Cervical cancer is slow-growing. This means that it is possible to catch abnormal cells before they turn into cancer. Doctors perform a test called a Pap test to check for cells that are cancerous or might become cancerous in the future. 

What is a Pap test?

You can get a Pap test at your gynecologist’s office. Your doctor will use a tiny brush to collect a sample of cells from your cervix. Then, they will send your cells away to a laboratory. The lab will test them to see if any of the cells look abnormal under a microscope. They may also see if the cells are infected with HPV. 

When should I start getting screened for cervical cancer?

 Women are advised to begin regular screenings for cervical cancer in their early 20s:  

• Pap test screenings begin at age 21 
• HPV test screenings begin at age 25 

How often should I get screened for cervical cancer?

Screenings are the best way to find cervical cancer in its early stages. Getting checked regularly is important. The American Society for Colposcopy and Cervical pathology (ASCCP) recommends that women:  

• Every three years get a Pap test
• Every five years combine your Pap and HPV test (starting at age 30) 

Your doctor can help you keep track of when you need to have screenings. Women over 65 who have always had normal Pap test and HPV test results do not need to be screened for cervical cancer. 

What’s my risk of cervical cancer? 

The best way to determine your risk of cervical cancer is to talk with your ob-gyn. However, to get a quick picture of your risk, you can use Your Disease Risk. It’s a tool that was developed by physicians and scientists right here at Siteman. It will estimate your risk and give you targeted suggestions to help reduce or manage it.  

For additional resources about screenings, explore more getscreenednow.com.

Cervical cancer is one of the most preventable forms of cancer. It’s important for women to know the options they have to stop cervical cancer before it starts. 

Frequently Asked Questions

What causes cervical cancer? 

Most cases of cervical cancer are caused by the human papillomavirus, or HPV. HPV is a sexually transmitted infection. It can change the cells in the cervix so that they become cancerous.

Who is at risk of getting cervical cancer?

Because HPV causes the majority of cervical cancers, your risk of cervical cancer is directly tied to your risk of HPV. 

Patients are at increased risk of being infected with HPV if:

• They have had many sexual partners 
• They first had sex under the age of 18 
• They have an illness that harms their immune system, such as human immunodeficiency virus (HIV) 

Additional risk factors 

If you have been diagnosed with HPV, other factors can increase your risk of cervical cancer. These include:

• Smoking 
• Taking oral birth control pills 
• Being pregnant and giving birth many times 

How can I lower my risk of cervical cancer?

There are two things you can do to lower your risk of cervical cancer:

• Get vaccinated for HPV 
• Have regular Pap tests to check for signs of cancer. 

The HPV vaccine was released in 2006. It is safe and effective at preventing both HPV infection and cervical cancer. A recent study showed that cases of cervical cancer have decreased significantly in vaccinated women.

Many children now receive the HPV vaccine as part of their routine vaccinations. The vaccine is given around the age of twelve. If you are older than 26 years old and have not been vaccinated, talk to your doctor to see if you could still benefit from getting the vaccine. In some cases, it is a good option for adults to reduce their cancer risk.

Regular Pap tests are also key to preventing cervical cancer. They can catch abnormal cells in the cervix before they become cancerous.

At Siteman Cancer Center, our team of WashU Medicine gynecologic oncologists understands that every patient is unique. They will design a personalized treatment plan for you. Their goal has two parts: 1.) to treat your cancer and 2.) to help you thrive as a person. As they make your plan, they will keep in mind your age, your hopes for your family, and your overall health.

We understand that you probably have many questions and concerns as you go through treatments for cervical cancer. There is no question too small or simple to ask. Your care team – your physicians, nurse coordinators, and others – are always ready to listen. 

What treatment could I have for my cervical cancer?

There are many ways to treat cervical cancer. Your treatment plan will depend on how far the cancer has spread. Many patients with early-stage cervical cancer will have surgery to remove the cancer. Some patients will also receive chemotherapy and/or radiation therapy to treat cancer cells that have spread to other organs or to reduce the risk of the cancer coming back. 

Surgery for Cervical Cancer

Some patients with early-stage cervical cancer may need surgery. Siteman surgeons excel at several surgical options and procedures. Surgery might be the only treatment you need. You may have one of the following procedures:

• Conization: This procedure is also called a cone biopsy. Your surgeons will remove the cancer from the cervix by cutting out a segment of tissue shaped like a cone. You may be eligible for a conization if cancer is limited to a small area of your cervix.  
• Radical Trachelectomy: This procedure is done when cancer has spread throughout the cervix but has not traveled to other parts of the body. The surgeon will remove the cervix and then connect the uterus directly to the vagina. It is a complex surgery that is not offered at all cancer centers.  
• Total Hysterectomy: A total hysterectomy is done when cancer has spread beyond the cervix. Your surgeon will remove your cervix, uterus, and fallopian tubes.  
• Radical Hysterectomy: A radical hysterectomy is more extensive than a total hysterectomy. In addition to the cervix, uterus and fallopian tubes, the surgeon also removes some of the surrounding tissues that touch the cervix, including the upper vagina and lymph nodes. The ovaries may be removed as well.

How does surgery for cervical cancer affect fertility?

Some procedures used to treat cervical cancer can protect a patient’s future fertility. These are:

• Conization 
• Radical trachelectomy 

We call these procedures “fertility-sparing.” The uterus stays in the body and can function normally. This means that it’s still possible to get pregnant and carry a child. Your WashU Medicine physicians may recommend a fertility-sparing procedure if your cancer is at an early stage and if you hope to have children in the future.

Sometimes, surgery for cervical cancer involves removing the uterus. That happens during the following procedures:

• Total hysterectomy 
• Radical hysterectomy 

If the uterus is removed, then it is no longer possible to become pregnant and carry a child. This is significant. Sometimes these options are necessary to remove cervical cancer. Your doctors may recommend this level of treatment if your cancer is more advanced.

We understand that the potential loss of fertility is a sensitive, challenging issue. Siteman offers a range of services to help patients expand their families even after a fertility-ending treatment. And every patient can work with trained psychologists to process the impact treatment has on you. 

When do patients with cervical cancer receive radiation therapy?

Most patients with cervical cancer have radiation therapy. Radiation therapy kills cancer cells that might be left behind after surgery and helps prevent the cancer from coming back (recurrence). For some patients, radiation therapy is their primary treatment.

There are two main types of radiation therapy used to treat cervical cancer at Siteman. Patients often receive a combination of both types. We are the only cancer center in the region that specializes in this combined, highly-effective approach.

• Intensity-modulated radiation therapy (IMRT): IMRT is an extra-precise form of radiation therapy. During IMRT, your doctors will shape the radiation to the exact 3-D shape of your tumor. This means that your tumor will get a high dose of radiation therapy but the tissues around it will be protected.   
• Brachytherapy: During brachytherapy, your doctors will deliver radiation therapy directly to the cancer cells in your cervix. To do this, they will place a device called an applicator in your cervix. Then, they will connect the applicator to an external source of radiation for a few minutes. This allows radiation therapy to flow through the applicator and into your cervix, where it can kill the cancer cells. 

Siteman has one of the largest and most comprehensive brachytherapy centers in the United States. We are national leaders in this form of treatment.

Drug therapy for cervical cancer

Some patients with cervical cancer will take medications as part of their treatment. These drugs all work differently, but they help kill cancer cells and prevent the cancer from spreading. Patients with more advanced cervical cancer are likely to need medications.

You may take one or more of these types of drugs:

• Chemotherapy: Chemotherapy is a type of medication that kills cancer cells wherever they are found in the body. You’ll receive chemotherapy through an IV. 
• Targeted therapy: Targeted therapies are medications that stop cancer cells from growing and multiplying. Some targeted therapies are used to bring additional drugs directly into cancer cells. Because targeted therapies focus on specific features of cancer cells instead of killing them directly, they can have fewer side effects than chemotherapies. You might receive targeted therapy if your cervical cancer is more advanced. At Siteman, we will sequence the genes of your tumor to help choose the most effective targeted therapy for you.  
• Immunotherapy: Immunotherapy is a new form of cancer treatment that trains your own immune system to recognize and attack cancer cells. It can be highly effective against cervical cancer. If your cervical cancer has started to spread, you may receive immunotherapy as part of your treatment plan.  

Diagnosing Cervical Cancer

Learning that you have cervical cancer may come as a surprise. Many patients have no symptoms. Often, they find out that something is wrong after a routine pelvic exam and Pap test. At Siteman, we understand what you’re going through. We’ll treat you with respect and dignity as we work to bring you an accurate diagnosis.   

What is the first step in a cervical cancer diagnosis?

The first step in a cervical cancer diagnosis is a routine test called a Pap test. During this test, a doctor will carefully swab the cervix to collect a sample of cells. An expert called a pathologist studies the cells under a microscope. If the cells look abnormal, it could mean that cancer is present. If any of the cells are infected with HPV, or human papilloma virus, that is another cause for concern.  

It’s important for women to get regular Pap tests with a pelvic exam starting at the age of 21. Learn more about screening guidelines for cervical cancer.

What are the symptoms of cervical cancer?

Some patients with cervical cancer may notice the following symptoms:

• Pain or pressure in the lower belly, or pelvis. 
• Pain and/or vaginal bleeding after having sex.
• Abnormal vaginal bleeding or discharge. 

Why Choose Siteman for Your Cancer Diagnosis?

It’s crucial to get a correct diagnosis of your cancer. Otherwise, your treatments won’t work the way they should. At Siteman, we’ll make sure your diagnosis is right. When you come to see us, any tests you’ve had before will be reviewed again by WashU Medicine pathologists to make sure everything is accurate.  

For your convenience, we try to make your visits with us as efficient as possible. This means you might have multiple tests and appointments on the same day so you don’t have to spend as much time traveling to and from one of our locations. 

What to expect during a diagnosis

There are a number of steps to getting a complete cervical cancer diagnosis. Your care team will probably ask you to have certain tests to pinpoint what is going on. 

At Siteman, we understand that getting medical tests can be anxiety-inducing. We will do everything we can to help you feel comfortable and safe with us. Don’t hesitate to ask questions or to speak up if there’s something you need.  

Tests for cervical cancer include:

• Colposcopy: During this test, your doctor will look at your cervix with a magnifying tool called a colposcope and check for signs of pre-cancer or cancer. The colposcope is only used to look and never touches your body. This is a simple procedure that can be done in your doctor’s office.   
• Biopsy: Your doctor will remove a very small piece of tissue from your cervix and send it to a laboratory so it can be checked for cancerous cells. A biopsy can be done at the same time as a colposcopy. You’ll get medicine to help numb the area to manage any discomfort.    
• Cone biopsy: This is a type of biopsy that can be used to remove all abnormal cells from the cervix. During a cone biopsy, a larger, cone-shaped sample of tissue is taken out. Sometimes, it’s the only treatment necessary for pre-cancer or early cervical cancer that has not spread. You’ll have a cone biopsy in an operating room. You’ll get medicine to numb the area or to make you sleep.  
• Imaging tests: These are tests that take pictures of the inside of the body. If you are diagnosed with cervical cancer, you might have imaging tests to see if the cancer has spread. These might include an ultrasound, a CT scan, an MRI, or a PET scan.  

Staging cervical cancer

If you are diagnosed with cervical cancer, your WashU Medicine physicians will find out how far the cancer has spread. This is called “staging” the cancer. It helps your care team develop the right treatment plan for you.
  
Cervical cancer is staged from Stage 1 (I) to Stage 4 (IV). At Stage 1, the cancer is only in the cervix. By Stage 4, the cancer has spread outside of the lower belly, or pelvis.  

It’s never easy to be diagnosed with cervical cancer. At Siteman Cancer Center at Barnes-Jewish Hospital and WashU Medicine, we’ll meet you where you are and support you and your loved ones during and after your treatment.  

About Cervical Cancer

The cervix is part of a woman’s reproductive system. It is located at the end of the vagina and just before the uterus. The bottom of the cervix can be seen and felt at the back of the vagina. OB/GYNs examine the cervix during a pelvic exam and collect cells from it. The cell collection is called a Pap test.    

How does cervical cancer develop?  

Abnormal cells growing on the outside or inside of the cervix cause cervical cancer. 

The human papilloma virus, or HPV, causes most cases of cervical cancer. It is also one of the only cancers that can be prevented with a vaccine. The HPV vaccine can stop cervical cancer before it starts. That’s why children starting at age 9 can receive the HPV vaccine. Some adults are eligible for the series of shots, too. Vaccinations can prevent HPV-related cancers. 

Why Choose Siteman

Siteman Cancer Center is the only cancer center in Missouri to be recognized as a Comprehensive Cancer Center by the National Cancer Institute (NCI). U.S. News & World Report consistently ranks us among the top cancer facilities in the nation. As an NCI institution, we provide world-class patient care and conduct ground-breaking research.  

At Siteman Cancer Center, WashU Medicine physicians have the tools and expertise to make a unique treatment plan just for you. Our ongoing research programs and clinical trials mean that you will get the most up-to-date, evidence-based treatment available for your cancer.  

Team-based, expert care

At Siteman, you don’t just have one doctor caring for you. You have an entire team of doctors, all of them with different specialties, from surgery to radiation therapy to drug therapy. Every doctor on your team will be an expert at treating cervical cancer and other cancers of the female reproductive system. These doctors are called “gynecologic oncologists.” Together, your WashU Medicine gynecologic oncologists will make a treatment plan for you that draws from their shared experience. 

Through this team-based approach, Siteman’s WashU Medicine gynecologic oncologists provide safe, innovative, and comprehensive care. 

Fertility-preserving surgical solutions

Patients with early-stage cervical cancer may be treated with surgery. We will always try to tailor surgery to our patients’ hopes and plans for their family. Our exceptional surgeons are sometimes able to remove the cervix without removing the uterus. This procedure is called a “radical trachelectomy.” It treats cervical cancer but leaves the uterus in place, so pregnancy is possible in the future. It is not available at most hospitals. 

Radiation Therapy

Many patients with cervical cancer will have radiation therapy. The WashU Medicine radiation oncologists at Siteman provide state-of-the-art radiation therapy. In addition to external-beam radiation therapy, we offer a highly-precise form of radiation therapy called brachytherapy. Brachytherapy delivers radiation inside the body, directly at the tumor site.  

Clinical Trials

Siteman’s clinical trials are research studies evaluating new cancer treatments. They give patients early access to drugs and procedures that could be more effective than the current standard of care. Siteman Cancer Center offers more clinical trials than any other facility in the region. When you come to Siteman, your team will recommend any trials that could be a good match for you. You can always ask to add clinical trials to your treatment plan.