Cervical Cancer
Cervical cancer is the cancer we should not still be losing women to. It is almost entirely caused by a virus we can vaccinate against, can be detected in a pre-cancerous stage with a simple screening test, and is highly curable when caught early. Every woman in Pakistan deserves access to this knowledge — and to the screening that follows from it.
What cervical cancer is — in plain words
Cervical cancer arises from cells of the cervix — the lower part of the uterus that opens into the vagina. Almost all cases are caused by persistent infection with high-risk types of the human papillomavirus (HPV), a very common virus spread through sexual contact. Most HPV infections clear on their own; a minority persist and, over years to decades, cause changes that progress through pre-cancer (dysplasia, CIN) to invasive cancer.
The two main types are squamous cell carcinoma (about 70%) and adenocarcinoma (about 25%). They are treated similarly.
Signs and symptoms to take seriously
Early cervical cancer often causes no symptoms — which is why screening matters. When symptoms occur, they include:
Abnormal vaginal bleeding
Bleeding between periods, after intercourse, or after menopause. Any of these needs prompt evaluation.
Unusual vaginal discharge
Watery, blood-tinged or foul-smelling discharge.
Pelvic pain or pain during intercourse
Persistent discomfort that doesn't settle.
Symptoms of advanced disease
Back pain, leg swelling, or urinary symptoms can signal more advanced spread.
"Cervical cancer in 2026 is, more than anything, a failure of access. A vaccine in adolescence and a screening test once every few years would prevent almost every case. We have to make those routine — for every woman, in every village and city."
How cervical cancer is diagnosed
- Pap smear / HPV test — the screening tests that pick up pre-cancerous changes.
- Colposcopy — a magnified examination of the cervix when a screening test is abnormal, with biopsies of any suspicious area.
- Pelvic examination under anaesthesia — sometimes performed for staging.
- MRI of the pelvis — the most important imaging test for cervical cancer; defines tumour size, depth of invasion, and involvement of nearby tissues.
- CT scan or PET-CT — to look for lymph node involvement and distant spread.
- HIV testing — cervical cancer is more common and more aggressive in women with HIV; this is an essential part of the work-up.
Stages — what the numbers mean
Stage I
Cancer confined to the cervix. Treated with surgery (in early stage I) or chemoradiation (for larger tumours). Five-year survival above 90%.
Stage II
Spread beyond the cervix but not to the pelvic wall or lower vagina. Chemoradiation is the standard.
Stage III
Extension to the pelvic wall, lower vagina, or lymph nodes. Chemoradiation, sometimes with additional immunotherapy.
Stage IV
Spread to bladder, rectum or distant organs. Treated with chemotherapy plus immunotherapy and targeted therapy.
How we treat cervical cancer
Surgery
For very early disease (stage IA), a cone biopsy or simple hysterectomy may be enough — and in young women who wish to preserve fertility, a trachelectomy (removing just the cervix) is an option. For stage IB1 and selected IB2 tumours, a radical hysterectomy with lymph node dissection is performed by a gynaec-oncology surgeon.
Chemoradiation
The mainstay of treatment for locally advanced cervical cancer (stages IB3 to IVA). External-beam radiation combined with weekly cisplatin chemotherapy, followed by brachytherapy (internal radiation placed in the uterus and cervix) — a sequence that produces high cure rates. Brachytherapy is essential; cure rates drop significantly when it is omitted.
Immunotherapy
Pembrolizumab added to chemoradiation has recently been shown to improve outcomes in locally advanced disease. For advanced or recurrent cervical cancer, pembrolizumab combined with chemotherapy (with or without bevacizumab) is now standard first-line treatment for PD-L1 positive tumours. Read more about immunotherapy →
Chemotherapy
Cisplatin or carboplatin combined with paclitaxel, with bevacizumab added in many cases, is the backbone of treatment for advanced disease. Newer agents (tisotumab vedotin, an antibody-drug conjugate) are now available for recurrent disease. Read more about chemotherapy →
Targeted therapy
Bevacizumab improves survival in advanced cervical cancer when added to chemotherapy.
What the outlook honestly looks like
Stage I cervical cancer has a five-year survival above 90%. Locally advanced disease (stages II–III), treated with complete chemoradiation including brachytherapy, has a five-year survival of around 60–70%. Stage IV is more challenging, but the addition of immunotherapy to chemotherapy has improved outcomes substantially over the last few years.
Prevention — the case for action
- HPV vaccination — protects against the high-risk HPV types responsible for most cervical cancers. Most effective when given before sexual activity begins.
- Pap-smear screening from age 25, every 3 years; or HPV-based screening every 5 years from age 30.
- Treat pre-cancerous lesions promptly — picked up by screening, treated with simple outpatient procedures (LEEP, cone biopsy) that prevent progression to invasive cancer.
- Use of condoms reduces but does not eliminate HPV transmission.
- Don't smoke — smoking accelerates the progression of HPV-related pre-cancer to cancer.
Fertility and quality of life
Cervical cancer affects many young women. Fertility-preserving surgery is possible for selected early-stage cases. For those needing pelvic radiation, ovarian transposition (moving the ovaries out of the radiation field) can preserve hormonal function. These conversations should happen before treatment, not after.
Life during treatment
Chemoradiation is intensive. Common side effects include fatigue, bowel and bladder changes, and skin reactions in the radiation field. Sexual function can be affected, particularly after radiation — open conversations and practical strategies (vaginal dilators, lubricants, topical oestrogen) help. Support, dignity and frank discussion are part of care.
After treatment — survivorship
Follow-up includes regular clinic visits and selective imaging. Long-term effects of pelvic radiation on bowel, bladder and sexual function need ongoing attention. Read about survivorship care →
An abnormal Pap smear or a new diagnosis of cervical cancer?
Bring the screening result, biopsy report, and any imaging. We'll explain what stage it is and what the recommended treatment looks like, and answer every question — including the ones about fertility and quality of life.
Medically reviewed by
Dr. Rehan Abdullah
Dr. Rehan Abdullah is a dual-trained clinical and radiation oncologist with over a decade of experience treating both solid tumours and hematologic malignancies. He serves as Consultant Oncologist at INMOL Hospital and sees patients at Farooq Hospital and Healthnox Medical Center, Lahore. Read full profile →
This page is patient education, not a substitute for an in-person consultation. Cancer care must be individualised. Read our medical disclaimer →