What is Cervical Cancer?
Cervical cancer is a cancer that affects the cervix, the lower section of the uterus that opens into the vagina. It develops slowly as abnormal cells in the cervix grow out of control and form a tumour.
Most cervical cancers are associated with a persistent infection caused by high-risk types of human papillomavirus (HPV). In a woman, the abnormal changes in cervical cells caused by HPV can take several years to develop into cancer. Routine cervical screening is conducted to identify these changes before they develop into cancer or to detect cancer at an earlier stage.
What are the Types of Cervical Cancer?
Cervical cancer is primarily divided based on the type of cell in which it begins. Common types of cervical cancer include:
-
Squamous Cell Carcinoma This variant of cervical cancer begins in the thin, flat cells called squamous cells that cover the outer surface of the cervix. It is the most prevalent variant among cervical cancer cases.
-
Adenocarcinoma Adenocarcinoma starts in glandular cells that are located in the cervical canal and is becoming more common in cervical cancer patients.
-
Adenosquamous Carcinoma It is a rarer form that shows features of both squamous cell carcinoma and adenocarcinoma.
How Common is Cervical Cancer in India?
Cervical cancer is a major health issue in India. According to the GLOBOCAN 2022 data, around 1,27,526 new cervical cancer cases were diagnosed in the year, along with 79,906 deaths.
Progress in cervical cancer awareness and screening in India is ongoing, but the level of coverage is still very low. The analysis of the National Family Health Survey-5 (NFHS-5) shows that only about 1.2% to 2% of women have ever been screened for cervical cancer.
What are the Stages of Cervical Cancer?
Cervical cancer is staged according to how far the tumour has spread. Staging helps doctors determine the appropriate treatment approach and assess prognosis. The stages of cervical cancer are as follows:
| Stage | Features |
| Stage I | Cancer is confined to the cervix. Stage I is further divided into IA and IB according to the size, depth of invasion, and clinical visibility of the tumour. |
| Stage II | Cancer has spread beyond the cervix or uterus but has not reached the pelvic wall or lower third of the vagina. |
| Stage III | Cancer may involve the lower third of the vagina, extend to the pelvic wall, cause hydronephrosis or a non-functioning kidney, or involve regional lymph nodes. |
| Stage IV | Cancer has spread to nearby pelvic organs, such as the bladder or rectum, or to distant parts of the body. |
What are the Symptoms of Cervical Cancer?
Cervical cancer may not cause any noticeable symptoms, especially in the early stages. Unusual vaginal bleeding is a common symptom that occurs in the later stages. Symptoms may become more extensive as the disease advances. Some common and advanced symptoms of cervical cancer are as follows:
| Early Symptoms | Advanced Symptoms |
|
|
These symptoms do not always indicate cervical cancer. Hormonal fluctuations, infections, and other gynaecological disorders can cause same symptoms. Anyone experiencing persistent or unusual symptoms should be promptly assessed by a medical professional.
Diseases Similar to Cervical Cancer
Cervical cancer may be mistaken for other gynaecological cancers, such as endometrial cancer and ovarian cancer, as all of them can result in abnormal vaginal bleeding, pelvic discomfort and other similar symptoms. However, these cancers occur in different organs and have different causes, risk factors and methods of treatment.
The table below compares these conditions to help distinguish them:
Cervical Cancer vs. Endometrial Cancer vs. Ovarian Cancer
| Feature | Cervical Cancer | Endometrial Cancer | Ovarian Cancer |
| Where It Starts | Begins in the cells of the cervix | Begins in the lining of the uterus (endometrium) | Begins in the ovaries or related tissues |
| Main Cause or Risk Factors | Persistent infection with high-risk HPV is the main cause | Risk is associated with factors such as obesity, excess estrogen exposure, increasing age and certain inherited conditions | Risk may be associated with increasing age, family history, inherited gene mutations and other factors |
| Common Symptoms | Abnormal vaginal bleeding, unusual vaginal discharge and pelvic pain | Abnormal vaginal bleeding, particularly bleeding after menopause | Bloating, abdominal or pelvic pain, feeling full quickly and urinary or bowel changes |
| Typical Spread | May spread from the cervix to nearby pelvic tissues, lymph nodes or distant organs | May spread from the uterus to nearby tissues, lymph nodes or distant organs | May spread within the pelvis and abdomen and, in advanced disease, to distant sites |
| Treatment Outlook | Often treatable and potentially curable when detected early; advanced disease may require combined treatment | Often treatable when detected early; prognosis depends on stage and tumour characteristics | Treatment can control the disease, but prognosis varies according to stage, tumour type and response to treatment |
What Causes Cervical Cancer?
Persistent infection with some high-risk types of human papillomavirus (HPV) is the main cause of cervical cancer. In most cases, the immune system clears HPV naturally. When a high-risk infection occurs, it may cause abnormal changes in cervical cells that may develop into cancer.
-
Core Biological Cause
- Persistent High-Risk HPV Infection: A persistent infection with high-risk HPV can cause changes in the DNA of infected cervical cells. If the infection persists, it may result in precancerous changes and become cervical cancer after a period of time.
-
HPV Types Linked to Cervical Cancer
- HPV 16 and HPV 18: HPV 16 and HPV 18 are the high-risk types of HPV and together cause around 70% of cervical cancers around the world.
- Other High-Risk HPV Types: Other high-risk types of HPV can cause persistent changes in cervical cells and increase the risk of cervical cancer.
What are the Complications of Cervical Cancer?
Advanced cervical cancer can lead to the following complications:
-
Severe Bleeding: Tumours due to cervical cancer can lead to heavy vaginal bleeding or life-threatening haemorrhage.
-
Kidney Failure: Tumours block the ureter, causing urine to back up, which leads to kidney damage.
-
Blood Clot: Cervical cancer can block pelvic veins, slowing blood flow and leading to blood clots or lymphedema.
-
Fistula: During advanced cervical cancer, abnormal holes may form between the vagina and the bladder. This leads to uncontrollable leakage of urine or stool.
What are the Risk Factors for Cervical Cancer?
Some factors can increase the risk of persistent HPV infection or the progression of abnormal cervical cell changes into cancer. They include:
-
Non-Modifiable Risk Factors
These risk factors cannot be changed or completely avoided:
- Previous HPV Infection: Persistent infection with oncogenic HPV types is the most important cause of cervical cancer.
- Weakened Immune System: Immunosuppression can make it more difficult for the body to clear HPV infection.
- HIV Infection: Women living with HIV have a substantially higher risk of cervical cancer, as HIV can impair immune control of HPV infection.
- Age: Cervical cancer may occur more often after years of persistent HPV infection and accumulated cellular changes.
-
Modifiable Risk Factors
The following factors may increase the risk and can be reduced through preventive measures:
- Smoking: Smoking can lead to abnormal changes in cervical cells and increase the risk of cervical cancer.
- Early Sexual Activity: Becoming sexually active at a younger age can increase the period during which a person may be exposed to HPV.
- Multiple Sexual Partners: Having multiple sexual partners can increase the risk of getting an HPV infection.
- Lack of HPV Vaccination: Not receiving HPV vaccination means missing an important preventive measure against HPV types associated with cervical cancer.
- Lack of Regular Screening: Failing to attend regular cervical screening can allow precancerous changes to remain undetected and untreated.
- Long-Term Oral Contraceptive Use: Long-term use of oral contraceptives is associated with higher cervical cancer risk.
- Multiple Full-Term Pregnancies: Having several full-term pregnancies has been associated with an increased cervical cancer risk, particularly among women with persistent HPV infection.
When Should I See a Healthcare Provider?
You should visit a healthcare provider if you experience:
-
Bleeding after menopause
-
Heavy or prolonged periods
-
Unexplained bleeding after sexual activity
-
Repeated bleeding between periods
-
Persistent watery, foul-smelling, or blood-stained vaginal discharge
-
Persistent pelvic pain or pain during sexual intercourse
-
Difficulty passing urine or blood in the urine
-
Persistent bowel problems accompanied by pelvic symptoms
Do not wait for symptoms if your cervical cancer screening is pending. Screening is important to detect the precancerous changes before symptoms occur.
How is Cervical Cancer Diagnosed?
Cervical cancer diagnosis involves several steps. It is important to distinguish screening tests, which identify women who may have cervical precancer or cancer, from diagnostic tests, which investigate an abnormal result or symptoms and confirm the presence of cancer. The common tests used to diagnose cervical cancer are as follows:
-
HPV Test An HPV test detects high-risk HPV types in cervical samples. It is primarily used for cervical cancer screening and risk assessment. However, a positive HPV test does not always mean that a woman has cervical cancer. WHO currently recommends HPV testing as the preferred primary screening method for cervical cancer prevention where suitable programmes and follow-up systems are available.
-
Pap Test A Pap test examines cervical cells for abnormalities that may represent precancerous changes. An abnormal Pap result does not by itself confirm cervical cancer. Further assessment, such as colposcopy and biopsy, may be required.
-
Pelvic Examination A pelvic examination allows a healthcare professional to assess the cervix and surrounding structures for visible or physical abnormalities.
-
Colposcopy Colposcopy provides a magnified examination of the cervix, usually after an abnormal screening result or when symptoms or clinical findings warrant further investigation.
-
Cervical Biopsy A cervical biopsy involves removing a small sample of abnormal tissue for examination under a microscope. Histopathological examination of tissue is generally required to confirm an invasive cervical cancer diagnosis.
-
Imaging Tests Imaging is mainly used after cancer is suspected or confirmed to assess the size and local or distant spread of the disease and assist with staging and treatment planning. Depending on the clinical situation, doctors may use MRI, CT or PET-CT.
Diagnostic Summary Table
| Test | What It Detects | Main Purpose |
| HPV Test | High-risk HPV infection | Primary screening and risk assessment |
| Pap Test | Abnormal cervical cells | Screening for precancerous changes |
| Pelvic Examination | Visible or physical abnormalities | Clinical assessment |
| Colposcopy | Abnormal areas of the cervix | Further evaluation after abnormal screening or clinical findings |
| Cervical Biopsy | Cancerous or precancerous tissue changes | Confirming the diagnosis |
| MRI Scan | Local tumour and pelvic structures | Assessing local extent and treatment planning |
| CT Scan | Tumour spread and lymph nodes or other structures | Staging and treatment planning |
| PET-CT Scan | Areas of increased metabolic activity | Assessing suspected lymph node or distant spread |
How is Cervical Cancer Treated and Managed?
Treatment for cervical cancer depends mainly on the stage, tumour size, lymph-node involvement, histological type, overall health and, where relevant, fertility preferences. The common treatments recommended by doctors are as follows:
-
Surgery Surgery is commonly considered for selected early-stage cervical cancers. Depending on the stage and tumour characteristics, procedures may include conisation, trachelectomy or hysterectomy. Conisation may be appropriate for certain very early cancers or high-grade precancerous lesions. A radical trachelectomy removes the cervix and surrounding tissue while preserving the uterus and may be considered for selected patients who wish to preserve fertility. Hysterectomy removes the uterus and may be used when fertility preservation is not appropriate.
-
Radiation Therapy Radiotherapy is an important treatment for locally advanced cervical cancer and may also be used in other stages, depending on the individual treatment plan. External beam radiation therapy delivers radiation to the tumour and relevant pelvic structures. Brachytherapy is a form of internal radiation in which radiation is delivered close to the tumour. For many patients receiving curative treatment for locally advanced cervical cancer, external beam radiation and brachytherapy are used together.
-
Chemotherapy Chemotherapy may be used with radiotherapy for locally advanced cervical cancer. Cisplatin is commonly used as a radiosensitising chemotherapy drug, although carboplatin may be considered when cisplatin is unsuitable. Chemotherapy may also be used in advanced or recurrent disease as part of systemic treatment.
-
Targeted Therapy Targeted therapies may be used for selected advanced or recurrent cervical cancers. Bevacizumab, for example, may be combined with systemic chemotherapy in appropriate patients with recurrent or metastatic disease. Treatment selection depends on the disease characteristics, previous treatment and overall health.
-
Immunotherapy Immunotherapy may be considered for selected cervical cancers, particularly in advanced, recurrent or specific high-risk locally advanced settings. Pembrolizumab has demonstrated benefit in selected patients when combined with chemoradiotherapy for certain high-risk locally advanced cervical cancers, and it is also used in selected advanced or recurrent disease. Treatment should therefore not be described as a fixed sequence for every patient. A multidisciplinary oncology team determines the treatment plan based on the stage, tumour characteristics and treatment goals.
-
Supportive and Palliative Care Supportive care may be provided throughout treatment to manage pain, nausea, fatigue, nutritional problems and other treatment-related effects. Palliative care may also be appropriate in advanced disease to control symptoms and improve quality of life.
Common Medicines Used to Treat Cervical Cancer
The medicines used for cervical cancer depend on the stage, treatment approach and whether the disease is newly diagnosed, recurrent or metastatic. Common medicines doctors prescribe for cervical cancer are as follows:
-
Cisplatin: Often used with radiotherapy for locally advanced cervical cancer, as it can enhance the effect of radiation.
-
Carboplatin: A platinum-based chemotherapy that may be used when cisplatin is unsuitable or in selected advanced or recurrent treatment regimens.
-
Paclitaxel: Often combined with a platinum-based medicine for advanced or recurrent cervical cancer.
-
Bevacizumab: A targeted medicine that may be combined with chemotherapy for selected recurrent or metastatic cervical cancers.
-
Pembrolizumab: An immunotherapy medicine used in selected cervical cancers based on disease stage and relevant clinical or biomarker characteristics.
-
Other Systemic Medicines: Additional chemotherapy, targeted medicines or immunotherapies may be considered depending on previous treatment, disease progression and treatment eligibility.
Note: Not all of these medicines are appropriate for every patient. The choice of medicines depends on the cancer stage, previous treatment, tumour characteristics, overall health, and treatment goals.
Living With Cervical Cancer: Challenges and Caregiving
Living with cervical cancer affects your daily activities, physical health, emotional well-being and family life. Treatment may involve hospital visits and support from family. Below are the challenges and caregiving support associated with cervical cancer:
-
Challenges
- Treatment-Related Challenges: Chemotherapy, surgery and radiotherapy may cause nausea, pain, fatigue, appetite changes and other side effects that affect daily activities.
- Emotional and Mental Health: During and after treatment, fear, anxiety, sadness and concerns about fertility, relationships, or the future affect emotional well-being.
- Fertility and Sexual Health: Certain treatments can affect fertility, menstrual function or sexual health. Patients may require counselling and specialist support.
- Fatigue and Reduced Independence: Persistent tiredness or treatment-related weakness can make routine activities, work and household responsibilities more difficult.
-
Caregiving and Patient Support
- Daily Physical Support: Caregivers can assist with meals, medicines, personal care, transport and other daily activities whenever the patient is feeling weak or unwell.
- Managing Treatment and Appointments: Family members can help organise hospital visits, treatment schedules, investigations and follow-up appointments.
- Nutrition and Hydration: Patients should maintain adequate nutrition and fluid intake to support general well-being during treatment, especially when appetite or eating is affected.
- Emotional and Social Support: Listening, providing reassurance, and encouraging communication with healthcare experts help patients cope with emotional challenges.
- Monitoring Symptoms and Side Effects: Caregivers should report concerning or worsening symptoms to the healthcare team rather than attempting to manage serious side effects.
- Follow-Up and Long-Term Care: Regular follow-up after treatment is important to monitor recovery, manage the ongoing effects of treatment and identify possible recurrence.
-
Expenses
- Treatment and Medical Expenses: The costs of treatment and medical care can include doctor consultations, diagnostic tests, surgery, chemotherapy, radiotherapy, medicines, hospitalisation and follow-up care.
- Travel and Support Costs: Patients who need to travel outside their city for treatment may also incur expenses for travel, accommodation, food and caregiver support.
- Long-Term Financial Planning: Families should plan for continuing medical care, follow-up appointments, rehabilitation and possible changes in their work or household income.
What is the Prognosis for Cervical Cancer?
The prognosis for cervical cancer varies between individuals. The stage at diagnosis is one of the most important factors, but tumour size, lymph node involvement, histological type, overall health and response to treatment also influence outcomes.
Cervical cancer detected at an early stage generally has a better prognosis than the disease diagnosed after it has spread beyond the cervix. Some early-stage cervical cancers can be treated with curative intent, while advanced disease may require a combination of treatments and long-term disease management.
Key factors that may affect prognosis include:
-
Stage at diagnosis
-
Tumour size and local extent
-
Lymph-node involvement
-
Whether the cancer has spread to distant organs
-
Histological type and tumour characteristics
-
Overall health and other medical conditions
-
Response to treatment
-
Whether the cancer recurs after treatment
Can Cervical Cancer Be Prevented?
Cervical cancer can often be prevented by reducing the risk of high-risk HPV infection and detecting precancerous cervical changes early. Key preventive measures include:
-
HPV Vaccination: HPV vaccination helps protect against the HPV types that cause most cervical cancers. It is most effective when given before exposure to HPV and does not treat an existing HPV infection.
-
Regular Cervical Screening: Screening can identify HPV infection or abnormal cervical cell changes before they develop into invasive cancer.
-
Timely Treatment of Precancerous Changes: Abnormal cervical changes identified through screening can often be monitored or treated before they progress to cervical cancer.
-
Practising Safer Sex: Using condoms can reduce the risk of HPV transmission, although they do not provide complete protection, as HPV can infect areas not covered by a condom.
-
Avoiding Tobacco Use: Smoking is associated with a higher risk of cervical cancer and may affect the body's ability to clear HPV infection.
-
Following Up on Abnormal Screening Results: Completing recommended follow-up tests and treatment after an abnormal screening result is important to prevent precancerous changes from progressing.
Cervical Cancer Treatment Cost in India
The cost of cervical cancer treatment in India varies considerably according to the stage of disease, treatment combination, hospital, city, duration of treatment and whether advanced medicines or technologies are required. Below are the estimated costs of different types of treatment for cervical cancer in India:
| Treatment Component | Approximate Cost Range |
| Cervical Cancer Surgery | ₹1 to ₹4 lakh |
| Radical Hysterectomy | ₹2.3 to ₹6 lakh |
| External Beam Radiotherapy | ₹65,000 to ₹1.5 lakh |
| Brachytherapy | ₹50,000 to ₹1.5 lakh |
| Chemotherapy | ₹20,000 to ₹70,000 per cycle |
Note: The above prices are estimates and may vary in reality.
Does Health Insurance Cover Cervical Cancer?
Yes. Health insurance plans cover cervical cancer treatment in India. Coverage may include hospitalisation, cancer surgery, chemotherapy, radiotherapy, day care procedures and pre and post-hospitalisation expenses. However, the exact coverage may vary depending on the policy.
Several insurers cover cervical cancer under their cancer insurance policy that offers customised coverage. Similarly, critical illness insurance pays a lump sum benefit on the diagnosis of cervical cancer, depending on the terms and conditions of the policy.
However, cervical cancer will be covered after a waiting period. In case the condition has been diagnosed before the policy was purchased, it may be treated as a pre-existing disease and a waiting period of up to 36 months may have to be served. In case of critical illness insurance plans, a waiting period of up to 90 days will apply.
Make sure to check the policy's terms and conditions, coverage, exclusions, waiting periods, sub-limits and co-payment before raising a claim.
How Much Health Insurance Coverage is Needed for Cervical Cancer Treatment?
The right amount of health insurance coverage for cervical cancer depends on its treatment cost. The cost of cervical cancer treatment can vary, as patients may require different combinations of surgery, radiation, chemotherapy or other treatment. Expenses can increase when the treatment involves repeated hospital visits or longer-term follow-up.
Hence, a sum insured of ₹5 to ₹10 lakh may be sufficient when the expected treatment for cervical cancer is limited, and the policy has adequate cancer-related benefits. A higher sum insured of ₹15 to ₹20 lakh may be more appropriate when treatment involves multiple therapies, repeated hospitalisation or prolonged care.
Frequently Asked Questions (FAQs)
-
Q1. What is cervical cancer?
Ans: Cervical cancer is a cancer that occurs in the cervix, which is the lower section of the uterus. -
Q2. What is the main cause of cervical cancer?
Ans: The main cause of cervical cancer is a continuous infection with high-risk human papillomavirus (HPV). -
Q3. What are the early symptoms of cervical cancer?
Ans: Early cervical cancer may not cause any noticeable symptoms. When symptoms appear, they can include unusual vaginal bleeding, bleeding after sex, abnormal discharge, and pelvic pain.
-
References
-
https://www.cancer.gov/types/cervical/symptoms
-
https://www.cancer.gov/types/cervical/diagnosis
-
https://www.cancer.gov/types/cervical/causes-risk-prevention
-
https://www.apollohospitals.com/cancer-treatment-centres/cancers/cervical-cancer/treatment/
-
https://irdai.gov.in/health-dept
-
https://pmc.ncbi.nlm.nih.gov/articles/PMC12840477/table/curroncol-33-00048-t003/
-
https://pubmed.ncbi.nlm.nih.gov/41671446/
-
