Cervical Cancer: What is it, Symptoms, Causes & Treatment

Introduction

Cervical cancer remains a major public health challenge, ranking as the fourth most common cancer among women worldwide¹. In India, it is the second most common cancer in women. By 2025, the burden of this cancer in India projected to reach 1.5 million Disability-Adjusted Life Years (DALYs), a measure that combines years of life lost due to premature death and years lived with illness or disability².  

This highlights the urgent need for action. Therefore, understanding what is cervical cancer, along with adopting preventive measures, ensuring early detection, and providing effective treatment, is essential for reducing its impact on women’s health. 

Understanding the Cervix

The cervix is the narrow, lower portion of the uterus (womb) that connects it to the vagina (birth canal). It allows fluids (like menstrual blood and mucus) to flow from the uterus into the vagina, and it also widens during childbirth to allow the baby to pass through³. 

The cervix has two main parts³: 

• Ectocervix: The outer part that can be seen during a pelvic exam. 
• Endocervix: The inner part that forms a canal linking the vagina to the uterus. 

The junction/zone where these two parts of the cervix meet is called the squamocolumnar junction (or transformation zone). This is where the thin, flat squamous cells are found, and where most abnormal cell changes and cervical cancers originate. 

What is Cervical Cancer?

Cervical cancer starts in the cells of the cervix. It usually develops slowly over time. Before cancer forms, the cells in the cervix may undergo changes (dysplasia) and abnormal cells appear in the cervical tissue³. 

If these abnormal cells are not detected and treated, these abnormal changes may turn into cancer and grow deeper into the cervix or spread to nearby areas³. 

HPV and Cervical Cancer

Human papillomavirus (HPV) is the primary cause of cervical cancer. It is a common sexually transmitted infection that can affect the skin, genital area, and throat. Certain high-risk types of HPV strains (such as HPV 16 and HPV 18) are responsible for about 70% of all cervical cancer cases worldwide^4,5. 

These viruses can infect the cells of the cervix and cause changes in their DNA. Over time, if the infection does not clear on its own or is left undetected, these changes can lead to dysplasia, which may eventually turn into cancer⁴.  

However, it is important to note that HPV infections are extremely common, often transient, and only persistent infections with high-risk subtypes can lead to cancers. Presence of cofactors like smoking and poor immunity increase the progression risk. 

Also Read: Human Papillomavirus (HPV): What Is It, Causes, Symptoms, and Prevention 

Cervical Cancer Symptoms

In the early cervical cancer stages, cancer often develops without any noticeable symptoms. This makes it difficult to detect early. Symptoms typically appear only after the cancer has started to spread. Possible early-stage cervical cancer symptoms may include⁶: 

• Pelvic pain (especially in the lower abdomen) 
• Pain during sexual intercourse 
• Bleeding (vaginal) between periods or unusually heavy/extended periods 
• Bleeding (vaginal) after sexual intercourse or menopause 
• Watery vaginal discharge (accompanied by a strong odour or blood) 
• Postcoital bleeding (bleeding after intercourse) is sometimes the first and the only sign 

When cervical cancer becomes advanced (spreading beyond the cervix), symptoms can include those listed above, along with⁶: 

• Constant fatigue 
• Persistent dull backache or abdominal pain 
• Swelling in the legs 
• Painful or difficult bowel movements, or rectal bleeding during bowel movements 
• Painful or difficult urination 
• Blood in the urine 
• Foul smelling discharge 

Note: It is important to remember that these symptoms can be caused by conditions other than cervical cancer. However, the only way to know for sure is to consult a doctor.  

Cervical Cancer Causes

As discussed earlier, the main cause of cervical cancer is persistent infection with high-risk types of HPV¹. 

Almost all sexually active individuals may get HPV at some point (often without symptoms), and in most cases, the immune system clears the virus naturally. However, if the infection with a high-risk HPV type does not go away or is left unaddressed (for around 10 to 15 years), it can cause abnormal cell changes in the cervix that may eventually develop into cervical cancer¹. 

Cervical Cancer Risk Factors

Risk factors that increase the chance of developing cervical cancer include⁴: 

• Infection with high-risk HPV types (e.g., HPV 16 and 18) 
• Smoking 
• Early age of first sexual intercourse 
• Multiple sexual partners 
• High number of births or high parity (due to increased risk of HPV exposure or hormonal/immune influences) 
• Long-term use of hormonal contraceptives 
• Weakened immune system (e.g., HIV infection) 
• Co-infection with other sexually transmitted infections (e.g., Chlamydia trachomatis or herpes simplex virus) 

Types of Cervical Cancer

Cervical cancers are classified based on the type of cell where the cancer begins. The main types include: 

• Squamous Cell Carcinoma: The most common type, accounting for up to 90% of cervical cancer cases. It develops from the squamous cells found in the ectocervix³. 
• Adenocarcinoma: This type develops in the glandular cells of the endocervix³. 
• Clear cell carcinoma or mesonephroma: A rare subtype of cervical adenocarcinoma, characterised by abundant clear, glycogen-rich cytoplasm and distinct cell membranes^3,7. 
• Mixed Carcinoma (Adenosquamous Carcinoma): This type contains features of both squamous cell carcinoma and adenocarcinoma and although rare, it is usually more aggressive³. 

Note: Very rarely, cervical cancer can even start in other cell types within the cervix³. 

Cervical Cancer Stages

Cervical cancer staging describes how far the cancer has grown or spread. Stages include⁸: 

• Stage I: Cancer is confined only to the cervix. 
• Stage II: Cancer has spread beyond the cervix to the upper two-thirds of the vagina or surrounding tissue, but not to the pelvic wall. 
• Stage III: Cancer involves the lower third of the vagina, pelvic wall, causes kidney issues, and/or has spread to lymph nodes. 
• Stage IV: Cancer has spread beyond the pelvis or to nearby organs like the bladder or rectum, or distant organs. 

Note: The staging now incorporates imaging and pathology findings also. 

Diagnosis of Cervical Cancer

If symptoms suggest cervical cancer, further tests are done to confirm the diagnosis. The process often starts with a colposcopy, where the cervix is examined using a magnifying device after applying acetic acid and Lugol’s iodine solution to highlight abnormal areas. If suspicious areas are seen, a biopsy is performed to collect tissue for examination under a microscope. These tests are a crucial part of visual screening in resource-limited areas. 

Types of biopsy procedures include⁹: 

• Punch biopsy: Removes small tissue samples from the cervix. 
• Endocervical curettage: Scrapes cells from the cervical canal. 
• Loop electrosurgical excision procedure (LEEP): Utilises a thin wire (with an electrical current) to remove tissue. It can also treat early changes. 
• Cone biopsy (conisation): Surgically removes a cone-shaped section of tissue from the cervix, often under general anaesthesia. 

If cervical cancer is confirmed, you will be referred to a gynaecologic oncologist (a specialist in staging and treating cancers of the female reproductive system). They will order tests to determine the stage of the cancer, whether it is confined to the cervix or has spread to other parts of the body. 

Note: Excisional biopsy (biopsy where the entire suspicious tissue is removed) can be both diagnostic or therapeutic in very early stages. 

Other tests may include⁹: 

• Imaging tests: PET-CT scan, MRI, ultrasound, or chest X-ray to locate tumours and detect spread. 
• Lab tests: Complete blood count and blood chemistry studies to assess overall health and organ function. 
• Visual examinations: Cystoscopy (to check the bladder) and sigmoidoscopy (to check the rectum and lower colon). 

Cervical Cancer Treatment

Cervical cancer treatment depends on the stage of the disease, overall health, and personal preferences. Most patients receive a combination of therapies to remove or destroy cancer cells and prevent recurrence. Common treatments include¹⁰: 

• Radiation therapy: Kills cancer cells using high-energy rays. It can be external (known as external beam radiation) or internal (known as brachytherapy). 
• Chemotherapy: Kills or stops cancer cells from dividing. It is often combined with radiation in advanced cervical cancer stages. Some common drugs include: 
  • Carboplatin 
  • Cisplatin 
  • Ifosfamide 
  • Gemcitabine 
  • Irinotecan 
  • Topotecan 
  • Paclitaxel
  • Vinorelbine 
• Targeted therapy: Blocks specific molecules that cancer cells need to grow. Some common drugs include: 
  • Bevacizumab 
  • Tisotumab Vedotin 
• Immunotherapy: Boosts the immune system to attack cancer cells. Example includes: 
  • Pembrolizumab 
• Surgery: Removes cancerous tissue. Options include: 
  • Sentinel Lymph Node Biopsy: Removal of the first lymph node(s) that cancer is most likely to spread to, to check for cancer cells. 
  • Conisation (Cone Biopsy): Surgical removal of a cone-shaped section of the cervix containing abnormal or cancerous tissue. 
  • Radical Trachelectomy (Fertility-Sparing): Removes the cervix and surrounding tissues but preserves the uterus to allow future pregnancy. This along with pelvic lymph node assessment is a valid option for selected early-stage cases. 
  • Bilateral Salpingo-Oophorectomy: Removal of both fallopian tubes and ovaries. 
  • Hysterectomy: Surgical removal of the uterus. 
    • Total Hysterectomy: Removes the uterus and cervix. 
    • Radical Hysterectomy: Removes the uterus, cervix, upper vagina, and a wide area of surrounding tissues, often including pelvic lymph nodes. 
    • Modified Radical Hysterectomy: Removes the uterus, cervix, part of the vagina, and surrounding tissues, but less extensively than a radical hysterectomy. 
  • Total Pelvic Exenteration: Removal of the uterus, cervix, vagina, bladder, rectum, and part of the colon in advanced cancer cases. 

Note: A treatment plan is tailored to each patient and may also consider fertility preservation, pregnancy, and follow-up care. It is therefore essential to discuss all available options with your doctor. 

Side Effects of Cancer Treatment

Cervical cancer treatment (such as radiation therapy, chemotherapy, targeted therapy, or surgery) can cause a range of side effects. These may vary depending on the type, stage of cancer, and individual response to treatment. 

 Common side effects include¹¹: 

• Fatigue 
• Nausea and vomiting 
• Loss of appetite 
• Diarrhoea or constipation 
• Skin changes (especially in areas exposed to radiation) 
• Hair loss (mainly with certain chemotherapy drugs) 
• Vaginal dryness or narrowing 
• Decrease in sexual drive 

Other than these, with radiation treatment, premature ovarian failure and early menopause may occur in premenopausal women. Also, after radical hysterectomy, possible bladder dysfunction can happen due to autonomic nerve damage. 

Complications of Cervical Cancer

In advanced stages, cervical cancer and its treatments may lead to several serious complications, similar to those seen in other cancers. These may include⁴: 

• Chronic pain 
• Hydronephrosis (swelling of the kidneys) 
• Lymphedema (swelling in the legs) 
• Fistulas (abnormal openings between organs) 
• Bleeding disorders 
• Renal failure  
• Infertility  

Besides the above-mentioned, there are concerns which impact quality-of-life such as sexual dysfunction, psychological effect and body image issues and unfortunately these are often under-addressed. 

Can Cervical Cancer be Cured Completely?

Cervical cancer can often be cured if it is detected and treated in its early stages¹.  

Recognising cervical cancer causes and obtaining an early diagnosis through regular screening, such as Pap smears and HPV testing, could greatly improve the chances of cure⁴. Additionally, when caught early, treatments like surgery, radiation therapy, or a combination of radiation and chemotherapy can be highly effective. However, the likelihood of a cure may decrease if the cancer is diagnosed at an advanced stage, as it may have spread to other parts of the body. 

Therefore, regular screening, HPV vaccination, and prompt treatment of precancerous changes are advised for improving long-term survival rates. 

Living With Cervical Cancer

Living with cervical cancer can be physically and emotionally challenging, but with the right support, care, and mindset, many women are able to maintain a good quality of life during and after treatment. Coping strategies may include: 

• Eating small, frequent, nutrient-rich meals and drinking plenty of fluids. 
• Getting adequate rest while staying moderately active to fight fatigue. 
• Protecting sensitive skin from the sun¹². 
• Joining support groups, talking to a counsellor, or leaning on friends and family. 
• Discussing any intimacy-related concerns with your doctor for advice and solutions. 
• Attending all scheduled follow-up tests and appointments for monitoring and managing side effects¹⁰. 

Always keep in mind that managing side effects is an important part of treatment, and your doctor can provide medications, therapies, and lifestyle guidance to help you cope effectively. 

Cervical Cancer Prevention Strategies

Prevention tips focus on reducing cervical cancer risk factors, protecting against HPV infection, and ensuring early detection through regular screening. Some proactive steps include: 

• Get vaccinated against HPV: The HPV vaccine protects against high-risk HPV strains (especially HPV 16 and 18). It is most effective when given before becoming sexually active (9-14 years) but can be given up to 26 years. In India, the bivalent (Cervarix), quadrivalent (Gardasil), and nonavalent (Gardasil 9) vaccines are available¹³. 
• Attend regular screening tests: Pap smears and HPV tests help detect abnormal cervical changes early, when they could be treated before turning into cancer. According to latest WHO recommendations¹³, HPV DNA testing should be done every 5–10 years for women aged 30–49, or Pap smear every 3 years where HPV testing isn’t available¹⁴. 
• Practice safe sex: Using condoms and limiting the number of sexual partners can reduce the risk of HPV transmission¹³. 
• Avoid smoking: Smoking weakens the immune system and increases the risk of cervical and other cancers¹. 

When to See a Doctor

You should seek medical attention promptly if you notice any signs or symptoms that could indicate cervical cancer. These may include⁶: 

• Unusual vaginal bleeding (between periods, after sex, or after menopause) 
• Persistent pelvic pain or discomfort 
• Unexplained vaginal discharge, especially if foul-smelling or blood-stained 
• Pain during sexual intercourse 
• Changes in menstrual patterns that are unusual for you 

Note: Even if your symptoms seem mild, early evaluation can help detect problems sooner and improve treatment outcomes. Additionally, regular gynaecological check-ups and screenings are equally important, even if you have no cervical cancer symptoms. 

Conclusion

Cervical cancer can often be prevented and is highly treatable if found early.  

Regular screening, HPV vaccination, and adopting healthy lifestyle habits can greatly reduce the risk of developing the disease. Additionally, early detection enables timely treatment, which improves the chances of a complete cure and helps maintain a good quality of life. Therefore, by staying aware of cervical cancer symptoms, attending routine checkups, and following cervical cancer prevention measures, individuals can take proactive steps to protect themselves. 

Frequently Asked Questions (FAQs)

References

1. World Health Organization. Cervical cancer [Internet]. WHO; [cited 2025 Aug 09]. Available from: https://www.who.int/news-room/fact-sheets/detail/cervical-cancer 
2. Ramamoorthy T, Kulothungan V, Sathishkumar K, et al. Burden of cervical cancer in India: estimates of years of life lost, years lived with disability and disability adjusted life years at national and subnational levels using the National Cancer Registry Programme data. Reprod Health. 2024;21:111. Available from: https://rdcu.be/ezV6c 
3. National Cancer Institute. What is cervical cancer? [Internet]. Cancer.gov; [cited 2025 Aug 09]. Available from: https://www.cancer.gov/types/cervical 
4. Fowler JR, Maani EV, Dunton CJ, et al. Cervical Cancer. StatPearls [Internet]. StatPearls Publishing; [cited 2025 Aug 09]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431093/ 
5. Ahmed HG, Bensumaidea SH, Alshammari FD, Alenazi FSH, ALmutlaq BA, Alturkstani MZ, Aladani IA. Prevalence of Human Papillomavirus subtypes 16 and 18 among Yemeni Patients with Cervical Cancer. Asian Pac J Cancer Prev. 2017 Jun 25;18(6):1543-1548. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6373819/ 
6. National Cancer Institute. Cervical Cancer Symptoms [Internet]. Cancer.gov; [cited 2025 Aug 09]. Available from: https://www.cancer.gov/types/cervical/symptoms 
7. Cue L, Martingano DJ, Mahdy H. Clear cell carcinoma of the cervix. StatPearls [Internet]. StatPearls; [Publishing cited 2025 Aug 09]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546591/ 
8. National Cancer Institute. Cervical Cancer Stages [Internet]. Cancer.gov; [cited 2025 Aug 09]. Available from: https://www.cancer.gov/types/cervical/stages 
9. National Cancer Institute. Cervical Cancer Diagnosis [Internet]. Cancer.gov; [cited 2025 Aug 09]. Available from: https://www.cancer.gov/types/cervical/diagnosis 
10. National Cancer Institute. Cervical Cancer Treatment [Internet]. Cancer.gov; [cited 2025 Aug 09]. Available from: https://www.cancer.gov/types/cervical/treatment 
11. Palagudi M, Para S, Golla N, Meduri KC, Duvvuri SP, Vityala Y, Sajja DC, Damineni U. Adverse Effects of Cancer Treatment in Patients With Cervical Cancer. Cureus. 2024 Feb 13;16(2):e54106. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10938271/ 
12. World Health Organization. Self Care for Health [Internet]. WHO; [cited 2025 Aug 09]. Available from: https://iris.who.int/bitstream/handle/10665/205887/B5084.pdf 
13. National Cancer Institute. Cervical Cancer Causes, Risk Factors, and Prevention [Internet]. Cancer.gov; [cited 2025 Aug 09]. Available from: https://www.cancer.gov/types/cervical/causes-risk-prevention 
14. World Health Organisation. HPV and cervical cancer: What you need to know. [Internet]. WHO; [cited 2025 Aug 09]. Available from: https://cdn.who.int/media/docs/librariesprovider2/euro-health-topics/vaccines-and-immunization/hpv-factsheet-2023.pdf?sfvrsn=fa98e9f8_2&download=true#:~:text=WHO%20therefore%20recommends%20screening%20for%20vaccinated%20and,screening%20test%2C%20until%2049%20years%20of%20age.  
15. Hajiesmaeil M, Mirzaei Dahka S, Khorrami R, Rastgoo S, Bourbour F, Davoodi SH, Shafiee F, Gholamalizadeh M, Torki SA, Akbari ME, Doaei S. Intake of food groups and cervical cancer in women at risk for cervical cancer: A nested case-control study. Caspian J Intern Med. 2022 Summer;13(3):599-606. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9348217/ 
16. Maruthur NM, Bolen SD, Brancati FL, Clark JM. The association of obesity and cervical cancer screening: a systematic review and meta-analysis. Obesity (Silver Spring). 2009 Feb;17(2):375-81. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3008358/ 

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