Cervical Cancer

Columbia cares for people with cervical cancer, abnormal Pap or HPV results, and cervical precancer. Our specialists are committed to providing expert gynecologic cancer care and compassionate support, from diagnosis through recovery. 

What Is Cervical Cancer?

Cervical cancer is caused by abnormal cells growing on the cervix, the lower portion of the uterus that extends into the vagina. Some of these cells may become cancerous over time if they are not treated.

There are two main types of cervical cancer:

• Squamous cell carcinomas start in the superficial (top) layer of cells on the lower outer part of the cervix, near the cervical canal. They account for 80 to 85% of cervical cancers.
• Adenocarcinomas develop in the glandular cells in the cervix and account for 15-20% of cervical cancers.

What Causes Cervical Cancer?

Most cervical cancers are caused by long-lasting infection with high-risk types of human papillomavirus, also called HPV, a common virus passed through sexual contact. In most people, HPV goes away on its own. In some people, the virus stays in the body and can cause abnormal cell changes. Cervical cancer often develops slowly, and screening can find many cell changes before they become cancer. There is a highly effective vaccine for HPV, which can prevent initial infection.

What Are the Risk Factors for Cervical Cancer?

Risk factors for cervical cancer may include:

• HPV or HIV infection
• A history of cervical precancer
• Smoking
• A weak immune system
• Long-term use of birth control pills
• Having multiple sexual partners
• Sexual activity at a young age
• Exposure before birth to a drug called DES

These risk factors may raise the chance of cervical cancer, but not everyone with risk factors develops cancer.

What Are the Symptoms of Cervical Cancer?

Cervical cancer may not cause symptoms at first. When symptoms happen, they may include:

• Bleeding after sex
• Bleeding between periods
• Bleeding after menopause
• Heavier or longer periods than usual
• Watery, bloody, or unusual vaginal discharge
• Pelvic pain
• Pain during sex

These symptoms can also be caused by other conditions. A doctor can help find the cause.

When Should I See a Doctor?

You should see a doctor if you have bleeding after sex, bleeding between periods, bleeding after menopause, pelvic pain, or unusual vaginal discharge.

You should also follow up if you have an abnormal Pap test or positive HPV test.

How Is Cervical Cancer Diagnosed?

Most routine cervical screening tests show abnormal cell changes long before an actual cancer develops.

Tests may include:

• Pelvic exam
• Pap test
• HPV test
• Colposcopy, which uses a special magnifying tool
• Cervical biopsy
• Cone biopsy
• CT scan, MRI, or PET scan

A biopsy is needed to know for sure if cancer is present.

How Is Cervical Cancer Treated?

Treatment depends on the type of cervical cancer, the stage, your overall health, and your goals for care.

If abnormal cells are found during testing, they are removed before they can grow into a cancer. This can be done through:

• Biopsy
• Laser removal, also known as excision
• Freezing, also known as cryotherapy
• Loop electrical excision procedure (LEEP): a portion of the cervix is removed using a radio wave sent through a wire loop.
• Cone excision, or conization: removes a cone-shaped sample of tissue from the cervix

Most of these procedures can be performed in an outpatient setting.

The earliest stages of cervical cancer can be treated and cured by removing the uterus in a procedure called a simple hysterectomy. In some cases, a conization may be used.

If the tumor is large but has not spread beyond the cervix, a more extensive procedure known as a radical hysterectomy may be performed. This procedure removes some tissue around the cervix to ensure all cancer is removed. In addition, lymph nodes in the pelvis are generally removed (lymphadenectomy) to remove any tumor cells that may have spread to these areas.

In most cases, the ovaries can be preserved during a radical hysterectomy at the patient’s request. Some patients who want to protect future fertility may be candidates for radical trachelectomy, a procedure that removes the cancer and cervix but preserves the uterus.

Radiation, chemotherapy, immunotherapy, and targeted therapy can be used to treat early-and advanced-stage cancers.

Can Cervical Cancer Be Prevented?

Some cervical cancers can be prevented with regular screening and HPV vaccination.

You can lower your risk by:

• Getting the HPV vaccine if recommended
• Getting regular Pap tests and HPV tests
• Following up after abnormal test results
• Not smoking
• Using condoms to lower the risk of transmission of HPV and other infections

Your doctor can tell you which screening schedule is right for you.