Overview
Cervical cancer develops in the cervix, the lower part of the womb. Almost all cases are caused by long-lasting infection with certain types of human papillomavirus, a very common virus that most people clear on their own.
WHO states that progression from persistent infection to cancer typically takes 15 to 20 years, which is a long window in which the changes can be found and treated. This is why cervical cancer is one of the most preventable cancers there is, and why WHO has set a global strategy to eliminate it.
Disease Summary
- Category
- Non-Communicable Disease
- Cause
- Persistent infection with high-risk human papillomavirus
- Transmission
- Not transmissible. The virus that causes it is sexually transmitted
- Body System
- Reproductive System
- Preventable
- Yes
- Curable
- Yes
Symptoms
Common Symptoms
Early cervical cancer and the precancerous changes that come before it usually cause no symptoms at all. This is why screening exists.
No Symptoms in the Early Stages
Precancerous changes and early cancer cause nothing at all. They are found by screening, not by symptoms.
Bleeding Between Periods
Unexpected bleeding is the commonest symptom that leads women to seek care.
Bleeding After Sex
This should always be checked, even though it usually has a harmless explanation.
Bleeding After the Menopause
Any bleeding after periods have stopped needs assessment.
Unusual Vaginal Discharge
Discharge that is persistent, watery, blood-stained or foul-smelling deserves review.
Pelvic Pain or Pain During Sex
Persistent pelvic pain is a later symptom and should not be waited out.
Heavier or Longer Periods Than Usual
A change in the usual pattern that persists is worth checking.
Back or Leg Pain and Swelling
These are symptoms of more advanced disease and need urgent assessment.
Danger Signs
Seek urgent medical attention immediately if any of the following symptoms develop.
Heavy Vaginal Bleeding
Bleeding that is soaking through protection needs emergency assessment.
Bleeding After the Menopause
This always requires investigation, whatever the eventual cause turns out to be.
Persistent Pelvic, Back or Leg Pain
Particularly with leg swelling, which suggests the disease may have spread.
Difficulty or Pain Passing Urine, or Blood in the Urine
These can indicate spread to nearby structures and need prompt assessment.
Unexplained Weight Loss and Fatigue
These general symptoms alongside any of the above need urgent review.
Diagnosis
Screening Before Symptoms Appear
WHO recommends testing for the virus as the preferred screening method, because it finds the changes that lead to cancer years before they become cancer.
Examination of the Cervix
A speculum examination allows the cervix to be seen and a sample to be taken. WHO notes that self-collected samples can be used for virus testing.
Colposcopy
A closer look at the cervix with a magnifying instrument, done when a screening test is abnormal.
Biopsy
A small sample of tissue is taken and examined. This is what confirms whether cancer is present and what type it is.
Staging Investigations
Scans establish whether and how far the cancer has spread, which determines the treatment plan.
Laboratory Tests
HPV DNA Test
WHO states this is the preferred screening method. It detects the virus types that cause cervical cancer, years before any cancer develops.
Cervical Cytology, the Pap Test
Looks at the cells themselves for abnormal changes. Still widely used and still effective where virus testing is not available.
Visual Inspection With Acetic Acid
A low-cost method used where laboratory testing is not available, allowing screening and treatment in a single visit.
Biopsy and Histology
The test that confirms the diagnosis and establishes exactly what is present.
HIV Test
WHO reports that women living with HIV are six times more likely to develop cervical cancer, and recommends earlier and more frequent screening for them.
Treatment
Treatment of Precancerous Changes
Changes found by screening are removed or destroyed before they become cancer, using methods such as thermal ablation, freezing or removing a small piece of the cervix. This is where most of the benefit of screening lies.
Surgery
For early cancer, surgery may remove the cancer alone or the womb as well, depending on the stage and on whether future pregnancy is a consideration.
Radiotherapy
Uses high-energy rays to destroy the cancer. It is a mainstay of treatment for cervical cancer, often combined with chemotherapy.
Chemotherapy
Medicines that shrink or kill the cancer, used alongside radiotherapy or for more advanced disease.
Palliative Care
WHO lists palliative care and pain management as part of cervical cancer services. It runs alongside treatment rather than replacing it.
Prevention
HPV vaccination for girls aged 9 to 14
WHO states the vaccine is highly effective at preventing infection, cervical cancer and other cancers caused by the virus. It works best before any exposure to the virus.
Screening from age 30
WHO recommends screening every 5 to 10 years from age 30 for the general population, using testing for the virus.
Earlier screening for women living with HIV
WHO recommends starting at age 25 and screening every 3 to 5 years, because the risk is six times higher and progression can be faster.
Treatment of precancerous changes when found
Finding changes is only half of screening. Treating them is what prevents the cancer.
Not smoking, or stopping
WHO lists being a non-smoker or stopping smoking among the measures that reduce cervical cancer risk.
Condom use
WHO lists condoms among preventive measures, while noting that the virus can affect areas a condom does not cover, so protection is partial.
Risk Factors
Women Who Are Not Screened
The single largest risk factor is never having been screened.
- Women over 30 who have never had a screening test
- Women in areas where screening services are not available
- WHO states the highest rates are in low- and middle-income countries, reflecting lack of access rather than biology
- WHO reports that nearly 94% of deaths in 2022 occurred in low- and middle-income countries
Women Living With HIV
WHO states women living with HIV are six times more likely to develop cervical cancer.
- Progression from infection to cancer can take 5 to 10 years rather than 15 to 20
- WHO recommends screening from age 25 rather than 30
- WHO recommends screening every 3 to 5 years rather than every 5 to 10
- WHO attributes around 5% of all cervical cancer cases to HIV
Unvaccinated Girls and Young Women
The vaccine prevents the infection that causes almost all cervical cancer.
- Girls who missed vaccination at ages 9 to 14
- Communities where the vaccine has not been introduced
- Young women already exposed to the virus, for whom the vaccine gives less benefit
- Vaccination does not remove the need for screening later
Women Who Smoke
Smoking is a recognised risk factor that can be changed.
- Smoking raises the risk of the virus persisting rather than clearing
- WHO lists stopping smoking among the measures that reduce risk
- The benefit applies whatever a woman’s vaccination or screening history
- Smoking also worsens outcomes from treatment
Complications
Bleeding
Advanced cancer can cause heavy bleeding that requires urgent treatment.
Blockage of the Kidneys
Spread of the cancer can obstruct the tubes draining the kidneys, which requires prompt intervention.
Pain
Pain from advanced disease is treatable, and WHO includes pain management explicitly within cervical cancer services.
Effects of Treatment on Fertility
Some treatments end the possibility of pregnancy, which is why this is discussed before treatment begins where there is a choice.
Spread to Other Organs
Advanced cancer can spread to the bladder, bowel, lungs and bones.
Emotional and Psychological Impact
A cancer diagnosis affects mental health, relationships and work. Support for this is part of proper care.
When to Seek Medical Care
Any Bleeding Between Periods, After Sex or After the Menopause
This is the symptom most likely to lead to an early diagnosis.
For Routine Screening, With No Symptoms at All
This is the most important reason to attend, because screening finds changes before they become cancer.
Persistent Unusual Vaginal Discharge
Particularly if it is watery, blood-stained or foul-smelling.
Persistent Pelvic Pain or Pain During Sex
These should not be attributed to something else without assessment.
Earlier and More Often If You Are Living With HIV
WHO recommends screening from age 25, every 3 to 5 years.
Prognosis
Precancerous Changes Are Almost Always Curable
Treatment of changes found by screening prevents cancer developing at all. This is where screening earns its value.
Early Cancer Has a Good Outlook
Cervical cancer found early is treatable with a high chance of cure.
Survival Is Much Worse Where Services Are Lacking
WHO states that the highest incidence and mortality are in low- and middle-income countries, reflecting inequity in access to vaccination, screening and treatment rather than any difference in the disease.
There Is a Long Window to Act
WHO states progression from persistent infection to cancer typically takes 15 to 20 years, which is what makes this cancer so preventable.
Differential Diagnosis
Cervical Infection or Inflammation
Causes discharge and bleeding after sex, and is far more common. It is separated by examination and testing.
Fibroids and Polyps
Cause heavy or irregular bleeding, and are identified by examination and ultrasound.
Cancer of the Womb Lining
Also causes bleeding after the menopause, and is separated by sampling the lining of the womb.
Hormonal Causes of Irregular Bleeding
Contraception and the years around the menopause both cause irregular bleeding, but this is a diagnosis made after other causes are excluded.
Other Causes of Pelvic Pain
Endometriosis, ovarian problems and pelvic infection all cause pelvic pain and need distinguishing.
References
World Health Organization: Cervical cancer
WHO fact sheet on causes, symptoms, screening, treatment and global burden.
World Health Organization: Cervical cancer elimination initiative
WHO’s global strategy, its targets for vaccination, screening and treatment, and the inequity it addresses.
CDC: Screening for Cervical Cancer
What screening involves, at what ages and how often.
CDC: Reducing Risk for Cervical Cancer
HPV vaccination, screening and the other measures that lower risk.
Frequently Asked Questions
What causes cervical cancer?
Almost all cases are caused by long-lasting infection with certain high-risk types of human papillomavirus. This virus is very common and most people clear it without ever knowing. WHO states that progression from persistent infection to cancer typically takes 15 to 20 years.
If I had the HPV vaccine, do I still need screening?
Yes. The vaccine protects against the virus types that cause most cervical cancer, but not all of them, and it does not help with an infection already present. WHO recommends screening for all women from age 30, whatever their vaccination history.
How often should I be screened?
WHO recommends screening every 5 to 10 years from age 30 for the general population using a test for the virus, and every 3 to 5 years from age 25 for women living with HIV. National programmes differ, so follow the one where you live.
Does an abnormal screening result mean I have cancer?
Almost always no. Most abnormal results reflect changes that can be treated before they ever become cancer, which is the entire purpose of screening. You will usually be offered a closer examination of the cervix to see what is there.
Can I collect the screening sample myself?
For testing for the virus, often yes. WHO states that self-collected samples can be used for HPV DNA testing and notes that women often feel more comfortable taking their own sample. Ask what is available in your area.