What Is Cervical Cancer?

Cervical cancer originates in the cells lining the cervix — the lower, narrow portion of the uterus that connects to the vagina. The cervix has two parts covered by different cell types: the ectocervix (visible outer surface) and the endocervical canal (inner passage). Most cervical cancers develop at the junction between these two regions, known as the transformation zone, where cellular changes triggered by HPV infection are most likely to occur.[Mayo Clinic]

Globally, cervical cancer is the fourth most common cancer in women. In India, it remains the second most common female cancer, with over 1.2 lakh new cases diagnosed every year according to data from the Federation of Obstetric and Gynaecological Societies of India (FOGSI). The vast majority of these deaths are preventable with timely screening and vaccination.

There are two main types of cervical cancer: squamous cell carcinoma (accounting for approximately 70–80% of cases) arising from the flat cells of the ectocervix, and adenocarcinoma (accounting for 20–25% of cases) developing from the glandular cells of the endocervical canal.

What Causes Cervical Cancer?

Human papillomavirus (HPV) is the primary causative agent in nearly all cervical cancer cases. HPV is an extremely common sexually transmitted infection — the Cleveland Clinic reports that most sexually active women will acquire HPV at some point in their lives. Most HPV infections are cleared naturally by the immune system, but persistent infection with high-risk genotypes triggers the cellular changes that can lead to cancer over time.[Cleveland Clinic]

Key Risk Factors for Cervical Cancer
  • →HPV Infection (Types 16 & 18): High-risk HPV strains responsible for the majority of cases
  • →Multiple sexual partners: Increases exposure risk to HPV
  • →Early sexual activity: Intercourse before age 18 raises lifetime risk
  • →Smoking: Tobacco carcinogens damage cervical cells and impair local immunity
  • →Immunosuppression: Including HIV infection, organ transplant, or long-term corticosteroid use
  • →Long-term oral contraceptive use: Associated with a modest increased risk after 5+ years
  • →History of other STIs: Chlamydia and herpes simplex virus may act as co-factors. Women with endometriosis or chronic pelvic inflammation should also maintain regular cervical screening
  • →Missed or irregular screening: Not having regular Pap smears significantly increases risk

Symptoms of Cervical Cancer

Early-stage cervical cancer typically produces no symptoms — which is precisely why regular screening is so critical. Symptoms, when they do appear, often indicate more advanced disease. Johns Hopkins Medicine highlights that precancerous cervical changes detected by Pap smear exist years before invasive cancer develops, making routine screening a genuine life-saving intervention.[Johns Hopkins Medicine]

Abnormal Vaginal Bleeding After intercourse, between periods, or after menopause — the most common warning sign
Unusual Vaginal Discharge Watery, bloody, or foul-smelling discharge that is different from normal
Pelvic Pain Persistent pelvic pain unrelated to the menstrual cycle or pain during intercourse
Leg Pain or Swelling In advanced cases, lymph node involvement may cause leg pain or swelling
Urinary Symptoms Difficulty urinating, blood in urine, or frequent urination in advanced disease
Back Pain Lower back or sciatic pain when the tumour affects nearby pelvic structures

Stages of Cervical Cancer

Cervical cancer is staged using the FIGO (International Federation of Gynecology and Obstetrics) classification system. Staging determines the extent of spread and guides treatment decisions. The stage at diagnosis is the single most important factor affecting prognosis and survival rates.[Cleveland Clinic]

Stage Description 5-Year Survival
Stage I Cancer confined to the cervix 80–93%
Stage II Spread beyond cervix but not to pelvic wall or lower vagina 58–63%
Stage III Reached pelvic wall or lower third of vagina; may affect kidneys 32–35%
Stage IV Spread to bladder, rectum, or distant organs 15–16%

Pap Smear & Cervical Screening

The Papanicolaou (Pap) smear is the cornerstone of cervical cancer prevention. During the procedure, a healthcare professional collects a small sample of cells from the cervix and examines them under a microscope for abnormal changes. Crucially, this test detects precancerous lesions — called cervical intraepithelial neoplasia (CIN) — that can develop into cancer if left untreated.[Mayo Clinic]

Recommended Screening Schedule
  • →Age 21–29: Pap smear alone every 3 years
  • →Age 30–65: Pap smear + HPV co-test every 5 years (preferred), or Pap smear alone every 3 years
  • →Over 65 / Post-Menopause: May stop screening if adequate prior screening history and no high-risk factors
  • →Immunocompromised women (including HIV+): More frequent screening as advised by doctor

Colposcopy: When Pap Smear Results Are Abnormal

If a Pap smear returns abnormal results, or if an HPV test is positive for high-risk strains, the next step is typically a colposcopy. A colposcope is a magnifying instrument that allows your gynaecologist to examine the cervix in detail, identify suspicious areas, and take a targeted biopsy for histological analysis. At Genova Clinic, Dr. Nilotpala Mohanty performs colposcopy with care and precision to give patients an accurate diagnosis as quickly as possible.

HPV Vaccination: Prevention First

HPV vaccination is the most powerful tool we have against cervical cancer. Vaccines like Gardasil 9 protect against the nine most dangerous HPV strains, including types 16 and 18 responsible for 70% of all cervical cancers. According to Johns Hopkins Medicine, countries with high HPV vaccination coverage have already seen dramatic reductions in cervical pre-cancers among vaccinated cohorts.[Johns Hopkins Medicine]

HPV Vaccination: Who Should Get It?
  • →Girls aged 9–14: 2-dose schedule (0 and 6 months) — most effective before first sexual exposure
  • →Girls & women aged 15–26: 3-dose schedule (0, 1–2, and 6 months)
  • →Women aged 27–45: May still benefit; discuss with your gynaecologist
  • →Vaccination does NOT replace Pap smear screening — both are needed

Treatment Options for Cervical Cancer

Treatment for cervical cancer depends on the stage at diagnosis, the histological type, the woman's age, and her desire for future fertility. The Mayo Clinic outlines that early-stage cervical cancer is often highly curable with surgery alone, while advanced stages require a combination of radiation therapy and chemotherapy.[Mayo Clinic]

  • LLETZ / LEEP (Loop Excision) For high-grade precancerous lesions (CIN 2–3). Removes abnormal tissue with a thin wire loop using electrical current. Often curative for precancer and very early invasive disease.
  • Cone Biopsy (Conisation) A cone-shaped tissue removal from the cervix used for diagnosis and treatment of early lesions, often fertility-sparing.
  • Laparoscopic Surgery & Radical Hysterectomy Surgical removal of the uterus, cervix, upper vagina, and surrounding tissue. Typically recommended for Stage I–IIA disease in appropriate surgical candidates.
  • Radical Trachelectomy Fertility-sparing surgery removing the cervix while preserving the uterus. An option for carefully selected early-stage patients who wish to preserve their ability to conceive.
  • Concurrent Chemoradiation The standard of care for locally advanced cervical cancer (Stages IB3–IVA). Radiation therapy combined with weekly cisplatin-based chemotherapy significantly improves outcomes.
  • Immunotherapy & Targeted Therapy Pembrolizumab (an immune checkpoint inhibitor) is now approved for advanced, recurrent, or metastatic cervical cancer. Bevacizumab (anti-angiogenic) is used in combination with chemotherapy for metastatic disease.

Cervical Cancer & Fertility

One of the most important concerns for younger women diagnosed with cervical cancer is the impact on their ability to have children in the future. The good news, as noted by Johns Hopkins Medicine, is that fertility-sparing options exist for early-stage disease diagnosed before the cancer has spread beyond the cervix.[Johns Hopkins Medicine]

For women with precancerous lesions or Stage IA1 disease, LLETZ/LEEP or cone biopsy typically preserves fertility completely. For early Stage IB1 disease in carefully selected patients, radical trachelectomy — removing the cervix while leaving the uterus intact — offers a chance at future pregnancy. Women who require hysterectomy or pelvic radiation for more advanced disease will lose fertility, which is why early detection through regular screening is so vital.

When to See a Gynaecologist

You should consult a gynaecologist if you notice any of the warning signs described above. Beyond symptoms, every woman should see a gynaecologist for routine cervical screening according to the schedule recommended for her age group. The FOGSI recommends that all sexually active Indian women begin Pap smear screening from age 21 or within 3 years of first sexual intercourse, whichever comes first.[FOGSI]

Prevention of Cervical Cancer

Cervical cancer is largely preventable — a fact that sets it apart from many other cancers. The Cleveland Clinic emphasises that combining HPV vaccination with regular cervical screening could virtually eliminate cervical cancer as a public health problem within a generation.[Cleveland Clinic]

Prevention Checklist
  • ✓Get the HPV vaccine — ideally in childhood or adolescence, but beneficial up to age 45
  • ✓Attend regular Pap smear screening as per age-appropriate guidelines
  • ✓Use condoms consistently — they reduce (but do not eliminate) HPV transmission risk
  • ✓Quit smoking — tobacco use damages cervical cells and suppresses local immunity
  • ✓Get tested and treated promptly for any STI including chlamydia
  • ✓Follow up on any abnormal Pap smear result without delay
  • ✓Report new gynaecological symptoms — unusual bleeding or discharge — to your doctor

Cervical health is closely connected to overall gynaecological wellbeing. Our specialist Dr. Nilotpala Mohanty also offers expert care in the following areas:

Laparoscopic Surgery Minimally invasive gynaecological procedures with faster recovery
Endometriosis Expert diagnosis and management of endometriosis in South Delhi
Menopause Management Compassionate care for menopause symptoms including HRT guidance

Frequently Asked Questions

Common questions about cervical cancer answered by Dr. Nilotpala Mohanty, Gold Medalist Gynaecologist at Genova Clinic, South Delhi.

Human papillomavirus (HPV) is responsible for nearly 99% of all cervical cancer cases worldwide. The most dangerous high-risk strains are HPV 16 and HPV 18, together accounting for approximately 70% of cases. HPV is transmitted through sexual contact. Most infections clear on their own, but persistent infection in some women leads to cellular changes that, over years, can progress to invasive cancer. Regular Pap smear screening and HPV vaccination are the two most powerful preventive tools available.
Early cervical cancer is often completely silent — no symptoms at all. This is why Pap smear screening is lifesaving. When symptoms do appear, they include: unusual vaginal bleeding (after intercourse, between periods, or after menopause); watery, bloody, or foul-smelling vaginal discharge; and persistent pelvic pain or pain during intercourse. Any of these symptoms warrant immediate medical evaluation. They do not necessarily mean cancer, but they always require investigation.
FOGSI recommends that Indian women begin cervical cancer screening at age 21 or within 3 years of first sexual intercourse, whichever comes first. Women between 21–29 should have a Pap smear every 3 years. Women aged 30–65 benefit most from a combination Pap smear and HPV test every 5 years. Women with risk factors such as HIV or immunosuppression should follow a more frequent screening schedule as advised by their gynaecologist.
Yes — cervical cancer caught at Stage I has a 5-year survival rate exceeding 90%. Even pre-cancerous lesions (CIN 2–3), which are not yet cancer, are completely treatable and curable with procedures such as LLETZ or cone biopsy. This is why regular Pap smear screening is such a crucial public health measure: it finds the problem before it becomes cancer, when it is most easily and completely treated.
HPV vaccination is highly effective. Gardasil 9, the most widely used vaccine, protects against 9 high-risk HPV strains including types 16 and 18, which cause approximately 70% of cervical cancers. Clinical trials show 97–99% efficacy against the targeted HPV types when the vaccine is given before HPV exposure. It is most effective in girls aged 9–14, ideally before first sexual activity. Importantly, vaccination does not replace Pap smear screening — vaccinated women should still have regular cervical checks.
A Pap smear is a simple, quick procedure performed in the clinic. A speculum is used to gently open the vagina, and a small brush or spatula collects a sample of cells from the cervix. Most women experience only mild discomfort or pressure — similar to a period cramp — and the procedure takes less than a minute. The sample is sent to a laboratory where a pathologist examines the cells for any abnormal changes. Results are typically available within 1–2 weeks.
It depends on the stage and type of treatment. Women with precancerous lesions or very early-stage disease can usually have fertility-sparing treatment — such as LLETZ, cone biopsy, or radical trachelectomy — that preserves the uterus and the ability to become pregnant. More advanced disease requiring hysterectomy or pelvic radiation will affect fertility permanently. This is one of the most important reasons to detect cervical cancer as early as possible. Always discuss your fertility goals with your gynaecologist before treatment begins.
Cervical dysplasia (also called cervical intraepithelial neoplasia, or CIN) refers to abnormal, precancerous changes in the cervical cells. It is not cancer — the cells are abnormal but have not invaded surrounding tissue. Low-grade dysplasia (CIN 1) often resolves on its own. High-grade dysplasia (CIN 2 and CIN 3) requires treatment to prevent progression. Without intervention, CIN 3 can evolve into invasive cervical cancer over several years. Regular Pap smears are specifically designed to catch dysplasia before it ever becomes cancer.
Colposcopy is a magnified examination of the cervix. A colposcope is a type of microscope placed outside the vagina — it does not enter your body. A small amount of dilute acetic acid (vinegar solution) or iodine solution is applied to the cervix to highlight any abnormal areas. If suspicious areas are seen, a small biopsy (tissue sample) is taken and sent for laboratory analysis. The procedure is usually performed in the outpatient clinic and takes about 15–20 minutes. Some women experience mild cramping during or shortly after the procedure.
Yes, cervical cancer can recur, particularly in the first 2 years after treatment. Recurrence is more likely with higher-stage disease at initial diagnosis. After completing treatment, regular follow-up appointments with your gynaecologist are essential — including physical examinations, imaging, and sometimes Pap smear testing depending on the type of surgery performed. Women who had fertility-sparing surgery (LLETZ or cone biopsy) should continue regular Pap smear monitoring. Signs of recurrence such as new bleeding, pelvic pain, or unexplained weight loss should be reported immediately.

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