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Cervical Cancer

by Pedro T. Ramirez, MD, David M. Gershenson, MD

Cervical cancer develops in the cervix (the lower part of the uterus).

  • Cervical cancer usually results from infection with the human papillomavirus (HPV), transmitted during sexual intercourse.

  • Cervical cancer may cause irregular vaginal bleeding, but symptoms may not occur until the cancer has enlarged or spread.

  • Papanicolaou (Pap) tests can usually detect abnormalities, which are then biopsied.

  • Treatment usually involves surgery to remove the cancer and often the surrounding tissue and often, if tumors are large, radiation therapy and chemotherapy.

  • Getting regular Pap tests and being vaccinated against HPV can help prevent cervical cancer.

The cervix is the lower part of the uterus. It extends into the vagina.

In the United States, cervical cancer (cervical carcinoma) is the third most common gynecologic cancer among all women and is common among younger women. The average age at diagnosis is about 50, but it can affect women as young as 20.

This cancer is most commonly caused by the human papillomavirus (HPV), which is transmitted during sexual intercourse. This virus also causes genital warts (see Genital Warts (Human Papillomavirus Infection, or HPV Infection)).

Risk of developing cervical cancer is increased by the following:

  • Having sexual intercourse for the first time at a young age

  • Having more than one sex partner

  • Having intercourse with men whose previous partners had cervical cancer

  • Smoking cigarettes

  • Having a weakened immune system (due to a disorder such as cancer or AIDS or to drugs such as chemotherapy drugs or corticosteroids)

The younger a woman was the first time she had sexual intercourse and the more sex partners she has had, the higher her risk of cervical cancer.

About 80 to 85% of cervical cancers are squamous cell carcinomas, which develop in the flat, skinlike cells that line the cervix. Most other cervical cancers are adenocarcinomas, which develop from gland cells

Cervical cancer begins with slow, progressive changes in normal cells on the surface of the cervix. These changes, called dysplasia or cervical intraepithelial neoplasia (CIN), are considered precancerous. That means that if untreated, they may progress to cancer, sometimes after years.

Cervical cancer begins on the surface of the cervix and can penetrate deep beneath the surface. The cancer can spread directly to nearby tissues, including the vagina. Or it can enter the rich network of lymphatic vessels inside the cervix, then spread to other parts of the body. Rarely, it is spread through the bloodstream.

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