Cervical Cancer: Frequently Asked Questions

Here are some answers to frequently asked questions about cervical cancer.

What is cancer of the cervix?

Cervical cancer is cancer that starts in the cells of the cervix—the opening to the uterus. Since the Pap test is now a routine test for women in the U.S, cervical cancer is not as much of a major health problem here. But in many developing countries where the Pap test is not a routine test, this form of cancer is very common. It is a major cause of cancer-related death there.

What is the cervix?

The cervix connects the vagina and the uterus. The uterus is the female reproductive organ that holds a baby during pregnancy.

The vagina leads to the outside of the body. Both the uterus and the cervix are located in the pelvis. They are in close contact with other pelvic organs. These include the ovaries, upper part of the vagina, bladder, and rectum.

Who gets cervical cancer?

Any woman can get cervical cancer. But in the U.S. it happens more often in Hispanic and African-American women than in non-Hispanic white women. Most cases are found in women younger than 50 years old. But it rarely occurs in women younger than 20. Most women who get cervical cancer have not had regular Pap tests or any screening Pap tests done.

Are there different types of cervical cancer?

Cervical cancer starts in cells that are on the surface of the cervix.

There are 2 main types of cervical cancer:

• Squamous cell carcinoma. This cancer forms in the cells that line the outer part of the cervix that's closest to the vagina (called the exocervix). These cells are squamous epithelial cells. Squamous cell cancers have flat, thin cells. They cover the surface of the exocervix. This type of cancer most often occurs where the exocervix meets the inner part of the cervix (called the endocervix). About 80% to 90% of cervical cancers are this type.

• Adenocarcinoma. This cancer starts in the gland cells lining the inner part of the cervix. These cells are called columnar epithelial cells. They line the inner part of the cervix, the endocervix, which is closest to the uterus.

Who is at risk for cervical cancer?

Certain factors can make one woman more likely to get cervical cancer than another woman. These are called risk factors. Risk factors for cervical cancer are:

• HPV infection. Some of the human papillomaviruses (HPV) put women at higher risk for cervical cancer. These viruses can be transmitted by sexual contact. Persistent HPV infection is the major risk factor for cervical cancer.

• Smoking. A woman who smokes has a higher chance of getting cervical cancer.

• Weakened immune systems. Women who have the HIV virus, which causes AIDS, and those who have weakened immune systems for other reasons (like a recent organ transplant or exposure to certain medicines) are at greater risk of getting cervical cancer. This is because conditions that affect the immune system make it harder for the body to deal with HPV infection. 

• Chlamydia infection. This is a sexually-transmitted bacterial infection that has been linked to an increased risk for cervical cancer.

• Diet. A diet low in fruits and vegetables may increase the risk for cervical cancer.

• Birth control pills (oral contraceptives). A woman who has taken birth control pills for a long time may have a higher risk.  This may be because these women are less likely to use condoms.

• High body weight. Women who are overweight or obese have a higher risk.

• Many pregnancies. A woman who has had 3 or more full-term pregnancies may be at greater risk.

• Pregnant at a young age. Women who had their first full-term pregnancy when they were younger than 17 are at higher risk.

• DES exposure. If a woman's mother took the drug DES (diethylstilbestrol) when she was pregnant, the woman has a greater chance of getting cervical cancer.

• Socioeconomic status. Many women with low incomes don't have access to good health care. This may prevent regular screenings and increase their risk of cervical cancer.

• Sexual history. A higher number of sexual partners and first intercourse at an early age are linked to an increased risk for cervical cancer. 

• Family history. Women who have a mother or sister with cervical cancer are at higher risk for it.

What can a woman do to decrease her risk of getting cervical cancer?

Regular Pap tests are very important in finding cervical changes early, when they can be more easily treated. These are things women can do to decrease their risk:

• Talk with your healthcare provider about when to go for screening checkups. Women age 21 and older are generally advised to have regular cervical cancer screening tests. 

• Quit smoking.

• Eat a well-balanced diet rich in fruits and vegetables. 

• Avoid intercourse at a young age.

• Discuss the HPV vaccine with your healthcare provider. (Generally, children and young adults between the ages of 9 and 26 are eligible for the vaccine.) 

• Use condoms during intercourse.

• Limit the number of sexual partners.

What is the Pap test?

The Pap test is a very simple and important test. The healthcare provider uses the Pap test to see if there are any changes in the cervix. The best time for a woman to have a Pap test is at least 5 days after her period. A Pap test can be done in a healthcare provider's office or a health clinic. The healthcare provider uses a tool called a speculum to hold the vagina open to see the upper part of the vagina and the cervix. Then a small brush is used to get some cells from the cervix and vagina. These cells are placed on a glass slide or in a solution. They are sent to a lab and checked under a microscope for abnormal cells.

Who should get Pap tests and how often?

According to the American Cancer Society, all women at average risk for cervical cancer should have Pap tests starting at age 21. Women between ages 21 and 29 should have a Pap test every 3 years. Women between the ages of 30 and 65 should have a Pap test plus an HPV test (called co-testing) every 5 years. This is the preferred approach. It is also acceptable to keep having Pap tests alone every 3 years. Women at higher risk for cervical cancer may need screenings more often. They should discuss their risk factors with their healthcare provider. 

Women over age 65 who have had regular screenings with normal results should not be screened for cervical cancer. Once screening is stopped, it should not be started again.

A woman who has been vaccinated against HPV should still follow the screening recommendations for her age group.

A woman should not be screened if both of the following are true:

• She has had surgery to remove her uterus including her cervix (called a total hysterectomy), for reasons not related to cervical cancer

• She has no history of cervical cancer or serious precancer

What are the symptoms of cervical cancer?

Women with precancerous lesions in the cervix usually have no symptoms. That is why it is important to have Pap tests. A woman usually does not have any symptoms until the cells turn into cancer and invade the deepest parts of the cervix or other pelvic organs. These are common symptoms in women with fully developed cervical cancer:

• Vaginal discharge

• Abnormal vaginal bleeding

• Pelvic pain

• Pain during vaginal sex

These symptoms may be caused by cancer or by other health problems. It is important for a woman to see her healthcare provider if she is having any of these symptoms.

How is cervical cancer diagnosed?

The healthcare provider asks questions about the woman's medical history and family history. The healthcare provider will also do a pelvic exam and Pap test (with or without an HPV test). If something suspicious is found, other tests can help determine if the woman has cervical cancer. It is very important to know the extent of the cancer — how deeply it has invaded tissues. The treatment can be quite different depending on whether or not the cancer has already spread.

One or more of these tests may be ordered to help make a diagnosis:

• HPV test

• Colposcopy

• Biopsy

Depending on the extent or location of the cancer, the biopsy may be done in a variety of ways.

Should everyone get a second opinion?

Many people with cancer get a second opinion from another healthcare provider. There are many reasons to get a second opinion. Here are some of those reasons:

• Not feeling comfortable with the treatment recommendation

• Being diagnosed with a rare type of cancer

• Having several options for how to treat the cancer

• Not being able to see a cancer expert

How can someone get a second opinion?

These are some of the many ways to get a second opinion.

• Ask a primary care provider. He or she may be able to suggest a specialist. This may be a gynecologic oncologist, medical oncologist, or radiation oncologist. Sometimes these healthcare providers work together at cancer centers or hospitals. Never be afraid to ask for a second opinion.

• You should be treated by a gynecologic oncologist. He or she is a subspecialist with advanced training in the diagnosis and treatment of women diagnosed with a gynecologic cancer. 

• Call the National Cancer Institute's Cancer Information Service. The number is 800-4-CANCER (800-422-6237). They have information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute. 

• Seek other options. Check with a local medical society, a nearby hospital or medical school, or support group to get names of healthcare providers who can give you a second opinion. Or ask other people who've had cancer for their recommendations.

What are the treatments for cervical cancer?

Treatment for cervical cancer often involves surgery, especially for cancers that have not spread far. Surgery is used to remove as much cancer as possible. It is called a local treatment. Local treatments fight cancer cells in one area. Another type of local treatment used for cervical cancer is high-energy X-rays known as radiation therapy.

Chemotherapy uses medicines to kill cancer. It is called a systemic treatment. It travels all over the body and can target cancerous cells that have spread far from the primary tumor. It may be combined with radiation, either before or after surgery. Chemotherapy is rarely used alone for cervical cancer, unless the cancer has spread to distant areas and can’t be treated by either surgery or radiation.

What check-ups should a woman have after treatment for cervical cancer?

In the first year after treatment, most women are advised to see their healthcare providers every 3 to 4 months. Your healthcare provider can perform pelvic exams and Pap tests as needed. Also, women may have chest X-rays and CT scans at the end of the first year. Until the fifth year, women may have checkups every 6 months. After 5 years, a woman will most likely go back to routine checkups. Talk with your healthcare provider about the best follow-up plan for you. Women who have been treated for cervical cancer should tell their healthcare providers about any vaginal discharge, bleeding, bone pain, weight loss, leg swelling, or bowel or bladder problems. They should quit smoking and use protection during intercourse to prevent further problems.

What's new in cervical cancer research?

Researchers are working on many fronts to better prevent, diagnose, and treat cervical cancer. For example, they are working on vaccines to help better prevent and treat cervical cancer. Surgical methods are being developed that will cure localized cancers while saving as much tissue as possible.

What are clinical trials?

Clinical trials are studies of new kinds of cancer treatments. Healthcare providers use clinical trials to learn how well new treatments work and what their side effects are. Promising treatments are ones that work better or have fewer side effects than the current treatments. People who take part in these studies get to use treatments before the FDA approves them. People who join trials also help researchers learn more about cancer and help future cancer patients. The National Cancer Institute runs a website to help people with cancer and healthcare providers find appropriate clinical trials. You can find it at www.clinicaltrials.gov.