Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body. To learn more about how cancers start and spread, see What Is Cancer?

Cervical cancer starts in the cells lining the cervix -- the lower part of the uterus (womb). This is sometimes called the uterine cervix. The fetus grows in the body of the uterus (the upper part). The cervix connects the body of the uterus to the vagina (birth canal).

The cervix has two different parts and is covered with two different types of cells.

• The part of the cervix closest to the body of the uterus is called the endocervix and is covered with glandular cells.
• The part next to the vagina is the exocervix (or ectocervix) and is covered in squamous cells.

These two cell types meet at a place called the transformation zone. The exact location of the transformation zone changes as you get older and if you give birth. 

Survival rates tell you what percentage of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed. They can’t tell you how long you will live, but they may help give you a better understanding about how likely it is that your treatment will be successful. Some people will want to know the survival rates for their cancer, and some people won’t. If you don’t want to know, you don’t have to.

What is a 5-year survival rate?

Statistics on the outlook for a certain type of cancer are often given as 5-year survival rates. The 5-year survival rate is the percentage of people who live at least 5 years after being diagnosed with cancer. For example, a 5-year survival rate of 70% means that an estimated 70 out of 100 people who have that cancer are still alive 5 years after being diagnosed. Keep in mind, however, that many of these people live much longer than 5 years after diagnosis.

But remember, all survival rates are estimates – your outlook can vary based on a number of factors specific to you.

Cancer survival rates don’t tell the whole story

Survival rates are often based on previous outcomes of large numbers of people who had the disease, but they can’t predict what will happen in any particular person’s case. There are a number of limitations to remember:

• The numbers below are among the most current available. But to get 5-year survival rates, doctors have to look at people who were treated at least 5 years ago. As treatments are improving over time, women who are now being diagnosed with cervical cancer may have a better outlook than these statistics show.
• These statistics are based on when the cancer was first diagnosed. They do not apply to cancers that later come back or spread, for example.
• The outlook for women with cervical cancer varies by the stage (extent) of the cancer – in general, the survival rates are higher for women with earlier stage cancers. But other factors can also affect a woman’s outlook, such as her age and overall health, and how well the cancer responds to treatment. The outlook for each woman is specific to her circumstances.

Your doctor can tell you how these numbers apply to you.

Survival rates for cervical cancer

The rates below were published in 2010 in the 7^th edition of the AJCC staging manual. They are based on data collected by the National Cancer Data Base from people diagnosed between 2000 and 2002. These are the most recent statistics available for survival by the 2010 staging system. Keep in mind the staging system in Cervical Cancer Stages has been updated to the 2017 version which is very similar to the 2010 version.  

• The 5-year survival rate for people with stage 0 cervical cancer is about 93%.
• For stage IA cervical cancer, the 5-year survival rate is about 93% For stage IB cancer, the 5-year survival rate is about 80%.
• For stage IIA cervical cancer, the 5-year survival rate is about 63%. For stage IIB cancer, the 5-year survival rate is about 58%.
• The 5-year survival rate for stage IIIA cervical cancer is about 35%. For stage IIIB cancer, the 5-year survival rate is about 32%
• Stage IVA cervical cancer has a 5-year survival rate of about 16%, and stage IVB cancer has a 5-year survival rate of about 15%. Still, there are often treatment options available for women with these stages of cancer.

Remember, these survival rates are only estimates – they can’t predict what will happen to any individual person. We understand that these statistics can be confusing and may lead you to have more questions. Talk to your doctor to better understand your specific situation.

New ways to prevent and treat cancer of the cervix are being researched. Some of the promising new developments include the following:

Sentinel lymph node biopsy (SNLB)

During surgery for cervical cancer, lymph nodes in the pelvis may be removed to check for cancer spread. Instead of removing many lymph nodes, a technique called sentinel lymph node biopsy can be used to target just the few lymph nodes most likely to contain cancer. In this technique a blue dye containing a radioactive tracer is injected into the cancer and allowed to drain into lymph nodes. Then, during surgery, the lymph nodes that contain radiation and the blue dye can be identified and removed. These are the lymph nodes most likely to contain cancer if it has spread. If these lymph nodes don’t contain cancer, the other lymph nodes don’t need to be removed. Removing fewer lymph nodes may lower the risk of later problems, such as lymphedema of the legs.

A clinical trial is looking at a different way of doing a sentinel node biopsy procedure. It maps the lymph nodes using with robotic (laparoscopic) assisted near infrared imaging after injecting indocyanine green (ICG) dye into the cervix.

SLNB is not a standard procedure for cervical cancer at this time. Available studies suggest that SLNB may be helpful in early-stage cervical cancer, but more studies are planned to see if this procedure should routinely become part of the treatment.

Immunotherapy

In cancer, the immune system cannot control the fast growth of tumor cells. Recently, new drugs called immune checkpoint inhibitors have been developed that “reset” the immune system. They have been found to be active in treating a number of types of cancer. Their helpfulness in cervical cancer treatment is not yet known, but clinical trials are underway to find out more. See Cancer Immunotherapy for more information on this type of treatment.

HPV vaccines

Vaccines have been developed to prevent infection with some of the HPV types  that cause associated with cervical cancer. Currently available vaccines are intended to produce immunity to HPV types that cause about 90% of cervical cancers. Studies are being done to see how well these vaccines will reduce the risk of cervical cancer.

Vaccines are also being developed to prevent infection with some of the other HPV types that also cause cancer. Studies are being done to see how well these vaccines will reduce the risk of cervical cancer.

Some experimental vaccines are also being studied for women with established HPV infections, to help their immune systems destroy the virus and cure the infection before a cancer develops.

Still other vaccines are meant to help women who already have advanced cervical cancer. These vaccines attempt to produce an immune reaction to the parts of the virus (E6 and E7 proteins) that make the cervical cancer cells grow abnormally. It is hoped that this immunity will kill the cancer cells or stop them from growing. One such study in advanced cervical cancer showed tumor shrinkage with a vaccine against the E7 protein. 

Targeted therapy

As researchers have learned more about the gene changes in cells that cause cancer, they have been able to develop newer drugs that specifically target these changes. These targeted drugs work differently from standard chemotherapy drugs. They often have different (and less severe) side effects. These drugs may be used alone or with more traditional chemotherapy.

Pazopanib is a type of targeted drug that blocks certain growth factors that help cancer cells grow. It has shown to be helpful in some early studies of patients with advanced cervical cancer. This drug continues to be studied. 

Hyperthermia

Some research indicates that adding hyperthermia to radiation may help keep the cancer from coming back and help patients live longer. Hyperthermia is a treatment that raises the temperature in the area where the tumor is, most often by using radiofrequency antennae placed around the patient.

The first step in finding cervical cancer is often an abnormal Pap test result. This will lead to further tests which can diagnose cervical cancer.

Cervical cancer may also be suspected if you have symptoms like abnormal vaginal bleeding or pain during sex. Your primary doctor or gynecologist often can do the tests needed to diagnose pre-cancers and cancers and may also be able to treat a pre-cancer.

If there is a diagnosis of invasive cancer, your doctor should refer you to a gynecologic oncologist, a doctor who specializes in cancers of women's reproductive systems.

Tests for women with symptoms of cervical cancer or abnormal Pap results

Medical history and physical exam

First, the doctor will ask you about your personal and family medical history. This includes information related to risk factors and symptoms of cervical cancer. A complete physical exam will help evaluate your general state of health. The doctor will do a pelvic exam and may do a Pap test if one has not already been done. In addition, your lymph nodes will be felt for evidence of metastasis (cancer spread). 

The Pap test is a screening test, not a diagnostic test. It cannot tell for certain if you have cervical cancer. An abnormal Pap test result may mean more testing, sometimes including tests to see if a cancer or a pre-cancer is actually present. The tests that are used include colposcopy (with biopsy), endocervical scraping, and cone biopsies. 

Colposcopy

If you have certain symptoms that are suggestive of cancer or if your Pap test result shows abnormal cells, you will need to have a test called colposcopy. You will lie on the exam table as you do with a pelvic exam. A speculum will be placed in the vagina to help the doctor see the cervix. The doctor will use a colposcope to examine the cervix. The colposcope is an instrument that stays outside the body and has magnifying lenses. It lets the doctor see the surface of the cervix closely and clearly. Colposcopy itself is usually no more uncomfortable than any other speculum exam. It can be done safely even if you are pregnant. Like the Pap test, it is better not to do it during your menstrual period.

The doctor will put a weak solution of acetic acid (similar to vinegar) on your cervix to make any abnormal areas easier to see. If an abnormal area is seen, a biopsy (removal of a small piece of tissue) will be done. The tissue is sent to a lab to be looked at under a microscope. A biopsy is the best way to tell for certain if an abnormal area is a pre-cancer, a true cancer, or neither. Although the colposcopy procedure is usually not painful, the cervical biopsy can cause discomfort, cramping, bleeding, or even pain in some women.

Cervical biopsies

Several types of biopsies can be used to diagnose cervical pre-cancers and cancers. If the biopsy can completely remove all of the abnormal tissue, it might be the only treatment needed.

Colposcopic biopsy

For this type of biopsy, first the cervix is examined with a colposcope to find the abnormal areas. Using a biopsy forceps, a small (about 1/8-inch) section of the abnormal area on the surface of the cervix is removed. The biopsy procedure may cause mild cramping, brief pain, and some slight bleeding afterward. A local anesthetic is sometimes used to numb the cervix before the biopsy.

Endocervical curettage (endocervical scraping)

Sometimes the transformation zone (the area at risk for HPV infection and pre-cancer) cannot be seen with the colposcope and something else must be done to check that area for cancer. This means taking a scraping of the endocervix by inserting a narrow instrument (called a curette) into the endocervical canal (the part of the cervix closest to the uterus). The curette is used to scrape the inside of the canal to remove some of the tissue, which is then sent to the laboratory for examination. After this procedure, patients may feel a cramping pain, and they may also have some light bleeding.

Cone biopsy

In this procedure, also known as conization, the doctor removes a cone-shaped piece of tissue from the cervix. The base of the cone is formed by the exocervix (outer part of the cervix), and the point or apex of the cone is from the endocervical canal. The tissue removed in the cone includes the transformation zone (the border between the exocervix and endocervix, where cervical pre-cancers and cancers are most likely to start).

A cone biopsy can also be used as a treatment to completely remove many pre-cancers and some very early cancers. Having had a cone biopsy will not prevent most women from getting pregnant, but if a large amount of tissue has been removed, women may have a higher risk of giving birth prematurely.

The methods commonly used for cone biopsies are the loop electrosurgical excision procedure (LEEP), also called the large loop excision of the transformation zone (LLETZ), and the cold knife cone biopsy.

• Loop electrosurgical procedure (LEEP, LLETZ): In this method, the tissue is removed with a thin wire loop that is heated by electricity and acts as a small knife. For this procedure, a local anesthetic is used, and it can be done in your doctor's office.
• Cold knife cone biopsy: This method is done in a hospital. A surgical scalpel or a laser is used to remove the tissue instead of a heated wire. You will receive anesthesia during the operation (either a general anesthesia, where you are asleep, or a spinal or epidural anesthesia, where an injection into the area around the spinal cord makes you numb below the waist). Having any type of cone biopsy will not prevent most women from getting pregnant, but if a large amount of tissue has been removed, women may have a higher risk of giving birth prematurely.

Pre-cancerous changes in a biopsy are called cervical intraepithelial neoplasia (CIN). Sometimes the term dysplasia is used instead of CIN. CIN is graded on a scale of 1 to 3 based on how much of the cervical tissue looks abnormal when viewed under the microscope.

How biopsy results are reported

• In CIN1, not much of the tissue looks abnormal, and it is considered the least serious cervical pre-cancer (mild dysplasia).
• In CIN2 more of the tissue looks abnormal (moderate dysplasia)
• In CIN3 most of the tissue looks abnormal; CIN3 is the most serious pre-cancer (severe dysplasia) and includes carcinoma in situ).

If a biopsy shows a pre-cancer, doctors will take steps to keep an actual cancer from developing. Treatment of women with abnormal pap results is discussed in Cervical Cancer Prevention and Early Detection
 

Diagnostic tests for women with cervical cancer

If a biopsy shows that cancer is present, your doctor may order certain tests to see how far the cancer has spread. Many of the tests described below are not necessary for every patient. Decisions about using these tests are based on the results of the physical exam and biopsy.

Cystoscopy, proctoscopy, and examination under anesthesia

These are most often done in women who have large tumors. They are not necessary if the cancer is caught early.

In cystoscopy a slender tube with a lens and a light is placed into the bladder through the urethra. This lets the doctor check your bladder and urethra to see if cancer is growing into these areas. Biopsy samples can be removed during cystoscopy for pathologic (microscopic) testing. Cystoscopy can be done under a local anesthetic, but some patients may need general anesthesia. Your doctor will let you know what to expect before and after the procedure.

Proctoscopy is a visual inspection of the rectum through a lighted tube to check for spread of cervical cancer into your rectum.

Your doctor may also do a pelvic exam while you are under anesthesia to find out if the cancer has spread beyond the cervix.

Imaging studies

If your doctor finds that you have cervical cancer, certain imaging studies may be done to look inside the body. These tests can show if and where the cancer has spread, which will help you and your doctor decide on a treatment plan.

Chest x-ray

Your chest may be x-rayed to see if cancer has spread to your lungs. This is very unlikely unless the cancer is far advanced.

Computed tomography (CT)

CT scans are usually done if the tumor is larger or if there is concern about cancer spread. For more information, see CT Scan for Cancer.

Magnetic resonance imaging (MRI)

MRI looks at soft tissue parts of the body sometimes better than other imaging tests. Your doctor will decide which imaging test is best for your situation.

For more information, see MRI for Cancer. 

Intravenous urography

Intravenous urography (also known as intravenous pyelogram, or IVP) is an x-ray of the urinary system taken after a special dye is injected into a vein. This test can find abnormal areas in the urinary tract, caused by the spread of cervical cancer. The most common finding is a blockage of the ureters (tubes that connect the kidneys to the bladder) by the cancer. IVP is rarely used for patients with cervical cancer because CT and MRI are also good at finding abnormal areas in the urinary tract, as well as others not seen with an IVP.

Positron emission tomography (PET scan)

PET scans use glucose (a form of sugar) that contains a radioactive atom. Cancer cells in the body absorb large amounts of the radioactive sugar and a special camera can detect the radioactivity.

This test can help see if the cancer has spread to lymph nodes. PET scans can also be useful if your doctor thinks the cancer has spread but doesn’t know where, because they scan your whole body.

PET scans are often combined with CT scans using a machine that can do both at the same time. The combined PET/CT test is rarely used for patients with early cervical cancer, but may be used to look for more advanced cancer or if radiation treatment is a possibility. For more information on this test, see Nuclear Medicine Scans for Cancer. 

Stage 0 (carcinoma in situ)

Although the AJCC staging system classifies carcinoma in situ (CIS) as the earliest form of cervical cancer, doctors often think of it as a pre-cancer. That is because the cancer cells in CIS are only in the surface layer of the cervix; they have not grown into deeper layers of cells.

All cases of CIS can be cured with the right treatment. However, pre-cancerous changes can sometimes recur (come back) in the cervix or vagina, so it’s very important for your doctor to watch you closely after treatment. This includes follow-up with regular Pap tests and in some instances with colposcopy.

• For information about work-up and treatment of abnormal Pap test results and cervical pre-cancers other than CIS, see Cervical Cancer Prevention and Early Detection.

Stages IIB, III, and IVA

Treatment options:

Chemoradiation: The chemo may be cisplatin or cisplatin plus fluorouracil. The radiation therapy includes both external beam radiation and brachytherapy.

Cancer that comes back after treatment is called recurrent cancer. Cancer can come back locally (in or near where it first started, such as the cervix, uterus or nearby the pelvic organs), or it can come back in distant areas (such as the lungs or bone).

If the cancer has recurred in the pelvis only, extensive surgery (pelvic exenteration) may be an option for some patients. Sometimes radiation, chemo, immunotherapy or targeted therapy may be used to slow the growth of the cancer or help relieve symptoms, but they aren’t expected to cure the cancer.

If chemo is used, you should understand the goals and limitations of this therapy. Sometimes chemo can improve your quality of life, and other times it might diminish it. You need to discuss this with your doctor.

A small number of cervical cancers are found in pregnant women. Most of these (70%) are stage I cancers. The treatment plan during pregnancy is determined by:

• Tumor size
• If nearby lymph nodes have cancer
• How far along the pregnancy is
• The specific type of cervical cancer

If the cancer is at a very early stage, such as carcinoma in situ (Stage 0) or stage IA, most doctors believe it is safe to continue the pregnancy to term and have treatment several weeks after birth. Surgery options after birth for early-stage cancers include a hysterectomy, radical trachelectomy, or a cone biopsy.

If the cancer is stage IB or higher, then you and your doctor must decide whether to continue the pregnancy. If not, treatment would be radical hysterectomy and/or radiation. Sometimes chemotherapy can be given during the pregnancy (in the second or third trimester) to shrink the tumor.

If you decide to continue the pregnancy, the baby should be delivered by cesarean section as soon as it is able to survive outside the womb. More advanced cancers typically need be treated immediately.

The treatment information given here is not official policy of the American Cancer Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor. Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

Women with early cervical cancers and pre-cancers usually have no symptoms. Symptoms often do not begin until the cancer becomes invasive and grows into nearby tissue. When this happens, the most common symptoms are:

• Abnormal vaginal bleeding, such as bleeding after vaginal sex, bleeding after menopause, bleeding and spotting between periods, and having (menstrual) periods that are longer or heavier than usual. Bleeding after douching or after a pelvic exam may also occur.
• An unusual discharge from the vagina − the discharge may contain some blood and may occur between your periods or after menopause.
• Pain during sex.

These signs and symptoms can also be caused by conditions other than cervical cancer. For example, an infection can cause pain or bleeding. Still, if you have any of these symptoms, see a health care professional right away. Ignoring symptoms may allow the cancer to grow to a more advanced stage and lower your chance for effective treatment.

Even better, don't wait for symptoms to appear. Have regular screening tests for cervical cancer.

Many women with cervical cancer will have some type of surgery. Surgery can be used to:

• Help diagnose cervical cancer
• Help determine how far the cancer has spread
• Help treat the cancer (especially for earlier-stage cancers)

Several types of ‘surgery’ can be used to help treat cervical cancer, although some of these destroy cervical tissue (with cold or with a laser) rather than removing it.

Cryosurgery

A very cold metal probe is placed directly on the cervix. This kills the abnormal cells by freezing them. This can be done in a doctor’s office or clinic. After cryosurgery, you may have a lot of watery brown discharge for a few weeks. 

Laser surgery

A focused laser beam, directed through the vagina, is used to vaporize (burn off) abnormal cells or to remove a small piece of tissue for study. This can be done in a doctor’s office or clinic and is done under local anesthesia (numbing medicine).

Conization

A cone-shaped piece of tissue is removed from the cervix. This is done using a surgical or laser knife (cold knife cone biopsy) or using a thin wire heated by electricity (the loop electrosurgical, LEEP or LEETZ procedure). (See  How are cervical cancers and pre-cancers diagnosed? for more information.) After the procedure, the removed tissue is examined with a microscope. If the margins (outer edges) of the tissue contain cancer (or pre-cancer) cells (called positive margins), some cancer (or pre-cancer) may have been left behind, so further treatment is needed.

Simple (total) hysterectomy

This surgery removes the uterus (both the body of the uterus and the cervix) but not the structures next to the uterus (parametria and uterosacral ligaments). The vagina and pelvic lymph nodes are not removed. The ovaries and fallopian tubes are usually left in place unless there is another reason to remove them.

There are different ways to do a hysterectomy:

• Abdominal hysterectomy: The uterus is removed through a surgical incision in the front of the abdomen.
• Vaginal hysterectomy: The uterus is removed through the vagina.
• Laparoscopic hysterectomy: The uterus is removed using laparoscopy (sometimes called ‘keyhole surgery’). A thin tube with a tiny video camera at the end (the laparoscope) is inserted into one or more very small surgical incisions to see inside of the abdomen and pelvis. Small instruments can be controlled through the tube, so the surgeon makes cuts and removes tissue through the tubes without making a large cut in the abdomen.
• Laparoscopic-assisted vaginal hysterectomy: The uterus, ovaries, and fallopian tubes are removed through a vaginal incision using the laparoscope, which makes it easier for the doctor.
• Robotic-assisted surgery: In this approach, the laparoscopy is done with special tools attached to robotic arms that are controlled by the doctor to help perform precise surgery.

General or epidural (regional) anesthesia is used for all of these operations.

For a laparoscopic or vaginal hysterectomy, the hospital stay is usually 1 to 2 days, followed by a 2- to 3-week recovery period. A hospital stay of 3 to 5 days is common for an abdominal hysterectomy, and complete recovery takes about 4 to 6 weeks.

Possible side effects: Any type of hysterectomy results in infertility (inability to have children). Complications are unusual but could include excessive bleeding, wound infection, or damage to the urinary or intestinal systems.

Hysterectomy does not change a woman's ability to feel sexual pleasure. A woman does not need a uterus or cervix to reach orgasm. The area around the clitoris and the lining of the vagina remain as sensitive as before a hysterectomy. More information about managing the sexual side effects of cervical cancer treatment can be found in Sex and the Woman with Cancer.

Radical hysterectomy

For this operation, the surgeon removes the uterus along with the tissues next to the uterus (the parametria and the uterosacral ligaments) and the upper part (about 1 inch) of the vagina next to the cervix. The ovaries and fallopian tubes are not removed unless there is some other medical reason to do so. This surgery is usually done through an abdominal incision. Often, some pelvic lymph nodes are removed as well. (This procedure, known as lymph node dissection, is discussed later in this section.)

A radical hysterectomy can also be done using laparoscopy (keyhole surgery). (See the ‘Simple hysterectomy’ section for a description of laparoscopy.) This can result in less pain and a shorter hospital stay compared to surgery using longer incisions.

• Laparoscopic-assisted radical vaginal hysterectomy is a surgical approach that combines a radical vaginal hysterectomy with a laparoscopic pelvic lymph node dissection.
• The laparoscope can also make it easier to perform a radical hysterectomy through the abdomen. When lymph nodes are removed in this abdominal procedure, this is called laparoscopically assisted radical hysterectomy with lymphadenectomy.
• Robot-assisted laparoscopic surgery is also sometimes used for radical hysterectomies. In this approach, the surgeon sits at a control panel to precisely move robotic arms that hold surgical tools. It results in less blood loss during the operation and possibly a shorter hospital stay than other types of laparoscopic surgery, but it’s not clear if long-term outcomes are any better, and its ultimate role in treatment is still being studied.

More tissue is removed in a radical hysterectomy than in a simple one, so the hospital stay can be longer.

Possible side effects: Because the uterus is removed, this surgery results in infertility. Because some of the nerves to the bladder are removed, some women have problems emptying their bladder after this operation and may need a catheter for a time. Complications are unusual but could include excessive bleeding, wound infection, or damage to the urinary and intestinal systems.

Radical hysterectomy does not change a woman's ability to feel sexual pleasure. Although the vagina is shortened, the area around the clitoris and the lining of the vagina is as sensitive as before. A woman does not need a uterus or cervix to reach orgasm. When cancer has caused pain or bleeding with intercourse, the hysterectomy may actually improve a woman's sex life by stopping these symptoms. More information about managing the sexual side effects of cervical cancer treatment can be found in Sex and the Woman with Cancer.

Trachelectomy

Another procedure, known as a radical trachelectomy, allows women to be treated without losing their ability to have children. The operation is done either through the vagina or the abdomen, and is sometimes done using laparoscopy (keyhole surgery).

This procedure removes the cervix and the upper part of the vagina but not the body of the uterus. The surgeon then places a "purse-string" stitch to act as an artificial opening of the cervix inside the uterine cavity. 

Chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein or given by mouth. These drugs enter the bloodstream and can reach all areas of the body, making this treatment useful for killing cancer cells in most parts of the body. Chemo is often given in cycles, with each period of treatment followed by a recovery period. There are a few situations in which chemo may be recommended for cervical cancer. 

As a part of the main treatment for cervical cancer

For some stages of cervical cancer, the preferred treatment is radiation and chemo given together (called concurrent chemoradiation). The chemo helps the radiation work better. Options for concurrent chemoradiation include:

• Cisplatin given weekly during radiation. This drug is given into a vein (IV) about 4 hours before the radiation appointment.
• Cisplatin plus 5-fluorouracil (5-FU) given every 4 weeks during radiation.

Sometimes chemo is also given (without radiation) before and/or after chemoradiation.

To treat cervical cancer that has spread or come back after treatment

Chemo may be used to treat cancers that have spread to other organs and tissues. It can also be helpful when cancer comes back after treatment with chemoradiation.

The chemo drugs most often used to treat advanced cervical cancer include:

• Cisplatin
• Carboplatin
• Paclitaxel (Taxol^®),
• Topotecan
• Gemcitabine (Gemzar^®)

Combinations of these drugs are often used.

Some other drugs can be used as well, such as docetaxel (Taxotere^®), ifosfamide (Ifex^®), 5-fluorouracil (5-FU), irinotecan (Camptosar^®), and mitomycin.

The targeted drug bevacizumab (Avastin^®) may be added to chemo. This is discussed in the section about targeted therapy.

Side effects of chemotherapy for cervical cancer

Chemo drugs kill cancer cells but also damage some normal cells, which can lead to certain side effects. Side effects depend on the type and dose of the drugs and the length of time you are treated. Common side effects of chemotherapy can include:

• Nausea and vomiting
• Loss of appetite
• Loss of hair
• Mouth sores
• Fatigue (tiredness)

Because chemotherapy can damage the blood-producing cells of the bone marrow, the blood cell counts might become low. This can result in:

• An increased chance of infection (from a shortage of white blood cells)
• Bleeding or bruising after minor cuts or injuries (because of a shortage of blood platelets)
• Shortness of breath (due to low red blood cell counts)

When chemo is given with radiation, the side effects are often more severe. The nausea, fatigue, and problems with low blood counts are often worse. Diarrhea can also be worse if chemo is given at the same time as radiation.

Your health care team will watch for side effects and can give you medicines to help prevent them or treat them to help you feel better. For example, you can be given drugs to help prevent or reduce nausea and vomiting.

Menstrual changes: For younger women who have not had their uterus removed as a part of treatment, changes in menstrual periods are a common side effect of chemo. But even if your periods stop while you are on chemo, you might still be able to get pregnant. Getting pregnant while receiving chemo is not safe, as it could lead to birth defects and interfere with treatment. This is why it’s important that women who are pre-menopausal before treatment and are sexually active discuss with their doctor the options for birth control. Patients who have finished treatment (like chemo) can often go on to have children, but it's important to talk to your doctor about when it is safe to do so.

Premature menopause (not having any more menstrual periods) and infertility (not being able to become pregnant) may occur and may be permanent. Some chemo drugs are more likely to cause this than others. The older a woman is when she gets chemo, the more likely it is that she will become infertile or go through menopause as a result. If this happens, there is an increased risk of bone loss and osteoporosis. Medicines can treat or help prevent problems with bone loss. 

Neuropathy: Some drugs used to treat cervical cancer, including paclitaxel and cisplatin, can damage nerves outside of the brain and spinal cord. The injury can sometimes lead to symptoms like numbness, pain, burning or tingling sensations, sensitivity to cold or heat, or weakness, mainly in the hands and feet. This called peripheral neuropathy. In most cases this gets better or even goes away once treatment is stopped, but it might last a long time in some women.

Increased risk of leukemia: Very rarely, certain chemo drugs can permanently damage the bone marrow, leading to blood cancers like myelodysplastic syndromes or even acute myeloid leukemia. If this is going to happen, it is usually within 10 years after treatment. In most women, the benefits of chemo in treating the cancer are likely to far exceed the risk of this serious but rare complication.

Other side effects are also possible. Some of these are more common with certain chemo drugs. Your cancer care team will tell you about the possible side effects of the specific drugs you are getting.

Many side effects are short-term and go away after treatment is finished, but some can last a long time or even be permanent. It's important to tell your health care team if you have any side effects, as there are often ways to lessen them. For example, you can be given drugs to help prevent or reduce nausea and vomiting.

For more information, please see the Chemotherapy section of our website.

Cancer survivors can be affected by a number of health problems, but often a major concern is facing cancer again. Cancer that comes back after treatment is called a recurrence. But some cancer survivors may develop a new, unrelated cancer later. This is called a second cancer.

Unfortunately, being treated for cervical cancer doesn’t mean you can’t get another cancer. Women who have had cervical cancer can still get the same types of cancers that other women get. In fact, they might be at higher risk for certain types of cancer, including:

• Cancers of the mouth and throat
• Cancer of the larynx (voice box)
• Anal cancer
• Acute myeloid leukemia
• Vulvar cancer
• Vaginal cancer
• Lung cancer
• Cancers of the bladder and ureter
• Stomach cancer
• Colorectal cancer
• Pancreas cancer

Many of these cancers are linked to smoking and/or infection with the human papilloma virus (HPV), which are also strongly linked to cervical cancer.

The increased risks of acute myeloid leukemia (AML) and cancers of the rectum, bladder, and soft tissue seem to be linked to treatment with radiation.

Can I lower my risk of getting a second cancer?

There are steps you can take to lower your risk and stay as healthy as possible. For example, women who have had cervical cancer should do their best to stay away from tobacco products. Smoking might further increase the risk of some of the second cancers that are more common after cervical cancer.

To help maintain good health, cervical cancer survivors should also:

• Get to and stay at a healthy weight
• Keep physically active
• Eat a healthy diet, with an emphasis on plant foods
• Limit alcohol to no more than 1 drink per day

These steps may also lower the risk of some other health problems.

See Second Cancers in Adults for more information about causes of second cancers.

Getting emotional support

Some amount of feeling depressed, anxious, or worried is normal when cervical cancer is a part of your life. Some women are affected more than others. But everyone can benefit from help and support from other people, whether friends and family, religious groups, support groups, professional counselors, or others. Learn more in Coping With  Cancer.

A risk factor is anything that changes your chance of getting a disease such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for many cancers. But having a risk factor, or even several, does not mean that you will get the disease.

Several risk factors increase your chance of developing cervical cancer. Women without any of these risk factors rarely develop cervical cancer. Although these risk factors increase the odds of developing cervical cancer, many women with these risks do not develop this disease. When a woman develops cervical cancer or pre-cancerous changes, it might not be possible to say that a particular risk factor was the cause.

In thinking about risk factors, it helps to focus on those you can change or avoid (like smoking or human papillomavirus infection), rather than those you cannot (such as your age and family history). However, it is still important to know about risk factors that cannot be changed, because it's even more important for women who have these factors to get regular Pap tests to detect cervical cancer early.

Cervical cancer risk factors include:

Human papillomavirus (HPV) infection

Infection by the human papillomavirus (HPV) is the most important risk factor for cervical cancer. HPV is a group of more than 150 related viruses. Some of them cause a type of growth called papillomas, which are more commonly known as warts .

• HPV can infect cells on the surface of the skin, and those lining the genitals, anus, mouth and throat, but not the blood or internal organs such as the heart or lungs.
• HPV can spread from one person to another during skin-to-skin contact. One way HPV spreads is through sexual activity, including vaginal, anal, and even oral sex.
• Different types of HPV cause warts on different parts of the body. Some cause common warts on the hands and feet; others tend to cause warts on the lips or tongue.

Certain types of HPV may cause warts on or around the female and male genital organs and in the anal area. These are called low-risk types of HPV because they are seldom linked to cancer.

Other types of HPV are called high-risk types because they are strongly linked to cancers, including cancer of the cervix, vulva, and vagina in women, penile cancer in men, and cancers of the anus, mouth, and throat in both men and women. 

Infection with HPV is common, and in most people the body can clear the infection by itself. Sometimes, however, the infection does not go away and becomes chronic. Chronic infection, especially when it is caused by certain high-risk HPV types, can eventually cause certain cancers, such as cervical cancer.

Although there is currently no cure for HPV infection, there are ways to treat the warts and abnormal cell growth that HPV causes. 

For more information on about this topic, see our documents Cervical Cancer Prevention and Early Detection and HPV and HPV Testing.

Smoking

When someone smokes, they and those around them are exposed to many cancer-causing chemicals that affect organs other than the lungs. These harmful substances are absorbed through the lungs and carried in the bloodstream throughout the body.

Women who smoke are about twice as likely as non-smokers to get cervical cancer. Tobacco by-products have been found in the cervical mucus of women who smoke. Researchers believe that these substances damage the DNA of cervix cells and may contribute to the development of cervical cancer. Smoking also makes the immune system less effective in fighting HPV infections.

Having a weakened immune system

Human immunodeficiency virus (HIV), the virus that causes AIDS, damages a woman’s immune system and puts them at higher risk for HPV infections.

The immune system is important in destroying cancer cells and slowing their growth and spread. In women with HIV, a cervical pre-cancer might develop into an invasive cancer faster than it normally would.

Another group of women at risk for cervical cancer are those taking drugs to suppress their immune response, such as those being treated for an autoimmune disease (in which the immune system sees the body's own tissues as foreign and attacks them, as it would a germ) or those who have had an organ transplant . 

Chlamydia infection

Chlamydia is a relatively common kind of bacteria that can infect the reproductive system. It is spread by sexual contact. Chlamydia infection can cause pelvic inflammation, leading to infertility.

Some studies have seen a higher risk of cervical cancer in women whose blood tests and cervical mucus showed evidence of past or current chlamydia infection.  Women who are infected with chlamydia often have no symptoms. In fact, they may not know that they are infected at all unless they are tested for chlamydia during a pelvic exam. 

A diet low in fruits and vegetables

Women whose diets don’t include enough fruits and vegetables may be at increased risk for cervical cancer.

Being overweight

Overweight women are more likely to develop adenocarcinoma of the cervix.

Long-term use of oral contraceptives (birth control pills)

There is evidence that taking oral contraceptives (OCs) for a long time increases the risk of cancer of the cervix. Research suggests that the risk of cervical cancer goes up the longer a woman takes OCs, but the risk goes back down again after the OCs are stopped, and returns to normal about 10 years after stopping.

The American Cancer Society believes that a woman and her doctor should discuss whether the benefits of using OCs outweigh the potential risks. 

Intrauterine device ( IUD) use

Some research suggests that women who had ever used an intrauterine device (IUD) had a lower risk of cervical cancer. The effect on risk was seen even in women who had an IUD for less than a year, and the protective effect remained after the IUDs were removed.

Using an IUD might also lower the risk of endometrial (uterine) cancer. However, IUDs do have some risks. A woman interested in using an IUD should first discuss the possible risks and benefits with her doctor. Also, a woman with multiple sexual partners should use condoms to lower her risk of sexually transmitted illnesses no matter what other form of contraception she uses.

Having multiple full-term pregnancies

Women who have had 3 or more full-term pregnancies have an increased risk of developing cervical cancer. No one really knows why this is true. Also, studies have pointed to hormonal changes during pregnancy as possibly making women more susceptible to HPV infection or cancer growth. Another thought is that pregnant women might have weaker immune systems, allowing for HPV infection and cancer growth. 

Being younger than 17 at your first full-term pregnancy

Women who were younger than 17 years when they had their first full-term pregnancy are almost 2 times more likely to get cervical cancer later in life than women who waited to get pregnant until they were 25 years or older. 

Economic status

Many low-income women do not have easy access to adequate health care services, including Pap tests. This means they may not get screened or treated for cervical pre-cancers. 

Diethylstilbestrol (DES)

DES is a hormonal drug that was given to some women between 1940 and 1971 to prevent miscarriage. Women whose mothers took DES (when pregnant with them) develop clear-cell adenocarcinoma of the vagina or cervix more often than would normally be expected. These types of cancer are extremely rare in women who haven’t been exposed to DES. There is about 1 case of vaginal or cervical clear-cell adenocarcinoma in every 1,000 women whose mothers took DES during pregnancy. This means that about 99.9% of "DES daughters" do not develop these cancers.

DES-related clear cell adenocarcinoma is more common in the vagina than the cervix. The risk appears to be greatest in women whose mothers took the drug during their first 16 weeks of pregnancy. The average age of women diagnosed with DES-related clear-cell adenocarcinoma is 19 years. Since the use of DES during pregnancy was stopped by the FDA in 1971, even the youngest DES daughters are older than 40 − past the age of highest risk. Still, there is no age cut-off when these women are felt to be safe from DES-related cancer. Doctors do not know exactly how long these women will remain at risk.

DES daughters may also be at increased risk of developing squamous cell cancers and pre-cancers of the cervix linked to HPV. 

You can learn more in DES Exposure: Questions and Answers. Read it on our website, or call (1-800-227-2345) to have a free copy sent to you.

Having a family history of cervical cancer

Cervical cancer may run in some families . If your mother or sister had cervical cancer, your chances of developing the disease are higher than if no one in the family had it. Some researchers suspect that some instances of this familial tendency are caused by an inherited condition that makes some women less able to fight off HPV infection than others. In other instances, women in the same family as a patient already diagnosed could be more likely to have one or more of the other non-genetic risk factors previously described in this section. 

In recent years, there has been a lot of progress in understanding what happens in cells of the cervix when cancer develops. In addition, several risk factors have been identified that increase the odds that a woman might develop cervical cancer (see What Are the Risk Factors for Cervical Cancer?).

The development of normal human cells mostly depends on the information contained in the cells’ DNA. DNA is the chemical in our cells that makes up our genes, which control how our cells work. We look like our parents because they are the source of our DNA. But DNA affects more than just how we look.

Some genes control when cells grow, divide, and die:· 

• Genes that help cells grow, divide, and stay alive are called oncogenes.
• Genes that help keep cell growth under control or make cells die at the right time are called tumor suppressor genes.

Cancers can be caused by DNA mutations (gene defects) that turn on oncogenes or turn off tumor suppressor genes.

Human papillomaviruses (HPV) cause the production of two proteins known as E6 and E7 which turn off some tumor suppressor genes. This may allow the cervical lining cells to grow too much and to develop changes in additional genes, which in some cases will lead to cancer.

But HPV is not the only cause of cervical cancer. Most women with HPV don’t get cervical cancer, and certain other risk factors, like smoking and HIV infection, influence which women exposed to HPV are more likely to develop cervical cancer.

The most common form of cervical cancer starts with pre-cancerous changes and there are ways to stop this disease from developing. The first way is to find and treat pre-cancers before they become true cancers, and the second is to prevent the pre-cancers.

Finding cervical pre-cancers

A well-proven way to prevent cervical cancer is to have testing (screening) to find pre-cancers before they can turn into invasive cancer. The Pap test (or Pap smear) and the human papillomavirus (HPV) test are used for this. If a pre-cancer is found it can be treated, stopping cervical cancer before it really starts. Most invasive cervical cancers are found in women who have not had regular Pap tests.

The Pap test is a procedure used to collect cells from the cervix so that they can be looked at under a microscope to find cancer and pre-cancer. These cells can also be used for HPV testing. A Pap test can be done during a pelvic exam, but not all pelvic exams include a Pap test.

An HPV test can be done on the same sample of cells collected from the Pap test. 

The most important thing you can do to prevent cervical cancer is to be tested according to American Cancer Society guidelines. These can be found in Cervical Cancer Prevention and Early Detection. Information on treatment if the Pap test results are abnormal is also covered.

Things to do to prevent pre-cancers

There are also some things you can do to prevent pre-cancers, such as:

• Getting an HPV vaccine
• Testing for HPV
• Not smoking
• Condom use

More information about ways to prevent cervical pre-cancer and cancer can be found in  Cervical Cancer Prevention and Early Detection.

You can also find information on preventing HPV infection in HPV Vaccines.

The best way to find cervical cancer early is to have regular screening with a Pap test (which may be combined with a test for human papilloma virus or HPV). As Pap testing became routine in this country, finding pre-invasive lesions (pre-cancers) of the cervix became far more common than finding invasive cancer. Being alert to any signs and symptoms of cervical cancer can also help avoid unnecessary delays in diagnosis. Early detection greatly improves the chances of successful treatment and can prevent any early cervical cell changes from becoming cancerous.

More information about using the Pap test and the HPV test to find cervical cancer early, including the American Cancer Society’s Guidelines for cervical cancer screening can be found in Cervical Cancer Prevention and Early Detection.

For some women with cervical cancer, treatment may remove or destroy the cancer. Completing treatment can be both stressful and exciting. You’ll be relieved to finish treatment, yet it’s hard not to worry about the cancer coming back. This is very common if you’ve had cancer.

For other women, the cancer may never go away completely. These women may get regular treatments with chemotherapy, radiation therapy, or other therapies to try to help keep the cancer in check. Learning to live with cancer that does not go away can be difficult and very stressful.

Life after cervical cancer means returning to some familiar things and also making some new choices.

Ask your doctor for a survivorship care plan

Talk with your doctor about developing a survivorship care plan for you. This plan might include:

• A suggested schedule for follow-up exams and tests
• A schedule for other tests you might need in the future, such as early detection (screening) tests for other types of cancer, or tests to look for long-term health effects from your cancer or its treatment
• A list of possible late- or long-term side effects from your treatment, including what to watch for and when you should contact your doctor
• Diet and physical activity suggestions

Typical follow-up schedules after cervical cancer

Even if you have completed treatment, you will probably have follow-up visits with your doctor for many years. It’s very important to go to all of your follow-up appointments. During these visits, your doctors will ask if you are having any problems and may do exams and lab tests or imaging tests to look for signs of cancer or treatment side effects.

Some treatment side effects might last a long time or might not even show up until years after you have finished treatment. Your doctor visits are a good time to ask questions and talk about any changes or problems you notice or concerns you have.

To some extent, the frequency of follow up visits and tests will depend on the stage of your cancer and the chance of it coming back.

Doctor visits

Your doctor will probably recommend you have a physical exam every 3 to 6 months for the first couple of years after treatment, then every 6 months or so for the next few years. People who were treated for early-stage cancers may need exams less often.

Most doctors recommend that women treated for cervical cancer keep getting regular Pap tests no matter how they were treated (surgery or radiation). Although cells for a Pap test are normally from the cervix, if you no longer have a cervix (because you had a trachelectomy or hysterectomy), the cells will be taken from the upper part of the vagina.

Imaging tests

Whether or not your doctor recommends imaging tests will depend on the stage of your cancer and other factors. CT scans may be done if you have worrisome symptoms of the cancer coming back.

Survivors of cervical cancer should also follow the American Cancer Society guidelines for the early detection of cancer, such as those for breast, lung, and colorectal cancer.

Keeping health insurance and copies of your medical records

Even after treatment, it’s very important to keep health insurance. Tests and doctor visits cost a lot, and even though no one wants to think of their cancer coming back, this could happen.

At some point after your cancer treatment, you might find yourself seeing a new doctor who doesn’t know about your medical history. It’s important to keep copies of your medical records to give your new doctor the details of your diagnosis and treatment. Learn more in Keeping Copies of Important Medical Records.

Can I lower my risk of cervical cancer progressing or coming back?

If you have (or have had) cervical cancer, you probably want to know if there are things you can do that might lower your risk of the cancer growing or coming back, such as exercising, eating a certain type of diet, or taking nutritional supplements. At this time, it’s not yet clear if those things will help.

It is known that smoking is linked to an increased risk of cervical cancer. While it’s not clear if smoking can affect cervical cancer growth or recurrence, it is still helpful to stop smoking to decrease your risk of getting another smoking related cancer (see Can I get another cancer after having cervical cancer?). Not smoking can also help you tolerate chemotherapy and radiation better and decrease further damage to the cells of the cervix or cervical area.

Adopting other healthy behaviors such as eating well, getting regular physical activity, and staying at a healthy weight might help, but no one knows for sure. However, we do know that these types of changes can have positive effects on your health that can extend beyond your risk of cervical cancer or other cancers.

About dietary supplements

So far, no dietary supplements (including vitamins, minerals, and herbal products) have been shown to clearly help lower the risk of cervical cancer progressing or coming back. This doesn’t mean that no supplements will help, but it’s important to know that none have been proven to do so.

Dietary supplements are not regulated like medicines in the United States – they do not have to be proven effective (or even safe) before being sold, although there are limits on what they’re allowed to claim they can do. If you’re thinking about taking any type of nutritional supplement, talk to your health care team. They can help you decide which ones you can use safely while avoiding those that might be harmful.