What causes cervical cancer?

Over 99% of cervical cancers are caused by persistent infection with high-risk types of human papillomavirus (HPV), primarily HPV types 16 and 18. HPV is an extremely common sexually transmitted infection, but most HPV infections clear on their own. Only persistent infections with high-risk HPV types can lead to precancerous changes and eventually cervical cancer over many years.

Can cervical cancer be prevented?

Yes. Cervical cancer is one of the most preventable cancers. HPV vaccination (such as Gardasil 9) prevents infection with the HPV types that cause most cervical cancers. Regular screening with Pap smears and HPV tests can detect precancerous changes before they become cancer. The WHO has launched a global strategy to eliminate cervical cancer as a public health problem through vaccination, screening, and treatment.

What are the stages of cervical cancer?

Cervical cancer is staged using the FIGO system. Stage I means the cancer is confined to the cervix. Stage II means it has spread beyond the cervix but not to the pelvic wall or lower third of the vagina. Stage III means it extends to the pelvic wall, lower vagina, or causes kidney problems. Stage IV means it has spread to the bladder, rectum, or distant organs. Each stage has substages that provide more detail about the extent of the disease.

What are the symptoms of cervical cancer?

Early cervical cancer often has no symptoms, which is why screening is critical. When symptoms do appear, they may include abnormal vaginal bleeding (between periods, after sexual intercourse, or after menopause), unusual vaginal discharge (watery, bloody, or foul-smelling), pelvic pain, and pain during sexual intercourse. Advanced cervical cancer may cause leg swelling, kidney problems, or bone pain.

Cervical Cancer — Comprehensive Guide

Not medical advice. StopMyCancer is an educational resource. It does not diagnose, predict outcomes, or replace your care team. If you experience severe symptoms — sudden pain, difficulty breathing, high fever, or bleeding — seek emergency medical care immediately.

New Cases Per Year

Approximately 660,000 new cervical cancer cases are diagnosed globally each year, with around 350,000 deaths. It is the fourth most common cancer in women worldwide.^[1,2]

Caused by HPV

Over 99% of cervical cancers are linked to persistent infection with high-risk human papillomavirus (HPV). HPV types 16 and 18 alone account for about 70% of all cases.^[3,6]

Highly Preventable

With HPV vaccination and regular screening, cervical cancer is one of the most preventable cancers. The WHO has launched a global strategy to eliminate it as a public health problem.^[1]

Cervical cancer develops from the cells of the cervix — the lower, narrow part of the uterus (womb) that connects to the vagina. The cervix is lined by two types of cells: squamous cells (on the outer surface, called the ectocervix) and glandular cells (lining the cervical canal, called the endocervix). The area where these two cell types meet is called the transformation zone, and this is where most cervical cancers begin.^[3]

Cervical cancer does not develop suddenly. It typically progresses through a series of precancerous changes over many years. These changes — known as cervical intraepithelial neoplasia (CIN) or squamous intraepithelial lesions (SIL) — can be detected through screening and treated before they become invasive cancer. This is why regular screening is so powerful: it can catch the disease at a stage when it is fully treatable and often curable.^[3,4]

The HPV Connection

Nearly all cervical cancers are caused by persistent infection with certain types of human papillomavirus (HPV). HPV is a group of more than 200 related viruses, of which about 14 are classified as "high-risk" types that can cause cancer. HPV is the most common sexually transmitted infection in the world — most sexually active people will be exposed to it at some point in their lives. In the vast majority of cases, the immune system clears the infection within one to two years. However, when a high-risk HPV infection persists, it can cause normal cervical cells to develop abnormal changes that, left untreated over 15 to 20 years, may progress to cancer.^[2,6]

This long progression window is precisely what makes cervical cancer so preventable — there is ample time for detection and intervention through screening and vaccination.

HPV Types 16 & 18

Of the 14 high-risk HPV types, HPV 16 and HPV 18 are responsible for approximately 70% of all cervical cancers worldwide. HPV 16 is the single most carcinogenic type, associated with both squamous cell carcinomas and adenocarcinomas. Other high-risk types (including HPV 31, 33, 45, 52, and 58) account for an additional 20% of cases. The current 9-valent vaccine (Gardasil 9) protects against all of these types.^[3,6]

HPV Vaccination (Gardasil 9)

HPV vaccines are highly effective at preventing infection with the HPV types they target. Gardasil 9, the most widely used vaccine, protects against nine HPV types: 6, 11, 16, 18, 31, 33, 45, 52, and 58. It has been shown to prevent over 90% of HPV-related cervical cancers when given before exposure to the virus.^[3,4]

Who Should Get Vaccinated?

Boys and girls ages 9-14: Routine vaccination is recommended, ideally before any sexual activity begins. At this age, two doses are typically sufficient.

Ages 15-26: Catch-up vaccination is recommended for those not previously vaccinated. Three doses are given at this age.

Ages 27-45: Shared clinical decision-making is recommended — some adults in this range may benefit if not previously vaccinated, depending on individual risk factors.

Both sexes: Vaccinating boys as well as girls reduces HPV transmission in the population and protects against HPV-related cancers in all genders.

Screening: Pap Smear & HPV Test

Cervical screening is the process of looking for precancerous changes or HPV infection in women who have no symptoms. Two main tests are used:^[3,4]

Pap test (Pap smear): Collects cells from the cervix to be examined under a microscope for abnormal changes. This test has been used for decades and has dramatically reduced cervical cancer rates in countries with screening programs.

HPV test: Detects the presence of high-risk HPV DNA in cervical cells. The WHO now recommends HPV testing as the preferred primary screening method because of its higher sensitivity.

Screening Guidelines by Age (General U.S. Recommendations)

Under 21: No screening recommended (regardless of sexual activity).

Ages 21-29: Pap test every 3 years.

Ages 30-65: Pap test every 3 years, HPV test every 5 years, or co-testing (Pap + HPV) every 5 years.

Over 65: May stop screening if adequate prior negative tests and no history of CIN2 or higher.

Note: Guidelines vary by country and organization. Women with HIV, immunosuppression, or a history of cervical abnormalities may need more frequent screening. Always discuss your personal screening schedule with your healthcare provider.

~70% of cases

Squamous Cell Carcinoma

The most common type. Arises from the thin, flat squamous cells lining the outer part of the cervix (ectocervix). Most of these cancers begin in the transformation zone where squamous cells meet glandular cells. Strongly linked to HPV 16.^[3,6]

~25% of cases

Adenocarcinoma

Develops from the mucus-producing glandular cells of the endocervical canal. The incidence of adenocarcinoma has been increasing in recent decades, particularly in younger women. It is associated with HPV 18 and can be more difficult to detect with Pap tests because it originates higher in the cervical canal.^[3,6]

Uncommon

Adenosquamous Carcinoma

A mixed type that has features of both squamous cell carcinoma and adenocarcinoma. It accounts for a small percentage of cervical cancers and is treated similarly to other cervical cancers based on stage.^[4]

Rare

Small Cell Carcinoma

A rare and aggressive neuroendocrine tumor of the cervix. Small cell cervical carcinoma tends to grow and spread quickly and is treated with an approach similar to small cell lung cancer, typically involving chemotherapy and radiation. It requires specialized oncological care.^[4]

Persistent HPV infection: The most significant risk factor. Persistent infection with high-risk HPV types (especially 16 and 18) is the necessary precursor for nearly all cervical cancers.^[3,6]

Smoking: Women who smoke are approximately twice as likely to develop cervical cancer as non-smokers. Tobacco byproducts have been found in cervical mucus and may damage the DNA of cervical cells, making them more vulnerable to HPV-driven changes.^[3]

Weakened immune system: Women with HIV/AIDS or those taking immunosuppressive medications (such as organ transplant recipients) have a higher risk because their immune system is less able to clear HPV infections.^[3,4]

Long-term oral contraceptive use: Using oral contraceptives for five or more years has been associated with a modestly increased risk of cervical cancer, though the risk decreases after stopping. The mechanism is not fully understood.^[6]

Multiple full-term pregnancies: Women who have had three or more full-term pregnancies may have a slightly increased risk, possibly related to hormonal changes and immune modulation during pregnancy.^[3]

Early sexual activity: Beginning sexual activity at a young age increases the duration of potential HPV exposure and the likelihood of encountering high-risk HPV types.^[3]

Lack of screening access: Women who have never been screened or who have not been screened regularly are at significantly higher risk. Approximately 90% of cervical cancer deaths occur in low- and middle-income countries where screening infrastructure is limited.^[1,7]

When symptoms do occur, they may include:

Abnormal vaginal bleeding: Bleeding between menstrual periods, after sexual intercourse, or after menopause. This is the most common symptom of cervical cancer.

Unusual vaginal discharge: A watery, bloody, or foul-smelling discharge that is different from your normal discharge.

Pelvic pain: Pain in the lower abdomen or pelvis that is not related to menstruation or other known causes.

Pain during sexual intercourse: Discomfort or pain during sex (dyspareunia) that was not previously experienced.

Advanced symptoms may include leg swelling (from lymph node involvement), back or leg pain, fatigue, weight loss, and problems with urination or bowel movements. These may indicate the cancer has spread beyond the cervix.^[3,4]

Screening Tests

Pap test (Pap smear): A sample of cells is gently scraped from the cervix and examined under a microscope to look for abnormal cells. Abnormal results trigger further investigation.

HPV test: Tests for the DNA or RNA of high-risk HPV types in cervical cells. A positive result with a high-risk type, especially HPV 16 or 18, may lead directly to colposcopy.

Diagnostic Procedures

Colposcopy: If screening results are abnormal, a colposcopy is performed. A magnifying instrument (colposcope) is used to closely examine the cervix. Acetic acid (vinegar) is applied to the cervix, which turns abnormal areas white, making them easier to identify and biopsy.

Punch biopsy: During colposcopy, small samples of suspicious tissue are removed using a special instrument. These are sent to a pathologist for examination under a microscope.

Cone biopsy / LEEP: A cone-shaped piece of cervical tissue is removed for deeper examination. This can be done using a heated wire loop (LEEP/LLETZ) or a scalpel (cold knife cone biopsy). A cone biopsy can also serve as treatment for precancerous changes or very early cancer.

Imaging & Staging Workup

If cervical cancer is confirmed, imaging studies are used to determine how far the cancer has spread (staging):^[4,5]

MRI (Magnetic Resonance Imaging): The preferred imaging modality for assessing local tumor extent, depth of invasion, and involvement of surrounding structures (parametrium, vagina, pelvic wall).

CT scan (Computed Tomography): Used to evaluate lymph node involvement and to check for distant metastases in the chest, abdomen, and pelvis.

PET-CT scan: Combines metabolic and anatomical imaging to identify areas of cancer spread. Particularly useful for detecting lymph node metastases and distant disease in locally advanced cases.

I

Stage I — Confined to the Cervix

The cancer is strictly confined to the cervix. Stage I is subdivided by the depth and width of invasion. Stage IA (microscopic): Invasive cancer that can only be seen under a microscope, with a depth of invasion up to 5 mm. Stage IB (visible): Clinically visible lesions confined to the cervix, or microscopic lesions greater than Stage IA. Treatment for early Stage I may involve surgery alone, including fertility-sparing options for selected patients.^[4,5,6]

II

Stage II — Beyond the Cervix, Not to Pelvic Wall

The cancer has spread beyond the cervix and uterus but has not reached the pelvic wall or the lower third of the vagina. Stage IIA: Involvement of the upper two-thirds of the vagina, without parametrial invasion. Stage IIB: Spread into the parametrium (the tissue adjacent to the cervix) but not reaching the pelvic wall. Stage IIA may be treated with radical surgery or radiation, while Stage IIB is typically treated with concurrent chemoradiation.^[4,5]

III

Stage III — Extends to Pelvic Wall or Lower Vagina

The cancer has spread to the lower third of the vagina and/or the pelvic wall, and/or has caused hydronephrosis (kidney swelling) or a nonfunctioning kidney, and/or involves pelvic or para-aortic lymph nodes. Stage IIIA: Involves the lower third of the vagina. Stage IIIB: Extends to the pelvic wall, causes hydronephrosis, or involves pelvic lymph nodes. Stage IIIC: Involves pelvic (IIIC1) or para-aortic (IIIC2) lymph nodes, regardless of tumor size. Treatment is concurrent chemoradiation.^[4,5]

IV

Stage IV — Distant Spread

The cancer has spread to nearby organs or to distant parts of the body. Stage IVA: The cancer has invaded the mucosa of the bladder or rectum (confirmed by biopsy). Stage IVB: Distant metastases — spread to organs beyond the pelvis, such as the lungs, liver, bones, or distant lymph nodes. Treatment focuses on systemic therapy (chemotherapy, immunotherapy, targeted therapy) and palliative care for symptom management.^[4,5]

Surgery

Surgery is the primary treatment for early-stage cervical cancer (Stages IA-IB and select IIA). The type of surgery depends on the extent of disease and desire for future fertility.^[4,5]

Cone biopsy (conization): Removal of a cone-shaped piece of cervical tissue. May be sufficient treatment for very early-stage (microinvasive) cancer and preserves the ability to have children.

Simple hysterectomy: Removal of the uterus and cervix. Used for Stage IA1 without lymphovascular space invasion when fertility is not a concern.

Radical hysterectomy: Removal of the uterus, cervix, upper part of the vagina, parametrium, and pelvic lymph nodes. The standard surgery for Stage IB-IIA cervical cancer. Can be performed abdominally or laparoscopically (though open surgery is generally preferred based on recent evidence).

Radical trachelectomy: Removal of the cervix, upper vagina, and parametrium while preserving the uterine body. A fertility-sparing option for selected young women with small, early-stage tumors (generally Stage IA2-IB1, tumor up to 2 cm). A cerclage is placed to allow future pregnancy.

Radiation Therapy

Radiation is a cornerstone of cervical cancer treatment, particularly for locally advanced disease (Stage IIB and above). It is often used in combination with chemotherapy (concurrent chemoradiation).^[4,5]

External beam radiation therapy (EBRT): High-energy beams directed at the pelvis from outside the body. Typically delivered daily (Monday-Friday) over 5-6 weeks. Targets the primary tumor, parametrium, and pelvic lymph nodes.

Brachytherapy (internal radiation): A radioactive source is placed directly into or next to the cervix, delivering a high dose of radiation to the tumor while minimizing exposure to surrounding healthy tissue. Brachytherapy is a critical component of curative treatment and should not be omitted.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells or stop them from growing. In cervical cancer, it is most commonly used concurrently with radiation therapy or as systemic treatment for advanced/recurrent disease.^[4,5]

Concurrent chemoradiation: Weekly cisplatin given alongside radiation therapy is the standard of care for locally advanced cervical cancer (Stage IIB-IVA). The chemotherapy acts as a "radiosensitizer," making the cancer cells more vulnerable to radiation damage.

Systemic chemotherapy: For recurrent or metastatic disease, combination regimens such as cisplatin/paclitaxel or carboplatin/paclitaxel are used. These may be combined with bevacizumab and/or pembrolizumab.

Immunotherapy & Targeted Therapy

Newer treatment approaches have significantly improved outcomes for advanced and recurrent cervical cancer:^[4,5]

Pembrolizumab (Keytruda): An immune checkpoint inhibitor (anti-PD-1) approved for cervical cancer that is PD-L1 positive. It helps the immune system recognize and attack cancer cells. Pembrolizumab has been shown to improve overall survival in combination with chemotherapy (with or without bevacizumab) for persistent, recurrent, or metastatic cervical cancer.

Bevacizumab (Avastin): A targeted therapy that inhibits angiogenesis (the growth of new blood vessels that tumors need to grow). When added to chemotherapy for advanced cervical cancer, bevacizumab has been shown to improve overall survival. It is now a standard part of first-line treatment for recurrent or metastatic cervical cancer.

Radical trachelectomy: As described above, this fertility-sparing surgery removes the cervix while preserving the uterus. It is an option for carefully selected patients with early-stage cancer (generally tumors up to 2 cm). Pregnancy after trachelectomy is possible, though it carries higher risks of preterm delivery and requires close monitoring.^[4,5]

Egg (oocyte) or embryo freezing: Before starting radiation or chemotherapy (both of which can damage the ovaries), eggs can be retrieved and frozen (cryopreserved) for future use. Embryo freezing involves fertilizing the eggs before freezing. This process typically takes 2-3 weeks and should be discussed with a reproductive specialist as soon as possible after diagnosis.

Ovarian transposition (oophoropexy): A surgical procedure that moves the ovaries out of the radiation field before pelvic radiation therapy. This can help preserve ovarian function and hormone production, though it does not always prevent radiation damage.

Discuss options early: Fertility preservation must be addressed before treatment starts. Ask your oncologist for a referral to a reproductive endocrinologist at the time of diagnosis. Delaying this conversation can mean losing the opportunity entirely.

Radiation Effects on Bowel & Bladder

Pelvic radiation can irritate the bowel and bladder, causing diarrhea, increased urinary frequency, urgency, or discomfort. These effects are common during treatment and usually improve within weeks to months after completion. In some cases, late effects (occurring months to years later) can include chronic changes such as rectal bleeding, bladder irritation, or narrowing of the bowel or vagina. Your radiation oncology team can provide strategies to manage these effects.^[4]

Menopausal Symptoms

If both ovaries are removed surgically or are damaged by radiation, women who have not yet reached menopause will experience surgical or radiation-induced menopause. This can cause hot flashes, night sweats, vaginal dryness, mood changes, sleep difficulties, and bone density loss. Hormone replacement therapy (HRT) may be considered to manage symptoms, depending on the type of cancer and individual risk factors. Discuss options with your care team.^[3,4]

Lymphedema

Removal of pelvic lymph nodes or radiation to the pelvic area can damage the lymphatic system, leading to lymphedema — swelling, usually in the legs. Lymphedema can develop weeks, months, or even years after treatment. Management includes compression garments, physical therapy, manual lymphatic drainage, and skin care. Early detection and treatment improve outcomes.

Sexual Health Changes

Cervical cancer treatment can affect sexual health in several ways. Surgery may shorten the vagina. Radiation can cause vaginal narrowing (stenosis) and dryness. Menopausal symptoms affect libido and comfort. These changes are real and valid — they deserve attention and treatment. Vaginal dilators (used during and after radiation to prevent stenosis), lubricants, estrogen creams, and sexual counseling are all available options. You have every right to raise these concerns with your care team.^[3,4]

Emotional Impact

A cervical cancer diagnosis can trigger fear, anxiety, grief, anger, and depression. The impact on body image, sexuality, fertility, and daily functioning can be profound. These emotional responses are normal and expected. Psychological support — including counseling, support groups, and psychiatric care if needed — should be considered an essential part of your treatment plan, not an optional extra. Ask your care team for referrals to psycho-oncology services.

WHO Elimination Strategy

In 2020, the World Health Organization launched its Global Strategy to Accelerate the Elimination of Cervical Cancer. This historic commitment sets three targets for every country to meet by 2030:^[1]

90% of girls fully vaccinated with the HPV vaccine by age 15.

70% of women screened with a high-performance test by age 35, and again by age 45.

90% of women identified with cervical disease receive treatment.

If these targets are achieved, cervical cancer could be effectively eliminated as a public health problem within the next century — a first for any cancer type.

Screening Gaps in Low-Resource Settings

Approximately 90% of cervical cancer deaths occur in low- and middle-income countries, particularly in sub-Saharan Africa, South-Central Asia, and parts of Latin America. In many of these regions, fewer than 5% of women have ever been screened. The barriers include limited healthcare infrastructure, shortage of trained providers, lack of laboratory facilities, cost, stigma, and geography. Innovative solutions such as HPV self-sampling, visual inspection with acetic acid (VIA), and screen-and-treat approaches are being deployed to close these gaps.^[1,2,7]

HPV Vaccine Access Worldwide

As of 2024, HPV vaccination has been introduced in over 140 countries. However, coverage remains deeply unequal. High-income countries have achieved coverage rates of 70-90% among target populations, while many low-income countries have coverage below 10%. GAVI, the Vaccine Alliance, and UNICEF are working to increase access through subsidized pricing and delivery programs. A single-dose HPV vaccine schedule, now recommended by the WHO, could dramatically simplify rollout in resource-limited settings.^[1,2]

At Diagnosis

What type and stage of cervical cancer do I have?

Has the cancer spread beyond the cervix? What did the imaging show?

Are there any additional tests needed before treatment can begin?

Should I get a second opinion before starting treatment?

Is my case being reviewed by a multidisciplinary tumor board?

About Treatment

What are my treatment options, and what do you recommend and why?

What are the expected side effects, and how will they be managed?

How long will treatment take, and what is the full treatment schedule?

Is brachytherapy included in my radiation plan? (It is critical and should not be omitted.)

Are there clinical trials I should consider for my situation?

About Fertility

Will my treatment affect my ability to have children?

Am I a candidate for fertility-sparing surgery (trachelectomy)?

Can I freeze eggs or embryos before treatment starts? How quickly can this happen?

Is ovarian transposition an option for me if I need pelvic radiation?

Can you refer me to a reproductive endocrinologist right away?

About Follow-Up

What is the follow-up schedule after treatment? How often will I need exams?

What symptoms should I watch for that might indicate recurrence?

What support is available for managing long-term side effects (lymphedema, sexual health, menopausal symptoms)?

Should I use vaginal dilators after radiation? When should I start?

Can you refer me to a psycho-oncologist or support group?

World Health Organization. "Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem." WHO, 2020. who.int
World Health Organization. "Cervical Cancer Fact Sheet." WHO, 2024. who.int
American Cancer Society. "Cervical Cancer." Cancer.org, 2024. cancer.org
National Cancer Institute. "Cervical Cancer Treatment (PDQ) — Health Professional Version." Cancer.gov, 2024. cancer.gov
National Comprehensive Cancer Network (NCCN). "NCCN Clinical Practice Guidelines in Oncology: Cervical Cancer." NCCN.org, 2024. nccn.org
Cohen PA, Jhingran A, Oaknin A, Denny L. "Cervical cancer." The Lancet. 2019;393(10167):169-182. doi:10.1016/S0140-6736(18)32470-X. The Lancet
Arbyn M, Weiderpass E, Bruni L, et al. "Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis." The Lancet Global Health. 2020;8(2):e191-e203. doi:10.1016/S2214-109X(19)30482-6. The Lancet Global Health

Last reviewed: January 2025. This page is regularly reviewed and updated as new evidence emerges. StopMyCancer does not provide medical advice. Always consult your healthcare team for decisions about your care.

Cervical Cancer

Quick Overview