Human papillomavirus (HPV) infection is the major risk factor for development of cervical cancer. Infection of the cervix with human papillomavirus (HPV) is the most common cause of cervical cancer. Not all women with HPV infection, however, will develop cervical cancer. Women who do not regularly have a Pap smear to detect HPV or abnormal cells in the cervix are at increased risk of cervical cancer.
Other possible risk factors include the following:

Giving birth to many children.
Having many sexual partners.
Having first sexual intercourse at a young age.
Smoking cigarettes.
A diet lacking in vitamins A and C.
Oral contraceptive use ("the Pill").
Weakened immune system.

There are usually no noticeable signs of early cervical cancer but it can be detected early with yearly check-ups. Early cervical cancer may not cause noticeable signs or symptoms. Women should have yearly check-ups, including a Pap smear to check for abnormal cells in the cervix. The prognosis
(chance of recovery) is better when the cancer is found early. Possible signs of cervical cancer include vaginal bleeding and pelvic pain. These and other symptoms may be caused by cervical cancer or
by other conditions. A doctor should be consulted if any of the following problems occur:
 

Vaginal bleeding.
Unusual vaginal discharge.
Pelvic pain.
Pain during sexual intercourse.
 

Tests that examine the cervix are used to detect and diagnose cervical cancer. The following procedures may be used:

• Pap smear: A procedure to collect cells from the surface of
  the cervix and vagina. A piece of cotton, a brush, or a
  small wooden stick is used to gently scrape cells from the
  cervix and vagina. The cells are viewed under a microscope
  to find out if they are abnormal. This procedure is also
  called a Pap test.
   

• Colposcopy: A procedure to look inside the vagina and cervix
  for abnormal areas. A colposcope (a thin, lighted tube) is
  inserted through the vagina into the cervix. Tissue samples
  may be taken for biopsy.
   

• Biopsy: If abnormal cells are found in a Pap smear, the
  doctor may do a biopsy. A sample of tissue is cut from the
  cervix and viewed under a microscope. A biopsy that removes
  only a small amount of tissue is usually done in the
  doctor’s office. A woman may need to go to a hospital for a
  cervical cone biopsy (removal of a larger, cone-shaped
  sample of cervical tissue).
   

• Pelvic exam: An exam of the vagina, cervix, uterus,
  fallopian tubes, ovaries, and rectum. The doctor or nurse
  inserts one or two lubricated, gloved fingers of one hand
  into the vagina and the other hand is placed over the lower
  abdomen to feel the size, shape, and position of the uterus
  and ovaries. A speculum is also inserted into the vagina and
  the doctor or nurse looks at the vagina and cervix for signs
  of disease. A Pap test or Pap smear of the cervix is usually
  done. The doctor or nurse also inserts a lubricated, gloved
  finger into the rectum to feel for lumps or abnormal areas.
   

• Endocervical curettage: A procedure to collect cells or
  tissue from the cervical canal using a curette (spoon-shaped
  instrument). Tissue samples may be taken for biopsy. This
  procedure is sometimes done at the same time as a
  colposcopy.

Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis depends on the following:

The stage of the cancer (whether it affects part of the cervix, involves the whole cervix, or has spread to the lymph nodes or other places in the body).

The type of cervical cancer.
The size of the tumour.

Treatment options depend on the following:

The stage of the cancer.
The size of the tumour.
The patient's desire to have children.
The patient’s age.

Treatment of cervical cancer during pregnancy depends on the stage of the cancer and the stage of the pregnancy. For cervical cancer found early or for cancer found during the last trimester of pregnancy, treatment may be delayed until after the baby is born.

Stages of Cervical Cancer

After cervical cancer has been diagnosed, tests are done to find out if cancer cells have spread within
the cervix or to other parts of the body. The following stages are used for cervical cancer:
Stage 0 (Carcinoma in Situ)
Stage I
Stage II
Stage III
Stage IV

After cervical cancer has been diagnosed, tests are done to find out if cancer cells have spread within the cervix or to other parts of the body. The process used to find out if cancer has spread within the
cervix or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

• Chest x-ray: An x-ray of the organs and bones inside the
  chest. An x-ray is a type of energy beam that can go through
  the body and onto film, making a picture of areas inside the
  body.
   

• CT scan (CAT scan): A procedure that makes a series of
  detailed pictures of areas inside the body, taken from
  different angles. The pictures are made by a computer linked
  to an x-ray machine. A dye may be injected into a vein or
  swallowed to help the organs or tissues show up more
  clearly. This procedure is also called computed tomography,
  computerized tomography, or computerized axial tomography.
   

• Lymphangiogram: A procedure used to x-ray the lymph system.
  A dye is injected into the lymph vessels in the feet. The
  dye travels upward through the lymph nodes and lymph
  vessels, and x-rays are taken to see if there are any
  blockages. This test helps find out whether cancer has
  spread to the lymph nodes.
   

• Pre-treatment surgical staging: Surgery (an operation) is
  done to find out if the cancer has spread within the cervix
  or to other parts of the body. In some cases, the cervical
  cancer can be removed at the same time. Pre-treatment
  surgical staging is usually done only as part of a clinical
  trial.
   

• Ultrasound: A procedure in which high-energy sound waves
  (ultrasound) are bounced off internal tissues or organs and
  make echoes. The echoes form a picture of body tissues
  called a sonogram.
   

• MRI (magnetic resonance imaging): A procedure that uses a
  magnet, radio waves, and a computer to make a series of
  detailed pictures of areas inside the body. This procedure
  is also called nuclear magnetic resonance imaging (NMRI).

The results of these tests are viewed together with the results of the original tumour biopsy to determine the cervical cancer stage.

The following stages are used for cervical cancer:

Stage 0 (Carcinoma in Situ)
In stage 0, cancer is found in the first layer of cells lining the cervix only and has not invaded the deeper tissues of the cervix. Stage 0 is also called carcinoma in situ.

Stage I:In stage I, cancer is found in the cervix only. Stage I is divided into stages IA and IB, based on the amount of cancer that is found.

Stage IA: A very small amount of cancer that can only be seen with a microscope is found in the tissues of the cervix. The cancer is not deeper than 5 millimetres (less than ¼ inch) and not wider than 7 millimetres (about ¼ inch).

Stage IB: In stage IB, cancer is still within the cervix and either can only be seen with a microscope and is deeper than 5 millimetre (less than ¼ inch) or wider than 7 millimetres (about ¼ inch) or can be seen without a microscope and may be larger than 4 centimetres (about 1 ½ inches).

Stage II: In stage II, cancer has spread beyond the cervix but not to the pelvic wall (the tissues that line the part of the body between the hips). Stage II is divided into stages IIA and IIB, based on how far the cancer has spread.

Stage IIA: Cancer has spread beyond the cervix to the upper two thirds of the vagina but not to tissues around the uterus.

Stage IIB: Cancer has spread beyond the cervix to the upper two thirds of the vagina and to the tissues around the uterus.

Stage III: In stage III, cancer has spread to the lower third of the vagina and may have spread to the pelvic wall and nearby lymph nodes. Stage III is divided into stages IIIA and IIIB, based on how far the cancer has spread.

Stage IIIA: Cancer has spread to the lower third of the vagina but not to the pelvic wall.

Stage IIIB: Cancer has spread to the pelvic wall and/or the tumour has become large enough to block the ureters (the tubes that connect the kidneys to the bladder). This blockage can cause the kidneys to enlarge or stop working. Cancer cells may also have spread to lymph nodes in the pelvis.

Stage IV: In stage IV, cancer has spread to the bladder, rectum or other parts of the body. Stage IV is divided into stages IVA and IVB, based on where the cancer is found.

Stage IVA: Cancer has spread to the bladder or rectal wall and may have spread to lymph nodes in the pelvis.

Stage IVB: Cancer has spread beyond the pelvis and pelvic lymph nodes to other places in the body, such as the abdomen, liver, intestinal tract, or lungs.

There are different types of treatment for patients with cervical cancer. Three types of standard treatment are used:

• Surgery
   

• Radiation therapy
   

• Chemotherapy
   

• Other types of treatment are being tested in clinical trials.

There are different types of treatment for patients with cervical cancer. Different types of treatment are available for patients with cervical cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the “standard” treatment, the new treatment may become the standard treatment. Three types of standard treatment are used:

Surgery (removing the cancer in an operation) is sometimes used to treat cervical cancer. The following surgical procedures may be used:

• Conization: A procedure to remove a cone-shaped piece of tissue from the cervix and cervical canal. A pathologist views the tissue under a microscope to look for cancer cells. Conization may be used to diagnose or treat a cervical condition. This procedure is also called a cone biopsy.
   

• Hysterectomy: A surgical procedure to remove the uterus and cervix. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision in the abdomen, the operation is called a total
  abdominal hysterectomy. If the uterus and cervix are taken out through a small incision in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.
   

• Bilateral salpingo-oophorectomy: A surgical procedure to remove both ovaries and both fallopian tubes.
   

• Radical hysterectomy: A surgical procedure to remove the uterus, cervix, and part of the vagina. The ovaries or lymph nodes may also be removed.
   

• Pelvic exenteration: A surgical procedure to remove the lower colon, rectum, and bladder. In women, the cervix, vagina, ovaries, and nearby lymph nodes are also removed. Artificial openings (stoma) are made for urine and stool to flow from the body to a collection bag. Plastic surgery may be needed to make an artificial vagina after this operation.
   

• Cryosurgery: A treatment that uses an instrument to freeze and destroy abnormal tissue, such as carcinoma in situ. This type of treatment is also called cryotherapy.

• Laser surgery: A cancer treatment that uses a laser beam (a narrow beam of intense light) as a knife to remove cancer. Loop electrosurgical excision procedure (LEEP): A treatment that uses electrical current passed through a thin wire loop as a knife to remove abnormal tissue or cancer.
   

• Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy
  uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of
  the cancer being treated.
   

• Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly
  into the spinal column, a body cavity such as the abdomen, or an organ, the drugs mainly affect cancer cells in those areas. The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Other types of treatment are being tested in clinical trials.

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