Cervix is the lowermost part of the womb (uterus) that lies on top of the vagina. It plays an important role in preventing the ascent of pathogens from the vagina into the uterus and allowing the entry of sperm into the fallopian tubes (channel for transport of eggs and fertilization). It is also crucial for the maintenance of pregnancy in the uterus until the onset of labor.
Cervical cancer is a type of cancer that occurs in the cells of the cervix. This cancer can affect the deeper tissues of the cervix and may spread to other parts of the body (metastasize), often the lungs, liver, bladder, vagina, and rectum.
This cancer is the second most common female malignant (cancerous) tumor globally which seriously threatens female’s health. Nearly all cervical cancers are caused by an infection with human papillomavirus (HPV).
Some cases may not show any symptoms, but general symptoms include bleeding in between periods and after sexual intercourse. Foul-smelling white discharge and low back pain or lower abdominal pain may also be present. Treatments include surgery, radiation, chemotherapy, and palliative care.
- Women between 15-44 years of age
- India: 6-29% (2016)
- Cervical fibroids
- Cervical polyps
- Pap smear
- Liquid-based cytology (LBC)
- HPV testing
- Imaging: CT scan & PET scan
- Gynecologic oncologist
- Radiation oncologist
- Medical oncologist
Types Of Cervical Cancer
Cervical cancers and cervical pre-cancers are classified based on their appearance on a microscope. They are most commonly of two types:
Squamous cell carcinoma
It is the most common type (80% to 90%). These cancers develop from the outer cells of the cervix (exocervix). Squamous cell carcinomas most often begin in the transformation zone (where the outer cells join the inner cells of the cervix).
This is the other type (10% to 20%) that develop from the mucus-producing gland cells of the inner cells of the cervix (endocervix).
Less commonly, cervical cancers have features of both squamous cell carcinomas and adenocarcinomas and are called adenosquamous carcinomas or mixed carcinomas. Here’s more on the common signs of cancer.
Symptoms Of Cervical Cancer
Cervical cancer symptoms are usually mild in the early stages and can go unnoticed. Symptoms according to the stage of cancer include:
Early or stage 1 cervical cancer
In the early stages of cervical cancer, a person may experience no symptoms at all. Some of the signs and symptoms of stage 1 cervical cancer can include:
Watery or bloody vaginal discharge
Foul odor in the vaginal discharge
Vaginal bleeding after sexual intercourse
Bleeding in between menstrual periods
Longer and heavier menstrual periods
Bleeding post menopause
Discomfort during sexual intercourse
Advanced cervical cancer
If there is a spread of cancer (metastasis) to nearby tissues or organs, symptoms may include:
Blood in urine
Loss of appetite
General feeling of being ill
Dull and aching pain in the back
Swelling in the legs
Difficulty or pain during urination
Pain or bleeding from your rectum while passing the stool
Note: It can take almost 20 years for the precursor lesion caused by sexually transmitted HPV to develop into an invasive form of cervical cancer.
Learn what the experts have to say about cervical cancer.
Causes Of Cervical Cancer
Almost all cervical cancers are caused by sexually transmitted human papillomavirus (HPV). This is the same virus that causes genital warts. There are more than 1000 strains of human papillomavirus, but only certain types can cause cervical cancer. The two types that most commonly cause cancer are HPV-16 and HPV-18.
The major mechanisms through which HPV contributes to cancerous activity involve the viral oncoproteins, E6 and E7, which interfere with major tumor suppressor genes (P53 and retinoblastoma). In addition, E6 and E7 have been associated with changes in host and viral DNA.
Most people will get HPV at some point in their lives and not realize it as the body fights against the infection. However, if the body fails to fight this infection, it can cause the cells of your cervix to change to cancerous cells. HPV can spread from the following:
Any direct skin-to-skin contact of the genitals
Vaginal, anal, or oral sex
Sharing sex toys
Risk Factors For Cervical Cancer
A number of risk factors for cervical cancer are linked to exposure to HPV. High-risk types, especially HPV16, are prevalent in the human population, and infection is usually transmitted by sexual contact, causing squamous intraepithelial lesions. Most lesions disappear after 6−12 months due to the intervention from the immune system. However, a small percentage of these lesions remain and can cause cancer. There are also other numerous risk factors for cervical cancers which include:
According to studies, the risk of developing an infection from high-risk HPV types is higher in women with HIV. The results showed a relationship between HIV and cervical cancer that suggested a higher rate of persistent HPV infection with multiple viruses with cancerous activity, among people with HIV.
Multiple sexual partners
Many studies have suggested that women with multiple sexual partners are at high risk for HPV acquisition and cervical cancer. Multiple sexual partners of the spouse can also be an additional risk factor.
Excessive use of oral contraceptives
Oral contraceptive (OC) pills are known to be a risk factor for cervical cancer. It has been reported in a study that the use of OC for 5 years or more can double the risk of cancer. In addition, the use of OC pills is an associated risk for developing cervical cancer, especially adenocarcinoma.
Smoking increases the chance of developing precancerous lesions of the cervix (called moderate or severe dysplasia) and increases the chance of developing cervical cancer. Smoking greatly increases your risk for dysplasia and cancer, and weakens the immune system, increasing the chances of getting affected by HPV.
In addition to increasing the risk of cervical cancer, smoking can lead to premature pregnancy, ectopic pregnancy and also affect reproductive health. Here's more on smoking can affect women's health.
Several genital hygiene patterns showed an association with cervical cancer. Not using a sanitary napkin, not maintaining vaginal hygiene, and not taking special care in cleaning their genitals when washing increases the risk of infections. Lack of particular care in cleaning the genitals can increase he risk of cervical cancer by 5.6 times.
Weak immune system
Having a weakened immune system caused by immunosuppression increases the risk of HPV infection and cervical cancer. Immunosuppression weakens the body’s ability to fight infection and other diseases.
Diagnosis Of Cervical Cancer
Early stages of cervical cancer don't usually involve symptoms and are hard to detect. The first signs of cervical cancer may take several years to develop. The International Federation of Gynecology and Obstetrics (FIGO) classified cervical cancer stages into the following:
Stage 0: Also known as carcinoma in situ, it is the presence of abnormal cells in the innermost lining of the cervix.
Stage I: Invasive form of cancer that is only confined to the cervix.
- Stage Ia cervical carcinoma: Preclinical invasive carcinoma that can be diagnosed only by means of microscopy.
- Stage Ib cervical carcinoma: Clinically visible lesion that is confined to the cervix uteri.
- Stage Ib1: Primary tumor not greater than 4.0 cm in diameter.
- Stage Ib2: Primary tumor greater than 4.0 cm in diameter.
Stage II: The locally limited spread of cancer beyond the uterus but not to the pelvic sidewall or the lower third of the vagina.
- Stage IIa cervical carcinoma: Spread into the upper two-thirds of the vagina without parametrial (the fat and connective tissue that surrounds the uterus) invasion.
- Stage IIb cervical carcinoma: Extension into the parametrium but not into the pelvic sidewall.
Stage III: Cancerous spread to the pelvic sidewall or the lower third of the vagina, and/or hydronephrosis or a non-functioning kidney that is incident to invasion of the ureter.
- Stage IIIa cervical carcinoma: Extension into lower one-third of the vagina, without spread to the pelvic sidewall.
- Stage IIIb cervical carcinoma: Extension into the pelvic sidewall and/or invasion of the ureter, with the latter resulting in a non-functioning kidney or hydronephrosis.
Stage IV: Cancerous spread beyond the true pelvis or into the mucosa of the bladder or rectum.
- Stage IVa cervical carcinoma: Extension of the tumor into the mucosa of the bladder or rectum.
- Stage IVb cervical carcinoma: Spread of the tumor beyond the true pelvis and/or by metastasis into distant organs.
Finding abnormal cells during cervical cancer screenings is the best way to avoid cervical cancer. Cervical cancer diagnosis requires the following:
A physical exam and complete medical history
Examining the whole body to check general signs of health, including checking for any signs of disease like lumps or anything unusual. Past medical history, patient’s health habits, and prior illnesses and treatments will also be taken.
An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum is done. A speculum is inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A pap test of the cervix is usually done. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
Traditional pap smear
A pap smear, also called a pap test, is a procedure to test for cervical cancer in women. It involves collecting cells from your cervix.
Here's everything you need to know about pap smear.
Liquid-based cytology (LBC)
Liquid-based cytology (LBC) is a new method of preparing cervical samples for cytological examination and unlike the conventional 'smear' preparation, it involves making a suspension of cells from the sample and this is used to produce a thin layer of cells on a slide.
Visual inspection with acetic acid & Lugol’s iodine (VIA/VILI)
Visual inspection with acetic acid (VIA) is a visualization of a woman's cervix to detect precursors of cervical cancer after application of acetic acid (ordinary table vinegar) on her cervix. Healthcare workers (midwives, nurses, and clinical officers) can practice VIA at several levels of healthcare settings.
The HPV test is a screening test for cervical cancer, but it doesn't confirm if an individual has cancer, instead, the test detects the presence of HPV, the virus that causes cervical cancer, in the system.
HPV-based testing is a pivotal part of cervical cancer screening besides cytology-based tests.
The application of HPV detection has accelerated the transition of cervical cancer screening from morphology to molecular biology.
Because human fatigue and error may be major contributors to false-negative readings of Pap smears, computer-assisted image analysis, and artificial intelligence have been introduced as a means of improving the sensitivity of the Pap smear.
Artificial intelligence (AI) has also shown promising results in screening and examination based on image pattern recognition.
This is a procedure to collect cells or tissue from the cervical canal using a curette (spoon-shaped instrument). Tissue samples are taken and checked under a microscope for any signs of cancer.
A procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormal areas. Tissue samples may be taken using a curette (spoon-shaped instrument) or a brush and checked under a microscope for signs of disease.
This is done if the pap smear shows any abnormal cells. A sample of tissue is cut from the cervix and viewed under a microscope by a pathologist to check for signs of cancer.
These tests help doctors find out where the cancer is located and whether it has spread to other parts of the body. They include:
1. Computed tomography (CT) scan: It involves taking pictures of the cervix at specific times after the intravenous (IV) injection of contrast medium to find out exactly where the tumor is in relation to nearby organs and blood vessels.
2. Positron emission tomography (PET) scan or PET-CT scan: A PET scan is usually combined with a CT scan or MRI scan to produce images of the inside of the body. The combination provides a more complete picture of the area being evaluated.
Women’s cancer awareness package is a group of tests clubbed together to detect cancer markers in women. Get your lab tests done by our professionals in the comfort and safety of your house.
Prevention Of Cervical Cancer
There are more than 100 kinds of HPV and about a dozen of them have been shown to lead to cancer. The two most important things to prevent cervical cancer are to get the HPV vaccine and to get tested regularly according to American Cancer Society (ACS) guidelines. These include:
Undergoing cervical screening
Early detection of the types of HPV that can cause cancer is key in preventing cervical cancer. A well-proven way to prevent cervical cancer is to have screening tests. Screening is having tests to find conditions that may lead to cancers and can find pre-cancers before they can turn into invasive cancer. Finding precancerous lesions through regular screening can limit the cases of cervical cancer to a greater extent.
Getting HPV vaccine
The HPV vaccine can help prevent HPV infection by protecting against HPV. Vaccines are available that can help protect children and young adults against certain HPV infections.
These vaccines only work to prevent HPV infection and will not treat an infection that is already there. These vaccines help prevent pre-cancers and cancers of the cervix. Some HPV vaccines are also approved to help prevent other types of cancers and anal and genital warts.
Note: India accounts for around 16% of the total deaths caused by cervical cancer across the world. And it can be prevented with a vaccine.
Learn more about vaccine to prevent cervical cancer: age, types, schedule & more.
Limiting exposure to HPV
HPV is passed from one person to another during skin-to-skin contact with an infected area of the body. Although HPV can be spread during skin-to-skin contact; vaginal, anal, and oral sex doesn't have to occur for the infection to spread. It is even possible for a genital infection to spread through hand-to-genital contact.
Also, HPV infection seems to be able to spread from one part of the body to another. This means that an infection may start in the cervix and then spread to the vagina and vulva.
HPV exposure can be limited by:
Encouraging the partners to talk with a doctor or nurse about the HPV vaccine
Not having sex when there are visible warts
Limiting the number of sex partners
Avoiding sex with people who have had many other sex partners
Not having unprotected sex
Some methods used to prevent sexually transmitted diseases (STDs) decrease the risk of HPV infection. The use of a barrier method of birth control such as a condom, and dental dams during oral, anal, and vaginal sex can help protect against HPV infection.
Maintaining a healthy lifestyle
There are a lot of cancer prevention clinical trials that aim to find out whether actions people take can prevent cancer. These may include eating fruits and vegetables, exercising, quitting smoking, or taking certain medicines, vitamins, minerals, or food supplements.
Specialist To Visit
Every kind of cancer requires comprehensive care that consists of a group of doctors. Doctors that take care of patients with cervical cancer and help in diagnosing and formulating a treatment plan are:
A gynecologist specializes in female reproductive health. Gynecologic oncologists are specialists in cancers of the female reproductive system and can perform surgery and prescribe chemotherapy and other medicines. A radiation oncologist is a doctor who uses radiation to treat cancer whereas a medical oncologist uses chemotherapy and other medicines to treat cancer.
What to ask your doctor?
What type of cervical cancer do I have?
Has my cancer spread outside the cervix?
What is the stage of my cancer and what does that mean?
Will I need other tests before we can decide on treatment?
Do I need to see any other doctors or health professionals?
Treatment Of Cervical Cancer
Different types of treatment are available for patients with cervical cancer. They include:
A. Surgical proceduresSurgery is the removal of the tumor and some surrounding healthy tissue during an operation. Surgical procedures opted for cancer that has not spread beyond the cervix include:
1. Conization: A procedure in which a cone-shaped piece of abnormal tissue is removed from the cervix. A scalpel, a laser knife, or a thin wire loop heated by an electric current may be used to remove the tissue.
2. Hysterectomy: A hysterectomy is a surgical procedure to remove the womb (uterus). A hysterectomy can be:
- Simple hysterectomy: It is the removal of the uterus and cervix.
- Radical hysterectomy: It is the removal of the uterus, cervix, upper vagina, and the tissue around the cervix. A radical hysterectomy also includes the removal of the surrounding lymph nodes.
3. Loop electrosurgical excision procedure (LEEP): This procedure uses a wire loop heated by an electric current to remove cells and tissue in the cervix and vagina. It is used as part of the diagnosis and treatment for abnormal or cancerous conditions.
4. Exenteration: This surgery is done if cancer has come back within the pelvis (the lowest part of your tummy, between your hips). This procedure removes the cervix, uterus, and ovaries.
5. Radical trachelectomy: It is a surgery to remove the cervix, nearby tissue and lymph nodes, and the upper part of the vagina. It can be used to treat women with early-stage cervical cancer to preserve their fertility. After the cervix is removed, the uterus is attached to the remaining part of the vagina.
6. Bilateral salpingo-oophorectomy: This is a surgical procedure to remove both the ovaries and fallopian tubes. It is done at the same time as a hysterectomy.
B. Radiation therapy
Uses high-energy x-rays or other particles to destroy cancer cells. Radiation therapy may be given alone, before surgery, or instead of surgery to shrink the tumor. The types of radiation therapy include:
External-beam radiation therapy: The most common type of radiation in which the radiation is given from a machine outside the body.
Internal-beam radiation therapy: When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. Brachytherapy involves the application of a radioactive source in close proximity to the tumor.
Note: For the early stages of cervical cancer, a combination of radiation therapy and low-dose weekly chemotherapy is often used. This is done to increase the effectiveness of the radiation treatment.
Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and multiplying of cells.
For people with cervical cancer, chemotherapy is often given in combination with radiation therapy (concurrent chemoradiation). The chemo helps the radiation work better. Options for concurrent chemoradiation include:
Cisplatin: This drug is given weekly during radiation. This drug is given into a vein (IV) before the radiation appointment.
Cisplatin with 5-fluorouracil (5-FU): This combination is given every 3 weeks during radiation.
The chemo drugs most often used to treat cervical cancer that has come back or metastasized include:
D. Targeted therapy
In this treatment, specific genes, proteins, or the tissue environment that contributes to cancer growth and survival are targeted. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.
For recurrent or metastasized cervical cancer, platinum-based chemotherapy combined with the targeted therapy is used. Targeted therapy uses the following:
This therapy uses the body's natural defenses to fight cancer by improving your immune system’s ability to attack cancer cells.
The immune checkpoint inhibitor pembrolizumab is used to treat cervical cancer that has recurred or metastasized during or after treatment with chemotherapy. It may also be used with chemotherapy with or without bevacizumab in people with recurrent or metastatic cervical cancer.
Home-care For Cervical Cancer
The news of cervical cancer can be devastating. Cancer not only affects the body but has a serious effect on the mind as well. Some of the things that the patients can do at home that can help manage the symptoms of treatment include:
Taking enough rest post any surgical procedure
Being physically active
Getting emotional support from loved ones
Following all the instructions given by doctors
Eating a well balanced and nutritious diet
Adding nutritional supplements to the diet
Taking to a counselor
Adopting a healthy behavior
Avoiding sex for 6-8 weeks after hysterectomy
Tips for caregiver
There are numerous resources available for the patient and their family, battling with cervical cancer. Tips that the caregivers can follow to help the patient in the difficult times include:
Encouraging and providing mental support to the patient
Understanding the course of treatment
Helping the patient manage their symptoms and side effects
Coordinating their medical appointments and giving medications on time
Assisting the patient in maintaining personal care and hygiene
Talking with empathy and positive attitude to the patient
Helping the patients with household chores
Handling insurance and billing issues for them
Cervical cancer diagnosis can lead to chronic stress. With so much to take care of, one often finds it hard to cope with situations that are beyond control. Read about effective ways to manage chronic stress.
Complications Of Cervical Cancer
Cervical cancer complications are seen in advanced disease and associated treatments and are similar to other cancers. They may include:
Renal failure: Kidney involvement typically occurs in the more advanced stages of cervical cancer. Kidney failure in cervical cancer can often be associated with blockage of the ureters.
Hydronephrosis: It is the swelling of a kidney due to a build-up of urine. It represents an advanced disease in patients with cervical cancer as it indicates the involvement of the parametria.
Pain: It is seen when cancer progresses and spreads to nearby tissues and organs. The patient may experience pain in the pelvis or have issues urinating.
Lymphedema: It refers to tissue swelling caused by an accumulation of protein-rich fluid that's usually drained through the body's lymphatic system. Lymphedema is usually seen as a result of treatment involving pelvic radiotherapy or lymph node removal.
Blood clots: Like any other cancer, cervical cancer can make the blood thicker leading to the formation of blood clots. Large cervical tumors can also put pressure on the veins in the leg, helping clots to form.
Fistulas: A fistula is an abnormal connection between two body parts, such as an organ or blood vessel and another structure. Vaginal fistulas are the most common type of fistula in patients with cervical carcinoma
Orbital apex syndrome (OAS) and blindness: OAS involves damage and dysfunction of the optic nerves. This occurs in rare cases where cancer spreads to the eye. It is seen in the malignant mixed Mullerian tumor which is a rare uterine and cervical carcinoma and accounts for <5% of uterine cancers.
The COVID-19 pandemic has led to a substantial reduction in preventive healthcare, including HPV vaccinations and cervical cancer screenings, which can lead to complications and an increased number of cervical cancer cases.
Alternative Therapies For Cervical Cancer
When considering alternative and complementary treatments for cervical cancer, it is very important to communicate with your medical teams as some of the alternative therapies may be contraindicated from the treatment plan. Alternative approaches, used by patients include:
Advocating a holistic approach to using plant-derived nutritional chemicals in the treatment of cervical cancer can be very beneficial. Naturotherapy may not replace the conventional treatment regimen, but it may enhance the efficacy of chemotherapy and radiotherapy. Some of the natural herbs include:
Homeopathy claims to stimulate healing responses to diseases by administering substances that mimic the symptoms of those diseases in healthy people. As far as therapeutic medication is concerned, several well-proved remedies are available for cervical cancer symptoms treatment which include:
One of the most distressing and intractable conditions in patients with cancer is pain. It has been reported that about 20% to 30% of cancer patients bear a variety of levels of pain.
Acupuncture is recommended for patients to control cancer pain. Previous studies have reported that it not only has beneficial efficacy for cancer pain management but also almost has no adverse events for patients with cancer pain. However, more research is required to specifically explore the effectiveness of acupuncture at pain acupoints for cervical cancer pain.
Living With Cervical Cancer
Cancer and its treatment not only causes physical symptoms and side effects, it also has emotional, social, and financial effects. Managing all of these effects is how patients and their families can survive this hardship. For some women, cancer may never go away completely. And they may get regular treatments. Learning to live with cancer that does not go away can be difficult and very stressful. Here are a few tips to manage it:
Give importance to palliative care
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Palliative care along with treatment for cancer has shown greater results with less severe symptoms, a better quality of life, and more satisfaction with treatment. Palliative treatments vary widely and often include:
Medication to relieve the symptoms
Emotional and spiritual support
Encouraging the patient to do things they love
For some women with cervical cancer, treatment may remove or destroy cancer, but the patient is always under the fear that cancer might come back. It's important to let your doctor know about any new symptoms or problems because they could be caused by cancer coming back or by a new disease or second cancer.
Most doctors recommend that women treated for cervical cancer keep getting regular pap tests no matter how they were treated (surgery or radiation). Survivors of cervical cancer should be vigilant for early detection of any other cancer, such as breast, lung, and colorectal cancer. Imaging tests may be done if the signs or symptoms of cancer come back.
Manage the physical symptoms of advanced cancer
Advanced cervical cancer means cancer that has spread to other areas of your body such as the liver or lungs. Unfortunately, advanced cancer can't usually be cured. But treatment can often control cancer and relieve symptoms. Things to keep in mind include:
Talk to the doctors and healthcare team regularly
Inform the doctor about new side effects or changes in existing side effects
Inform the healthcare team about the new symptoms so that they can potentially keep them from worsening
Get treatment for long-term symptoms
Coping with tiredness
Walking may improve quality of life for people with advanced cancer. The American Cancer Society recommends brisk walking for at least 150 minutes or any vigorous-intensity activity for 75 minutes for every adult each week to stay healthy. Read how wailing can help you if you have cancer.
Focus on emotional and mental wellbeing
Lots of information and support is available for family and friends of patients with cervical cancer. Some people find it helpful to find out more about their cancer and the treatments they might have. Fear and anxiety can be managed.
Talking about advanced cancer
Sharing feelings with close family members and friends
Getting all the information needed to go about with the treatment
Understanding the physical limitations
Managing the sexual relationship by talking to the partner
Coping with practical issues like financial expenses, child care and work issues
Supervise the cost of cancer care
Cancer treatment can be expensive and coping financially can become a source of stress and anxiety for patients and their families. In addition to treatment costs, there might be extra unplanned expenses as well. This can stop many patients from continuing the treatment. This can be managed by asking the social worker about benefits or grants, they can also help with the claiming process.
Frequently Asked Questions
- Basic Information About Cervical Cancer. Cervical Cancer. Center for Disease Control And Prevention. Dec 2021.
- Zhang S, Xu H, Zhang L, Qiao Y. Cervical cancer: Epidemiology, risk factors and screening. Chin J Cancer Res. 2020 Dec 31.
- What Is Cervical Cancer? About Cervical Cancer. American Society of Cancer.
- Kashyap N, Krishnan N, Kaur S, Ghai S. Risk Factors of Cervical Cancer: A Case-Control Study. Asia Pac J Oncol Nurs. 2019 Jul-Sep.
- International Collaboration of Epidemiological Studies of Cervical Cancer, Appleby P, Beral V, et al. Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies. Lancet. 2007.
- Panagiotis Tsikouras1, Stefanos Zervoudis, et al. Cervical cancer: screening, diagnosis and staging. JBUON 2016; 21(2).
- Ronco G, Cuzick J, Pierotti P, Cariaggi MP, Dalla Palma P, Naldoni C, Ghiringhello B, Giorgi-Rossi P, Minucci D, Parisio F, Pojer A, Schiboni ML, Sintoni C, Zorzi M, Segnan N, Confortini M. Accuracy of liquid based versus conventional cytology: overall results of new technologies for cervical cancer screening: randomized controlled trial. BMJ. 2007 Jul 7.
- How Is Cervical Cancer Treated? Cervical Cancer: Types of Treatment. Cancer. Net. Jan 2022.
- Cervical Cancer Treatment (PDQ®)–Patient Version. Cervical Cancer. National Cancer Institute. Apr 2022.
- Banerjee R, Kamrava M. Brachytherapy in the treatment of cervical cancer: a review. Int J Womens Health. 2014 May 28.
- Fowler JR, Maani EV, Jack BW. Cervical Cancer. [Updated 2022 Apr 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
- Wadhwani M, Phuljhele S, Kumar R, Shameer A. Cervical carcinoma leading to orbital apex syndrome and blindness. BMJ Case Rep. 2019 Mar 1.
- Meng FF, Feng YH. A pilot study of acupuncture at pain acupoints for cervical cancer pain. Medicine (Baltimore). 2018 Dec.
- Sreedevi A, Javed R, Dinesh A. Epidemiology of cervical cancer with special focus on India. Int J Womens Health. 2015 Apr 16.
- Bobdey S, Sathwara J, Jain A, Balasubramaniam G. Burden of cervical cancer and role of screening in India. Indian J Med Paediatr Oncol. 2016 Oct-Dec.