Important: This page is for general information only and is not a diagnosis. Please see a doctor if you notice any unusual vaginal bleeding, pelvic pain, or other symptoms that worry you.
What is cervical cancer?
Cervical cancer is cancer that starts in the cells of the cervix. The cervix is the lower, narrow end of the uterus that connects the uterus to the vagina (the birth canal). Cervical cancer usually develops slowly over many years. Before cancer appears, the cells of the cervix go through changes called dysplasia, in which abnormal cells begin to appear; over time, if these changes are not found and treated, they may turn into cancer.
Most cervical cancers are squamous cell carcinomas, which start in the thin, flat cells that line the outer part of the cervix; a smaller share are adenocarcinomas, which start in the glandular cells that line the inner part of the cervix. Long-lasting (persistent) infection with high-risk types of human papillomavirus (HPV) causes virtually all cervical cancers; HPV 16 and HPV 18 alone cause about 70% of cervical cancers worldwide.
Common warning signs
Early-stage cervical cancer often has no symptoms, which is why regular screening is important; symptoms usually begin only after the cancer has spread. When early-stage symptoms do appear, they may include:
- Vaginal bleeding after sex
- Vaginal bleeding after menopause
- Vaginal bleeding between periods, or periods that are heavier or longer than normal
- Vaginal discharge that is watery, has a strong odor, or contains blood
- Pelvic pain or pain during sex
In more advanced cervical cancer, additional symptoms may include difficult or painful bowel movements or bleeding from the rectum, difficult or painful urination or blood in the urine, a dull backache, swelling of the legs, abdominal pain, or feeling very tired.
These symptoms may be caused by many conditions other than cervical cancer. The only way to know is to see a doctor or healthcare provider. Ignoring symptoms can delay treatment and make it less effective.
Risk factors
The main cause of cervical cancer is long-lasting infection with high-risk HPV. Nearly all sexually active people will be infected with HPV at some point in their lives, and most infections clear on their own within a year or two; only when a high-risk infection lasts for years can it lead to cell changes that may become cancer.
Factors that increase the chance that an HPV infection will lead to cervical cancer include:
- A weakened immune system, such as from HIV infection or medicines that suppress the immune system (for example, after an organ transplant or for autoimmune disease)
- Smoking or breathing in secondhand smoke — the more you smoke or are exposed, the higher the risk
- Becoming sexually active at a young age, especially before age 18, or having multiple sexual partners (which increases the chance of exposure to high-risk HPV)
- Long-term use of oral contraceptives (birth control pills)
- Having given birth to many children
- Obesity, which can make screening less reliable
The HPV vaccine prevents infection with the HPV types that cause most cervical cancers; it works best when given before someone becomes sexually active. In India, the HPV vaccine is available at private hospitals and through some government programmes; the indigenously developed vaccine Cervavac has expanded access since 2023 . Talk to a doctor about whether HPV vaccination is right for you or your child.
Even after HPV vaccination, regular cervical screening is still important, because the vaccine does not protect against every cancer-causing HPV type.
When to seek medical attention
Please see a doctor for evaluation if you notice any of the following:
- Vaginal bleeding after sex, between periods, or after menopause that lasts more than 1 to 2 weeks
- Vaginal discharge that is watery, has a strong odor, or contains blood and lasts more than 2 weeks
- Pelvic pain or pain during sex that lasts more than 2 weeks
- New, unexplained back pain or leg swelling
- Periods that are suddenly heavier or much longer than normal
Routine cervical screening is recommended for people with a cervix, even if they feel well and have no symptoms. The two main screening tests are the HPV test, which checks cervical cells for high-risk HPV types, and the Pap test (also called a Pap smear or cervical cytology), which collects cervical cells to check for changes that may turn into cancer. The HPV/Pap cotest combines both. Talk to a doctor about when to start screening and how often, based on your age and history.
How is cervical cancer diagnosed?
If you have symptoms or screening results that suggest cervical cancer, your doctor will ask about your personal and family medical history and do a physical exam, including a pelvic exam. The following tests may be used:
- Colposcopy — a procedure in which a speculum is used to gently open the vagina, a vinegar solution is applied to the cervix, and a colposcope (a tool with a bright light and a magnifying lens) is used to look closely at the cervix. A colposcopy usually includes a biopsy.
- Biopsy — a small sample of tissue is removed from the cervix so a pathologist can check it under a microscope. Types include punch biopsy (small round samples), endocervical curettage (cells collected from the cervical canal), LEEP (a thin wire loop that uses an electrical current to remove tissue, often done in the doctor’s office under local anesthesia), and cone biopsy (a cone-shaped piece of tissue removed under general anesthesia).
- Imaging tests such as a PET-CT scan, MRI, ultrasound, or chest X-ray may be done to find out if the cancer has spread (this is called staging).
- Lab tests such as a complete blood count and blood chemistry tests may be done to check overall health.
A biopsy is the only test that can confirm cervical cancer. Some people have light bleeding, discharge, or cramping after a biopsy. If your doctor recommends a biopsy, it is to rule out cancer or to plan treatment.
Treatment basics
Cervical cancer treatment depends on the stage of the cancer, your overall health, your preferences, and whether you wish to preserve fertility. Treatment plans are individualized — what is best for one person may not be best for another. Common treatments may include:
- Surgery — options range from cone biopsy (which can sometimes remove all of an early cervical cancer) to radical trachelectomy (which removes the cervix but spares the uterus, leaving the option for future pregnancy) to hysterectomy (removal of the uterus and cervix; sometimes also nearby tissue and lymph nodes).
- Radiation therapy — may be given as external beam radiation (from a machine outside the body) or internal radiation (brachytherapy, where a radioactive source is placed near the cancer). Both types are used to treat cervical cancer.
- Chemotherapy — drugs given by vein that travel through the body. Chemotherapy is sometimes given alongside radiation (called chemoradiation) for locally advanced cervical cancer.
- Targeted therapy — drugs that block specific molecules involved in cancer growth, used in some cases.
- Immunotherapy — may be used in some cervical cancers based on biomarker test results.
If you are concerned about whether treatment will affect your fertility, talk with your cancer care team before treatment begins about what to expect.
In India, much of the cost of cervical cancer surgery, chemotherapy, radiation therapy, and diagnostic procedures including biopsy may be covered by Ayushman Bharat (PM-JAY) for eligible families, up to Rs. 5 lakh per family per year. Ask the hospital’s PMJAY desk before paying out of pocket.
Questions to ask your doctor
When you visit a doctor about possible cervical cancer or after a diagnosis, you may want to ask:
- What do my screening or biopsy results mean?
- Do I need a colposcopy, biopsy, or further imaging? When will I get the results?
- If it is cancer, what stage is it and what does that mean?
- What are my treatment options — surgery, radiation, chemotherapy, targeted therapy, immunotherapy — and what side effects can I expect?
- Can my fertility be preserved? What are my options if I want to have children in the future?
- How long will the full treatment plan take?
- Should I get a second opinion? Some people choose to get a second opinion to confirm the diagnosis and treatment plan.
- Is my treatment covered under PMJAY or any other scheme?
- What follow-up tests will I need after treatment, and how often?
- If I have children or younger family members, should they get the HPV vaccine?
Bring a family member or trusted person to the visit. Write the answers down — it is normal to feel overwhelmed.
When urgent care is needed
Please seek urgent medical help — go to the nearest hospital or call an ambulance — if you have any of the following:
- Heavy vaginal bleeding that soaks through pads within 1 hour and does not stop
- A fever ≥ 100.4°F / 38°C during chemotherapy — this is an emergency
- Severe pelvic or abdominal pain that comes on suddenly
- Sudden serious difficulty breathing or severe chest pain
- A severe allergic reaction (sudden swelling of face or throat, difficulty breathing, full-body rash) within 24 hours of treatment
- Sudden confusion, severe weakness, or fainting
In India, you can call 108 or 112 for ambulance services. The Indian Cancer Society helpline is 1800-22-1951 for non-emergency questions and support.
If you live in Bihar and need a starting point for cervical cancer evaluation, Mahavir Cancer Sansthan in Phulwarisharif, Patna is Bihar’s super-specialty cancer centre and has surgical, medical, and radiation oncology departments. AIIMS Patna and IGIMS (the State Cancer Institute) in Patna also provide gynecologic-oncology care.
