Cervical cancer

Cervical cancer is a cancer that starts in the cervix — the lower, narrow part of the womb (uterus) that connects to the top of the vagina. You can think of the cervix as the doorway between the vagina and the womb.

Cancer happens when cells in the body start to grow in an abnormal, uncontrolled way. In the cervix, this usually develops slowly. Long before any cancer appears, the surface cells of the cervix often go through gradual changes that doctors call dysplasia or precancer — cells that look abnormal but are not yet cancer. These changes are not painful and cause no symptoms, but they can be found and treated, which is exactly why regular screening is so powerful.

Because this process is usually slow and has a long “warning” stage, cervical cancer is considered one of the most preventable cancers. When it is found early, it is also one of the most treatable. Understanding it is the first step to feeling less frightened and more in control.

Cervical cancers are grouped mainly by the kind of cell they begin in:

• Squamous cell carcinoma. This is by far the most common type, making up roughly 9 in 10 cervical cancers. It begins in the thin, flat cells (squamous cells) that line the outer part of the cervix, the part nearest the vagina (the ectocervix).
• Adenocarcinoma. This begins in the gland cells that line the cervical canal (the endocervix), the passage running up into the womb. It is less common than squamous cell carcinoma but has become relatively more frequent in recent years.
• Adenosquamous (mixed) carcinoma. A less common type that has features of both squamous cell carcinoma and adenocarcinoma.

There are also rarer forms, such as clear cell adenocarcinoma. Knowing the exact type matters because it can influence which treatments a specialist recommends. Your medical team will confirm the type by looking at a tissue sample under a microscope.

Almost all cervical cancers are caused by a long-lasting infection with certain high-risk types of human papillomavirus (HPV). HPV is an extremely common virus passed on through skin-to-skin and sexual contact. Most sexually active people will come into contact with it at some point, and in the great majority of cases the body's immune system clears it on its own within a year or two with no lasting harm.

The problem arises only when a high-risk type of HPV stays in the body for many years. Two types in particular, HPV 16 and HPV 18, are responsible for around 70% of cervical cancers worldwide. Over a long period, a persistent infection can slowly cause the cell changes that may eventually become cancer.

It is important to be kind to yourself here: having HPV is not a sign of anything you did wrong, and an HPV infection on its own is not cancer. Most people who carry the virus never develop cervical cancer.

Things that can increase the risk that an HPV infection persists or progresses include:

• A weakened immune system — for example from HIV or from medicines that suppress immunity (such as after an organ transplant).
• Smoking, including exposure to second-hand smoke.
• Long-term use of oral contraceptive pills and having had several pregnancies (the reasons are not fully understood).
• Becoming sexually active at a young age or having had several sexual partners, which raises the chance of HPV exposure.
• Exposure before birth to a medicine called DES (diethylstilbestrol), once given to some pregnant women, which is linked to a rare subtype.

Having one or more risk factors does not mean you will get cervical cancer, and many people with cervical cancer have no obvious risk factor other than HPV.

In its early stages, cervical cancer and the precancer changes before it usually cause no symptoms at all. This is the most important reason to attend screening even when you feel completely well.

When symptoms do appear, the most common ones include:

• Unusual vaginal bleeding — for example bleeding after sex, between periods, or after the menopause, or periods that are heavier or longer than usual.
• Watery or bloody vaginal discharge that may have a strong or unpleasant smell.
• Pain or discomfort in the pelvis, or pain during sex.

If the cancer is more advanced, other symptoms can develop, such as lower back pain, swelling in the legs, blood in the urine or pain when passing urine, changes in bowel habits, tiredness, or unexplained weight loss.

Please remember: all of these symptoms are far more often caused by something other than cancer, such as a common infection. But the only way to know is to be checked. See a doctor if you have any unusual or persistent bleeding, discharge, or pelvic pain — especially bleeding after sex or after the menopause. Getting checked early gives you the best chance of a simple outcome, and most often brings reassurance.

Cervical cancer is one of the few cancers with an excellent, well-established screening test — and screening is the single most effective thing you can do to catch problems early or prevent them entirely.

Screening (often called a smear test or Pap test) involves a clinician gently taking a small sample of cells from the cervix using a soft brush. It takes only a few minutes. Most programmes now test that sample first for high-risk HPV; if HPV is found, the same sample is examined for cell changes. The aim is to find and treat abnormal cells before they ever become cancer.

Recommendations vary by country, so follow your local programme:

• In the UK, women and people with a cervix aged 25 to 64 are invited for cervical screening, with HPV testing as the first step.
• The World Health Organization recommends that screening with a high-performance (HPV) test start at age 30 for most women, repeated every 5 to 10 years, and earlier and more often (from age 25, every 3 to 5 years) for women living with HIV.

If you have ever had screening that was overdue, it is never too late to restart — just book an appointment. Screening is for people without symptoms; if you already have symptoms, see a doctor for assessment rather than waiting for a routine screen.

If screening shows a problem, or if you have symptoms, the next steps are designed to look more closely and, if needed, confirm the diagnosis.

Colposcopy. A doctor uses a speculum (the same instrument used for a smear) and a magnifying device with a bright light, called a colposcope, to examine the cervix closely. A mild vinegar-like solution is often applied to make any abnormal areas easier to see. This is usually done in a clinic and is not normally painful.

Biopsy. The only way to be certain is to take a small tissue sample and examine it under a microscope. Common methods include a punch biopsy (tiny samples taken in the clinic), endocervical curettage (gently scraping cells from the cervical canal), LEEP (using a thin heated wire loop to remove a small area, which can both diagnose and treat early changes), and a cone biopsy or conization (removing a small cone-shaped piece of tissue, usually under general anaesthetic).

Staging. If cancer is confirmed, a specialist (a gynaecological oncologist) works out how far it has spread — this is called staging, and it guides treatment. Staging may involve a physical examination, imaging such as MRI, CT or PET-CT scans and ultrasound, blood tests, and sometimes a look inside the bladder (cystoscopy) or bowel (sigmoidoscopy). Cervical cancer stages run broadly from very early (confined to the cervix) to advanced (spread to other organs). Knowing the stage helps your team recommend the most suitable plan.

Treatment depends mainly on the stage, the type of cancer, your general health, and whether you might wish to have children in the future. Care is planned by a multidisciplinary team — typically a gynaecological oncologist (surgeon), a radiation oncologist, a medical oncologist, pathologists, radiologists, specialist nurses and supportive-care professionals — who discuss your case together.

Surgery is often used for early-stage disease:

• Conization (cone biopsy) can sometimes remove all of a very early cancer.
• Radical trachelectomy removes the cervix and nearby tissue while keeping the womb, which may preserve the option of pregnancy for some people.
• Hysterectomy (total, modified radical, or radical) removes the womb and cervix, and sometimes surrounding tissue and lymph nodes.
• Lymph nodes may be checked (including sentinel lymph node biopsy) to see whether the cancer has spread.

Radiation therapy uses high-energy beams to destroy cancer cells, given as external beam radiation (sometimes intensity-modulated, or IMRT) and/or internal radiation (brachytherapy), where a radioactive source is placed close to the cancer.

Chemotherapy uses medicines such as cisplatin or carboplatin, often combined with others. For many cervical cancers, chemotherapy and radiation are given together as chemoradiation, which can be more effective than either alone.

Targeted therapy and immunotherapy are newer options for some advanced or recurring cancers. These include bevacizumab and tisotumab vedotin, and the immunotherapy pembrolizumab for cancers with a marker called PD-L1.

Supportive (palliative) care — managing pain, side effects and emotional wellbeing — is an important part of treatment at every stage, not only for advanced disease.

The outlook for cervical cancer is often encouraging, especially when it is found early. Survival statistics are gathered from large groups of people, and it is essential to understand what they can and cannot tell you.

One widely used measure is the 5-year relative survival rate. Based on people in the United States diagnosed between 2015 and 2021, the American Cancer Society reports approximately:

• 91% when the cancer is found while still confined to the cervix (localised);
• 62% when it has spread to nearby tissues or lymph nodes (regional);
• 20% when it has spread to distant parts of the body (distant);
• 68% across all stages combined.

Please read these numbers gently. They are population-level averages, not a prediction for any individual. They reflect people diagnosed years ago and so may not capture today's improved treatments, and they cannot account for your particular cancer, your age, your overall health, or how you respond to treatment. They describe groups of people, not you. The clearest picture of your own situation will come from your specialist, who knows the details of your diagnosis.

Life during and after treatment looks different for everyone. Many people are able to return to their normal routines, while others need time to recover and adjust. Being well supported makes a real difference.

Follow-up appointments are an important part of care after treatment. These are typically more frequent at first — often every few months — and then spaced out over time. They usually include a physical examination and may include further tests. The purpose is to check that you are recovering well, to manage any lasting side effects, and to spot any signs of the cancer returning early.

Treatment can affect fertility, hormones (sometimes bringing on an early menopause), sexual wellbeing, and emotional health. None of this should be faced alone. Ask your team about:

• Fertility options before treatment begins, if having children may matter to you.
• Managing menopausal symptoms, vaginal health, and intimacy after treatment.
• Emotional and psychological support — anxiety and low mood are common and treatable.
• Practical help, including specialist nurses and patient support organisations.

Tell your team promptly about any new or returning symptoms between appointments rather than waiting.

If you are considering treatment in another country, such as Turkiye, careful preparation helps you compare options clearly and avoid surprises. Costs vary widely from person to person, so rather than quoting figures, it helps to understand what drives the cost of cervical cancer care:

• The stage and type of cancer, which determine how complex the treatment needs to be.
• The treatments required — for example surgery alone versus chemoradiation, brachytherapy, or newer targeted and immunotherapy medicines.
• The type of surgery (such as conization, trachelectomy, or hysterectomy) and whether it is open, laparoscopic, or robotic.
• Length of hospital stay, scans and laboratory tests, anaesthesia, and medicines.
• Follow-up care and any rehabilitation or supportive services.
• Practical costs such as travel, accommodation, translation, and the length of time you stay in the country.

To prepare your medical records, gather your biopsy and pathology reports, any imaging (scans on disc or via a portal) and their written reports, your screening and HPV test history, a summary of any treatment already received, your current medicines, and a list of your questions. Having these ready allows a specialist team to review your case accurately and give you a clear, personalised plan. We can help you request a personalised estimate after a free consultation, with no obligation.

Turkiye has become a well-known destination for medical care, including cancer treatment, because it combines experienced specialist teams, modern hospitals, and established services for international patients. As with anywhere in the world, quality varies between centres, so the most important thing is to choose carefully and verify the details rather than relying on reputation alone.

When assessing a hospital or clinic, it is reasonable to check:

• Accreditation — for example international accreditation such as JCI (Joint Commission International), alongside national licensing and oversight.
• A dedicated multidisciplinary team for gynaecological cancers, including a gynaecological oncologist, radiation and medical oncologists, and specialist nurses.
• Experience with your specific situation — ask how often they treat cervical cancer at your stage and with the treatment you may need.
• Availability of the full range of treatments, including brachytherapy and modern radiotherapy, if relevant to you.
• Clear, written treatment plans and cost estimates, transparent communication, and language support.
• Arrangements for follow-up, and how the centre will share records with your doctors back home.

A trustworthy team will welcome your questions, encourage a second opinion, and never pressure you. Take the time you need to feel confident in your choice.

Few cancers are as preventable as cervical cancer, and there are concrete, proven steps that lower the risk:

• HPV vaccination. Vaccines that protect against the high-risk HPV types are highly effective at preventing the infections that cause most cervical cancers. They work best when given before any exposure to the virus. The WHO highlights vaccination of girls aged 9 to 14, and in the United States the CDC recommends routine vaccination at ages 11 to 12 (it can start at age 9), with catch-up vaccination generally offered up to age 26. The vaccine can also benefit boys, helping prevent other HPV-related cancers.
• Regular screening. Attending cervical screening when invited allows precancerous changes to be found and treated before they ever become cancer.
• Not smoking, and using condoms, which reduce (though do not eliminate) HPV transmission.

If you have been diagnosed, two more options are worth knowing about. Clinical trials are research studies that may offer access to newer treatments; ask your specialist whether any are suitable for you. And seeking a second opinion is a normal, accepted part of cancer care — good doctors expect and support it. A second opinion can confirm a plan or open up other options, and either way it can help you feel more confident in the path ahead.