Cervical cancer is a disease in which malignant cancer cells form in the tissues of the cervix. If you’ve been diagnosed with a cervical cancer, talk to us about treatment options. At City of Hope, our multidisciplinary team pursues an integrated approach to treating cervical cancer by combining the latest research findings with outstanding patient care.
- What is cervical cancer?
- What are the symptoms of cervical cancer?
- How is cervical cancer diagnosed?
- What are the screening guidelines for cervical cancer?
- What are the treatments for cervical cancer?
- What risk factors are linked to cervical cancer?
- What clinical trials are being offered for cervical cancer?
Request a Consultation
If you have been diagnosed with cervical cancer, are at a high risk for developing cervical cancer or are looking for a second opinion consultation about your treatment, you may request an appointment online or contact us at 800-826-4673 (HOPE). Please visit Making Your First Appointment for more information.
Highlights of our cervical cancer treatment program include:
- Minimally invasive and robotic surgery, which uses smaller incisions than a traditional open procedure, resulting in less blood loss, reduced pain, shorter recovery time and quicker return to normal activities
- Advanced radiation therapy delivery that is more focused on cancerous cells with less exposure on surrounding normal tissues
- Fertility-preserving therapy options for young women who want to preserve their fertility after cancer treatment
- Individually customized chemotherapy regimens, including novel drugs and drug combinations in our clinical trials program
Your care continues long after treatment is completed, and we are committed to helping you and your loved ones manage your recovery. This includes our survivorship program, which has resources to improve quality of life for our gynecologic cancer survivors.
Nationally Ranked Cancer Center
City of Hope is a nationally recognized leader in the research and treatment of gynecological cancers. We are one of the few facilities designated a comprehensive cancer center by the National Cancer Institute.
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Cervical cancer is a disease in which the cells of the cervix, the lower part of a woman’s uterus, become abnormal and grow uncontrollably.
Most cases of cervical cancer are found in women younger than 50. It's rare in women younger than 20.
Risk factors for cervical cancer include:
- HPV infection. Human papillomavirus (HPV) is the most common cause of cervical cancer. An HPV infection is usually harmless and temporary. Anyone, male or female, who has had sex can get an HPV infection. Most people with HPV never know they’re infected because the virus tends to go away on its own. There are more than 150 types of this virus. Only about 13 types of HPV have been found to lead to cervical cancer if they don’t go away on their own. These include HPV 16, HPV 18, HPV 31, HPV 33 and HPV 45. HPV 16 and 18 cause about 70 percent of all cervical cancer. The only way to tell if you have a high-risk type of HPV is to be tested.
- Sex at a young age or with multiple partners. Both of these put you at increased risk of cervical cancer. You get high-risk HPV by having sex with someone who has the virus. A person with HPV may not have symptoms. Many people have it and don't know it. The only sure way to protect yourself is to not have sex, or to have sex only with a partner you know doesn’t have HPV. Condoms don’t protect you from HPV. But condom use is still important. Condoms help protect against other sexually transmitted diseases, such as HIV and chlamydia. Chlamydia has been linked to an increase in the risk of cervical cancer.
- Smoking. If you smoke, you are about twice as likely to get cervical cancer as women who do not smoke. Chemicals in cigarettes end up in your bloodstream and in the mucus in your cervix. Smoking also weakens the immune system, making you less able to fight HPV infections.
- Infection with HIV, or a weak immune system. HIV is the virus that causes AIDS. Women with HIV also have a weak immune system. If you have HIV, it’s harder to get rid of a high-risk HPV infection. This leads to a higher risk of cervical cancer. Taking medicines that weaken the immune system raises the risk of cervical cancer, too.
- Use of oral birth control. Long-term use of birth control pills increases the risk of cervical cancer. Your risk may go down after you stop taking birth control pills.
- Three or more full-term pregnancies. Women who have three or more full-term pregnancies are at increased risk for cervical cancer..
- Not getting regular Pap tests. Women who don’t get screened for cervical cancer with a Pap test as advised have a higher risk of cervical cancer.
- A personal history of cervical cancer. If you've had cervical cancer before, you have a higher chance of getting cervical cancer again.
- Mother or sister with cervical cancer. Some studies show that having a mother or sister who has had cervical cancer increases your risk for the disease.
- Past chlamydia infection. You can become infected with these bacteria during sex. Some studies show a link between chlamydia and cervical cancer.
- A diet low in fruits and vegetables. This is especially the case if you don’t eat enough foods with carotene and vitamins A, C and E. These foods can help lower your risk of cervical cancer.
- Being overweight. Some studies have shown that women who are overweight have a greater chance of getting cervical cancer.
- A mother who took the medicine Diethylstilbestrol (DES) while pregnant with you. Between the years 1940 and 1971, doctors sometimes prescribed this medicine to women who had miscarriages. The majority of women whose mothers took DES don’t get cervical cancer. But you’re still at higher risk for cervical cancer if your mother took DES while pregnant with you.
Common symptoms of cervical cancer include:
- Vaginal discharge. You may have a watery or unusual discharge.
- Abnormal vaginal bleeding. Your may have bleeding between your periods or after sex. Blood flow during your period may be heavier and last longer than usual. Or you may have bleeding after menopause.
- Pain. You may have pain during sex or pain in the pelvic area not from sex or other activities.
Although these symptoms can be caused by other conditions, you should check with your doctor to get a definitive diagnosis.
Many women don't have symptoms of cervical cancer. A health care provider may first see signs of cancer during a pelvic exam or a Pap test.
If your health care provider thinks you might have cervical cancer, certain exams and tests will need to be done to be sure. Diagnosing cervical cancer starts with your health care provider asking you questions. You will be asked about your medical history, your symptoms, risk factors, and family history of disease. Your health care provider will also give you a physical exam. You will likely need to have some tests to find out what has caused the changes in your cervix.
You may have one or more of the following tests:
- Pelvic exam
- Pap and HPV tests
Your doctor or health care provider does a pelvic exam in his or her office. This exam is recommended as a part of regular cancer screening for women. To have the exam, you need to remove your clothes from the waist down and put on a medical gown. You lie on your back on an exam table, bend your knees, and then place your feet in supports called stirrups at the end of the table. This position allows the doctor to look at or feel your cervix, uterus, vagina, ovaries, fallopian tubes, bladder, and rectum. The doctor places a plastic or metal tool called a speculum inside your vagina. This lets the doctor see the upper portion of your vagina and your cervix. After removing the speculum, the doctor inserts two or three gloved fingers into your vagina and uses his or her other hand to press on your abdomen. This is to feel other organs and check for lumps (masses) or anything unusual.
Some cervical cancer may be found during a pelvic exam. While your doctor can’t see precancer changes such as dysplasia, he or she may see some invasive cancer during an exam. If something suspicious is seen during the pelvic exam, more tests can help see if you have cervical cancer.
Pap and HPV tests
A Pap test is the standard way to see if there are any cervical cell changes that cause concern. An HPV test shows if you have an infection with the types of HPV that are known to be linked to cervical cancer.
Both tests can be done in the doctor's office during a pelvic exam. The HPV and Pap tests may feel uncomfortable, but they should not hurt, and it takes just seconds to do them. The doctor uses a speculum to widen your vagina and examine the upper part of your vagina and cervix. This is the area that connects your vagina to your uterus. The doctor then uses a small, soft brush to collect cells from the cervix and vagina. A specialized doctor called a pathologist looks at the cells under a microscope in a lab to check for cancer and HPV infection.
This procedure is used to allow the health care provider to look very closely at your cervix using a magnifying tool called a colposcope. It can help pinpoint abnormal areas in the cervix. A speculum is used, like during a pelvic exam, so the cervix can be seen. The doctor looks at it through the colposcope, which stays outside your body. Cells from areas that look different from the normal cervix cells may be removed to be examined in the lab. This is called a biopsy.
There are different ways to do a cervical biopsy. All are done by removing tissue to be examined under a microscope. Endocervical curettage is a biopsy where a small spoon-like tool is used to scrape cells or tissue from the part of the cervix that is closest to the uterus (cervical canal). This may be done during colposcopy. There are other procedures used to collect larger pieces of tissue from the cervix. This may be called a cone biopsy, and a laser or wire may be used to remove the tissue. You may be given medicines to put you in a deep sleep and not feel pain. Or the cervix may be numbed during these types of biopsy. A biopsy may cause some bleeding or other discharge. The area usually heals quickly. Some women also feel some pain similar to menstrual cramps.
When your health care provider has the results of your biopsy, he or she will contact you with the results. Your provider will talk with you about other tests you may need if cervical cancer is found. Make sure you understand the results and what follow-up you need.
A Pap test can find precancerous cells of the cervix before they become cancer. Having regular Pap tests gives you a better chance of preventing cancer. In fact, most cases of cervical cancer are found in women who have not had regular screening tests.
The American Cancer Society (ACS) notes that all women should get regular Pap tests starting at age 21. The ACS recommendations say that:
Women between ages 21 and 29 should get a Pap test done every three years.
- Women between the ages of 30 and 65 should have a Pap test plus an HPV test (co-testing) every five years.
- Women older than 65 who have had regular screening with normal results should not be screened for cervical cancer. Once screening is stopped, it should not be started again.
- Women who have an increased risk for cervical cancer because of a weak immune system or other risk factors may need screening more often and should talk with their health care provider.
- A woman who has had a hysterectomy with removal of the cervix for reasons not related to cervical cancer and who has no history of cervical cancer or serious precancer should not be screened.
- A woman who has been vaccinated against HPV should follow the screening advice for her age group.
Surgery for cervical cancer is done to remove the tumor and not leave any cancer cells behind. A gynecologic oncologist can determine if a tumor can be safely removed with surgery.
The type used depends on the extent (stage) of the cancer, as well as your desire to have children. The most common types of surgery for invasive cervical cancer include:
- Conization or LEEP. This is a type of biopsy. Your doctor may use this procedure instead of a hysterectomy to treat a stage IA1 cancer if you want to get pregnant in the future. He or she can do this procedure in the office under local anesthetic. The doctor uses a laser knife or an electric wire to remove a cone-shaped piece of tissue from the outer part of the cervix. A pathologist examines the cells under a microscope to make sure no cancer cells are found around the edges of the cone. In many cases, women are cured after one procedure. However, when using this treatment there is a small chance that the cancer will come back. So make sure to keep all follow-up appointments with your doctor.
- Hysterectomy. This is the standard treatment for stage IA1 invasive cancer in women who don’t want to get pregnant in the future. A doctor removes your whole uterus and cervix through your abdomen or vagina. This surgery requires regional or general anesthesia. You are sedated or asleep. You stay at least one night in the hospital. Women often recover faster when the hysterectomy is done through the vagina. Laparoscopic or robot-assisted surgery also usually leads to faster recovery. The ovaries and fallopian tubes don’t need to be removed to cure cervical cancer. Talk about the removal of your ovaries and tubes with your surgeon before the surgery. Removing ovaries causes menopause and long-term side effects.
- Radical abdominal hysterectomy. This type of surgery can be used to treat stage IA2, IB1, IB2 and IIA cancer. A doctor removes your uterus, cervix, the upper part of your vagina and the tissue that holds your uterus in place. The surgeon removes the lymph nodes in the pelvic area to test them for disease spread. The doctor can remove all the tissues through an incision in your abdomen. He or she may be able to use minimally invasive techniques, like laparoscopic surgery. This is a surgery where these tools are used through smaller cuts. This surgery is done with general anesthesia. You are asleep during the procedure. You may spend several days in the hospital. It’s not needed to remove your ovaries in a radical hysterectomy. This is important for younger women. Removing ovaries causes menopause and long-term side effects.
- Radical trachelectomy. This procedure is less often used. It is an option that may be used to preserve fertility in young women. The doctor removes your cervix, pelvic lymph nodes, upper part of your vagina and surrounding tissue. The uterus is then reattached to the remaining vagina. For certain people, this procedure is as likely as a radical hysterectomy to cure cervical cancer. The procedure is complex. It should only be done by a gynecologic oncologist who has experience with this method. After this surgery, there is an increased risk of infertility and pregnancy-related complications. For a future pregnancy, you may need fertility treatments and high-risk pregnancy care.
Radiation therapy uses high-energy X-rays or other forms of radiation to kill cancer cells. It may be delivered externally using focused beams of energy, or internally, placing an energy emitting substance in or near the tumor site.
Your doctor may advise radiation therapy in these cases:
- You have cervical cancer that has spread beyond the cervix.
- You have a large cancer that is found only in the pelvis. When cancer is large, radiation therapy is the preferred treatment.
- You need treatment after surgery to make sure that all the cancer cells are gone.
- You have early-stage cervical cancer, so you can have radiation instead of surgery. Radiation therapy works as well as radical hysterectomy for treating small cervical cancer.
- You can’t have surgery because you have other medical problems.
- You need treatment to shrink a tumor before surgery.
Women with cervical cancer who are treated with radiation usually receive low-dose chemotherapy at the same time. This makes the radiation work more effectively. For smaller cancer or one that has not spread, radiation works as well as surgery. Doctors also use radiation for larger cancer or one that has spread in combination with other therapies or to help control symptoms.
City of Hope is a leader in image-driven radiation planning, using computed tomography and magnetic resonance imaging scans to determine tumor size and location. This ensures radiation is accurately delivered to the tumor site, while minimizing exposure to nearby normal tissues.
Drug therapy may be given to patients to fight cervical cancer cells throughout the body by killing the cancer cells or stopping their growth and spread. These drugs include:
- Chemotherapy, which targets rapidly dividing cells, including cervical cancer cells
- Targeted therapy, which selectively attacks cancer cells based on specific characteristics
The drug or drug combination used depends on the type and stage of cervical cancer, previous treatments used, the patient’s health and overall treatment goals. This personalized medicine approach may be further enhanced by molecular or genetic testing of your cancer, which can help identify treatments that are more effective and with fewer side effects.
In addition to standard drug treatments, patients may also be eligible for new, promising drugs through our clinical trials program.
City of Hope’s renowned physicians and researchers utilize the latest in technology and innovation to treat cervical cancer, coupled with our enduring belief in providing unparalleled compassionate care.
Female Pelvic Medicine and Reconstructive Surgery
- Gynecologic Oncology
- Gynecologic Oncology
- Gynecologic Oncology
- Gynecologic Oncology
- Gynecologic Oncology
- Gynecologic Oncology
- Gynecologic Oncology
- Gynecologic Oncology
At City of Hope, cervical cancer clinicians and researchers collaborate extensively to develop and evaluate new therapies for better survival and quality-of-life outcomes. Our patients have access to a wide variety of clinical trials including new chemotherapy and targeted therapies, hormone therapies, novel surgical techniques, innovative radiation approaches and new prevention strategies.
These trials give current patients access to promising, leading-edge therapies and improve overall care for future patients worldwide. Visit our clinical trials page to learn more about current studies and their eligibility criteria.
Some of our current research projects include:
- Evaluating the best therapy for relieving malignant bowel obstruction due to cervical cancer or its treatments
- Enhancing the quality of life for cervical cancer patients and survivors by engaging them in a peer-to-peer support program with other survivors
- Improving cancer caregivers’ quality of life by connected them with a nurse to educate them on symptom evaluation and management, caregivers’ self-care needs and resources available to them
Living with cervical cancer
When you come to City of Hope, you automatically gain access to an unparalleled array of support services to help you and your loved ones take each step during and after your cervical cancer treatment.
We can help with all of the following concerns, and more:
- Managing symptoms and side effects, such as pain, nausea and fatigue
- Handling emotional, social and spiritual issues
- Addressing fertility and intimacy concerns
- Coping with stress
- Navigating the health care system
- Maintaining a healthy lifestyle with expert nutrition and physical activity guidance
- Building caregiver skills
- Improving communication with family, partners and loved ones
- Restoring normalcy in your family, job or school routine
- Healing arts workshops to restore the body and mind
- Learning cosmetic techniques for cancer- or treatment-related appearance issues
- Returning to wellness after active treatment
For more information about the supportive care programs we offer, please contact the Sheri & Les Biller Patient and Family Resource Center at 626-218-2273 (CARE) or the Women's Center at 800-934-5555.