The cervix is the lower part of the uterus, the place where a baby grows during pregnancy. Cervical cancer is caused by a virus called HPV. The virus spreads through sexual contact. Most women's bodies are able to fight HPV infection. But sometimes the virus leads to cancer. You're at higher risk if you smoke, have had many children, use birth control pills for a long time, or have HIV infection.

Cervical cancer may not cause any symptoms at first. Later, you may have pelvic pain or bleeding from the vagina. It usually takes several years for normal cells in the cervix to turn into cancer cells. Your health care provider can find abnormal cells by doing a Pap test to examine cells from the cervix. You may also have an HPV test. If your results are abnormal, you may need a biopsy or other tests. By getting regular screenings, you can find and treat any problems before they turn into cancer.

Treatment may include surgery, radiation therapy, chemotherapy, or a combination. The choice of treatment depends on the size of the tumor, whether the cancer has spread and whether you would like to become pregnant someday.

Vaccines can protect against several types of HPV, including some that can cause cancer.

Cervical cancer is cancer that starts in the cells of the cervix. The cervix is the lower, narrow end of the uterus (womb). The cervix connects the uterus to the vagina (birth canal). 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 abnormal cells begin to appear in the cervical tissue. Over time, if not destroyed or removed, the abnormal cells may become cancer cells and start to grow and spread more deeply into the cervix and to surrounding areas.

The cervix has two main parts:

• The ectocervix (also called exocervix) is the outer part of the cervix that can be seen during a gynecologic exam. The ectocervix is covered with thin, flat cells called squamous cells.
• The endocervix is the inner part of the cervix that forms a canal that connects the vagina to the uterus. The endocervix is covered with column-shaped glandular cells that make mucus.

The transformation zone is the border where the endocervix and ectocervix meet. Most cervical cancers begin in the squamous cells in the transformation zone.

Types of cervical cancer

Cervical cancers are named after the type of cell where the cancer started. The two main types are:

• Squamous cell carcinoma: Most cervical cancers (up to 90%) are squamous cell carcinomas. These cancers develop from cells in the ectocervix.
• Adenocarcinoma: Cervical adenocarcinomas develop in the glandular cells of the endocervix. Clear cell adenocarcinoma, also called clear cell carcinoma or mesonephroma, is a rare type of cervical adenocarcinoma.

Sometimes, cervical cancer has features of both squamous cell carcinoma and adenocarcinoma. This is called mixed carcinoma or adenosquamous carcinoma. Very rarely, cancer develops in other cells in the cervix.

A quick look at causes, symptoms, and treatment

Human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S., and there are more than 200 strains of it.

Forty of those are known as high-risk HPV, which can lead to cervical cancer in women. Low-risk HPV usually causes symptoms that are not life threatening, such as genital warts.

It's important to know that high-risk HPV by itself is not cancer. Eight out of 10 women will have high-risk HPV at some point in their lives, but few of them will get cervical cancer.

Luckily, there is a vaccine that protects people against some high-risk strains of HPV.

How do you get HPV?

You can get HPV by having vaginal, anal, or oral sex with someone who has the virus. Anyone who is sexually active can get HPV, even if you have had sex with only one person. HPV can be passed on even if the infected person has no symptoms.

Who can get HPV?

Both men and women can get HPV. It's important to know that women can be tested for HPV, but men can't. However, men can get the HPV vaccine, which helps prevent them from getting genital warts and some types of cancer, including penile, anal, and throat cancer. The vaccine also helps protect their partners.

The Centers for Disease Control and Prevention does not recommend routine testing for men for these cancers because they're much less common. However, if you think you may have HPV or cancer, contact your health care provider.

What are the symptoms of HPV and cervical cancer?

Genital warts can be a sign of HPV in men and women. However, many strains of HPV, especially those that cause cancer, have no noticeable symptoms. These strains can be detected only by a Pap smear, which tests a woman's cervix, the lower part of her uterus, for any cell changes.

Symptoms of cervical cancer in women can appear years after an HPV infection. They include:

• Bleeding and spotting between menstrual periods
• Bleeding after vaginal sex
• Bleeding after menopause
• Heavier than usual menstrual periods
• Bleeding after a pelvic exam
• Unusual discharge from the vagina
• Pain during sex

How are HPV and cervical cancer treated?

Both men and women can get HPV, but men can't be tested for it.

There is no cure or treatment for HPV, but there are treatments for the complications it can cause, such as genital warts, cancer-causing cells, and cervical cancer.

Treatment for cervical cancer is based on how advanced the cancer is, but it can include chemotherapy, radiation, and surgery.

Getting regular Pap smears and HPV testing helps your doctor know whether you have HPV and, if you do, monitor it. Early detection often prevents cervical cancer. Make sure to ask your health care provider about the best screening schedule for you.

Who should get the HPV vaccine?

The HPV vaccine is an important tool for preventing HPV and its complications, and it is especially effective when received at a young age.

The Food and Drug Administration recommends that most children get vaccinated for HPV at age 11 or 12. The dosage schedule depends on how old the child is when he or she is first vaccinated, but children usually get two doses.

Vaccination is not generally recommended for people older than 26. However, some adults ages 27 through 45 who are not already vaccinated may decide to get the HPV vaccine after talking with their health care provider.

Cancer is a disease in which cells in the body grow out of control. Cancer is always named for the part of the body where it starts, even if it spreads to other body parts later. When cancer starts in the cervix, it is called cervical cancer. The cervix connects the vagina (birth canal) to the upper part of the uterus. The uterus (or womb) is where a baby grows when a woman is pregnant.

All women are at risk for cervical cancer. It occurs most often in women over age 30. Long-lasting infection with certain types of human papillomavirus (HPV) is the main cause of cervical cancer. HPV is a common virus that is passed from one person to another during sex. At least half of sexually active people will have HPV at some point in their lives, but few women will get cervical cancer.

Cervical cancer is highly preventable in most Western countries because screening tests and a vaccine to prevent HPV infections are available. When cervical cancer is found early, it is highly treatable and associated with long survival and good quality of life.

Are you worried about the cost? CDC offers free or low-cost cervical cancer screening tests.

What Are the Risk Factors for Cervical Cancer?

Almost all cervical cancers are caused by HPV. Other things also can increase your risk of cervical cancer.

What Can I Do to Reduce My Risk?

The most important thing you can do to help prevent cervical cancer is to have regular screening tests starting at age 21.

What Are the Symptoms of Cervical Cancer?

Early on, cervical cancer may not cause signs and symptoms. Advanced cervical cancer may cause bleeding or discharge from the vagina that is not normal for you.

What Should I Know About Screening?

Two screening tests can help prevent cervical cancer or find it early: the Pap test (or Pap smear) and the HPV test.

What Do My Test Results Mean?

Your Pap test will come back as “normal,” “unclear,” or “abnormal.” If you also have an HPV test, it will come back as either “positive” or “negative.”

How Is Cervical Cancer Diagnosed and Treated?

Cervical cancer is treated in several ways. It depends on the kind of cervical cancer and how far it has spread. Treatments include surgery, chemotherapy, and radiation therapy.

Almost all cervical cancers are caused by human papillomavirus (HPV), a common virus that can be passed from one person to another during sex. There are many types of HPV. Some HPV types can cause changes on a woman’s cervix that can lead to cervical cancer over time, while other types can cause genital or skin warts.

HPV is so common that most people get it at some time in their lives. HPV usually causes no symptoms so you can’t tell that you have it. For most women, HPV will go away on its own; however, if it does not, there is a chance that over time it may cause cervical cancer.

Other things can increase your risk of cervical cancer—

• Having HIV (the virus that causes AIDS) or another condition that makes it hard for your body to fight off health problems.
• Smoking.
• Using birth control pills for a long time (five or more years).
• Having given birth to three or more children.
• Having several sexual partners.

Early on, cervical cancer usually doesn’t have symptoms, making it hard to detect. Symptoms usually begin after the cancer has spread.

When symptoms of early-stage cervical cancer do occur, they may include

• vaginal bleeding after sex
• vaginal bleeding after menopause
• vaginal bleeding between periods or periods that are heavier or longer than normal
• vaginal discharge that is watery and has a strong odor or that contains blood
• pelvic pain or pain during sex

Symptoms of advanced cervical cancer (cancer has spread beyond the cervix to other parts of the body) may include the symptoms of early-stage cervical cancer and

• difficult or painful bowel movements or bleeding from the rectum when having a bowel movement
• difficult or painful urination or blood in the urine
• dull backache
• swelling of the legs
• pain in the abdomen
• feeling tired

These symptoms may be caused by many conditions other than cervical cancer. The only way to know is to see a health professional. If it is cervical cancer, ignoring symptoms can delay treatment and make it less effective.

If you have symptoms or screening test results that suggest the possibility of cervical cancer, your doctor will do follow-up tests to find out if it is due to cancer or some other cause. They will usually start by asking about your personal and family medical history and by doing a physical exam, which will include a pelvic exam and rectovaginal exam. They may recommend diagnostic tests to find out if you have cervical cancer, and if so, whether it has spread to another part of the body. The results of these tests will also help you and your doctor plan treatment.

How cervical cancer is diagnosed

The following procedures are used to diagnose cervical cancer:

Colposcopy

Colposcopy is a procedure in which the health care provider inserts a speculum to gently open the vagina and view the cervix. A vinegar solution will be applied to the cervix to help show abnormal areas. The health care provider then places an instrument called a colposcope close to the vagina. It has a bright light and a magnifying lens and allows the health care provider to look closely at the cervix. A colposcopy usually includes a biopsy.

Biopsy

Biopsy is a procedure in which a sample of tissue is removed from the cervix so that a pathologist can view it under a microscope to check for signs of cancer. The following types of biopsies are used to check for cervical cancer:

• Punch biopsy is a procedure in which a small, round piece of tissue is removed using a sharp, hollow circular instrument. Sometimes several different areas of the cervix will be checked with punch biopsy. This procedure is usually done in the doctor’s office.
• Endocervical curettage is a procedure to collect cells or tissue from the cervical canal using a curette (spoon-shaped instrument). This procedure removes only a small amount of tissue and is usually done in the doctor’s office.
• Loop electrosurgical excision procedure (LEEP) uses a thin wire loop, through which an electrical current is passed, to remove tissue from the cervix. LEEP may be used to diagnose cervical cancer. It also may be used to remove precancer or early-stage cancer. This procedure is typically done in a doctor’s office. It usually takes only a few minutes, and local anesthesia is used to numb the area.
• Cone biopsy is surgery to remove a larger, cone-shaped piece of tissue from the cervix and cervical canal. A cone biopsy may be used to diagnose cervical cancer. It also may be used to remove precancer or early-stage cancer. This procedure is also called conization. A cone biopsy is done at the hospital under general anesthesia.

Talk with your health care provider to learn what to expect during and after your biopsy procedure. Some people have bleeding and/or discharge after a biopsy. Others have pain that feels like cramps during menstruation.

To learn about the type of information that can be found in a pathologist’s report about the cells or tissue removed during a biopsy, see Pathology Reports.

Tests and procedures used to stage cervical cancer

If you are diagnosed with cervical cancer, you will be referred to a gynecologic oncologist. This is a doctor who specializes in staging and treating cervical cancer and other cancers of the female reproductive system. They will recommend tests to determine the extent (stage) of cancer. Sometimes the cancer is only in the cervix. Or, it may have spread from the cervix to other parts of the body. The process of learning the extent of cancer in the body is called staging. It is important to know the stage of the cervical cancer in order to plan the best treatment.

The following procedures may be used to determine the cervical cancer stage:

Imaging tests

• PET-CT scan combines the pictures from a positron emission tomography (PET) scan and a computed tomography (CT) scan. The PET and CT scans are done at the same time on the same machine. The pictures from both scans are combined to make a more detailed picture than either test would make by itself.
  • For the PET scan, a small amount of radioactive glucose (sugar) is injected into a vein. The scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells.
  • For the CT scan, a series of detailed x-ray pictures of areas inside the body is taken from different angles. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
• Magnetic resonance imaging (MRI) 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.
• Ultrasound uses high-energy sound waves (ultrasound), which bounce off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
• Chest x-ray is an x-ray of the organs and bones inside the chest. An x-ray is a type of high-energy radiation that can go through the body and onto film, making a picture of areas inside the chest.

Lab tests

• Complete blood count (CBC) is a blood test that measures the following in a sample of blood:
  • the number of red blood cells, white blood cells, and platelets
  • the amount of hemoglobin (the protein that carries oxygen) in the red blood cells
  • the portion of the blood sample made up of red blood cells
• Blood chemistry study is a blood test that measures the amounts of certain substances released into the blood by organs and tissues in the body, including electrolytes, lactate dehydrogenase, uric acid, blood urea nitrogen, creatinine, and liver function values. An unusual (higher or lower than normal) amount of a substance can be a sign of cancer spread or other diseases.

For more information about lab tests used in cancer medicine, see Understanding Laboratory Tests.

Visual examination

• Cystoscopy is a procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope is inserted through the urethra into the bladder. A cystoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
• Sigmoidoscopy uses a sigmoidoscope to look inside the rectum and sigmoid (lower) colon for abnormal areas. A sigmoidoscope is inserted through the rectum into the sigmoid colon. A sigmoidoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.

Getting a second opinion

Some people want to get a second opinion to confirm their cervical cancer diagnosis and treatment plan. If you choose to seek a second opinion, you will need to get important medical test results and reports from the first doctor to share with the second doctor. The second doctor will review the pathology report, slides, and scans before giving a recommendation. The doctor who gives the second opinion may agree with your first doctor, suggest changes or another approach, or provide more information about your cancer.

Screening means checking for a disease before there are symptoms. Cervical cancer screening is an important part of routine health care for people who have a cervix.

What is cervical cancer screening?

The goal of screening for cervical cancer is to find precancerous cervical cell changes, when treatment can prevent cervical cancer from developing. Sometimes, cancer is found during cervical screening. Cervical cancer found at an early stage is usually easier to treat. By the time symptoms appear, cervical cancer may have begun to spread, making treatment more difficult.

There are three main ways to screen for cervical cancer:

• The human papillomavirus (HPV) test checks cells for infection with high-risk HPV types that can cause cervical cancer.
• The Pap test (also called a Pap smear or cervical cytology) collects cervical cells so they can be checked for changes caused by HPV that may—if left untreated—turn into cervical cancer. It can find precancerous cells and cervical cancer cells. A Pap test also sometimes finds conditions that are not cancer, such as infection or inflammation.
• The HPV/Pap cotest uses an HPV test and Pap test together to check for both high-risk HPV and cervical cell changes.

When to get screened for cervical cancer

Cervical screening recommendations are developed by several organizations, including the United States Preventive Services Task ForceExit Disclaimer (USPSTF) and the American Cancer SocietyExit Disclaimer (ACS). How often you should be screened for cervical cancer and which tests you should get will depend on your age and health history. Because HPV vaccination does not prevent infection with all high-risk HPV types, vaccinated people who have a cervix should follow cervical cancer screening recommendations.

Age 21-29 years

If you are in this age group, USPSTF recommends getting your first Pap test at age 21, followed by Pap testing every 3 years. Even if you are sexually active, you do not need a Pap test before age 21.

Age 30-65 years

If you are in this age group, USPSTF recommends getting screened for cervical cancer using one of the following methods:

• HPV test every 5 years
• HPV/Pap cotest every 5 years
• Pap test every 3 years

Updated cervical cancer screening guidelines from ACS recommend starting screening at age 25 with an HPV test and having HPV testing every 5 years through age 65. However, testing with an HPV/Pap cotest every 5 years or with a Pap test every 3 years is still acceptable. To read about the reasons for updates to the guidelines, see ACS’s Updated Cervical Cancer Screening Guidelines Explained.

Older than 65 years

If you are in this age group, talk with your health care provider to learn if screening is still needed. If you have been screened regularly and had normal test results, your health care provider will probably advise you that you no longer need screening. However, if your recent test results were abnormal or you have not been screened regularly, you may need to continue screening beyond age 65.

Exceptions to the cervical cancer screening guidelines

Your health care provider may recommend more frequent screening if you

• are HIV positive
• have a weakened immune system
• were exposed before birth to a medicine called diethylstilbestrol (DES), which was prescribed to some pregnant women through the mid 1970s
• had a recent abnormal cervical screening test or biopsy result
• have had cervical cancer

If you’ve had an operation to remove both the uterus and cervix (called a total hysterectomy) for reasons not related to cancer or abnormal cervical cells you do not need to be screened for cervical cancer. However, if your hysterectomy was related to cervical cancer or precancer, talk with your health care provider to learn what follow-up care you need. If you’ve had an operation to remove the uterus but not the cervix (sometimes called a partial or supracervical hysterectomy) you should continue routine cervical cancer screening.

Where to get screened for cervical cancer

Doctors' offices, clinics, and community health centers offer HPV and Pap tests. Many people receive these tests from their ob/gyn (obstetrics/gynecology) or primary care provider.

If you don't have a primary care provider or doctor you see regularly, you can find a clinic near you that offers cervical cancer screening by contacting

• your state or local health department
• the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) or call 1-800-232-4636; NBCCEDP provides low-income, uninsured, and underserved people access to timely cervical cancer screening and diagnostic services
• a Planned Parenthood clinic, or call 1-800-230-7526
• NCI’s Cancer Information Service, or call 1-800-422-6237

Cervical screening test results usually come back from the lab in about 1-3 weeks. If you don't hear from your health care provider, call and ask for your test results. Make sure you understand any follow-up visits or tests you may need.

What to expect during a cervical cancer screening test

Cervical cancer screening tests are usually done during a pelvic exam, which takes only a few minutes. During the exam, you lie on your back on an exam table, bend your knees, and put your feet into supports at the end of the table. The health care provider uses a speculum to gently open your vagina to see the cervix. A soft, narrow brush or tiny spatula is used to collect a small sample of cells from your cervix.

The sample is then sent to a lab, where the cells can be checked to see if they are infected with the types of HPV that cause cancer (an HPV test). The same sample can be checked for abnormal cells (a Pap test). When both an HPV test and a Pap test are done on the same sample, this is called an HPV/Pap cotest.

A pelvic exam may include more than taking samples for an HPV and/or Pap test. Your health care provider may also check the size, shape, and position of the uterus and ovaries and feel for any lumps or cysts. The rectum may also be checked for lumps or abnormal areas. You may talk with your health care provider about being tested for sexually transmitted infections.

Most health care providers will tell you what to expect at each step of the exam, so you will be at ease.

Researchers have found that cervical cancer screening may be less effective for people with obesity, possibly because of challenges in visualizing the cervix and obtaining a cell sample. Approaches to improve cervical visualization, including the use of larger speculum, may be helpful.

Does cervical cancer screening have any risks?

Cervical cancer screening saves lives. Very few people screened for cervical cancer at routine intervals develop cervical cancer. Screening can detect cervical changes early, lowering a person’s chance of dying from cervical cancer. Despite these benefits, cervical screening is not perfect, and there are several possible harms to be aware of. Before having any screening test, you may want to discuss the test with your doctor.

Potential risks of harm from cervical cancer screening include:

• Unnecessary follow-up tests and treatment: Finding a condition through screening that would not have caused problems may lead to unnecessary follow-up tests and possibly treatment. The current recommended screening intervals and tests reduce the chance of finding and treating cervical cell abnormalities that would have gone away on their own.
• False-positive test results: Screening test results may sometimes appear abnormal even though no precancer or cancer is present. When a Pap test shows a false-positive result (one that shows there is precancer or cancer when there isn't), it can cause anxiety and is usually followed by more tests and procedures (such as colposcopy, cryotherapy, or loop electrosurgical excision procedure), which also have harms.
• False-negative test results: Screening test results may appear normal even though cervical precancer or cancer is present. A person who receives a false-negative test result (one that shows there is no cancer when there is) may delay seeking medical care even if there are symptoms.

A cancer stage describes the extent of cancer in the body, especially whether the cancer has spread from where it first formed to other parts of the body. It is important to know the stage of cervical cancer in order to plan the best treatment.

The International Federation of Gynecology and Obstetrics staging system is used for cervical cancer. Learn about tests and procedures used to determine the stage of cervical cancer.

Stage I cervical cancer

In stage I, cervical cancer has formed and is found in the cervix only. It is divided into stages IA and IB, based on the size of the tumor and the deepest point of tumor invasion.

Stage IA is subdivided based on the deepest point of tumor invasion.

• Stage IA1: A very small amount of cancer that can only be seen with a microscope is found in the tissues of the cervix. The deepest point of tumor invasion is 3 millimeters or less.
• Stage IA2: A very small amount of cancer that can only be seen with a microscope is found in the tissues of the cervix. The deepest point of tumor invasion is more than 3 millimeters but not more than 5 millimeters.

Stage IB is subdivided based on the size of the tumor and the deepest point of tumor invasion.

• Stage IB1: The tumor is 2 centimeters or smaller and the deepest point of tumor invasion is more than 5 millimeters.

• Stage IB2: The tumor is larger than 2 centimeters but not larger than 4 centimeters.

• Stage IB3: The tumor is larger than 4 centimeters.

Stage II cervical cancer

In stage II, cervical cancer has spread to the upper two-thirds of the vagina or to the tissue around the uterus.

Stage II is subdivided based on how far the cancer has spread.

• Stage IIA: Cancer has spread from the cervix to the upper two-thirds of the vagina but has not spread to the tissue around the uterus. Stage IIA is further divided based on the size of the tumor:
  • Stage IIA1: The tumor is 4 centimeters or smaller.
  • Stage IIA2: The tumor is larger than 4 centimeters.
• Stage IIB: Cancer has spread from the cervix to the tissue around the uterus.

Stage III cervical cancer

In stage III, cervical cancer has spread to the lower third of the vagina and/or to the pelvic wall, and/or has caused kidney problems, and/or involves lymph nodes.

Stage III is subdivided based on how far the cancer has spread.

• Stage IIIA: Cancer has spread to the lower third of the vagina but has not spread to the pelvic wall.

• Stage IIIB: Cancer has spread to the pelvic wall; and/or the tumor has become large enough to block one or both ureters or has caused one or both kidneys to get bigger or stop working.

• Stage IIIC: Stage IIIC is divided into stages IIIC1 and IIIC2, based on the spread of cancer to the lymph nodes.

Stage IV cervical cancer

In stage IV, cervical cancer has spread beyond the pelvis, or has spread to the lining of the bladder or rectum, or has spread to other parts of the body.

Stage IV is subdivided into stages IVA and IVB, based on where the cancer has spread.

• Stage IVA: Cancer has spread to nearby pelvic organs, such as the bladder or rectum.

• Stage IVB: Cancer has spread to other parts of the body, such as the liver, lungs, bones, or distant lymph nodes.

Stage IV is also called metastatic cancer. Metastatic cancer happens when cancer cells travel through the lymphatic system or blood and form tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if cervical cancer spreads to the lung, the cancer cells in the lung are actually cervical cancer cells. The disease is called metastatic cervical cancer, not lung cancer.

Recurrent cervical cancer

Recurrent cervical cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the cervix or as metastatic tumors in other parts of the body. Tests will be done to help determine where the cancer has returned in your body, if it has spread, and how far. The type of treatment that you have for recurrent cervical cancer will depend on how far it has spread.  

Different types of treatment are available for cervical cancer. You and your cancer care team will work together to decide your treatment plan, which may include more than one type of treatment. Many factors will be considered, such as the stage of the cancer, your overall health, and your preferences. Your treatment plan will include information about your cancer, the goals of treatment, the treatment options and possible side effects, and the expected length of treatment.

If you are concerned about whether treatment will affect your fertility, talk with your cancer care team before treatment begins about what to expect. To learn about fertility preservation options and ways to find support, see Fertility Issues in Girls and Women with Cancer.

Surgery

Surgery (also called an operation) is sometimes used to treat cervical cancer. The type of surgery depends on where the cancer is located. Learn more about Surgery to Treat Cancer.

The following surgical procedures may be used:

Cold knife conization

Cold knife conization uses a scalpel to remove a cone-shaped piece of tissue from the cervix and cervical canal. Sometimes all the cancer can be removed during this procedure. Cold knife conization is done in the hospital under general anesthesia.

Conization may also be used to treat high-grade cervical cell changes.

Sentinel lymph node biopsy

Sentinel lymph node biopsy removes the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node in a group of lymph nodes to receive lymphatic drainage from the primary tumor. It is therefore the first lymph node the cancer is likely to spread to from the primary tumor. To identify the sentinel lymph node, a radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, more lymph nodes will be removed through a separate incision (cut). This is called a lymph node dissection. After the sentinel lymph node biopsy, the surgeon removes the cancer.

Learn more about Sentinel Lymph Node Biopsy.

Hysterectomy

A hysterectomy is surgery to remove the uterus. As a treatment for cervical cancer, the cervix, and sometimes the surrounding structures, are removed. Several types of hysterectomy may be used to treat cervical cancer:

• Total hysterectomy removes the uterus and the cervix. When the surgery is done entirely through the vagina (with no incisions on the abdomen) and the uterus and cervix are removed through the vagina, the operation is called a total vaginal hysterectomy. If the surgery is done through a large incision on the abdomen (either vertical or horizontal) and the uterus and cervix are removed through this incision, the operation is called a total abdominal hysterectomy. If the surgery is done through small incisions on the abdomen, the operation is called a total laparoscopic hysterectomy. The uterus and cervix are usually taken out through the vagina, although sometimes an abdominal incision is made to remove the uterus and cervix.

• Radical hysterectomy removes 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 removes the uterus, cervix, upper part of the vagina, and ligaments and tissues that closely surround these organs. This type of surgery removes fewer tissues and/or organs than radical hysterectomy. The ovaries, fallopian tubes, or nearby lymph nodes may also be removed.

Radical trachelectomy

Radical trachelectomy (also called radical cervicectomy) removes the cervix, nearby tissue, and the upper part of the vagina. Lymph nodes may also be removed. After the surgeon removes the cervix, they attach the uterus to the remaining part of the vagina. A special stitch or band is placed on the uterus (in a procedure called a cerclage) to help keep the uterus closed during pregnancy. If you have this surgery, you may still be able to become pregnant.

Bilateral salpingo-oophorectomy

Bilateral salpingo-oophorectomy removes both ovaries and both fallopian tubes. This is done when the cancer has spread to these organs.

Total pelvic exenteration

Total pelvic exenteration removes the lower colon, rectum, and bladder. The cervix, vagina, ovaries, and nearby lymph nodes are also removed. Artificial openings (stoma) are made for urine and stool to flow from the body to a collection bag. Plastic surgery may be needed to make an artificial vagina after this operation.

Radiation therapy

Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing by damaging their DNA. The two main types of radiation therapy are external radiation therapy and internal radiation therapy (also called brachytherapy).

Both external and internal radiation therapy are used to treat cervical cancer and may also be used as palliative therapy to relieve symptoms and improve quality of life in people with advanced cervical cancer.

External radiation therapy

External-beam radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. Intensity-modulated radiation therapy (IMRT) is a way of giving external radiation therapy that can help keep radiation from damaging nearby healthy tissue.

IMRT is a type of 3-dimensional (3-D) radiation therapy that uses a computer to make pictures of the size and shape of the tumor. Thin beams of radiation of different intensities (strengths) are aimed directly at the tumor from many angles. IMRT is being studied for the treatment of cervical cancer.

Learn more about External Beam Radiation Therapy for Cancer.

Internal radiation therapy

Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. Internal radiation therapy is also called brachytherapy.

Learn more about Brachytherapy to Treat Cancer.

Chemotherapy

Chemotherapy (also called chemo) uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given alone or with other types of treatment.

Chemotherapy drugs used to treat cervical cancer include

• cisplatin
• carboplatin
• gemcitabine
• ifosfamide
• irinotecan
• paclitaxel
• topotecan
• vinorelbine

Combinations of these drugs may be used. Other chemotherapy drugs not listed here may also be used.

Learn more about how chemotherapy works against cancer, how it is given, common side effects, and more in Chemotherapy to Treat Cancer.

Targeted therapy

Targeted therapy uses drugs or other substances to block the action of specific enzymes, proteins, or other molecules involved in the growth and spread of cancer cells.

Targeted therapies used to treat cervical cancer include

• bevacizumab
• tisotumab vedotin

Learn more about how targeted therapy works against cancer, how it is given, possible side effects, and more in Targeted Therapy to Treat Cancer.

Immunotherapy

Immunotherapy helps a person’s immune system fight cancer. Biomarker tests can be used to help predict your response to certain immunotherapy drugs. Learn more about Biomarker Testing for Cancer Treatment.

Pembrolizumab is an immunotherapy drug used to treat certain patients whose cervical cancer has the biomarker PD-L1.

Learn more about how immunotherapy works against cancer, how it is given, possible side effects, and more in Immunotherapy to Treat Cancer.

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. For some patients, taking part in a clinical trial may be an option.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. 

Follow-up testing during and after treatment

Some of the tests that were done to diagnose cervical cancer or to find out the stage of the cancer may be repeated during treatment 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.

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 checkups.

Tell your doctor if you have any of the following signs or symptoms, which may mean the cancer has come back:

• vaginal bleeding or discharge
• pain in the abdomen, back, or leg
• swelling in the leg
• trouble urinating
• change in your bowel movements
• cough
• feeling tired

For cervical cancer, follow-up tests are usually done every 3 to 4 months for the first 2 years, followed by check-ups every 6 months. The check-up includes a current health history and exam of the body to check for signs and symptoms of recurrent cervical cancer and for late effects of treatment. A Pap test may or may not be done during your visits.

The cancer stage (the extent of cancer in the body) is an important factor in deciding the best treatment for cervical cancer. Other factors, such as your preferences and overall health, are also important.

An important factor for some patients is fertility preservation. If you would like to retain the ability to become pregnant, ask your doctor about fertility-sparing treatment options (treatments for cervical cancer that preserve the uterus and ovaries). Such treatments may be an option for some small cancers that are only in the cervix. If your cancer is more advanced or has a high chance of coming back, you are more likely to have treatments that will prevent you from becoming pregnant. A reproductive endocrinologist can help you understand your options for becoming a parent, such as freezing eggs. For more information on fertility preservation options and ways to find support, see Fertility Issues in Girls and Women with Cancer.

Treatment of stage IA cervical cancer

Stage IA cervical cancer is separated into stage IA1 and IA2.

Treatment of stage IA1 cervical cancer may include

• cold knife conization, a fertility-sparing procedure, for some small cancers
• total hysterectomy with or without bilateral salpingo-oophorectomy, for patients whose cancer has a high risk of coming back

Treatment of stage IA2 cervical cancer may include

• modified radical hysterectomy and removal of lymph nodes 
• radical trachelectomy, a fertility-sparing surgery, and removal of lymph nodes
• internal radiation therapy, for patients who cannot have surgery

Treatment of stages IB and IIA cervical cancer

Treatment of stage IB and stage IIA cervical cancer may include

• radiation therapy given at the same time as chemotherapy
• radical hysterectomy and removal of pelvic lymph nodes with or without radiation therapy to the pelvis, plus chemotherapy
• radical trachelectomy, a fertility-sparing surgery
• radiation therapy alone

When radiation is used, it may be given as external radiation therapy only or as a combination of external and internal radiation therapy. Chemotherapy drugs, such as cisplatin or carboplatin, may be given at the same time as radiation therapy. Giving chemotherapy at the same time as radiation therapy helps the radiation therapy work better.

Treatment of stages IIB, III, and IVA cervical cancer

Treatment of stage IIB, stage III, and stage IVA cervical cancer may include

• radiation therapy given at the same time as chemotherapy
• surgery to remove pelvic lymph nodes followed by radiation therapy with or without chemotherapy

Most people with stage IIB, III, or IVA cervical cancer will receive a combination of external and internal radiation therapy. Chemotherapy drugs, such as cisplatin or carboplatin, may be given at the same time as radiation therapy. Giving chemotherapy at the same time as radiation therapy helps the radiation therapy work better.

Treatment of stage IVB cervical cancer

Treatment of stage IVB cervical cancer may include

• Radiation therapy as palliative therapy, to stop bleeding caused by the cancer.
• Chemotherapy and the targeted therapy drug bevacizumab as palliative therapy. There are many chemotherapy drugs used as palliative therapy for stage IVB cervical cancer, including cisplatin, carboplatin, ifosfamide, irinotecan, gemcitabine, paclitaxel, and topotecan. These drugs may be given alone, or combinations of them may be used.

  Palliative therapy is treatment meant to improve the quality of life of patients who have a serious or life-threatening disease, such as cancer. Many of the same treatments for cancer, such as medicines and radiation therapy, can also be used for palliative therapy to help a patient feel more comfortable. Learn more about Palliative Care in Cancer.

For some patients, taking part in a clinical trial may be an option. Clinical trials of new cancer drugs or drug combinations may be available.

Treatment of recurrent cervical cancer

Treatment of cervical cancer that has recurred (come back) may include

• The immunotherapy drug pembrolizumab.
• Radiation therapy and chemotherapy given at the same time, for cancer that has come back in the pelvis. Radiation may be given as external radiation therapy only or as a combination of external and internal radiation therapy. Many different chemotherapy drugs are used to treat recurrent cervical cancer, including cisplatin, carboplatin, ifosfamide, irinotecan, gemcitabine, paclitaxel, topotecan, and vinorelbine. These drugs may be given alone, or combinations of them may be used. Giving chemotherapy given at the same time as radiation therapy helps the radiation therapy work better.
• Chemotherapy and the targeted therapy drug bevacizumab as palliative therapy. Many different chemotherapy drugs are used as palliative therapy for recurrent cervical cancer, including cisplatin, carboplatin, ifosfamide, irinotecan, gemcitabine, paclitaxel, topotecan, and vinorelbine. These drugs may be given alone, or combinations of them may be used.

  Palliative therapy is treatment meant to improve the quality of life of patients who have a serious or life-threatening disease, such as cancer. Many of the same treatments for cancer, such as medicines and radiation therapy, can also be used for palliative therapy to help a patient feel more comfortable. Learn more about Palliative Care in Cancer.

• Pelvic exenteration, for certain patients who cannot have radiation therapy. The goal of pelvic exenteration is to cure the cancer by removing it from all the organs to which it has spread.

For some patients, taking part in a clinical trial may be an option.

This page lists cancer drugs approved by the Food and Drug Administration (FDA) for cervical cancer. The list includes generic names and brand names. This page also lists common drug combinations used in cervical cancer. The individual drugs in the combinations are FDA-approved. However, the drug combinations themselves usually are not approved, although they are widely used.

The drug names link to NCI's Cancer Drug Information summaries. There may be drugs used in cervical cancer that are not listed here.

Drugs Approved to Prevent Cervical Cancer

• Cervarix (Recombinant HPV Bivalent Vaccine)
• Gardasil (Recombinant HPV Quadrivalent Vaccine)
• Gardasil 9 (Recombinant HPV Nonavalent Vaccine)
• Recombinant Human Papillomavirus (HPV) Bivalent Vaccine
• Recombinant Human Papillomavirus (HPV) Nonavalent Vaccine
• Recombinant Human Papillomavirus (HPV) Quadrivalent Vaccine

Drugs Approved to Treat Cervical Cancer

• Alymsys (Bevacizumab)
• Avastin (Bevacizumab)
• Bevacizumab
• Bleomycin Sulfate
• Hycamtin (Topotecan Hydrochloride)
• Keytruda (Pembrolizumab)
• Mvasi (Bevacizumab)
• Pembrolizumab
• Tisotumab Vedotin-tftv
• Tivdak (Tisotumab Vedotin-tftv)
• Topotecan Hydrochloride
• Zirabev (Bevacizumab)

Drug Combinations Used in Cervical Cancer

• CARBOPLATIN-TAXOL
• GEMCITABINE-CISPLATIN

Cervical cancer during pregnancy is rare. When it occurs, the cancer is usually found early and confined to the cervix, and it may not need to be treated immediately. But sometimes the cancer is fast-growing or found at a later stage and needs immediate treatment. Before treatment begins, it is important to discuss the benefits and risks of all your treatment options, including how treatment could affect you, your pregnancy, and your future fertility. Your cancer care team will consider your personal wishes when helping you decide the best treatment.

Typically, treatment depends on your trimester of pregnancy.

Treatment of slow-growing stage I cervical cancer in the first trimester

If you have a type of slow-growing cervical cancer that is diagnosed in stage I, are less than 3 months pregnant, and want to continue your pregnancy, your cancer care team might suggest that you delay treatment until later in your pregnancy or after delivery.

Your cancer care team may also suggest you deliver early (around 37 weeks) via cesarean section. You may have a hysterectomy (surgery to remove the uterus and cervix, and sometimes surrounding structures) at the same time as the cesarean section.

Treatment of fast-growing or advanced stage cervical cancer in the first trimester

Tests will be done throughout your pregnancy to find out if the cancer has grown much larger or has spread outside of the cervix. Cervical cancer that is fast-growing or has evidence of spread outside the cervix to other tissues and organs may require immediate treatment, which may include

• hysterectomy, surgery to remove the uterus (womb), cervix, and sometimes surrounding structures
• chemotherapy
• radiation therapy

It is not possible to continue the pregnancy during any of these treatments. Chemotherapy is not safe for the fetus during the first trimester, and radiation therapy is harmful throughout fetal development.

Treatment of stage I cervical cancer in the second or third trimester

If you are diagnosed with stage I cervical cancer during the second or third trimester of pregnancy, your cancer care team might suggest surgery with cold knife conization or radical trachelectomy.

Cold knife conization uses a scalpel to remove a cone-shaped piece of tissue from the cervix and cervical canal. Cold knife conization is done in the hospital under general anesthesia.

Radical trachelectomy (also called radical cervicectomy) removes the cervix, nearby tissue, and the upper part of the vagina. Lymph nodes may also be removed. After the surgeon removes the cervix, they attach the uterus to the remaining part of the vagina. A special stitch or band is placed on the uterus (in a procedure called a cerclage) to help keep the uterus closed during pregnancy.

Your cancer care team may suggest you deliver early via cesarean section. If all the cancer couldn’t be removed with cold knife conization or radical trachelectomy, you may receive other treatments after delivery, such as hysterectomy and radiation therapy.

Treatment of stage II, III, or IV cervical cancer in the second or third trimester

If you are diagnosed with stage II, III, or IV cervical cancer during the second or third trimester of pregnancy, your cancer care team may suggest you continue the pregnancy and receive chemotherapy.

Chemotherapy, such as with cisplatin or carboplatin and paclitaxel, given in the second or third trimester does not usually harm the unborn baby but may cause early labor and low birth weight.

Your cancer care team may suggest you deliver early via cesarean section so you can receive other treatments, such as hysterectomy and radiation therapy.

​​When you first learn that you have cervical cancer, it is normal to feel a mix of emotions. You may wonder how you will cope with the upcoming changes in your life. One step you can take is to be informed of the changes that may occur and what resources are available to help you cope. Doing so can give you a greater sense of control.

Because cervical cancer tends to occur in people of reproductive age, and because of where it forms in the body, certain aspects of your diagnosis and treatment are of special concern.

Fertility issues

For some people, infertility can be one of the most difficult and upsetting long-term effects of cervical cancer treatment. Although it might feel overwhelming to think about, you may benefit from talking with you doctor about how treatment may affect your fertility and about options to preserve fertility. If you choose to take steps to preserve your fertility, your doctor and a fertility specialist will work together to develop a treatment plan that includes fertility preservation, whenever possible.

Learn more about which cancer treatments may affect fertility and about fertility-sparing treatment options in Fertility Issues in Girls and Women with Cancer.

Sexual problems

Some treatments for cervical cancer can cause short-term or long-term problems with sex after treatment. Sexual problems are often caused by changes to your body. These changes result from chemotherapy, radiation therapy, surgery, or certain medicines.

Learn more about the sexual problems some cancer treatments can cause and ways to cope and share your concerns with your health care team in Sexual Health Issues in Women with Cancer.

Body changes

Cervical cancer and its treatment can change how you look and feel about yourself. Know you aren't alone in how you feel. Coping with these changes can be hard. But, over time, most people learn to adjust to them and move forward.

Learn more about how body changes may affect your self-image and sex life after treatment and ways to cope and communicate your feelings in Self-Image and Sexuality.

Stigma and guilt

Because cervical cancer results from a sexually transmitted infection with human papillomavirus (HPV), you may worry that some people assume your behavior caused your cancer. Or you may blame yourself for lifestyle choices you think could have led to your cancer. It is important to remember almost everyone will have an HPV infection at some point in their lives and that most HPV infections of the cervix will not cause cervical cancer. Having cervical cancer is not your fault. It may help you to share your feelings with someone. Let your doctor know if you would like to talk with a counselor or go to a support group.

Learn more about the emotions many people with cancer feel and ways to cope in Feelings and Cancer and Cancer Support Groups.

Financial toxicity

Cancer is one of the most costly diseases to treat in the United States. You may face major financial challenges and need help dealing with the costs of cervical cancer treatment, even if you have insurance. The problems a person has related to the cost of treatment is known as financial toxicity. Find out if you are at risk and learn about ways to cope in Financial Toxicity (Financial Distress) and Cancer Treatment and Managing Costs and Medical Information.

The most important things you can do to help prevent cervical cancer are to get vaccinated against HPV, have regular screening tests, and go back to the doctor if your screening test results are not normal.

Human Papillomavirus (HPV) Vaccine

The HPV vaccine protects against the types of HPV that most often cause cervical, vaginal, and vulvar cancers.

• HPV vaccination is recommended for preteens aged 11 to 12 years, but can be given starting at age 9.
• HPV vaccine also is recommended for everyone through age 26 years, if they are not vaccinated already.
• HPV vaccination is not recommended for everyone older than age 26 years. However, some adults age 27 through 45 years who are not already vaccinated may decide to get the HPV vaccine after speaking with their doctor about their risk for new HPV infections and the possible benefits of vaccination. HPV vaccination in this age range provides less benefit, as more people have already been exposed to HPV.

If vaccination is started before age 15, a two-dose schedule is recommended, with the doses given 6 to 12 months apart. For people who start the series after their 15^th birthday, the vaccine is given in a series of three shots.

HPV vaccination prevents new HPV infections, but does not treat existing infections or diseases. This is why the HPV vaccine works best when given before any exposure to HPV. You should get screened for cervical cancer regularly, even if you received an HPV vaccine.

Screening Tests

Two screening tests can help find changes that could become precancer or cervical cancer—

• The Pap test (or Pap smear) looks for precancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately.
• The HPV test looks for the virus (human papillomavirus) that can cause these cell changes.

Both tests can be done in a doctor’s office or clinic. If you have a low income or do not have health insurance, you may be able to get free or low-cost screening tests through CDC’s National Breast and Cervical Cancer Early Detection Program. Find out if you qualify.

More Steps to Help Prevent Cervical Cancer

These things may also help lower your risk for cervical cancer—

• If you’re 26 or younger, get an HPV vaccine if you haven’t been vaccinated already.
• Don’t smoke.
• Use condoms during sex.*

*HPV infection can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. While the effect of condoms in preventing HPV infection is unknown, condom use has been associated with a lower rate of cervical cancer.

If you have been diagnosed with cervical cancer, you may have questions about how serious the cancer is and your chances of survival. The likely outcome or course of a disease is called prognosis.

The prognosis for cervical cancer depends on many factors:

• the stage of the cancer (the size of the tumor and whether the cancer has spread beyond the cervix)
• the type of cervical cancer (adenocarcinoma or squamous cell carcinoma)
• your age and general health
• whether you have other health problems or diseases, including if you are immunocompromised or have HIV
• whether the cancer is newly diagnosed or has recurred (come back)

Survival rates for cervical cancer

Doctors estimate cervical cancer prognosis by using statistics collected over many years from people with cervical cancer. One statistic that is commonly used in making a prognosis is the 5-year relative survival rate. The 5-year relative survival rate tells you what percent of people with the same type and stage of cervical cancer are alive 5 years after their cancer was diagnosed, compared with people in the overall population. For example, the 5-year relative survival rate for cervical cancer diagnosed at an early stage is 92%. This means that people diagnosed with early-stage cervical cancer are about 92% as likely as people who do not have cervical cancer to be alive 5 years after diagnosis. The 5-year relative survival rates for cervical cancer are as follows:

• When cervical cancer is diagnosed at an early stage, the 5-year relative survival rate is 92%.
• When cervical cancer is diagnosed after it has spread to nearby tissues, organs, or regional lymph nodes, the 5-year relative survival rate is 58%.
• When cervical cancer is diagnosed after it has spread to a distant part of the body, the 5-year relative survival rate is 18%.
• The 5-year relative survival rate for all people with cervical cancer is 66%.

Understanding survival rate statistics

Because prognosis statistics are based on large groups of people, they cannot be used to predict exactly what will happen to you. The doctor who knows the most about your situation is in the best position to discuss these statistics and talk with you about your prognosis. It is important to note the following when reviewing survival statistics:

• No two people are entirely alike, and responses to treatment can vary greatly.
• Survival statistics use information collected from large groups of people who may have received different types of treatment.
• It takes several years to see the effect of newer and better treatments, so these effects may not be reflected in current survival statistics.

To learn more about survival statistics and to see videos of patients and their doctors exploring their feelings about prognosis, see Understanding Cancer Prognosis.