvis.
Stage III: The cancer has spread to the lower part of the vagina or to the pelvic wall. It may block the flow of urine to the bladder. Cancer cells may also be found in the lymph nodes in the pelvis.
Stage IV: The cancer has spread to other body parts within or outside the pelvis. Cancer cells may be found in the bladder, rectum, abdomen, liver, intestines or lungs.
Cervical cancer treatment and side effects
Cervical cancer may be treated with surgery, radiation therapy or chemotherapy. Depending on a number of factors, your treatment team may recommend using a combination of treatments to treat your cancer.
Understanding the goals of treatment
As you begin your treatment, make sure that you understand what to expect. Is this for cure? What are the chances of cure? If there is no cure, will the treatment make me live better or longer? It is very important to understand the truth about what to expect from the treatment—and what are the potential costs of side effects, expenses, etc.—so that you can make the best decisions for yourself and the life you want to lead.
All treatments for cervical cancer have side effects. Most side effects can be managed or minimized. Some treatments may affect your sexual function or your ability to have children.
Before beginning treatment, it is important to learn about the possible side effects and talk with your treatment team members about your feelings or concerns. They can prepare you for what to expect and tell you which side effects should be reported to them immediately. They can also help you find ways to manage the side effects you experience.
Cervical cancer treatment options
Surgery is the most common treatment for early cervical cancer, although radiation can also be used and typically works equally as well. Several types of surgery can be performed, but the final choice for you will depend on several factors that your gynecologic oncologist will consider, especially the stage and size of your cancer as well as your general health.
- Cervical conization: the surgical removal of just the cancerous (or precancerous in many cases) part of the cervix. Conization is an option only for the earliest cancers, the ones that are microscopic. This is the preferred treatment for women with very small cancers who wish to preserve fertility.
- Abdominal hysterectomy: the uterus and cervix are removed through an incision on the abdomen. In the less common vaginal hysterectomy, these organs are removed through the vagina.
- Laparoscopic hysterectomy: this involves the removal of the uterus and cervix in a procedure that is performed through several (3 to 5) very small incisions on your abdomen, and the uterus and cervix are brought out through the vagina. This procedure allows for quicker recovery than abdominal hysterectomy.
- Robotic hysterectomy: this procedure is essentially the same as a laparoscopic hysterectomy using several small incisions, but in this procedure your surgeon uses the assistance of a robotic technology (robot) that s/he is in control of at all times.
- Radical hysterectomy: this procedure can be performed abdominally (with an incision), laparoscopically, or robotically. The word radical means that the uterus and the tissue between the uterus and pelvic wall, as well as part of the upper vagina, are removed. Lymph nodes in the pelvis are also removed and examined to determine if the cancer has spread (radical pelvic lymphadenectomy). In some cases, both ovaries and both fallopian tubes must be removed. This procedure is called a bilateral salpingo-oophorectomy.
- Radical trachelectomy: in this surgery, your cervix and surrounding tissues are removed, but the upper uterus is preserved for future pregnancy. This operation is only available for carefully selected women and is dependent on several factors.
Side effects of surgery
Some pain and discomfort are common after surgery. Pain can be controlled with medicine. Tell your treatment team if you are experiencing more than mild pain.
Other early side effects (days to weeks after surgery):
- Discomfort related to tubes, catheters and medical devices
- Difficulty urinating so that a catheter that may stay in your bladder for a few days to weeks is often necessary
- Soreness of the abdomen around the incision
- Cramps and gas pains
- Watery vaginal discharge or bleeding
Later side effects (weeks to months):
- Difficulty urinating
- Shortening of the vagina
Some things may be done at the time of your surgery to minimize these side effects—such as placement of a temporary drainage catheter in your bladder. Women who have a hysterectomy will stop having periods and will no longer be able to have children. Hormone levels will remain the same if the ovaries are left in, or may fall to menopausal levels if the ovaries are removed. Hormone therapy to treat menopausal symptoms is usually an option if the ovaries are removed.
Radiation therapy (also called radiotherapy) uses high-energy radiation to kill cancer cells or stop them from growing. Radiation therapy can be an effective treatment for early-stage cervical cancers. However, in early cervical cancer, it is more commonly used as extra treatment after surgery for patients at highest risk for recurrence of their cancer—such as when the tumor might have spread beyond the cervix. Radiation is also used to treat larger or higher-stage cancers where it actually works better than surgery. Your need for radiation therapy will be determined using information from your staging tests, examinations and surgery if an operation was performed based on findings at the time of your evaluation.
Two types of radiation therapy are used to treat cervical cancer. Radiation therapy for cervical cancer is most often given in combination with chemotherapy.
- External radiation therapy: uses a machine that directs the radiation toward a precise region of the body. The therapy is usually given daily, Monday through Friday, for about six weeks. Radiation does not hurt during the treatment and only takes a few minutes each day. You can be treated at a clinic, hospital, or radiation oncology office, and typically you return home each day after treatment.
- Internal radiation therapy (also called brachytherapy): involves placing a small capsule of radioactive material inside the vagina or near the cervix. This procedure can sometimes be performed on an outpatient basis and other times requires hospitalization for a night or two. Medication is given to alleviate the discomfort from these procedures. During the time the radiation capsules are in, your family may be allowed only limited time next to you, but the radiation capsules are removed prior to going home.
Side effects of radiation
The side effects of radiation therapy depend on the dose used and the part of the body being treated. Common side effects for cervix cancer patients are listed below.
Early side effects (occurring during treatment):
- Dry, reddened skin in the treated area
- Diarrhea and nausea
- Discomfort when urinating
Most of these side effects are temporary. Not everybody experiences all of these side effects. Be sure to talk with your treatment team members about any side effects you experience. They can help you find ways to manage them.
Later side effects:
- Narrowing of the vagina and loss of lubrication
- Urinary frequency (radiation cystitis)
- Diarrhea (radiation colitis)
- Early or sudden menopause (if the ovaries stop working)
- Skin thickening and irritation
Be sure to talk with your health care team about what you can do to reduce your risk of having long-term side effects from the radiation. Some long-term complications, for example, narrowing of the vagina, are better prevented than treated once they are severe.
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for cervical cancer is usually given intravenously (injected into a vein). You may be treated in the doctor’s office or the outpatient part of a hospital. The drugs travel through the bloodstream to reach all parts of the body. This is why chemotherapy can be effective in treating cervical cancer that has spread beyond the cervix. However, the same drugs that kill cancer cells may also damage healthy cells. To limit the damage to healthy cells, chemotherapy is usually given in cycles. Periods of chemotherapy are alternated with rest periods, during which no chemotherapy is given. Side effects usually still occur, but are manageable.
Side effects of chemotherapy
Each person responds to chemotherapy differently. Some people may have very few side effects while others experience several. Most side effects are temporary. They include:
- Loss of appetite
- Mouth sores
- Increased chance of infection
- Bleeding or bruising easily
- Mild hair loss
Importance of participation in clinical trials
There are many ongoing clinical trials studying new and better ways to treat cervical cancer. Many treatment options are available today because women diagnosed with cervical cancer were willing to participate in prior clinical trials.
Clinical trials are designed to test some of the newest and most promising treatments for cervical cancer. The Foundation for Women’s Cancer (FWC) partners with NRG Oncology (formerly Gynecologic Oncology Group), part of the National Cancer Institute cooperative group working only on gynecologic cancer clinical trials, and others to make information about current clinical trials available. For more information about clinical trials available for enrollment, visit ClinicalTrials.gov.
Living with Cancer Therapy
Regardless of the treatment prescribed, you are likely to experience fatigue, frequent medical appointments and times when you do not feel well.
Survivorship is about living, and is something you and your care team should be thinking about from the time you are diagnosed.