The short version
- Nearly all cervical cancer is caused by long-lasting infection with high-risk human papillomavirus, called HPV.
- Screening finds changes in the cervix before they become cancer. That is why screening works so well here and does not exist for most other cancers.
- HPV vaccination prevents the infections that cause most of these cancers.
- Early cervical cancer often causes no symptoms at all. Bleeding after sex, between periods, or after menopause is the symptom that most often brings women in.
- Treatment depends on the stage. Early disease is usually treated with surgery. More advanced disease is usually treated with radiation and chemotherapy together.
What it is
The cervix is the lower part of the uterus, the part that opens into the vagina. Cervical cancer starts there. Before it becomes cancer it passes through a stage called dysplasia, where the cells look abnormal but have not invaded anything. That stage can last years, and it is what screening is designed to catch.
What causes it
High-risk HPV is the cause of nearly all cervical cancer. HPV is a common virus. Most people who are ever sexually active will be exposed to it, and in most people the immune system clears it within a couple of years and nothing ever comes of it. Cancer develops in the small number of people whose bodies do not clear a high-risk type, and it usually takes many years.
That long timeline is the opening. It is why a test every three to five years is enough to work, and why the vaccine given before exposure works so well. Read more on the HPV page and the screening page.
Signs and symptoms
Early cervical cancer often causes nothing you would notice. When symptoms appear, they usually include:
- Bleeding after sex
- Bleeding between periods, or periods that become much heavier or longer
- Any bleeding after menopause
- Vaginal discharge that is watery, bloody, or has an odor
- Pelvic pain, or pain with sex
When to seek care right away
Most of the symptoms above should prompt a call, not a trip to the emergency department. Go to the emergency department if you have:
- Bleeding that soaks more than one pad an hour
- Severe pelvic or back pain that is new
- Fever with foul-smelling vaginal discharge
- New swelling in one leg
How it is diagnosed
An abnormal screening result does not mean cancer. It means we look closer. The next step is usually colposcopy, where the cervix is examined with a magnifying scope in the office and small biopsies are taken from anything that looks abnormal.
If the biopsies show a significant change, or if the picture does not add up, the next step is a cone biopsy. The National Cancer Institute describes cold knife conization as using a scalpel to remove a cone-shaped piece of tissue from the cervix and the cervical canal. [1] It does two jobs at once. It tells us exactly what is there, and for many pre-cancers it removes the problem entirely. We explain the whole procedure on the cone biopsy page.
How it is treated
Treatment depends on the stage, which means how deep the cancer goes and whether it has spread.
| Usual approach | What it involves | |
|---|---|---|
| Pre-cancer, or very early invasion | Cone biopsy | Removes a cone of cervical tissue. Often this is both the diagnosis and the treatment. [1] |
| Early-stage cancer | Hysterectomy, sometimes radical | A radical hysterectomy removes the uterus, the cervix, part of the vagina, and a wide area of surrounding ligaments and tissue. [1] |
| Locally advanced cancer | Radiation with chemotherapy | External radiation and internal radiation are both used for cervical cancer, usually combined with chemotherapy. [1] |
| Advanced or recurrent cancer | Chemotherapy, often with other drugs | Drugs used for cervical cancer include cisplatin, carboplatin, gemcitabine, ifosfamide, irinotecan, paclitaxel, topotecan, and vinorelbine. [1] |
Which of these applies to you is decided from your biopsy, your exam, and your imaging together. Nobody should be told their stage from a Pap result alone. For what radiation and chemotherapy involve, see chemotherapy and radiation.
Fertility
If you want to carry a pregnancy in the future, say so at the first visit, before any plan is made. For some early cervical cancers there are fertility-sparing options, and the window to choose them is at the beginning. This is one of the questions patients most often wish they had asked sooner.
After a cone biopsy
The printed instructions given after a cold knife cone procedure.
Sources
- National Cancer Institute. Cervical Cancer Treatment (PDQ) Patient Version. Updated April 3, 2025. https://www.cancer.gov/types/cervical/patient/cervical-treatment-pdq
- Society of Gynecologic Oncology. Cervical Cancer patient resources. Accessed August 21, 2026. https://www.sgo.org/patient-resources/cervical-cancer/
- Screening for cervical cancer. Committee Statement No. 28. American College of Obstetricians and Gynecologists. Obstet Gynecol 2026;148:e63-e67. Published online April 15, 2026. https://www.acog.org/clinical/clinical-guidance/committee-statement/articles/2026/07/screening-for-cervical-cancer
- Neibart S, Zhou N, Chino J, et al. Health equity, disparities, and barriers to cervical cancer care in the U.S.: A consensus statement by SGO, ACOG, ASCCP, ASTRO, and ABS. Gynecol Oncol. 2025;200:186-192. Retrieved from PubMed (PMID 40947174). https://doi.org/10.1016/j.ygyno.2025.07.029
- Vasques DR. Post Cold Knife Cone Procedure Instructions. The Center for Cancer and Blood Disorders, Fort Worth, TX. Patient handout supplied by the practice. pdfs/after-cone-biopsy.pdf
Reviewed by DeEtte R. Vasques, DO, MBA · September 2026