What Is the First Stage of Cervical Cancer?

Early cervical cancer and pre-cancer usually do not have any symptoms. Symptoms of cervical cancer often do not start until the cancer grows and spreads into nearby tissue. When symptoms of cervical cancer occur, they may include: 

• Abnormal vaginal bleeding
  • Bleeding and spotting between periods
  • Menstrual periods that are longer or heavier than usual
  • Bleeding after vaginal sex
  • Bleeding after menopause
  • Bleeding after douching 
• Unusual vaginal discharge 
  • May contain blood 
  • May occur between periods or after menopause
• Pain during sex
• Pain in the pelvic region

Symptoms of advanced cervical cancer may include:

• Leg swelling
• Problems urinating or having a bowel movement
• Blood in the urine

The cause of cervical cancer is not always known though it may be due to genetic changes (mutations). 

Certain types of human papillomavirus (HPV) infection are the biggest risk factor for cervical cancer. 

In addition to HPV infection, risk factors for developing cervical cancer include: 

• Sexual history
  • Becoming sexually active before 18 years old
  • Having many sexual partners
  • Having a partner who is considered high risk (someone with HPV infection or who has many sexual partners)
• Smoking
• A weakened immune system
  • Human immunodeficiency virus (HIV), the virus that causes AIDS
  • Taking immunosuppressant drugs for an autoimmune disease or organ transplant
• Chlamydia infection 
• Long-term use of oral contraceptives (birth control pills)
• Age younger than 20 years at first full-term pregnancy 
• Having multiple (3 or more) full-term pregnancies 
• Economic status
  • Women with a low income may not have easy access to some health care services, including cervical cancer screening with Pap tests and HPV tests, which means they may not get screened or treated for cervical pre-cancers
• A diet low in fruits and vegetables 
• Diethylstilbestrol (DES) 
• A family history of cervical cancer 

Cervical cancer is diagnosed with regular screenings. 

• A Pap smear (Pap test) is a test that collects cells from the cervix to check for abnormal cervical cells that can lead to cervical cancer
  • Pap tests are also used to find abnormal cervical cells before they become cancer (precancers)
• The HPV test is usually used in 2 situations:
  • The primary HPV test is preferred for cervical cancer screening in women age 25-65 years 
  • Some HPV tests are part of a co-test, when the HPV test and the Pap test are done at the same time to screen for cervical cancer

Treatments for cervical cancer may include one or more of the following:

• Surgery 
  • For pre-cancer: 
    • Ablation to destroy cervical tissue with cold temperatures (cryosurgery) or a laser 
    • Excisional surgery (conization) to cut out and remove the pre-cancer
  • For invasive cervical cancer:
    • Hysterectomy (simple or radical) to remove the cervix and uterus
    • Trachelectomy to remove the cervix and the upper part of the vagina but not the body of the uterus for women who want maintain the ability to have children 
  • Lymph node removal
• Radiation therapy 
  • External beam radiation
  • Brachytherapy (internal radiation therapy)
• Chemotherapy (“chemo”)
  • For cervical cancer that has come back or spread to other areas:
    • Cisplatin
    • Carboplatin
    • Paclitaxel (Taxol)
    • Topotecan
    • Combinations of these drugs are often used
    • Other drugs may be used, such as docetaxel (Taxotere), ifosfamide (Ifex), 5-fluorouracil (5-FU), irinotecan (Camptosar), gemcitabine (Gemzar) and mitomycin
    • The targeted drug bevacizumab (Avastin) may be added to chemo
• Chemoradiation, which is chemotherapy given along with radiation to help it work better
  • Cisplatin given weekly during radiation (carboplatin may be used instead) 
  • Cisplatin plus 5-fluorouracil (5-FU) given every 3 weeks during radiation
• Targeted therapy 
  • Vascular endothelial growth factor (VEGF): bevacizumab (Avastin)
• Immunotherapy 
  • Immune checkpoint inhibitors: pembrolizumab (Keytruda)