Cervical cancer

At a glance

  • Cervical cancer is usually caused by an infection with human papillomaviruses (HPV).
  • These viruses can cause the tissue to change over time. In rare cases this can lead to cancer.
  • Screening tests can detect abnormal tissue, which can then be removed.
  • The HPV vaccine reduces the risk of developing cervical cancer.
  • Cervical cancer is treated with surgery, radiation or chemotherapy.

Introduction

Photo of patient and doctor
wavebreakmedia / iStockphoto / Thinkstock

Cervical cancer is the term used to describe tumors that can grow at the lower end of the womb. These tumors usually develop from abnormal cell changes at the entrance to the womb from the vagina (the opening of the cervix). Abnormal tissue can be detected through and then removed. A vaccine against viruses that cause cancer (HPV vaccine) can reduce the risk of cervical cancer.

The cervix (neck of the womb) is a strong, muscular tube-like structure. The very bottom end of the cervix sticks out into the vagina a little, at the opening of the cervix. The inside of the cervix is lined with a mucous membrane. The glands in the mucous membrane produce a thick liquid (cervical mucus) that acts as a barrier, preventing germs from entering the womb from the vagina.

Illustration: Cervix and opening of the cervix

Cervix and opening of the cervix

Symptoms

It usually takes years, if not decades, for abnormal cells to develop into cervical cancer. These abnormal cells aren't dangerous and don't cause any, or only few, symptoms. If they develop into cancer, it can cause the following symptoms:

  • Abnormal bleeding – for instance after sex, between periods or after the menopause
  • Abnormal vaginal discharge that might have an unpleasant odor
  • Tiredness and weight loss
  • Pain in the abdomen and pelvis
  • Pain when urinating (“peeing”)

By the time cervical cancer starts causing symptoms, it is often already at quite an advanced stage.

Causes

Cervical cancer is usually caused by a long-term with particular viruses known as human papillomaviruses (HPV). There are many different types of HPV. They infect skin cells and mucous membrane cells, and are spread through sex or direct contact in the genital area. Infection through body fluids like sperm, blood or saliva is considered to be unlikely. Most women have an HPV at some point in their lives, many between the ages of 20 and 30. Men can also become infected and pass the on.

HPV infections usually don’t cause any symptoms. They may lead to temporary abnormal cell changes (dysplasia) in the mucous membranes lining the cervix. These often go away again on their own. But sometimes particular types of HPV stay in the lining of the cervix for several years or decades. If this happens, the cells may gradually become precancerous and eventually develop into cervical cancer.

Most cervical cancer tumors develop from abnormal cells at the opening of the cervix. The medical name for this kind of cancer is “squamous cell carcinoma.” Cervical cancer can also develop from gland cells, but that is less common. Those tumors are called adenocarcinomas.

Risk factors

Certain groups of women are more likely than others to get cervical cancer. For instance, women who smoke are at higher risk. This might be because their immune systems are less effective at fighting the viruses. Other things that weaken the – such as diseases like AIDS, and medication that is taken after an organ transplant – can increase this risk too.

Because HPV infections are spread through sex, things that generally increase the risk of sexually transmitted diseases are also considered to be risk factors for cervical cancer. So, for example, the more sexual partners someone has, the higher their risk of cervical cancer.

Prevalence

About 4,600 women develop cervical cancer in Germany each year, and about 1,600 of them die of it. A woman’s risk of cervical cancer mainly depends on whether she goes for , whether she has had an HPV vaccine, and how old she is.

The following table shows estimates of how many women of different ages will develop cervical cancer if they don’t go for and don’t have an HPV vaccine.

Woman's age Out of 1,000 women, the following number are expected
to get cervical cancer within the next ten years (if they don't have or an HPV vaccine):
20 years old Fewer than 1
30 years old 1
40 years old 5
50 years old 9
60 years old 8
70 years old 6

Diagnosis

There may be reason to believe that a woman has precancerous cell changes or cervical cancer if she has certain symptoms, abnormal smear test (Pap test) results, or abnormal findings during a gynecological examination. In this kind of physical examination, the doctor feels the area around the womb with their hands, both from the outside (belly) and from the inside (vagina). They also insert a special instrument (speculum) into the vagina, to look at the tissue at the opening of the cervix. If the tissue has changed a lot, it can be examined more closely using a kind of magnifying glass called a colposcope. A sample of tissue can be taken too (biopsy). This is then examined in a lab.

If the lab results confirm that the cervical tissue has abnormal cells or cancer cells in it, what happens next will depend on how much the cells have changed. Smaller areas of abnormal cells and smaller tumors can be removed using a type of surgery called conization. This involves removing a cone-shaped piece of tissue.

Other examinations such as ultrasound, x-ray, (MRI) or (CT) scans may be needed if the cancer has spread to deeper layers of tissue. Keyhole surgery is often performed too, to remove lymph nodes in the abdomen (lower belly). The results of these examinations can be used to determine how advanced the cancer is.

Screening

Screening allows abnormal (precancerous) tissue to be discovered and removed before it can develop into cervical cancer. The test involves doing a “smear test” (or “Pap test”) to get a sample of cells which are then examined. Statutory health insurers in Germany cover the costs of this test once a year in women aged 20 and above. Since these regular tests were introduced in the 1970s, there has been quite a big drop in the number of women who develop cervical cancer.

Women between the ages of 20 and 34 can have a free smear test once a year. This involves taking a sample of cells from the cervix and examining them in a laboratory. From the age of 35, women are offered a combined test that includes a smear test and a test for certain human papillomaviruses (an HPV test) every three years. The sample of cells is then checked to both look for changes in the cells as well as for HPV viruses.

Depending on the results of the , further tests may be needed.

Prevention

Cervical cancer usually develops as a rare consequence of a long-term with particular types of HPV. So, at least theoretically, there are three ways to help prevent it:

  • Avoiding sexual contact, or using condoms
  • HPV vaccine in girls
  • Screening and removing abnormal tissue

If you would like to protect yourself from , you would either have to avoid sexual contact altogether or be sure that your partner has also never had sexual contact with other people.

Condoms can offer effective protection from many sexually transmitted diseases, so it definitely makes sense to use them if you have different sexual partners. But condoms don’t offer 100% protection from HPV because they don’t cover all of the possibly infected areas of skin in the genital area.

Girls and women can choose to have a vaccine that can prevent cervical cancer. The HPV vaccine is recommended for girls between the ages of 9 and 14 – before they become sexually active. Boys and men can have the vaccine too. Doing so prevents them from passing HPV on to other people.

Treatment

The most appropriate type of treatment will mainly depend on the size of the tumor and whether the cancer has spread. If the tumor is discovered at a very early stage, a small surgical procedure (conization) might be enough. If the tumor has already spread to the surrounding tissue, doctors usually recommend having surgery to remove the entire womb (a hysterectomy). The lymph nodes are removed in a wide area around the womb too. Radiotherapy might also be considered. Radiotherapy is still an option even if the tumor can no longer be removed through surgery. In some patients it can be combined with chemotherapy. In Germany and other countries, people who have had cancer treatment are generally entitled to follow-up rehabilitation treatment (Anschlussheilbehandlung).

Further Information

When people are ill or need medical advice, they usually go to see their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.

Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), Arbeitsgemeinschaft Gynäkologische Onkologie (AGO). S3-Leitlinie Diagnostik, Therapie und Nachsorge der Patientin mit Zervixkarzinom. AWMF-Registernr.: 032-033OL (Leitlinienprogramm Onkologie). 2021.

Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Invitation and decision aid for cervical cancer screening; Final report; Commission P15-02. 2017.

Krebsinformationsdienst (KID), Deutsches Krebsforschungszentrum (DKFZ). Gebärmutterhalskrebs: Das Zervixkarzinom. 2016.

Robert Koch-Institut (RKI). Bericht zum Krebsgeschehen in Deutschland 2016. Berlin: Ruksaldruck; 2016.

World Health Organization (WHO). Comprehensive cervical cancer control: a guide to essential practice. Second edition. Genf: WHO Press; 2014.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Comment on this page

What would you like to share with us?

We welcome any feedback and ideas. We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Updated on September 6, 2021
Next planned update: 2024

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

How we keep you informed

Follow us on Twitter or subscribe to our newsletter or newsfeed. You can find all of our films online on YouTube.