The cervix is a hollow tube that attaches the uterus (womb) to the top part of the vagina. Cervical cancer starts from abnormal cell growth on the surface of the cervix. Abnormal cell growth is not cancer. It is a precancerous condition called cervical intraepithelial neoplasia (cervical neoplasia).

Cervical neoplasia occurs in the epithelial (surface) layer of the cervix. These abnormal cells have not yet invaded the cervix, uterus, or any other area of the body.

Cervical cancer develops very slowly. It can take years for cervical neoplasia to grow into invasive cervical cancer.  This slow growth provides opportunities to arrest cervical neoplasia before it progresses.

Cervical neoplasia has no symptoms, and cervical cancer may have symptoms in common with other conditions. For that reason, it’s very important to get screened regularly.

This article will talk about the types and stages of cervical cancer. It will also go into the causes of cervical cancer, risk factors you can control, and prevention strategies.

How Long Does Cervical Cancer Take to Develop?

Cervical cancer can take as long as 15 to 20 years to develop in people with a healthy immune system. If you’re immunocompromised (have a weakened immune system), cervical cancer develops more quickly, at around five to 10 years.

The changes that turn normal cells into cancerous cells take place over time. When they occur, these precancerous changes may be referred to as cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL), or dysplasia.

Precancerous cells are graded on a scale from 1 to 3. Each grade is based upon the amount of abnormal cervical tissue that can be seen under a microscope:

  • C1N1 (mild dysplasia or low-grade SIL): A small amount of tissue is affected. This is the least serious cervical precancer stage.C1N2 (moderate dysplasia): The amount of affected tissue has increased but is still not severe.C1N3 (severe dysplasia or high-grade SIL): More abnormal tissue can be seen. This is the most serious cervical precancer stage.

Screening Tests

Not every precancer becomes cancer. However, early testing and diagnosis can stop cervical cancer from occurring. Regular testing is recommended for people age 21 to 65 who have a cervix. There are three separate testing protocols currently recommended by the American Cancer Society.

You and your healthcare provider can decide which testing schedule is best for you:

  • Primary HPV (human papillomavirus) test: Once every five years
  • Pap test alone: Once every three years
  • Pap test and HPV test: Once every five years

Symptoms

Cervical intraepithelial neoplasia is asymptomatic (no symptoms), so it’s important to see your healthcare provider for testing, even when you’re feeling fine. Any changes that worry you should also be checked out. The symptoms of cervical cancer can indicate other conditions as well. Symptoms include:

  • Abnormal vaginal dischargeAbnormal vaginal bleedingLow-back painPelvic painPain during vaginal sexDifficulty moving your bowels or urinating

Types of Cervical Cancer

There are several types of cervical cancer. Squamous cell carcinoma and adenocarcinoma are the most common types:

  • Squamous cell carcinoma: Nine out of 10 cervical cancers are squamous cell carcinomas. These cancers begin in the ectocervix. The ectocervix is the outer part of the cervix. It is covered with squamous cells.Adenocarcinoma: Adenocarcinomas form in the endocervix. The endocervix is the part of the cervix that leads into the uterus. It is covered with glandular cells.Mixed carcinoma: Some cancers contain both glandular cells and squamous cells. These tumors are known as mixed carcinomas or adenosquamous carcinomas. Mixed carcinomas are less common than squamous cell carcinoma or adenocarcinoma.

Glandular cells and squamous cells can both be found in a part of the cervix called the transformation zone. Most cervical cancers begin in this area. The location of the transformation zone changes with age. Giving birth also alters its location.

Stages of Cervical Cancer

If you have cervical cancer, the amount that it has spread will determine the stage of cancer you have. The International Federation of Gynecology and Obstetrics (FIGO) staging system is used to categorize cervical cancer spread. Cervical cancer stages range from 1 to 4. The lower the number, the less spread you have:

  • Stage 1: Cancerous cells have progressed from the surface of the cervix into deeper cervical tissues.Stage 2: Cancerous cells have spread outside of the cervix and uterus but have not penetrated the pelvic walls or spread into the lower portion of the vagina.Stage 3: Cancerous cells have spread into the lower vagina or walls of the pelvis. At this stage, a tumor may be blocking the ureters (tubes that carry urine from the kidneys to the bladder).Stage 4: The cancer has metastasized (spread) into the bladder or rectum or distant areas of the body, such as the bones or lungs.

What Is HPV?

HPV (human papillomavirus) is the most common type of sexually transmitted infection (STI) in the United States and worldwide. HPV is passed between partners during vaginal, anal, and oral sex. It can also be transmitted through sex toys and intimate, skin-to-skin contact that doesn’t include penetrative sex.

There are over 150 HPV virus strains. Most of these are low-risk. Some low-risk HPV strains may cause genital warts, but not cancerous changes to cells. Approximately 14 HPV viruses are high risk. These strains of HPV may cause cancerous changes within cells to occur. HPV16 and HPV18 are the ones most likely to cause cervical cancer.

In addition to cervical cancer, high-risk HPV strains can also cause other types of cancer. These include:

  • Vaginal cancer
  • Vulvar cancer
  • Anal cancer
  • Penile cancer
  • Oropharyngeal cancer

High-risk HPV infection does not usually cause symptoms. That’s why cervical cancer screening is so important.

Does HPV Infection Always Lead to Cancer?

Most instances of cervical cancer are caused by HPV infection. However, HPV infections don’t always lead to cancer.

Low-risk strains of HPV do not cause cancer. High-risk strains can put you at risk but are usually cleared by the immune system before they can do any harm.

Persistent, high-risk HPV infections that the immune system can’t tackle may lead to changes in squamous cells or glandular cells in the cervix. These cell changes can turn into cancer over many years.

Causes and Risk Factors for Cervical Cancer

HPV infection is the main cause of cervical cancer. Over 90% of all cases of cervical cancer in the United States are caused by HPV.

Most people with HPV don’t know they have it. Unless you’re vaccinated (which reduces your risk), you can get HPV from an infected intimate partner without knowing it.

Risk factors include:

  • Having many intimate or sexual partnersBecoming sexually active at a young ageHaving sex with someone who is or was intimate with many partnersSmoking cigarettes: Cigarettes contain chemicals that can damage the cells of the cervix, making you more vulnerable to infection.Long-term use of oral contraceptives: Birth control pills make cervical cells less resistant to persistent infection from high-risk HPV strains.Having a compromised immune system due to HIV or other conditionsFamily history of cervical cancerDES (diethylstilbestrol) exposure: If the person who gave birth to you took DES during pregnancy, you might have an increased risk of a type of cervical cancer called clear cell adenocarcinoma. DES stopped being prescribed to pregnant people in the United States in 1971, so this risk factor has become increasingly rare.

Can Cervical Cancer be Prevented?

Strategies for cervical cancer prevention include proactive lifestyle choices, vaccination, and screening.

HPV vaccination is the best tool for preventing cervical cancer before it can start. In the U.S., Gardasil 9 is the vaccine used against HPV. Gardasil 9 prevents infection from HPV 16, 18, 6, 11, 31, 33, 45, 52, and 58. These are the types most associated with cervical cancer and other types of cancer.

HPV vaccination is recommended starting at age 11 or 12. However, the Centers for Disease Control and Prevention (CDC) recommends vaccination for everyone up to age 26 if you were not vaccinated sufficiently at an earlier age.

If you have a cervix, you can also prevent cervical cancer by getting screened regularly. Consistent screening is your best way to identify precancerous changes to the cervix before they escalate into cancer.

While not an ironclad guarantee for prevention, eating a diet rich in fruits and vegetables, exercising, and keeping your weight at a healthy level may help reduce your overall risk.    

Summary

Cervical cancer develops very slowly over the course of years or decades. The main cause of cervical cancer is infection from a high-risk strain of HPV. HPV is the most common type of STI (sexually transmitted infection).

Since cervical cancer progresses slowly, regular screening is the best way to diagnose and treat precancers and early-stage cancer.

HPV vaccination is the best way to reduce your risk of contracting HPV strains that cause cervical cancer. Even if you’ve been vaccinated, talk to your healthcare provider about your need for screening.  

A Word From Verywell

HPV exposure is extremely common. Unless you are and always have been celibate, it may be hard to avoid completely. If you are young enough to get vaccinated against HPV, doing so is your best defense against cervical cancer. If this is no longer possible, regular screening is a self-care strategy you can’t afford not to take.

Cervical cancer may grow slowly but like all cancers, can be relentless. If you already have cervical cancer, know that it is not your fault. When caught early, cervical cancer has a high cure rate. Taking care of yourself with regular medical support is your best way to remain or become healthy and cancer-free. 

Frequently Asked Questions

  • What are the earliest signs of cervical cancer?
  • Very early cervical cancer usually has no symptoms. As the disease progresses, you may experience vaginal pain, low-back pain, and unusual bleeding or discharge
  • Can you have cervical cancer for years and not realize it?
  • Yes, you can. Cervical cancer advances slowly. That’s why seeing a healthcare provider regularly for screening is so important. Even if you’re screened regularly, let your healthcare provider know of symptoms or changes that worry you.
  • At what age are you most likely to get cervical cancer?
  • Cervical cancer is typically diagnosed in people who are between age 35 and 44. The average age of diagnosis is 50 years old. This type of cancer is rare in people under 20 years old.

Very early cervical cancer usually has no symptoms. As the disease progresses, you may experience vaginal pain, low-back pain, and unusual bleeding or discharge

Yes, you can. Cervical cancer advances slowly. That’s why seeing a healthcare provider regularly for screening is so important. Even if you’re screened regularly, let your healthcare provider know of symptoms or changes that worry you.