Cervical Cancer

Overview and Staging

Cervical cancer develops in the cervix, which is the lower, narrow end of the uterus leading to the vagina. It is often caused by human papillomavirus (HPV), a sexually transmitted virus. HPV is so common that it develops at some point in nearly all sexually active people, both women and men. Cervical cancer grows slowly and may not cause symptoms, but it can be detected with regular Pap tests and HPV testing.

Most cervical cancers (about 80 to 90 percent) are squamous cell carcinomas that start in the squamous cells covering the surface of the portion of the cervix closest to the vagina (known as the exocervix). The remaining cases are usually adenocarcinomas that arise from gland cells in the portion of the cervix closest to the uterus (known as the endocervix). The disease typically affects women younger than 50, but more than 15 percent of cases are in women older than 65.

The human papillomavirus (HPV) is a virus that can lead to cancer and, particularly, oropharyngeal (throat) and cervical cancer. HPV is the most common sexually transmitted disease in the United States. Most people acquire an HPV infection at some point in their lifetime, and the majority are able to heal from it, often without symptoms. If the infection does not resolve, however, it may lead to the development of cancer.

Preventing a life-threatening HPV infection begins with learning how to protect your health and the health of your loved ones. 

The Centers for Disease Control and Prevention recommend routine HPV vaccination for girls and boys at age 11 or 12, and can be given starting at age 9. For young people not vaccinated within the age recommendations, HPV vaccination is recommended up to age 26. 

Three vaccines are approved by the U.S. Food and Drug Administration (FDA) for male and female children and young adults, 9 to 26 years old, to provide protection against new HPV infections and include:

• Gardasil (Human Papillomavirus Quadrivalent [Types 6, 11, 16, and 18] Vaccine, Recombinant).

• Gardasil 9 (Human Papillomavirus 9-valent Vaccine, Recombinant). Gardasil 9’s approval was recently expanded to include males and females ages 27 through 45 years.

• Cervarix (Human Papillomavirus Bivalent [Types 16 and 18] Vaccine, Recombinant).

Although the HPV vaccine does not treat existing infections or diseases, it offers the most protection when given before a person becomes sexually active. Those who are already sexually active may benefit less from the vaccine because they may have been exposed to some of the HPV types the vaccine targets. Adults between the ages of 27 and 45 who are not already vaccinated may decide to get the HPV vaccine after talking with their doctor about their risk of new HPV infections and other ways to lower the risk of passing on HPV, such as using condoms or dental dams. 

Diagnosing and staging

An abnormal Pap test result is often the first step in diagnosing cervical cancer. After the abnormal Pap test result, you may have a colposcopy (an examination of your cervix during which a biopsy sample may be taken) or diagnostic imaging. A biopsy confirms the presence of cancer.

Staging a cancer is finding out the extent of the cancer, including the tumor size and if and how far it has spread. Determining the stage of cervical cancer is crucial in deciding which treatment options to pursue. Cervical cancer is clinically staged, which means your doctor classifies your cervical cancer based on your physical examination and diagnostic testing.

Cervical cancers are classified according to the tumor, node, metastasis (TNM) system developed by the American Joint Committee on Cancer. The tumor (T) is categorized according to its size and location, whether cancer cells are found in nearby lymph nodes (N), and whether cancer has metastasized (spread) (M) to other parts of the body. Once a cervical cancer has been classified, an overall stage is assigned (see Figures in Staging Illustrations).