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).

Enlarge

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 cells that are not
normal begin to appear in the cervical tissue. Later, cancer cells
start to grow and spread more deeply into the cervix and to
surrounding areas.

Cervical cancer in children is rare. For more information, see

the PDQ summary on Unusual Cancers of Childhood.

Human papillomavirus (HPV) infection is the major risk factor

for development of cervical cancer.

Anything that increases your risk 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. People who think they may be at risk should discuss this
with their doctor.

Infection of the cervix with human papillomavirus (HPV) is the

most common cause of cervical cancer. Not all women with HPV
infection, however, will develop cervical cancer. Women who do
not regularly have a Pap smear to detect HPV or abnormal cells
in the cervix are at increased risk of cervical cancer.

Other possible risk factors include the following:

 Giving birth to many children.

 Having many sexual partners.
 Having first sexual intercourse at a young age.
 Smoking cigarettes.
 Oral contraceptive use ("the Pill").
 Weakened immune system.

There are usually no noticeable signs of early cervical cancer

but it can be detected early with yearly check-ups.

Early cervical cancer may not cause noticeable signs

or symptoms. Women should have yearly check-ups, including a
Pap smear to check for abnormal cells in the cervix.
The prognosis (chance of recovery) is better when the cancer is
found early.

Possible signs of cervical cancer include vaginal bleeding

and pelvic pain.

These and other symptoms may be caused by cervical cancer.

Other conditions may cause the same symptoms. A doctor should
be consulted if any of the following problems occur:

 Vaginal bleeding.
 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:

 Pap smear: 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 test.

Enlarge
 Pap smear. 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 (genetic material) for certain types of HPV infection.
Cells are collected from the cervix and checked to find out if an
infection is caused by a type of human papillomavirus that is
linked to cervical cancer. This test may be done if the results of
a Pap smear show certain abnormal cervical cells. This test is
also called the HPV DNA test.
 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) and checked under a
microscope for signs of disease.
 Biopsy: If abnormal cells are found in a Pap smear, 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).
 Pelvic exam: An exam of the vagina, cervix, uterus, fallopian
tubes, ovaries, and rectum. The doctor or nurse 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. Aspeculum is
also 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 a
lubricated, gloved finger into the rectum to feel for lumps or
abnormal areas.

Enlarge

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.

 Endocervical curettage: A procedure to collect cells or tissue

from the cervical canal using a curette (spoon-shaped
instrument). Tissue samples may be taken and checked under
a microscope for signs of cancer. This procedure is sometimes
done at the same time as a colposcopy.

Certain factors affect prognosis (chance of recovery) and

treatment options.

The prognosis (chance of recovery) depends on the following:

 The patient's age and general health.

 Whether or not the patient has a certain type of human
papillomavirus.
 The stage of the cancer (whether it affects part of the cervix,
involves the whole cervix, or has spread to the lymph nodes or
other places in the body).
 The type of cervical cancer.
 The size of the tumor.

Treatment options depend on the following:

 The stage of the cancer.

 The size of the tumor.
 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.

After cervical cancer has been diagnosed, tests are done to

find out if cancer cells have spread within the cervix or to
other parts of the body.

The process used to find out if cancer has spread within

the cervix or to other parts of the body is calledstaging. The
information gathered from the staging process determines
the stage of the disease. It is important to know the stage in order
to plan treatment. The following tests and procedures may be
used in the staging process:

 Chest x-ray: An x-ray of the organs and bones inside the chest.
An x-ray is a type of energy beam that can go through the body
and onto film, making a picture of areas inside the body.
 CT scan (CAT scan): A procedure that makes a series of
detailed pictures of areas inside the body, taken from different
angles. The pictures are made by a computer linked to an x-ray
machine. A dyemay be injected into a vein or swallowed to help
the organs or tissues show up more clearly. This procedure is
also called computed tomography, computerized tomography,
or computerized axial tomography.
 Lymphangiogram: A procedure used to x-ray the lymph system.
A dye is injected into the lymphvessels in the feet. The dye
travels upward through the lymph nodes and lymph vessels,
and x-rays are taken to see if there are any blockages. This
test helps find out whether cancer has spread to the lymph
nodes.
 Pretreatment surgical staging: Surgery (an operation) is done
to find out if the cancer has spread within the cervix or to other
parts of the body. In some cases, the cervical cancer can be
removed at the same time. Pretreatment surgical staging is
usually done only as part of a clinical trial.
 Ultrasound exam: A procedure in which high-energy sound
waves (ultrasound) are bounced off internal tissues or organs
and make echoes. The echoes form a picture of body tissues
called asonogram.
 MRI (magnetic resonance imaging): A procedure that uses a
magnet, radio waves, and a computer to make a series of
detailed pictures of areas inside the body. This procedure is
also called nuclear magnetic resonance imaging (NMRI).
 Fine-needle aspiration (FNA) biopsy: The removal of tissue
or fluid, using a thin needle.

The results of these tests are viewed together with the results of
the original tumor biopsy to determine the cervical cancer stage.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

 Through tissue. Cancer invades the surrounding normal tissue.

 Through the lymph system. Cancer invades the lymph system
and travels through the lymph vesselsto other places in the
body.
 Through the blood. Cancer invades
the veins and capillaries and travels through the blood to other
places in the body.

When cancer cells break away from

the primary (original) tumor and travel through the lymph or blood
to other places in the body, another (secondary) tumor may form.
This process is called metastasis. The secondary (metastatic)
tumor is the same type of cancer as the primary tumor. For
example, if breast cancer spreads to the bones, the cancer cells
in the bones are actually breast cancer cells. The disease is
metastatic breast cancer, not bone cancer.

The following stages are used for cervical cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the innermost lining of

the cervix. These abnormal cells may become cancer and spread
into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

Enlarge

Millimeters (mm). A sharp pencil point is about 1 mm, a

new crayon point is about 2 mm, and a new pencil eraser
is about 5 mm.

In stage I, cancer has formed and is found in the cervix only.

Stage I is divided into stages IA and IB, based on the amount of
cancer that is found.
 Stage IA: A very small amount of cancer that can only be seen
with a microscope is found in thetissues of the cervix. Stage IA
is divided into stages IA1 and IA2, based on the size of
the tumor.
 In stage IA1, the cancer is not more than 3 millimeters deep
and not more than 7 millimeters wide.
 In stage IA2, the cancer is more than 3 but not more than
5 millimeters deep, and not more than 7 millimeters wide.
 Stage IB: In stage IB, cancer can only be seen with a
microscope and is more than 5 millimetersdeep or more than 7
millimeters wide, or can be seen without a microscope. Cancer
that can be seen without a microscope is divided into stages
IB1 and IB2, based on the size of the tumor.
 In stage IB1, the cancer can be seen without a microscope
and is not larger than 4 centimeters.
 In stage IB2, the cancer can be seen without a microscope
and is larger than 4 centimeters.

Stage II

In stage II, cancer has spread beyond the cervix but not to
the pelvic wall (the tissues that line the part of the body between
the hips) or to the lower third of the vagina. Stage II is divided into
stages IIA and IIB, based on how far the cancer has spread.

 Stage IIA: Cancer has spread beyond the cervix to the upper
two thirds of the vagina but not totissues around the uterus.
 Stage IIB: Cancer has spread beyond the cervix to the upper
two thirds of the vagina and to thetissues around the uterus.

Stage III

In stage III, cancer has spread to the lower third of the vagina,
may have spread to the pelvic wall, and/or has caused
the kidney to stop working. Stage III is divided into stages IIIA and
IIIB, based on how far the cancer has spread.
 Stage IIIA: Cancer has spread to the lower third of
the vagina but not to the pelvic wall.
 Stage IIIB: Cancer has spread to the pelvic wall and/or
the tumor has become large enough to block the ureters (the
tubes that connect the kidneys to the bladder). This blockage
can cause the kidneys to enlarge or stop working.
Cancer cells may also have spread to lymph nodes in
the pelvis.

Stage IV

In stage IV, cancer has spread to the bladder, rectum, or other

parts of the body. Stage IV is divided into stages IVA and IVB,
based on where the cancer is found.

 Stage IVA: Cancer has spread to the bladder or rectal wall and
may have spread to lymph nodes in the pelvis.
 Stage IVB: Cancer has spread beyond
the pelvis and pelvic lymph nodes to other places in the body,
such as the abdomen, liver, intestinal tract, or lungs.

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.

Three 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. Apathologist views
the tissue under a microscope to look for cancer cells.
Conization may be used todiagnose or treat a cervical
condition. This procedure is also called a cone biopsy.
 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.

Enlarge
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.
 Bilateral salpingo-oophorectomy: Surgery to remove both
ovaries and both fallopian tubes.
 Pelvic exenteration: Surgery to remove the lower colon, rectum,
and bladder. In women, the cervix, vagina, ovaries, and nearby
lymph nodes are also removed. Artificial openings (stoma) are
made for urine andstool to flow from the body to a collection
bag. Plastic surgery may be needed to make an artificial vagina
after this operation.
 Cryosurgery: A treatment that uses an instrument to freeze and
destroy abnormal tissue, such ascarcinoma in situ. This type of
treatment is also called cryotherapy.
 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.
 Loop electrosurgical excision procedure (LEEP): A treatment
that uses electrical current passed through a thin wire loop as a
knife to remove abnormal tissue or cancer.

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. Internal radiation therapy uses
a radioactivesubstance 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.

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 spinal column, 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.

New types of treatment are being tested in clinical trials.

Information about clinical trials is available from the NCI Web site.

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. This is sometimes
called re-staging.

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.

Treatment Options by Stage

Stage 0 (Carcinoma in Situ)

Stage IA Cervical Cancer
Stage IB Cervical Cancer
Stage IIA Cervical Cancer
Stage IIB Cervical Cancer
Stage III Cervical Cancer
Stage IVA Cervical Cancer
Stage IVB Cervical Cancer

A link to a list of current clinical trials is included for each

treatment section. For some types or stages of cancer, there may
not be any trials listed. Check with your doctor for clinical trials
that are not listed here but may be right for you.

Stage 0 (Carcinoma in Situ)

Treatment of stage 0 may include the following:

 Loop electrosurgical excision procedure (LEEP).

 Laser surgery.
 Conization.
 Cryosurgery.
 Total hysterectomy for women who cannot or no longer want to
have children.
 Internal radiation therapy for women who cannot have surgery.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical
Trials Registry 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. General information
about clinical trials is available from the NCI Web site.

Stage IA Cervical Cancer

Treatment of stage IA cervical cancer may include the following:

 Total hysterectomy with or without bilateral salpingo-

oophorectomy.
 Conization.
 Modified radical hysterectomy and removal of lymph nodes.
 Internal radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical
Trials Registry 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. General information
about clinical trials is available from the NCI Web site.

Stage IB Cervical Cancer

Treatment of stage IB cervical cancer may include the following:

 A combination of internal radiation therapy and external

radiation therapy.
 Radical hysterectomy and removal of lymph nodes.
 Radical hysterectomy and removal of lymph nodes followed
by radiation therapy plus chemotherapy.
 Radiation therapy plus chemotherapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical
Trials Registry that are now accepting patients with stage IB
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. General information
about clinical trials is available from the NCI Web site.

Stage IIA Cervical Cancer

Treatment of stage IIA cervical cancer may include the following:

 A combination of internal radiation therapy and external

radiation therapy plus chemotherapy.
 Radical hysterectomy and removal of lymph nodes.
 Radical hysterectomy and removal of lymph nodes followed by
radiation therapy plus chemotherapy.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical
Trials Registry that are now accepting patients with 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. General information
about clinical trials is available from the NCI Web site.

Stage IIB Cervical Cancer

Treatment of stage IIB cervical cancer may

include internal and external radiation therapy combined
withchemotherapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical
Trials Registry that are now accepting patients with stage IIB
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. General information
about clinical trials is available from the NCI Web site.

Stage III Cervical Cancer

Treatment of stage III cervical cancer may

include internal and external radiation therapy combined
withchemotherapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical
Trials Registry that are now accepting patients with stage III
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. General information
about clinical trials is available from the NCI Web site.

Stage IVA Cervical Cancer

Treatment of stage IVA cervical cancer may
include internal and external radiation therapy combined
withchemotherapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical
Trials Registry that are now accepting patients with 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. General information
about clinical trials is available from the NCI Web site.

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 improvequality of
life.
 Chemotherapy.
 Clinical trials of new anticancer drugs or drug combinations.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical
Trials Registry that are now accepting patients with stage IVB
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. General information
about clinical trials is available from the NCI Web site.

Treatment Options for Recurrent Cervical Cancer

Treatment of recurrent cervical cancer may include the following:

 Pelvic exenteration followed by radiation therapy combined

with chemotherapy.
 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.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical
Trials Registry that are now accepting patients with recurrent
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. General information
about clinical trials is available from the NCI Web site.