Cervical cancer is cancer of the cervix, which is the lower part of the uterus that connects to the vagina. According to Nebraska Medicine gynecologic oncologist Lindsey McAlarnen, MD, more than 99% of cervical cancer cases are caused by the human papillomavirus, also known as HPV. HPV is a very common virus that is spread through sexual contact.

The good news is that cervical cancer is one of the most preventable and treatable cancers when it is found early through regular screening.

How is cervical cancer diagnosed?

Cervical cancer is most often found during routine screening, before symptoms begin.

“A cervical cancer screening includes a pelvic exam and a Pap smear,” says Dr. McAlernan. “The Pap smear looks for abnormal cells on the cervix and also tests for HPV. This allows us to find precancer changes early, before cancer develops.”

Pap smears are usually done by a primary care provider or OB-GYN. If abnormal cells or cancer are found, the patient is referred to a gynecologic oncologist, a doctor who specializes in cancers of the female reproductive system.

Some patients are diagnosed after coming to the emergency department or being transferred from another hospital. In these cases, imaging tests or biopsies may lead to a cervical cancer diagnosis. The patient is then connected with a specialist.

The gynecologic oncologist will perform an exam to look more closely at the cervix.

• For early stages, a colposcopy may be done. This procedure uses a special microscope to look closely at the cervix and take small tissue samples (biopsies).

• For more advanced cancer, imaging tests such as an MRI, CT or PET scans may be used to see if the cancer has spread.

Cervical cancer symptoms

Many people with early cervical cancer have no symptoms, which is why screening is so important.

When symptoms do appear, they may include:

• Vaginal bleeding between periods.

• Bleeding after sex.

• Heavier or longer periods.

• Bleeding after menopause.

If the cancer spreads to nearby organs, symptoms may become more serious and include pelvic pain or problems with kidney function.

Anyone with unusual vaginal bleeding should contact their healthcare provider.

Treatment options for cervical cancer

Treatment depends on the stage of cancer and whether it has spread.

Precancer and very early cancer

Precancerous cells and some very early cancers can be treated with small procedures that remove abnormal tissue from the cervix. These are often outpatient procedures, meaning patients go home the same day.

Common procedures include:

• LEEP (loop electrosurgical excision procedure). 

• Cone biopsy (conization). 

These procedures may preserve fertility and part of the cervix.

Early-stage cervical cancer

For larger early cancers, surgery may be needed. This can include a radical hysterectomy, which removes the uterus, cervix and surrounding tissue to ensure all cancer is removed.

Only a small number of patients are candidates for surgery alone, which is why early screening is critical.

Advanced cervical cancer

Most cervical cancers are treated with a combination of radiation therapy and chemotherapy.

Chemotherapy is usually given once a week for about five weeks to help radiation work better. Radiation therapy is typically given five days a week for five to six weeks. Some patients also receive internal radiation, called brachytherapy.

After completing treatment, some patients may receive newer therapies, including targeted therapy or immunotherapy. These treatments help keep the cancer under control by prompting the immune system to fight the cancer.

Why screening and prevention matter

Precancer and early cervical cancer are highly treatable and often curable. In stage one cervical cancer, the five-year survival rate is 80% or higher.

When cancer spreads to other organs, treatment becomes more difficult. In stage four cervical cancer, the five-year survival rate drops to 16% or less.

“Once cervical cancer has spread, it cannot be cured,” says Dr. McAlarnen. “That’s why screening and prevention are so important.”

HPV vaccination

The HPV vaccine is the only vaccine that can prevent cancer. It protects against HPV types that cause most cervical cancers. 

• Recommended for both males and females.

• Can be started as early as age 9.

• Target age is 11–12.

• Approved by the FDA up to age 45.

• Given as a series of two or three shots.

Adults who were not vaccinated when younger may still benefit from the vaccine.

“I strongly encourage patients of all ages to talk with their provider about the HPV vaccine,” says Dr. McAlarnen. “It can prevent most HPV-related cancers.”