What Is Cervical Cancer? Symptoms, Causes, and Treatment Options

What Is Cervical (Servical) Cancer?

Cervical cancer is a malignancy that develops from abnormal cell growth in the cervix, the lower part of the uterus that opens into the vagina. Infection with human papillomavirus (HPV) is the main cause of this disease. It is the fourth most common cancer in women worldwide and can be detected at an early, treatable stage.
Cervical cancer can affect women of all ages, but it is more common between ages 30 and 45.

Types of Cervical Cancer

Cervical cancer is broadly divided into two main types according to histology and development:

• Squamous cell carcinoma: Arises from the squamous cells covering the outer surface of the cervix; accounts for 80–90% of cases.

• Adenocarcinoma: Arises from the glandular cells lining the cervical canal; less common but may behave more aggressively.
  Mixed tumors such as adenosquamous carcinoma (containing both components) can also occur, though they are rare.

Stages of Cervical Cancer (FIGO 2018)

Staging follows FIGO 2018 and depends on tumor size, spread beyond the cervix, and involvement of adjacent organs/lymph nodes.

• Stage I: Cancer limited to the cervix.

  • IA: Microscopic disease, not visible to the naked eye.

    • IA1: Stromal invasion ≤3 mm.

    • IA2: Stromal invasion >3 mm and ≤5 mm.

  • IB: Clinically visible lesion or depth of invasion >5 mm.

    • IB1: Tumor <2 cm.

    • IB2: Tumor 2–4 cm.

    • IB3: Tumor >4 cm.

• Stage II: Tumor extends beyond the cervix but not to the pelvic wall or lower third of the vagina.

  • IIA: Involves upper two-thirds of the vagina, not the parametria.

    • IIA1: Tumor <4 cm.

    • IIA2: Tumor ≥4 cm.

  • IIB: Parametrial involvement.

• Stage III: Involvement of the pelvic wall and/or lower third of the vagina; may affect kidney function.

  • IIIA: Lower third of vagina, no pelvic wall involvement.

  • IIIB: Pelvic wall involvement and/or hydronephrosis/obstructed ureter.

  • IIIC: Pelvic and/or para-aortic lymph node metastasis.

    • IIIC1: Pelvic nodes only.

    • IIIC2: Para-aortic nodes.

• Stage IV: Spread beyond the pelvis.

  • IVA: Invasion of adjacent organs (bladder or rectum).

  • IVB: Distant metastasis (e.g., liver, lungs).

Causes of Cervical Cancer

About 99% of cervical cancer cases are caused by HPV infection, a sexually transmitted virus. Types HPV-16 and HPV-18 are most commonly implicated. Most women worldwide are exposed to HPV at some point.

Other risk factors include:

• Early onset of sexual activity

• Multiple sexual partners

• Weakened immune system

• Smoking

• Genetic predisposition

• Long-term use of oral contraceptives

• Low socioeconomic status

• Having many births

• Other STIs (e.g., chlamydia, gonorrhea)

• Poor intake of vitamins A, C, and E

• Uncircumcised male partner

• Poor hygiene conditions

Symptoms of Cervical Cancer

Early stages are often asymptomatic, underscoring the importance of regular screening (Pap smear and HPV test). In more advanced stages, symptoms may include:

• Abnormal vaginal bleeding (between periods, after intercourse, or after menopause)

• Abnormal vaginal discharge (possibly foul-smelling, bloody, or heavy)

• Pelvic pain

• Pain during intercourse (dyspareunia) and postcoital bleeding

• Pain or difficulty with urination; hematuria if the bladder is involved

• Leg swelling (lymphedema)

• Lower abdominal or flank pain

• Low back pain

• General symptoms such as weakness, fatigue, and weight loss

Diagnosis

Diagnosis is often prompted by cellular changes detected during routine screening.

• Pap smear: Detects abnormal cervical cells and precancerous changes. Recommended regularly for sexually active women, generally starting at age 21.

• HPV testing: Identifies high-risk HPV types; often combined with Pap testing.

• Co-testing (Pap + HPV DNA): Offers higher sensitivity, especially recommended for women ≥30 years.

• Colposcopy: Magnified examination of the cervix; biopsy is taken if abnormal areas are seen.

• Biopsy: Confirms malignancy.

• Endocervical curettage (ECC): Samples cells from the endocervical canal.

• LEEP / Conization: Excisional procedures that remove a cone-shaped portion for diagnosis/treatment and margin assessment.

• Imaging (MRI, CT, PET): Determines extent and stage.

Age-Based Screening Recommendations

• <21 years: No screening recommended.

• 21–29 years: Pap smear every 3 years (HPV testing can be considered 25–29 every 5 years as an alternative per local guidance).

• 30–65 years: Either Pap every 3 years, HPV DNA every 5 years, or co-testing every 5 years.

• >65 years: Screening may stop if adequate negative results in the previous 10 years (e.g., 3 negative Pap, or 2 negative HPV DNA/co-tests).
  These recommendations apply to asymptomatic women regardless of HPV vaccination status.

Treatment

Management depends on stage, spread, and overall health; modalities may be used alone or in combination.

Surgery

• Stage IA: Microinvasive disease—options vary by fertility desire.

  • IA1: Type I hysterectomy for those not desiring fertility; conization is an option for fertility preservation.

• IA2 (especially with LVSI): More radical approaches such as Type II–III hysterectomy and lymphadenectomy.

• Stages I–III: Modified radical or radical hysterectomy may be required per Piver–Rutledge–Smith classification:

  • Type I – Extrafascial (simple) hysterectomy

  • Type II – Modified radical hysterectomy

  • Type III – Radical hysterectomy

  • Type IV – Extended radical hysterectomy

  • Type V – Partial exenteration (with resection of portions of bladder/rectum when indicated)

Radiotherapy (RT)
Key modality across stages; treats local nodes and reduces the primary tumor. In Stages I–II, external beam RT combined with intracavitary brachytherapy is common.

Chemoradiotherapy
For more advanced disease (e.g., IIB–IV), RT is often combined with chemotherapy to improve tumor control.

Chemotherapy
May be used as neoadjuvant chemotherapy (NACT) in selected IB2–II cases to reduce tumor size, facilitate surgery, and potentially reduce RT needs; also used concurrently with RT.

Prevention

• HPV vaccination

• Regular Pap/HPV screening

• Avoid smoking

• Practice safer sex; use condoms

• Limiting number of sexual partners / mutual monogamy

• Strengthen immunity; healthy diet and regular exercise

• Manage conditions that weaken immunity (e.g., HIV)

• Control obesity and diabetes

FAQs

What are the first signs?
Often none. When present: abnormal bleeding (between periods or after menopause), postcoital bleeding, pelvic pain, increased (often malodorous) discharge, dysuria, lower abdominal or back pain, weakness, fatigue, weight loss.

Is cervical cancer contagious?
No. The HPV virus that can cause it is sexually transmitted.

When should HPV vaccination be given?
Most effective at ages 9–12; can be given up to age 26.

What is the risk of death?
Early lesions have >90% treatment success.

How often should I be screened?
Pap every 2–3 years (per local guidelines), HPV test every 5 years.

When do symptoms appear?
Usually as the disease advances; early stages are often asymptomatic.

 

For detailed evaluation, please consult the Obstetrics & Gynecology (OB/GYN) clinic.