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Cervical cancer starts in the cells of the cervix. The cervix is the lower, narrow end of the uterus (or womb, where a baby grows). It joins the uterus to the vagina (birth canal).
Before cervical cancer appears, the cells of the cervix go through precancerous changes, known as dysplasia. This is usually a slow process that develops over many years. A Papanicolaou test (Pap test) given every three to five years looks for these changes. If precancerous cells are found, they often can be removed preventing the formation of cancer. Over time, if not destroyed or removed, the abnormal cells may become cancerous and spread more deeply into the cervix and to surrounding tissues.
Most women who develop cervical cancer are between 20 and 50 years old. Cervical cancer was once one of the main causes of death from cancer in the United States, but the widespread use of the Pap test has helped doctors find cervical cancer in the early stages, when treatment is most effective. As more women get the human papillomavirus (HPV) vaccine, the number of patients with cervical cancer in the United States should decrease even further.
Causes of cervical cancer
Most cases of cervical cancer are caused by infection with HPV, which usually is passed from person to person by sexual contact. The average person's lifetime risk of contracting HPV is about 80%.
In most people, the immune system clears HPV before it is detected or causes cells to change, so most women with an HPV infection do not develop cervical cancer. However, in a small percentage of people the virus will remain and cause cell changes that may develop into cancer.
Types of cervical cancer
Cervical cancer is classified based on the type of cell where it develops. The most common types of cervical cancer are:
Squamous cell carcinoma: This is the most common type of cervical cancer and is found in 80% to 90% of cases. It develops on the surface of the cervix.
Adenocarcinoma: This accounts for about 10% to 20% of cervical cancer cases. It develops in gland cells that produce cervical mucus.
Mixed carcinoma: Occasionally, cervical cancer has features of squamous cell carcinoma and adenocarcinoma.
In rare instances, other types of cancer, such as neuroendocrine (small and large cell cervical cancer), melanoma, sarcoma and lymphoma, are found in the cervix.
Cervical cancer risk factors
Anything that increases a woman's chances of getting HPV, decreases her ability to get Pap tests, or lowers her immune system’s ability to fight infection is a risk factor for cervical cancer.
Risk factors include:
- Age: The risk of cervical cancer increases with age. It is found most often in women over the age of 40. However, younger women often have precancerous lesions that require treatment to prevent cancer.
- Smoking: Cigarette smoke contains chemicals that damage the body's cells. It increases the risk of precancerous changes in the cervix, especially in women with HPV.
- Sexual behavior: HPV is spread by sexual contact and is the cause of almost all cases of cervical cancer, as well as many vaginal and vulvar cancers. HPV may cause the cells in the cervix to change. If abnormal cells are not found and treated, they may become cancer. Certain types of sexual activity may increase the risk of getting HPV infection. These include:
- Multiple sexual partners
- High-risk male partners
- First intercourse at an early age
- Not using condoms during sex.
- Diethylstilbestrol (DES) exposure before birth: This drug was used between 1940 and 1971 to help prevent miscarriages. Women whose mothers took DES during pregnancy have a high risk of vaginal and cervical cancers.
- Lack of regular Pap tests
- Having a sexually transmitted disease (STD), including chlamydia
- HIV infection
- Weakened immune system
- Having an organ transplant
- Taking steroids
Not everyone with risk factors gets cervical cancer. However, if a woman does have risk factors it’s a good idea to discuss them with a health care provider.
Some people have an elevated risk of developing cervical cancer. Review the cervical cancer screening guidelines to see if you need to be tested.
Behavioral and lifestyle changes can help prevent cervical cancer. Visit our prevention and screening section to learn how to manage your risk.
Learn more about cervical cancer:
MD Anderson is #1 in Cancer Care
Why choose MD Anderson for cervical cancer treatment?
At MD Anderson’s Gynecologic Oncology Center, some of the nation's top experts work together to carefully plan your cervical cancer treatment. They customize your plan of action to deliver the most advanced cervical cancer treatment with the least impact on your body.
Your personal group of experts, which includes highly specialized pathologists, radiologists, radiation oncologists and gynecological oncologists, is supported by a thoroughly trained staff. They communicate and collaborate at every step to increase your chances for successful cervical cancer treatment.
MD Anderson also offers treatment for pre-cancerous changes of the cervix and performs cervical biopsies to investigate abnormal Pap tests.
Surgery often is an integral part of cervical cancer treatment, and the surgeon’s skill can make a crucial difference in the success of these delicate operations. MD Anderson’s surgeons are among the most experienced in the nation in surgery for cervical cancer.
Procedures available may include:
- Radical hysterectomy
- Lymphatic mapping and sentinel lymph node biopsy
- Laparoscopic retroperitoneal lymph node dissection, a minimally invasive procedure to determine the extent of cancer and help plan treatment
- Fertility-sparing techniques, including radical trachelectomy, a highly specialized surgery that may help some women keep the ability to have children
Over the past several years, MD Anderson has advanced cervical cancer treatment by leading and participating in several pivotal discoveries. For example, MD Anderson led the clinical trial that demonstrated the superiority of treating cervical cancer with chemotherapy and radiation, instead of radiation alone. This changed the standard of cervical cancer treatment and became the universally accepted approach.
Our ConCerv trial evaluated the feasibility of conservative surgery in women with early-stage, low-risk cervical cancer. Conservative surgery is less aggressive than the current standard of care, which is radical hysterectomy. For certain patients with small tumors, a simple hysterectomy is likely adequate. This greatly reduces many of the surgical complications associated with radical surgery.
Additionally, when comparing standard-of-care surgical options for women with early-stage cervical cancer, two studies led by researchers at MD Anderson discovered that minimally invasive radical hysterectomy is associated with higher recurrence rates and worse overall survival compared to abdominal radical hysterectomy.
We continue to make progress toward helping women with cervical cancer by offering a range of clinical trials (research studies) for new medications. And, at MD Anderson you’re surrounded by the strength of one of the nation’s largest and most experienced comprehensive cancer centers, which has all the support and wellness services needed to treat the whole person – not just the disease.
As a mom and a cancer survivor, I tell other parents, 'Don't wait to get your kids the HPV vaccine.'
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Prevention & Screening
Many cancers can be prevented with lifestyle changes and regular screening.