Cervical Cancer

ON THIS PAGE: You will find a drawing of the main body parts affected by cervical cancer. Use the menu to see other pages.

The next section in this guide is Risk Factors . It describes the factors that may increase the chance of developing cervical cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find out more about screening for cervical cancer, including risks and benefits of screening. You will also learn about some of the things a person can do to reduce their risk of developing cervical cancer. Use the menu to see other pages.

Prevention

Cervical cancer can often be prevented by having regular screenings with Pap tests and human papillomavirus (HPV) tests to find any precancers and treat them. It can also be prevented by receiving the HPV vaccine.

The HPV vaccine Gardasil is approved by the U.S. Food and Drug Administration (FDA) for prevention of cervical cancer caused by HPV (see Risk Factors ) for people between ages 9 and 45. Gardasil 9 is available in the United States for preventing infection from HPV16, HPV18, and 5 other types of HPV linked with cancer. There were 2 other vaccines previously available in the United States: Cervarix and the original Gardasil. However, because of newer vaccines becoming available, these 2 are no longer available in the United States. However, these vaccines may still be in use outside of the United States.

To help prevent cervical cancer, HPV vaccination is recommended for all adolescents as part of their routine vaccines. It may be given starting at age 9. Talk with your health care provider about the appropriate schedule for vaccination as it may vary based on many factors, including age, gender, and vaccine availability. Learn more about HPV vaccination and the American Society of Clinical Oncology's (ASCO's) recommendations for preventing cervical cancer .

Additional actions people can take to help prevent cervical cancer include:

• Delaying first sexual intercourse until the late teens or older

• Limiting the number of sexual partners

• Practicing safer sex by using condoms and dental dams

• Avoiding sexual intercourse with people who have had many partners

• Avoiding sexual intercourse with people who are infected with genital warts or who show other symptoms

• Quitting smoking

Screening information for cervical cancer

Screening is used to detect precancerous changes or early cancers before signs or symptoms of cancer occur. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer before signs or symptoms appear. The overall goals of cancer screening are to:

• Reduce the number of people who die from the cancer, or completely eliminate deaths from the cancer

• Reduce the number of people who develop the cancer

Learn more about the basics of cancer screening .

The following tests and procedures may be used to screen for cervical cancer:

1. HPV test. This test is done on a sample of cells removed from the cervix, the same sample used for the Pap test (see below). This sample is tested for the strains of HPV most commonly linked to cervical cancer. HPV testing may be done by itself or combined with a Pap test. This test may also be done on a sample of cells collected from the vagina, which a person can collect on their own.

2. Pap test. The Pap test has been the most common test for early changes in cells that can lead to cervical cancer. This test is also called a Pap smear. A Pap test involves gathering a sample of cells from the cervix. It is often done at the same time as a bimanual pelvic exam as part of a gynecologic checkup. A Pap test may be combined with an HPV test.

3. Visual inspection with acetic acid (VIA). VIA is a screening test that can be done with a few tools and the naked eye. During VIA, a dilution of white vinegar is applied to the cervix. The health care provider then looks for abnormalities on the cervix, which will turn white when exposed to vinegar. This screening test is very useful in places where access to medical care is limited.

Screening for cervical cancer can be done during an appointment with a primary care doctor or a gynecologic specialist. In some areas, free or low-cost screening may be available.

Screening recommendations for cervical cancer (updated 09/2022)

Different organizations have looked at the scientific evidence, risks, and benefits of cervical cancer screening. These groups have developed screening recommendations for people in the United States.

ASCO recommends that all women receive at least 1 HPV test, at a minimum, to screen for cervical cancer in their lifetime, with general frequencies being between every 5 to 10 years. Specific recommendations may vary based on your age and the resources available in the area where you live, so talk with your doctor about how often you should be tested. ASCO recommends that women ages 25 to 65 should receive an HPV test once every 5 years. ASCO and the American Cancer Society (ACS) recommend that women 65 and older or women who have had a hysterectomy may stop screening if their HPV test results have been mostly negative over the previous 15 years.

Decisions about screening for cervical cancer are becoming increasingly individualized. Sometimes, screening may differ from the recommendations discussed above due to a variety of factors, including your personal risk factors and your health history. For example, ASCO recommends that women who have tested positive for the human immunodeficiency virus (HIV) or are immunosuppressed should receive HPV testing as soon as they are diagnosed. ASCO also recommends that people who have given birth be screened for cervical cancer 6 months after childbirth. It’s important to talk with your health care team or a health care professional knowledgeable in cervical cancer screening about how often you should receive screening and which tests are most appropriate for you.

Some questions to ask your health care provider include:

• At what age should I start being screened for cervical cancer?

• Should my screening include an HPV test? If so, how often?

• Why are you recommending these specific tests and this screening schedule for me?

• At what age could I stop being regularly screened for cervical cancer?

• Do any recommendations change if I have had cervical dysplasia or precancer?

• Do any recommendations change if I have human immunodeficiency virus (HIV)?

• Do any recommendations change if I have had a hysterectomy?

• Do any recommendations change if I am pregnant?

• Do any recommendations change if I have had the HPV vaccine?

• What happens if the screening shows positive or abnormal results?

Everyone should talk with their health care team about cervical cancer and decide on an appropriate screening schedule. For people at high risk for developing cervical cancer, screening is recommended at an earlier age and more often than for people who have an average risk of cervical cancer.

To view different groups’ national recommendations, visit the websites of ASCO , the American Society for Colposcopy and Cervical Pathology , the American Cancer Society , the American Congress of Obstetricians and Gynecologists , Cancer Care Ontario , the U.S. Preventive Services Task Force , and the World Health Organization . (Please note that these links will take you away from this guide to other, independent websites.)

The next section in this guide is Symptoms and Signs . It explains what changes or medical problems cervical cancer can cause. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

How cervical cancer is diagnosed (updated 09/2022)

There are many tests used for diagnosing cervical cancer. Not all tests described here will be used for every person. Some or all of these tests may be helpful for your doctor to plan the treatment of your cancer. Your doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected

• Your signs and symptoms

• Your age and general health

• The results of earlier medical tests

The following tests may be used to diagnose cervical cancer:

• Bimanual pelvic examination and sterile speculum examination. In this gynecologic examination, the doctor will check for any unusual changes in the patient's cervix, uterus, vagina, ovaries, and other nearby organs. To start, the doctor will look for any changes to the vulva outside the body and then, using an instrument called a speculum to keep the vaginal walls open, the doctor will look inside the vagina to visualize the cervix. A Pap test is often done at the same time. Some of the nearby organs are not visible during this exam, so the doctor will insert 2 fingers of 1 hand inside the vagina while the other hand gently presses on the lower abdomen to feel the uterus and ovaries. This exam typically takes a few minutes and is done in an examination room at the doctor’s office.

• Pap test. During a Pap test , the doctor gently scrapes the outside and inside of the cervix, taking samples of cells for testing.
  
  Improved Pap test methods have made it easier for doctors to find cancerous cells. Traditional Pap tests can be hard to read because cells can be dried out, covered with mucus or blood, or may clump together on the slide.

  • The liquid-based cytology test, often referred to as ThinPrep or SurePath, transfers a thin layer of cells onto a slide after removing blood or mucus from the sample. The sample is preserved so other tests can be done at the same time, such as the human papillomavirus (HPV) test (see Screening and Prevention ).

  • Computer screening, often called AutoPap or FocalPoint, uses a computer to scan the sample for abnormal cells.

• Human papillomavirus (HPV) typing test. An HPV test is similar to a Pap test. The test is done on a sample of cells from the cervix. The doctor may test for HPV at the same time as a Pap test or after Pap test results show abnormal changes to the cervix. Certain types or strains of HPV, such as HPV16 and HPV18, are called high-risk HPV. These strains are seen more often in people with cervical cancer and may help confirm a diagnosis. If the doctor says the HPV test is “positive,” this means the test found the presence of high-risk HPV. Many people have HPV but do not have cervical cancer, so HPV testing alone is not enough for a diagnosis of cervical cancer and other testing will be needed. If a person with a positive HPV test does not show signs of cervical cancer with further testing, the American Society of Clinical Oncology (ASCO) recommends that they receive a follow-up HPV test 1 year later.

• Colposcopy. The doctor may do a colposcopy to check the cervix for abnormal areas. A colposcopy can also be used to help guide a biopsy of the cervix (see below). During a colposcopy, a special instrument called a colposcope is used. The colposcope magnifies the cells of the cervix and vagina, similar to a microscope. It gives the doctor a lighted, magnified view of the tissues of the vagina and the cervix. The colposcope is not inserted into the body, and the examination is similar to a speculum examination. It can be done in the doctor's office and has no side effects. This test can be done during pregnancy. ASCO recommends that people who receive an abnormal or positive result from cervical cancer screening tests receive a colposcopy.

• Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. If the lesion is small, the doctor may remove all of it during the biopsy.
  
  There are several types of biopsies. Most are usually done in the doctor's office, sometimes using a local anesthetic to numb the area. There may be some bleeding and other discharge after a biopsy. There may also be discomfort similar to menstrual cramps. One common biopsy method uses an instrument to pinch off small pieces of cervical tissue. Other types of biopsies include:

  • Endocervical curettage (ECC). If the doctor wants to check an area inside the opening of the cervix that cannot be seen during a colposcopy, they will use ECC. During this procedure, the doctor uses a small, spoon-shaped instrument called a curette to scrape a small amount of tissue from inside the cervical opening.

  • Loop electrosurgical excision procedure (LEEP). LEEP uses an electrical current passed through a thin wire hook. The hook removes tissue for examination in the laboratory. A LEEP may also be used to remove a precancer or an early-stage cancer.

  • Conization (a cone biopsy). This type of biopsy removes a cone-shaped piece of tissue from the cervix. Conization may be done as treatment to remove a precancer or an early-stage cancer. It is done under a general or local anesthetic and may be done in the doctor's office or the hospital.

  If the biopsy shows that cervical cancer is present, the doctor will refer you to a gynecologic oncologist, which is a doctor who specializes in treating cancers of the female reproductive system. Your doctor may suggest additional tests to see if the cancer has spread beyond the cervix.

• Pelvic examination under anesthesia. In cases where it is necessary for treatment planning, the specialist may re-examine the pelvic area while the patient is under anesthesia to see if the cancer has spread to any organs near the cervix, including the uterus, vagina, bladder, or rectum.

• X-ray. An x-ray is a way to create a picture of the structures inside of the body using a small amount of radiation. An intravenous urography is a type of x-ray that is used to view the kidneys and bladder.

• Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

• Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

• Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan . However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.

• Biomarker testing of the tumor. Your doctor may recommend running laboratory tests on a tumor to identify specific genes, proteins, and other factors unique to the tumor. This may also be called molecular testing of the tumor. Results of these tests can help determine your treatment options .

If there are signs or symptoms of bladder or rectal problems, these procedures may be recommended and may be performed at the same time as a pelvic examination:

• Cystoscopy. A cystoscopy is a procedure that allows the doctor to view the inside of the bladder and urethra (the canal that carries urine from the bladder) with a thin, lighted tube called a cystoscope. The person may be sedated as the tube is inserted in the urethra. A cystoscopy is used to determine whether cancer has spread to the bladder.

• Sigmoidoscopy (also called a proctoscopy). A sigmoidoscopy is a procedure that allows the doctor to see the colon and rectum with a thin, lighted, flexible tube called a sigmoidoscope. The person may be sedated as the tube is inserted in the rectum. A sigmoidoscopy is used to see if the cancer has spread to the rectum.

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cervical cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages . It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will learn about the different types of treatments for cervical cancer. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for cervical cancer. “Standard of care” means the best treatments known. Clinical trials may also be an option for you, which is something you can discuss with your doctor. A clinical trial is a research study that tests a new approach to treatment. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How cervical cancer is treated

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team . Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

The treatment of cervical cancer depends on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is particularly important for cervical cancer because there are different treatment options. Learn more about making treatment decisions .

A diagnosis of cervical cancer may bring concerns about if or how treatment may affect sexual function and the ability to have children, called fertility . These topics should be discussed with the health care team before treatment begins. If you are pregnant, talk with their doctor about your treatment options, including whether or not each could affect your unborn child . Treatment may be able to be delayed until after the baby is born.

The common types of treatments used for cervical cancer are described below. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care.

• Surgery

• Radiation therapy

• Chemotherapy

• Targeted therapy

• Immunotherapy

• Physical, emotional, and social effects of cancer

• Treatment options by stage

• Metastatic cervical cancer

• Remission and the chance of recurrence

• If treatment does not work

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. For cancer that has not spread beyond the cervix, these procedures are often used:

• Conization. The use of the same procedure as a cone biopsy (see Diagnosis ) to remove all of the abnormal tissue. It can be used to remove cervical cancer that can only be seen with a microscope, called microinvasive cancer.

• Loop electrosurgical excision procedure (LEEP). The use of an electrical current passed through a thin wire hook. The hook removes the tissue. It can be used to remove microinvasive cervical cancer.

• Hysterectomy. The removal of the uterus and cervix. A hysterectomy can be either simple or radical. A simple hysterectomy is the removal of the uterus and cervix. A radical hysterectomy is the removal of the uterus, cervix, upper vagina, and the tissue around the cervix. A radical hysterectomy also includes an extensive pelvic lymph node dissection, which means lymph nodes are removed. This procedure can be done using a large cut in the abdomen, called laparotomy, or using smaller cuts, called laparoscopy.

• Bilateral salpingo-oophorectomy. If needed, this surgery is the removal of both fallopian tubes and both ovaries. It is done at the same time as a hysterectomy.

• Radical trachelectomy. A surgical procedure in which the cervix is removed, but the uterus is left intact. It includes pelvic lymph node dissection (see above). This surgery may be used for young patients who want to preserve their fertility. This procedure has become an acceptable alternative to a hysterectomy for some patients.

• Exenteration. The removal of the uterus, vagina, lower colon, rectum, or bladder if cervical cancer has spread to these organs after radiation therapy (see below). Exenteration is rarely recommended. It is most often used when cancer has come back after radiation therapy.

Complications or side effects from surgery vary depending on the type and extent of the procedure. Occasionally, patients experience significant bleeding, infection, or damage to the urinary and intestinal systems. Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have and how they can be relieved.

Because these surgical procedures affect sexual health, patients should talk with their doctor about their symptoms and concerns in detail before the surgery. The doctor may be able to help reduce the side effects of surgery and provide support resources on coping with any changes. If extensive surgical procedures have affected sexual function, other surgical procedures can be used to make an artificial vagina.

Learn more about the basics of cancer surgery .

Return to top

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. Radiation therapy may be given alone, before surgery, or instead of surgery to shrink the tumor.

The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time that combines external and internal radiation treatments. This combined approach is the most effective to reduce the chances the cancer will come back, called a recurrence.

For early stages of cervical cancer, a combination of radiation therapy and low-dose weekly chemotherapy is often used (see below). The goal of radiation therapy combined with chemotherapy is to increase the effectiveness of the radiation treatment. This combination is given to control the cancer in the pelvis with the goal of curing the cancer without surgery. It may also be given to destroy microscopic cancer cells that might remain after surgery.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Side effects of internal radiation therapy may include abdominal pain and bowel obstruction, although it is uncommon. Most side effects usually go away after treatment is finished. After radiation therapy, the vaginal area may lose elasticity, so some patients may also want to use a vaginal dilator, which is a plastic or rubber cylinder that is inserted into the vagina to prevent narrowing. People who have received external-beam radiation therapy will lose the ability to become pregnant, and unless the ovaries have been surgically moved out of the pelvis, premenopausal patients will enter menopause.

Sometimes, doctors advise their patients not to have sexual intercourse during radiation therapy. Normal sexual activity can restart within a few weeks after treatment if the patient feels ready.

Learn more about the basics of radiation therapy , or read the American Society for Radiation Oncology’s pamphlet, Radiation Therapy for Gynecologic Cancers (PDF; please note that this link takes you to a separate, external website).

Return to top

Therapies using medication

The treatment plan may include medications to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication. Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If you are given oral medications, be sure to ask your health care team about how to safely store and handle them.

The types of medications used for cervical cancer include:

• Chemotherapy

• Targeted therapy

• Immunotherapy

Each of these types of therapies is discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases .

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time. For people with cervical cancer, chemotherapy is often given in combination with radiation therapy (see above).

Although chemotherapy can be given orally (by mouth), all the drugs used to treat cervical cancer are given intravenously (IV). IV chemotherapy is either injected directly into a vein or given through a thin tube called a catheter , which is a tube temporarily put into a large vein to make injections easier.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished.

Rarely, specific drugs may cause some hearing loss. Others may cause kidney damage or peripheral neuropathy, which is numbness, pain, or tingling in the hands or feet. Patients may be given extra fluid intravenously to protect their kidneys. Talk with your doctor about the possible short-term and long-term side effects based on the drugs and dosages you will be receiving.

Learn more about the basics of chemotherapy .

Return to top

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.

Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them.

If cervical cancer comes back after treatment, called recurrent cancer, or if cervical cancer has spread beyond the pelvis, called metastatic disease, it can be treated with a platinum-based chemotherapy combined with the targeted therapy bevacizumab (Avastin). There are 2 drugs similar to bevacizumab, called bevacizumab-awwb (Mvasi) and bevacizumab-bvzr (Zirabev), that have been approved by the U.S. Food and Drug Administration (FDA) to treat advanced cervical cancer. These are called biosimilars .

In addition, in 2021, the FDA granted accelerated approval to the targeted therapy tisotumab vedotin (HuMax-TF) for the treatment of recurrent or metastatic cervical cancer that has progressed during or after chemotherapy. Tisotumab vedotin is a type of targeted therapy called an antibody-drug conjugate that works by attaching to targets on cancer cells and then releasing a small amount of the anticancer drug directly into the tumor cells.

Talk with your doctor about the possible side effects of the targeted therapy prescribed for you, and how they can be managed. Learn more about the basics of targeted treatments .

Return to top

Immunotherapy ( updated 01/2024 )

Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells.

The immune checkpoint inhibitor pembrolizumab (Keytruda) is used to treat cervical cancer that has recurred or spread to other parts of the body during or after treatment with chemotherapy. In those with newly diagnosed advanced cervical cancer, pembrolizumab may be combined with chemotherapy and radiation therapy as an initial treatment. Pembrolizumab may also be used in combination with chemotherapy with or without bevacizumab in people with recurrent or metastatic cervical cancer whose tumors express PD-L1. Some cancer cells express the PD-L1 protein, which binds to the PD-1 protein on T cells. T cells are immune system cells that kill certain other cells, like cancer cells. When the PD-1 and PD-L1 proteins bind, the T cell does not attack the cancer cell. Pembrolizumab is a PD-1 inhibitor, so it blocks the binding between PD-1 and PD-L1, which allows the T cells to find and attack the cancer cells.

Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy .

Return to top

Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Return to top

Treatment options by stage

Radiation therapy alone or surgery is generally used for an early-stage tumor. These treatments have been shown to be equally effective at treating early-stage cervical cancer. Chemoradiation (a combination of chemotherapy and radiation therapy) is generally used for people with a larger tumor, an advanced-stage tumor found only in the pelvis, or if the lymph nodes have cancer cells. Commonly, radiation therapy and chemotherapy are used after surgery if there is a high risk of the cancer coming back or if the cancer has spread.

Return to top

Metastatic cervical cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.

Chemotherapy, immunotherapy, surgery, and targeted therapy may be used to treat or remove newly affected areas in both the pelvic area and other parts of the body. Palliative care will also be important to help relieve symptoms and side effects, especially to relieve pain and other side effects from radiation therapy.

For many people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

Return to top

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. An important part of follow-up care is watching for recurrence . Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence .

If the cancer returns after the original treatment, it is called recurrent cancer. Recurrent cancer may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

If a recurrence happens, a new cycle of testing will begin again to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as surgery, systemic therapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat recurrent cervical cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence .

Return to top

If treatment does not work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called incurable, distant metastatic, or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning .

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss .

Return to top

The next section in this guide is About Clinical Trials . It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about the scientific research being done to learn more about cervical cancer and how to treat it. Use the menu to see other pages.

Doctors are working to learn more about cervical cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

• Improved detection and screening methods. Because cervical cancer is highly treatable when detected early, researchers are developing better ways to detect precancer and cervical cancer. For example, fluorescent spectroscopy is the use of fluorescent light to detect changes in precancerous cervix cells.

• Human papillomavirus (HPV) prevention. As discussed in the Screening and Prevention section, HPV vaccines help prevent infection from the HPV strains that cause most cervical cancers. Gardasil is also approved by the U.S. Food and Drug Administration (FDA) for boys and men ages 9 through 26 to prevent genital warts. Researchers are looking at the impact of the HPV vaccine on boys to reduce the risk of HPV transmission.

• Immunotherapy. As explained in Types of Treatment , immunotherapy is a systemic therapy using medication designed to boost the body’s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. For people who already have cervical cancer, a therapeutic vaccine is being developed. This type of vaccine helps "train" the immune system to recognize cervical cancer cells and destroy them. Learn more about immunotherapy .

• Fertility-preserving surgery. Research continues to focus on improving surgical techniques and finding out which patients can be treated successfully without losing their ability to become pregnant and have children. Learn more about fertility preservation .

• Targeted therapy. As explained in Types of Treatment , targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. Targeted drugs called angiogenesis inhibitors that block the action of a protein called vascular endothelial growth factor (VEGF) have been shown to help people live longer if they have cervical cancer that has spread to other parts of the body. VEGF promotes angiogenesis, which is the formation of new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of angiogenesis inhibitors is to “starve” the tumor. Learn more about angiogenesis inhibitors and targeted treatments .

• Combination therapy. Some clinical trials are exploring different combinations of immunotherapy, radiation therapy, and chemotherapy.

• Palliative care/supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current cervical cancer treatments to improve comfort and quality of life for patients.

Looking for More About Latest Research?

If you would like more information about the latest areas of research in cervical cancer, explore these related items that take you outside of this guide:

• To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases .

• Visit the Cancer.Net Blog to read research and perspectives about cervical cancer.

• Listen to a webinar featuring an ASCO expert discussing research in cervical cancer presented at the 2021 ASCO Annual Meeting.

• Visit the website of Conquer Cancer, the ASCO Foundation , to find out how to help support cancer research. Please note that this link takes you to a different ASCO website.

The next section in this guide is Coping with Treatment . It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cervical cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead.

Surveillance after treatment is recommended, and early detection of a local recurrence may be potentially curable. Follow-up care for cervical cancer will typically include clinical history and physical examination, which includes a pelvic examination and a smear of the vagina. Additional scans may be recommended depending on clinical factors.

In patients treated for a higher-risk cervical cancer, clinical follow-up may be performed every 3 months for the first 2 years, every 6 months for years 3 through 5, and then annually. If there are suspicious clinical findings or symptoms, further exams and assessments, including scans, will be done.

For patients treated for precancerous lesions, the American Society of Clinical Oncology (ASCO) recommends they receive follow-up testing 1 year later with a human papillomavirus (HPV) test.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, occupational therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible. Learn more about cancer rehabilitation.

Learn more about the importance of follow-up care .

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress .

Managing long-term and late side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed.

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship . It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask about prevention of cervical cancer

• Should I receive the human papillomavirus (HPV) vaccine?

• Should I be tested for HPV infection? What does this mean?

• How often should I have a Pap test?

Questions to ask after a diagnosis of cervical cancer or precancer

• What is my diagnosis, and what does it mean?

• What is the stage of the precancer or cancer? What does this mean?

• Can you explain my pathology report (laboratory test results) to me?

Questions to ask about choosing a treatment and managing side effects

• What are my treatment options?

• What clinical trials are available for me? Where are they located, and how do I find out more about them?

• What treatment plan do you recommend? Why?

• What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

• Who will be part of my health care team, and what does each member do?

• Who will be leading my overall treatment?

• What are the possible side effects of this treatment, both in the short term and the long term?

• Will this treatment affect my ability to become pregnant in the future? Should I talk with a fertility expert before starting treatment?

• How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

• If I’m worried about managing the costs of cancer care, who can help me?

• Could this treatment affect my sex life? If so, how and for how long?

• What can I do to stay as healthy as possible during and after treatment?

• If I have questions or problems, who should I contact?

Questions to ask about having surgery

• What type of surgery will I have? Will lymph nodes be removed?

• How long will the operation take?

• How long will I be in the hospital?

• Can you describe what my recovery from surgery will be like?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term effects of having this surgery?

Questions to ask about having radiation therapy

• What type of radiation therapy is recommended?

• What is the goal of this treatment?

• How long will it take to give this treatment?

• What side effects can I expect during treatment?

• Who should I contact about any side effects I experience? And how soon?

• Will this treatment cause early menopause?

• Should I avoid sexual intercourse during this treatment?

• How often should I dilate the vagina after radiation therapy? For how long?

• What are the possible long-term or late effects of having this treatment?

• What can be done to prevent or relieve the side effects?

Questions to ask about having therapies using medication

• What type of medication is recommended?

• Will this treatment be combined with other treatments?

• What is the goal of this treatment?

• How long will it take to give this treatment?

• Will I receive this treatment at a hospital or clinic? Or will I take it at home?

• What side effects can I expect during treatment?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term or late effects of having this treatment?

• What can be done to prevent or relieve the side effects?

Questions to ask about planning follow-up care

• What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

• What long-term side effects or late effects are possible based on the cancer treatment I received?

• What follow-up tests will I need, and how often will those tests be needed?

• How do I get a treatment summary and survivorship care plan to keep in my personal records?

• Who will be leading my follow-up care?

• What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources . It offers more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.