Cervical cancer was historically one of the most common causes of cancer death for American women, and fortunately there has been a dramatic decrease in the number of cases in recent years due to screening and prevention. Cervical cancer survival is well over 90% when caught early, making screening undeniably important.

“This is one of the most preventable cancers; we have a screening test that works,” said Endeavor Health gynecologic oncology specialist Kathryn Mills, MD, who also stresses the need for continued work to increase access to and awareness of screening among Black, Hispanic and lower socio-economic populations that continue to have higher rates of cervical cancer.

Screening, which typically means a combination pap smear and HPV test, should begin between ages 21-25 and continue through age 65.

The human papillomavirus (HPV) vaccine prevents HPV infections that cause the vast majority of cervical cancer, and thus is also critically important, said Dr. Mills. Most efficacious before the onset of sexual activity, the vaccine can be given in two doses to 9 to 14-year-olds, and in three doses to children and young adults over 14. It is, however, approved up to age 45 by the Food and Drug Administration.

Treatment for cervical cancer varies greatly depending on its stage:

  • Stage 1A: Cancer is only microscopic.
  • Stage 1B: Cancer is confined to the cervix, but can often be seen or felt by a physician. 
  • Stage 2: Cancer is confined to the pelvis and vagina.
  • Stage 3: Cancer has spread from the pelvis into the lymph nodes or side walls.
  • Stage 4: There is distant spread through the bladder or rectum.

Early-stage cervical cancer treatment

Even in early-stage cancers, surgical management can be fairly complicated and is never a one-size-fits-all approach, said Dr. Mills, who practices at Endeavor Health Northwest Community Hospital and the University of Chicago.

“For the majority of patients who are done with their fertility, early-stage treatment is some kind of hysterectomy. The location of the tumor and the cell type determine how aggressive the surgery needs to be, and how much connective tissue we need to take,” said Dr. Mills. “The goal is obviously to fix the problem and remove the cancer before it becomes more serious.”

Patients often have questions about whether fallopian tubes need to be removed and the answer is yes definitely, as this eliminates future risks related to other issues like cysts or even fallopian tube cancer, explained Dr. Mills. In many cases ovaries can be preserved, depending on the patient’s age and cancer cell type, to help patients avoid early menopause, she added.

Later-stage cervical cancer treatment

Later-stage cervical cancers are often treated with surgery and a combination of radiation and some chemotherapy. Advanced brachytherapy, or intracavitary radiation is now used for more advanced cancers and has been shown to be crucial to improve cancer-related outcomes. Targeted therapies and immunotherapy are also showing promise for more advanced cancers, said Dr. Mills.

“New, more targeted drugs are becoming real game changers for some of the advanced and recurrent cervical cancers that were previously so difficult to treat,” added Dr. Mills.

Risk factors for developing cervical cancer include an increased number of sexual partners and smoking, which has been shown to cause chronic damage to cell DNA and immune system damage. Cervical cancer caused by HPV is an immune system driven cancer, so women with various autoimmune conditions can also face higher risks.

While older women may not think they are still at risk of developing cervical cancer, the American Cancer Society reports that more than 20% of cervical cancers are diagnosed past the age of 65.