Cervical cancer !

Cervical cancer is a cancer of the cervix, almost always caused by long-lasting human papillomavirus (HPV) infection; vaccines and screening largely prevent it.

Updated 2026-10-30

Structures involved

Tap one to see what it is and open it in 3D.

In biochemistry

Ubiquitin–proteasome system

Microorganisms that cause it

Human papillomavirus

In immunology

Colombia's PAI schedule (which vaccines, at what age)

In histology

In the clinical exam

Why it happens

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What it is

A malignant tumour of the uterine cervix, almost always caused by persistent infection with high-risk human papillomavirus (HPV). It is largely preventable with vaccination and screening.

Who gets it

A leading cause of cancer death in women in much of Latin America; the burden falls on those with less access to screening. Among women aged 20–44, mortality fell from 1997 to 2017 in Colombia (2.0% a year) and Peru (2.2% a year). Colombia has national screening and HPV vaccination programmes, organised by current national guidelines.

Causes

Persistent high-risk HPV infection; types 16 and 18 cause most cases
Squamous cell carcinoma (most) and adenocarcinoma
Develops over years from precursor lesions (CIN, HSIL)

Risk factors

No or irregular screening
Early sexual debut and multiple partners
Smoking
Immunosuppression, including HIV
Long-term combined oral contraceptive use; high parity
Other sexually transmitted infections

Pathophysiology

HPV infects basal cells at the transformation zone. Viral oncoproteins E6 and E7 inactivate p53 and Rb, removing brakes on cell growth. Most infections clear, but persistent ones can cause CIN that progresses over years to invasion. Spread is local (parametrium, vagina, bladder, rectum), then to pelvic nodes and distant sites.

Classification

FIGO stage I: confined to the cervix (IA microscopic, IB visible or deeper)
FIGO stage II: beyond the uterus but not to the pelvic wall or lower third of the vagina (IIA vagina, IIB parametrium)
FIGO stage III: lower third of vagina, pelvic wall, hydronephrosis, or pelvic or para-aortic nodes (IIIC)
FIGO stage IV: bladder or rectal mucosa (IVA) or distant spread (IVB)
Precursors: CIN 1–3, or low- and high-grade squamous intraepithelial lesions (LSIL, HSIL)

Symptoms and signs

Often none in early stages (found by screening)
Abnormal vaginal bleeding: after intercourse, between periods or after menopause
Watery, bloody or foul-smelling vaginal discharge
Pelvic or low back pain, dyspareunia
Advanced: leg swelling, flank pain, urinary or rectal symptoms, weight loss

Diagnosis

Clinical: Speculum exam; visible lesions are biopsied directly. Abnormal screening leads to colposcopy with guided biopsy.
Tests: Screening with cytology (Pap test) and/or high-risk HPV testing; histology confirms cancer; blood count and kidney function; cystoscopy or proctoscopy in selected cases.
Imaging: Pelvic MRI for local extent; CT or PET-CT for nodes and distant spread. FIGO 2018 allows imaging and pathology to assign the stage.

Differential diagnosis

Cervicitis
Cervical polyp or ectropion
Endometrial cancer
Vaginal cancer or metastasis
Pregnancy-related bleeding

Goal of treatment

Find and treat precancer before it invades; for cancer, cure with stage-based treatment, keeping fertility when safe, and relieve symptoms in advanced disease.

Treatment

Procedure: Precancer (CIN 2–3, HSIL): excision of the transformation zone (LEEP or cone) or ablation (cryotherapy or thermal ablation) in screen-and-treat programmes.
Surgical: Early stages: cone or radical trachelectomy to preserve fertility in selected cases; otherwise radical hysterectomy with pelvic lymph node assessment.
Medical: Locally advanced: chemoradiation (external beam radiotherapy plus brachytherapy) with platinum-based chemotherapy.
Medical: Advanced or recurrent: systemic chemotherapy, anti-angiogenic agents and immune checkpoint inhibitors according to guidelines.
Follow-up: Follow-up visits after treatment, and palliative care for symptom control when needed.

Drugs for this condition

Complications

Ureteric obstruction and kidney failure
Vesicovaginal or rectovaginal fistula
Bleeding
Lymphoedema
Treatment effects: radiation cystitis or proctitis, vaginal stenosis, early menopause, infertility

Prognosis

Excellent when found as precancer or early cancer; survival falls with higher FIGO stage, nodal spread and distant metastasis. Most recurrences appear in the first years after treatment.

Prevention

HPV vaccination, ideally before sexual activity begins, as in national programmes
Regular screening with cytology and/or HPV testing, at the ages set by national guidelines
Prompt follow-up and treatment of abnormal results
Condoms (reduce, but do not remove, HPV transmission) and not smoking

Test yourself

Think of the answer, then tap the question to see it.

Which virus causes almost all cervical cancers?

High-risk human papillomavirus (HPV), mainly types 16 and 18.

Which HPV oncoproteins inactivate p53 and Rb?

E6 inactivates p53 and E7 inactivates Rb.

In which part of the cervix do most cancers begin?

The transformation zone, where columnar epithelium changes to squamous epithelium.

What is the standard treatment for locally advanced cervical cancer?

Chemoradiation: external beam radiotherapy plus brachytherapy, with platinum-based chemotherapy.

What does FIGO stage IIIB mean?

The tumour reaches the pelvic wall and/or causes hydronephrosis or a non-functioning kidney.

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Educational information, not medical advice. For any symptom, see a health professional.

Sources: Cervical Cancer (StatPearls (NCBI Bookshelf), 2023); Cervical cancer mortality among young women in Latin America and the Caribbean: trend analysis from 1997 to 2030 (BMC public health, 2022) · adapted, CC BY 4.0.

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Representative model, for educational purposes only.

Cervix highlighted on the Durgical 3D model