This information should not be used to self-diagnose, or be used in place of a qualified physician’s care.

• Patients with cervix cancers are treated by members of the BC Cancer Agency’s Gynecology Tumour Group.
• For healthcare professional information on treating this cancer, please see our Cancer Management Guidelines (Uterine Cervix).
• For newly diagnosed patients, we offer  Taking it Step by Step: a guide for women diagnosed with gynecological cancer. This BC guide was created by survivors and health care professionals of the BC Cancer Agency and covers all aspects of the patient journey.
• Cervix cancer is also called carcinoma of the cervix, cervical cancer, cervical squamous cell carcinoma (SCC).
• Precancerous changes to the cervix are called dysplasia, cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL).
• The cervix is part of the female reproductive system. It is the narrow, lower part of the uterus (womb) that serves as a canal between the uterus and vagina. It is about 2.5cm long.
• The cervix makes mucus that cleans and lubricates the vagina. During childbirth, the cervix widens to allow the baby to pass from the uterus into the vagina.

What causes it and who gets it?
Listed below are some of the known risk factors for this cancer.  Not all of the risk factors below may cause this cancer, but they may be contributing factors.

• All women who have ever been sexually active (touching or intercourse) are at risk of cervical cancer.
• Almost all cervical cancers are caused by certain types of the Human Papillomavirus (HPV).
•  There are more than 100 types of HPV and about 40 can infect the genital area. About 15 types of genital HPV can cause cervical cancer.
• HPV is one of the most common sexually transmitted infections (STIs). Most adults have HPV some time in their lives and it usually goes away within 24 months without any problem.
• In some women, the dysplasia (abnormal cells caused by HPV) does not go away. Over time these abnormal cells in the cervix can change into cervical cancer. 
• Risk factors for HPV infection:
• Starting sexual activity at a young age
• Multiple sexual partners
• A sexual partner who has had multiple partners
• Not using condoms
• Risk factors for HPV progressing to cervical cancer:
• Weakened immunity, for example because of HIV / AIDS, or drugs taken for an organ transplant.
• Smoking
• Cervical cancer is probably not affected by heredity (family or genetic history).
• Cervical cancer can start to develop at a younger age than many cancers and affects women over a wide age range. Most women diagnosed with cervical are between the ages of 30 and 60.
•  Statistics
  •  BC
  • Canada

Can I help to prevent it?

• Limit your sexual partners
• Use condoms
• Don’t smoke
• Vaccination for girls and women, prior to beginning sexual activity

Vaccination

• A vaccine is available that protects against two types of Human Papillomaviruses that cause most cervical cancers.
• The vaccine is recommended for girls and women between the ages of 9 and 26 years before they come in contact with HPV.
• The vaccine may also benefit women who are sexually active and have not yet been infected with HPV. The vaccine prevents HPV infection but it does not get rid of it once the infection occurs.
• In women who have never been infected with HPV, the vaccine:
• Protects against 7 out of 10 cases of cervical cancer
• Is safe, effective and has few side effects
• For more information call your local public health unit or speak to your family physician.  You can also find information at http://www.immunizebc.ca/default.htm.

Screening for this cancer

• Pre-cancerous and cancerous cells in the cervix are often found through routine physical exams that include a Pap test, the current method used for cervical cancer screening.
• The Pap test is named after its inventor Dr. Georgios Papanicolaou. The test detects pre-cancerous changes in the cervix and cervical cancer before symptoms appear.
• Cervical cancer can be prevented from developing when abnormal cells are found and treated early, through regular Pap test screening.
• When abnormal cells are removed before cancer develops, the cure rate is 100 per cent. For cancer limited to the surface tissue of the cervix, the cure rate is 80 to 90 per cent.

See our Cervical Cancer Screening program for information on:

• Do you need a Pap test? How often?
• At what age can screening stop?
• Is screening necessary if you have had a hysterectomy?
• Where do you go for a Pap test?
• How do you prepare for a Pap test?
• How is a Pap test done?
• Pap test results

Signs and Symptoms

• Women with abnormal cells in the cervix and early stage cervical cancer often do not experience any symptoms.
• As the cancer advances, the more common symptoms are:
• Spotting: spots of blood from the vagina, other than a normal menstrual period.
• Bleeding after intercourse
• Discharge: from the vagina, more or different than your usual.

Diagnosis
This is a list of some or all of the tests used to diagnose this type of cancer.

• Pap test: as described (above) for Screening.
• Colposcopy is used to confirm the diagnosis from the Pap test.
• The vagina and cervix are examined with a magnifying instrument called a colposcope.
• The magnification allows for more accurate identification of the type and extent of the abnormal cells.
• Colposcopy clinics are located throughout the province.
• Biopsy: removing the suspicious area (lesion, or tissue) so the cells can be examined with a microscope or other tests.
• Other tests may be recommended by your doctor, possibly including:
• Blood tests at a lab
• Chest X-ray or CT scans
• Cystoscopy: viewing the bladder through a scope.
• Sigmoidoscopy: viewing the lower intestine and rectum through a scope. 
• For more information on all cancer diagnostic tests, see our Recommended Websites, Diagnosis section. 

Types and Stages
Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world.  In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.

• T describes the site and size of the main tumour (primary);
• N describes involvement of lymph nodes;
• M relates to whether the cancer has spread (presence or absence of distant metastases).

• Squamous cell cervical cancer account for about 75 per cent of all cervical cancers
• Adenocarcinoma cervical cancer
• Other rare types ( mixed adenosquamous carcinomas, small cell carcinomas)

Treatment 
Cancer therapies can be highly individualized – your treatment may differ from what is described below.

Treatment by Stage

Stage 0 – pre-cancerous abnormal cells (dysplasia)

Before treatment:

Patients go for colposcopy to assess the degree and extend of any abnormal cells in the cervix. 

Loop Electrosurgical Excision (LEEP)

• A fine wire loop electrode is used to remove the abnormal cells.
• Done in a physician’s office or clinic, with a local anesthesia.
• Increased but small risk of future pregnancy problems.

Laser

• A high-energy beam of light is used to vaporize the abnormal cells.
• Extremely precise and minimal effect on the surrounding normal tissue.
• Done in a clinic, without need for local anesthesia.
• Patients may experience a sensation of heat or warmth, but this passes rapidly as the procedure is completed.
• More rapid healing compared to other treatment methods.
• Unlikely to affect a woman’s fertility or ability to carry a pregnancy.
• Not recommended during pregnancy.
• If a biopsy (sample) specimen is required, laser may not be recommended.

Cone biopsy (conization)

• A cone-shaped sample of tissue is removed from the cervix using a scalpel or laser.
• Used for treatment when the precancerous cells are too far up the cervical canal to be reached with other methods.
• Usually requires hospital day surgery, done under local anesthetic.
• Increased but small risk of future pregnancy problems.

Hysterectomy

• Surgical removal of the cervix, uterus and sometimes the fallopian tubes and ovaries.
• Chosen under certain circumstances, and for women who have other gynecological conditions, for which a hysterectomy is an appropriate treatment option, and who do not want to have future pregnancies.

Cryotherapy / cryosurgery is no longer used in BC as it has a higher long term risk of later cancer than laser or LEEP.

After treatment of pre-cancers (with laser, cone biopsy, LEEP):

• Patients may feel menstrual-like cramps after treatment.  Aspirin, Ibuprofen or a similar mild pain medication can be used to relieve discomfort.
• There is usually a bloodstained or yellow-coloured vaginal discharge for several weeks following these procedures.
• To prevent infection while the cervix heals do not put anything into the vagina - no tampons, no douches. You should not have intercourse for several weeks following treatment.
• Contact your doctor if you have heavy bleeding, or bleeding with clots, fever, or persistent, increasing pain.

Stage I - IIa – Treatment will be tailored to individual patients depending on biopsy results

Surgery

• Cone biopsy may be used for early stage cancer if future pregnancy is desired
• Simple hysterectomy
• Radical hysterectomy and removal of pelvic lymph nodes

Radiotherapy

• Radiotherapy may be the primary treatment or may be used with surgery.
• Radiation is directed at the cancer with an external beam, or from inside the body (brachytherapy, Selectron treatment).

Stage II, III, IV

Radiotherapy is usually the primary treatment (as above).

Further surgery may be considered if disease persists after radiation.

Chemotherapy

• Chemotherapy is an option when cancer re-occurs or has spread to other sites.
• Some chemotherapy drugs are used in combination with radiotherapy, as a radiation sensitiser (improves outcomes).

Follow-up after Treatment

• Guidelines for follow-up after treatment has ended have been developed by the BC Cancer Agency and are listed on our website.
• You will be returned to the care of your family doctor or specialist for regular follow-up.
• Follow-up testing is based on your type of cancer and your individual circumstances.
• The BCCA Survivorship Research Centre focusses on the issues that cancer survivors can face.

Coping with Cancer

The Coping with Cancer section of our website is a joint project among different BC Cancer Agency departments and programs. This website section provides information and links that can help cancer patients with the physical, emotional, psychological and practical aspects of care. Each cancer experience is different, but in one way or another, many cancer patients share the same needs.

The effects of cancer and its treatment can present unique challenges: from practical concerns like money and housing, to emotional concerns like anxiety and grief. If you need support with the practical and emotional impacts of cancer, or in managing symptoms and side effects you can use the information in Coping with Cancer to connect to these resources. 

Search our library catalogue

• The BC Cancer Agency Library has many resources about cancer, coping, talking to children, etc.  Please visit the Library in your Centre, call a librarian, or visit the Library online to see the many resources available.
• Automatically get a bibliography of books, videos and other items available through our library.

Recommended websites 
The BC Cancer Agency has selected and evaluated these useful websites for your further information.

Cervical Cancer
Fertility and Sexuality
Websites for cancer survivors, and how to stay healthy after treatment.

Videos
View videos on cancer-related topics that the BC Cancer Agency produces.

How can I help with research at BCCA?
BC Cancer Agency patients are very helpful when it comes to the fight against cancer. Here are a few ways that you can help:

• The HPV FOCAL Study is looking at whether HPV testing can replace the Pap test and allow women to be screened less often.
• The BCCA is deeply involved in cancer research.  We operate various Research Programs, the BC Cancer Research Centre and Canada's Michael Smith Genome Sciences Centre.
• Clinical Trials – join our treatment-based research.  Ask your oncologist if you qualify for a clinical trial. What are the pros and cons of joining a clinical trial?
• Tumour Tissue Repository – support our research by donating some of your cancer tissue.
• BC Cancer Foundation – support our research with a donation of money.

This information has been reviewed and approved by a member of the Gynecology Tumour Group.