Cervical cancer develops when cancer cells form in the cervix, the narrow part of the uterus that serves as the entrance to the womb.

Doctors use a number of tools and techniques to help detect cervical cancer as early as possible.

Abnormal cells that have the potential to develop into cancer are “precancerous.” Identifying and treating precancerous cells may help prevent cancer from developing.

The outlook for people with cervical cancer has greatly improved in recent years, thanks to advances in screening, detection, and treatment.

This article describes the process of detecting cervical precancer and cancer. It also outlines cervical cell types and explores cervical cancer types, stages, and treatments, as well as the outlook.

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In its early stages, cervical cancer typically does not cause symptoms. So doctors rely on screening and other techniques for identifying it early as possible. These approaches include:

Pelvic exam

Screening for cervical cancer may begin with a pelvic exam.

A doctor uses a device called a speculum to hold the vaginal canal open. With the aid of a light, this allows the doctor to make a visual inspection of the cervix.

Screening tests

Screening tests can help show changes to cervical cells before they become cancerous. These precancerous cells may show up on Pap or human papillomavirus (HPV) tests.

Pap test

A Pap test, or Pap smear, looks for precancerous changes in the cells of the cervix. Precancerous cells have a high risk of becoming cancerous if the person does not receive treatment.

The test involves brushing and removing some cells from the cervix and sending this sample to a lab for analysis.

Doctors may recommend regular Pap screening for women aged 21–65 years. The frequency of screening varies from every 3–5 years, depending on a person’s age and specific risk factors.

HPV testing

An HPV test also involves collecting cells from the cervix to test for an infection with the virus.

HPV testing is a crucial component of screening, as HPV infections cause up to 90% of cervical cancer cases.

During screening, a doctor may recommend an HPV vaccine to protect against the forms of HPV that can cause cervical cancer.

Learn more about HPV vaccines here.

Colposcopy

A colposcopy involves using an instrument called a colposcope to inspect the cervix. This tool has a light and it magnifies the cervix, allowing for a very close inspection.

Doctors tend to rely on colposcopy if other screening tests suggest that abnormal cells are present. Or, they may use this test to investigate bleeding, pain, or symptoms suggesting inflammation.

Tissue biopsies

If necessary, such as when a test detects abnormal cells, doctors may remove tissue from the cervix for testing. They may use one of the following methods:

  • Punch biopsy: This involves removing a small section of cervical tissue.
  • Endocervical curettage: This involves inserting an instrument called a curette into the cervical canal to scrape some tissue from inside the cervix.
  • Loop electrosurgical excision procedure: The doctor uses an electrically heated wire loop to remove cells from the cervix.

There are two main parts of the cervix: The exocervix and the endocervix. Each contains different types of cells.

Exocervix

The exocervix is the outer area of the cervix, and it meets the vaginal canal. A doctor can see the exocervix during a pelvic exam.

Cells called squamous cells cover most of the exocervix.

Endocervix

The endocervix is the opening of the cervix that leads into the main part of the uterus.

Cells called glandular cells cover the endocervix.

Transformation zone

The transformation zone refers to the area where the exocervix meets the endocervix. It contains both squamous cells and glandular cells.

The exact area of the transformation zone varies, based on factors such as age and whether a person has given birth.

The type of cervical cancer depends mainly on the kinds of cells involved.

The most common type of cervical cancer is squamous cell carcinoma, followed by adenocarcinoma. It is also possible to develop both types.

Squamous cell carcinoma

Squamous cell carcinomas develop from the squamous cells in the exocervix. It tends to form in the transformation zone.

Squamous cell carcinomas account for up to 90% of cervical cancer cases.

Adenocarcinoma

Adenocarcinomas are cancerous cells that develop from the glandular cells and tissues in the endocervix.

Mixed carcinoma

If a person has features of both squamous cell carcinoma and adenocarcinoma, doctors may diagnose “mixed carcinoma” or “adenosquamous carcinoma.”

Other types

Other, less common types of cancer may also develop in the cervix. Examples include:

  • Lymphoma of the cervix: This develops in the lymph nodes of the cervix.
  • Melanoma of the cervix: This develops in the cervical cells that produce the pigment melanin.
  • Sarcoma: This is an aggressive cancer that develops in soft tissues.

Cervical cancer has two main stages: precancer and cancer.

Precancer

A healthy cell may develop abnormally in a way that suggests that it will become cancerous. Doctors may refer to these cells as “precancerous.”

Precancerous cells are not a sign of cancer, but without treatment, they may develop into cancer.

Precancerous cell types and grades

Doctors may use the terms “cervical dysplasia” or “cervical intraepithelial neoplasia” (CIN) to describe precancerous cervical cells.

Based on how much cervical tissue is precancerous, doctors give the issue different grades:

  • CIN 1 or mild dysplasia: The surface of the cervix has slightly abnormal cells. Doctors may consider this type of dysplasia to present the lowest risk.
  • CIN 2 or moderate dysplasia: The surface of the cervix contains moderately abnormal cells.
  • CIN3 or severe dysplasia: The surface of the cervix contains severely abnormal cells.

Without treatment, all of these grades have the potential to develop into cancer and spread to nearby healthy tissues.

In some cases, doctors may recommend more frequent monitoring for changes to determine whether intervention is necessary.

For some people, precancerous cells resolve without treatment. Depending on a person’s risk, doctors may still recommend removing the cells.

Cancer

If doctors discover cancerous cells, they stage the cancer using the International Federation of Gynecology and Obstetrics, or FIGO, staging system.

Considering factors such as the cancer’s spread, doctors assign the cancer a stage of 1–4. Lower numbers indicate less spread and higher numbers indicate that the cancer has spread to distant tissues or lymph nodes.

Doctors may recommend various treatments for precancerous or cancerous cervical cells. The best approach depends on various factors, including:

  • the person’s age
  • whether the cells are precancerous or cancerous
  • the person’s specific risk factors for cervical cancer
  • the types of cells involved
  • the stage of the cancer, if this applies

Treatment options may include:

  • surgery to cut away cancerous cells
  • surgery to remove all or part of the cervix
  • surgery to remove the cervix and surrounding affected areas, such as the uterus
  • cryotherapy to freeze away the cells
  • laser therapy to burn away the cells
  • internal or external radiation therapy
  • chemotherapy
  • targeted drug therapies
  • immunotherapy drug treatments
  • supportive care and symptom relief

Cervical cancer can progress at different rates. Some precancerous cells develop into invasive cancer over 10–12 years. Others may do so within 1 year. Without prompt treatment, aggressive cancers may quickly spread to surrounding tissues.

If doctors diagnose the cancer at a late state, they may recommend a more aggressive approach to treatment. Late stage cancers tend to have a worse outlook.

When describing a person’s outlook, a doctor may talk about the 5-year survival rate. This figure reflects the likelihood of living for at least another 5 years after the diagnosis.

It is worth keeping in mind that all survival rates are based on averages of past data, and they may not take into account recent advances in detection and treatment. Also, factors specific to each person can play an important role.

The combined 5-year survival rate for all types of cervical cancer is 66%. But the 5-year survival rate for cancer that has not spread outside the cervix and uterus is 92%. This reflects the importance of screening and prompt diagnosis and treatment.

Cells in the cervix may begin to change and become precancerous long before they become cancerous.

Doctors may discover precancerous or cancerous cells during a routine pelvic exam or during regular screening.

Doctors recommend having this screening every few years to help detect potentially cancerous changes as early as possible. This is crucial because an early diagnosis and treatment can greatly improve the outlook.