Cervical cancer: symptoms, signs, causes and treatment options

Medically reviewed: 1, February 2024

Cervical Cancer: Most comprehensive guide

The treatments for cervical cancer vary according to the severity and stage of the cancer. If detected in its early stages, treatment is more minimal and less invasive than it is for cancer that has progressed and penetrated deeper into the walls of the cervix.

Knowing the symptoms of cervical cancer and receiving annual exams are two means of preventing this disease from going beyond the more easily treated stages.

Symptoms of Cervical Cancer

When cervical cancer is in its early stages, there are often no symptoms present, making the need for annual pelvic exams and Pap tests so important.

Symptoms you may experience once the disease begins to progress into more severe stages include vaginal bleeding between menstrual cycles or after intercourse, pelvic pain during or after intercourse, or the appearance of a bloody vaginal discharge that has a watery consistency and foul odor.

Cervical cancer is type of cancer that affects the cervix. According to the California Department of Health Services, 85 percent of women will live five years or more if cervical cancer is found before it spreads to other areas outside of the uterus. The best method to find cervical cancer in the early stage is by recognizing the signs and having yearly pap smears.

Unusual Discharge

Discharge is a substance that is naturally expelled from the vagina. A discharge that has a yellow or green color, produces a foul odor or has a unique texture (a “cottage cheese” appearance) should be reported. Although unusual discharge can be related to other problems such as a yeast infection, it may be a sign of cervical cancer.

Bleeding

Bleeding between menstrual periods and during/after sexual intercourse is not normal. Bleeding like this is often caused by irritation to the vaginal wall, cervix or uterus. Irritation can be from a number of factors such as minor infections or small abrasions. It can also be from more major issues such as cervical cancer.

Painful Intercourse

Pain during sexual intercourse is considered not normal for most women. Although this is considered a sign of cervical cancer, it can also be caused by minor issues such as vaginal dryness or a yeast infection.

10 stages of cervical cancer

The cervix is situated in the lower region of the uterus, serving as a crucial anatomical structure that connects the uterus to the vaginal canal. Human papillomavirus, or HPV, causes cervical cancer. Regular Pap tests and pelvic exams can help in the treatment and management of HPV prior to the development of cancer. A vaccine is currently available for younger women to protect against four types of HPV.

Cervical cancer staging begins with stage 0, which includes abnormal cells in the inner lining of the cervix that may become cancerous.

Stages I through IV include the presence of cancer and are divided into subcategories for each stage.

Cervical cancer: Stage IA1

According to the National Cancer Institute, stage IA1 has a small amount of cancer in the cervix that can be seen only under a microscope. It is usually no more than 3 mm deep and no more than 7 mm wide.

Stage IA2

Similar to stage IA1, stage IA2 can only be seen under a microscope and is a tumor between 3 and 5 mm deep and not greater than 7 mm wide.

Stage IB

According to the National Cancer Institute, stage IB cancer is confined to the cervix and can only be seen with a microscope, and the tumor is more than 5 mm deep and 7 mm wide.

The classification of cervical cancer involves two distinct stages, namely IB1 and IB2. In the case of stage IB1 cervical cancer, the tumor size does not exceed 4 cm and is visible to the naked eye, eliminating the need for microscopic examination.

Stage IB2

According to the National Cancer Institute, the tumor in the cervix is more than 4 cm and can be seen without a microscope.

Stage IIA

Stage IIA cervical cancer, according to the National Cancer Institute, has spread past the cervix but not yet to the pelvic wall area or the lower part of the vagina. Stage IIA has spread to the upper two-thirds of the vagina, but not yet to the tissues around the uterus.

Stage IIB

According to the National Cancer Institute, stage IIB is characterized by the cancer spreading past the cervix to the upper two-thirds of the vagina and also to other tissues around the uterus.

Stage IIIA

In stage IIIA, the cancer has spread past the cervix and the upper two-thirds of the vagina and the uterine tissue to the lower third of the vagina. During stage IIIA, it has not yet moved to the pelvic wall.

Stage IVA

In stage IVA, the cancer may have spread to the bladder, rectum and lymph nodes. This is in addition to its presence in the cervix and uterus.

Stage IVB

According to the National Cancer Institute, in stage IVB, the cancer has moved past the pelvic lymph nodes and may be present in the abdomen, liver, intestinal track or lungs.

Coping with cervical cancer during pregnancy

Turn to a Medical Team

Women who receive the diagnosis of cervical cancer during pregnancy are faced with a series of difficult decisions that can only be made on an individual basis with a support team. A decision to delay treatment rests on the stage of pregnancy, the stage of cancer, age, family input and personal beliefs.

When this diagnosis occurs, you will get information from a team of doctors and professionals. This team could include your obstetrician, cancer specialist, surgeon and pathologist. An experienced counselor can help you with the emotional aspects of your treatment.

A social worker can organize your course of treatment. The emotional turmoil of this diagnosis means you will probably want a loved one or cancer advocate beside you at times. Some hospitals will help you connect with an advocate.

Review Early Stage Options

The National Cancer Institute (NCI) explains that if a cervical cancer diagnosis is made, then a series of tests are done to discover if the cancer has spread and to determine the disease stage. Certain diagnostic tests may be chosen because they are safer for the fetus.

If cancer is diagnosed in its early stages, a “cone” of cancerous tissue can be removed from the cervix through a surgical procedure called a cone biopsy. This procedure does carry a risk of miscarriage though. The Institute explains that treatment is often delayed until birth for cervical cancer found in its early stages. It might also be delayed if the cancer is diagnosed during the last trimester.

If a diagnosis occurs when delivery is near, a Cesarean section may be recommended. Then, early stage cancerous tissue can be destroyed with techniques, such as laser therapy, that do not harm uterus or cervix.

Weigh Actions for Advanced Stages

If advanced cancer is diagnosed during the first trimester, a woman must be prepared for a medical recommendation of ending the pregnancy so treatment can begin quickly.

This is an extremely difficult decision to be discussed with loved ones. If you receive an advanced diagnosis in the second or third trimester, your doctor may recommend an early Cesarean section, in conjunction with a hysterectomy, the surgical removal of the uterus.

If a radical hysterectomy is performed, the uterus, cervix, and part of the vagina will be removed. Internal radiation therapy is another form of treatment for cervical cancer. According to the NCI, this therapy places sealed radioactive material into or near a tumor. A combination of surgery, radiation therapy and chemotherapy is sometimes required to battle this disease.

Understand Precancerous Conditions

Remember, an abnormal pap smear does not mean a cancer diagnosis. A doctor may delay treatment for “precancerous” conditions until your baby is born, since cervical cancer can be a slow-growing disease. Any abnormalities can be monitored until delivery.

For women of child-bearing age, even a potential diagnosis of cervical cancer is overwhelming. Should the diagnosis be confirmed, turn to your local, non-profit cancer organization for additional support.

Cervical cancer: Noninvasive Cancer Treatments

The best-case scenario for women who are diagnosed with cervical cancer is to discover they have a noninvasive form of the disease. This means the cancerous cells are localized to the outer area of the cervix, requiring a simpler treatment to remove the cells.

Among these treatments are a cone biopsy, laser surgery, cryosurgery and hysterectomy.

• During a cone biopsy, the doctor removes a cone-shaped piece of tissue from the cervix where the cell abnormality is located.
• Laser surgery involves using intense laser light beams to kill both cancerous and precancerous cells.
• Cryosurgery freezes and kills both cancerous and precancerous cells.
• Finally, a hysterectomy is considered major surgery and is performed only in certain cases. During this procedure, the doctor removes the area containing the cancerous and precancerous cells, along with the cervix and uterus.

In most cases, women whose cell abnormalities are confined outside of the cervix need to only undergo one of the aforementioned procedures. It is generally not necessary to follow up with any additional treatment, only regular exams to ensure the cancer has not returned.

Radical Hysterectomy as a cervical cancer treatment

This procedure is performed when the cancer has spread, or invaded, the outer layers of the cervix wall–typically 3 mm into the cervix. Unlike the simple hysterectomy performed for noninvasive cervical cancer, which usually cures this disease in its early stages, a radical hysterectomy involves the removal of the cervix, uterus, surrounding lymph nodes and part of the vagina.

A six-week recovery time is average, and most women experience temporary problems with urination and bowel movements, along with pelvic pain.

Surgery is used for both noninvasive and invasive cervical cancer. Noninvasive is any cancer located and confined outside of the cervix, while invasive cervical cancer has penetrated the inner layer of the cervical wall.

The most common noninvasive surgeries include cryosurgery, which freezes the cancerous cells using liquid nitrogen; laser surgery, a procedure that vaporizes or burns the cancer cells using high energy laser beams, and loop electrosurgical excision procedure (LEEP), which passes an electric current through a wire loop to cut away the cancerous tissue from the opening of the cervix.

A hysterectomy might also be recommended, and can be either simple or radical, depending on the stage. If detected early enough, a simple hysterectomy may be all that’s needed.

During this, the uterus and cervix are removed. Once the cancer has penetrated deeper into the cervix, however, a radical hysterectomy is required. This involves the removal of the uterus, cervix, surrounding lymph nodes and part of the vagina.

Radiation Therapy

In cases of invasive cervical cancer, radiation therapy is typically used in conjunction with surgery to ensure the destruction of any stray cancer cells, thus decreasing the odds of recurrence. For cervical cancer, external or internal radiation may be utilized.

External beam delivers low doses of radiation via a machine placed outside of the body. The process is similar to undergoing X-rays and sessions typically last for a period of 6 to 7 weeks. The most common side effects associated with external beam include nausea, diarrhea and skin that appears to be sunburned at the site of administration.

Internal beam delivers high doses of radiation directly into the tumor or nearby areas via plastic tubes containing radioactive seeds, or through thin needles that are placed directly into the tumor.

This type of therapy lasts approximately 7 to 10 days, and is administered on an outpatient basis. The radioactive material is inserted and removed the same day.

The most common side effects include pelvic discomfort and painful intercourse.

Radiation therapy is another treatment used for invasive cervical cancer and can be administered one of two ways–externally or internally.

When given externally, high-powered energy beams are directed at the site of the cancer using a machine located outside of the body. When administered internally, also known as brachytherapy, devices containing radioactive seeds are implanted close to the cervix and are activated using a radiation machine.

If the cervical cancer is in its early stages, radiation therapy may be effective by itself. For more advanced cases, it may be used in conjunction with chemotherapy to ensure any remaining cancer cells are destroyed, thus reducing the risk of recurrence.

The most common side effects of radiation therapy include nausea, bladder irritation, upset stomach and a narrowing of the vagina that makes sexual intercourse painful.

Chemotherapy for cervical cancer

Chemotherapy may also be used when radiation is not, or a variety of other chemotherapy drugs may be used to help destroy cancer cells that have spread throughout the body.

Chemotherapy drugs are typically administered through an intravenous line or taken as an oral tablet. Because of the means of administration, the drug travels through your bloodstream, destroying not only the cancer cells, but your healthy cells as well. This results in temporary, yet unpleasant side effects such as nausea, vomiting, fatigue and hair loss.

Chemotherapy involves the use of some very powerful anti-cancer drugs to destroy any cancer cells that may remain in the body. In some cases, more than one type of cancer drug may be used to ensure the best possible outcome. When used in combination with radiation, the most frequently used chemotherapy drug is cisplatin.

While chemotherapy is an effective means of treating cancer, the drugs travel through the bloodstream to reach the cancer cells. Unfortunately, they destroy healthy cells along with the cancer cells, which results in some unpleasant side effects. These include diarrhea, fatigue, nausea and temporary hair loss. In some cases, infertility may also occur.