Cervical Cancer: Symptoms, Stages and Treatment
In this article
What Is Cervical Cancer?
Cervical cancer is one of the few cancers for which the cause of almost all cases is known — persistent infection with high-risk HPV (Human Papillomavirus). This also makes it one of the most preventable types of cancer because, with an effective vaccine and regular screening tests, the vast majority of cases can be detected and treated at the CIN (cervical intraepithelial neoplasia) stage, before they become cancer. The past few years have also brought important advances in treatment — most notably, adding immunotherapy to standard chemoradiotherapy for locally advanced disease has now received FDA approval. This guide comprehensively covers every aspect, from the causes of the disease and ways to prevent it to diagnosis and the latest treatment options, including those available in 2026.
Anatomy of the Female Reproductive Organs
The internal female reproductive organs include: the narrow-ended structure forming a channel between the uterus and vagina, the cervix; the structure serving as the birth canal, the vagina; the organ in which the embryo develops and pregnancy continues, the uterus (womb); the structures connecting the ovaries to the uterus, the uterine tubes (fallopian tubes); and the organs situated on either side of the uterus that are responsible for hormone production and egg development, the ovaries.
The cervix contains a "transition area" (transformation zone) where two different types of cells meet: the flat (squamous) cells covering the outer surface facing the vagina and the mucus-producing glandular cells lining the cervical canal. Persistent damage from HPV infection most often begins in this transformation zone — this is why the two main histological subtypes of cervical cancer, squamous cell carcinoma and adenocarcinoma, arise from these two cell populations.
Types of Cervical Cancer
| Subtype | Frequency | Characteristics |
|---|---|---|
| Squamous cell carcinoma | %70-80 | Arises from the flat cells lining the cervix; it is the most common subtype and the easiest to detect through screening tests |
| Adenocarcinoma | %20-25 | Arises from the mucus/fluid-producing glandular cells in the cervix; because it is located deeper within the cervical canal, it is relatively harder to detect with a Pap smear, and its incidence has been tending to rise in recent years |
| Other epithelial tumors | Rare | Includes much rarer subtypes such as adenosquamous carcinoma, neuroendocrine tumors and undifferentiated (anaplastic) carcinomas |
How Common Is It? (Current Statistics)
According to the International Agency for Research on Cancer (IARC) report "Global cancer statistics 2024" (Sung H, et al., CA: A Cancer Journal for Clinicians, published on 8 July 2026, DOI: 10.3322/caac.70090), the 2024 data indicate that approximately 661.021 new cases of cervical cancer (ranking 4th in incidence among women) and 348.874 deaths from cervical cancer were reported worldwide. This makes cervical cancer a disproportionate burden for developing countries: approximately 90% of deaths occur in low- and middle-income countries — primarily because of inadequate HPV screening programs and low HPV vaccination rates. The highest incidence rates are seen in Eastern, Southern, Middle and Western Africa and Melanesia; the lowest rates are found in Australia/New Zealand and Western Asia.
According to the American Cancer Society report "Cancer Statistics, 2026" (Siegel RL, et al., CA: A Cancer Journal for Clinicians, published on 13 January 2026, DOI: 10.3322/caac.70043), the 2026 estimates indicate approximately 13.360 new cases of cervical cancer and 4.320 deaths are expected in the United States. With the expansion of screening programs, cervical cancer has become one of the cancers showing the most marked decreases in incidence and mortality over the past 50 years. However, more than half of cases are still diagnosed in women under 45 — maintaining its characteristic as a cancer affecting relatively young women.
According to GLOBOCAN 2024 data, the age-standardized incidence of cervical cancer in Türkiye is approximately 4,8 per 100.000 women, placing Türkiye well below the global average — this low rate may partly reflect the success of the national HPV-DNA-based screening program implemented since 2014 (see below). However, the fact that Türkiye has not yet included the HPV vaccine in its national immunization schedule (see "The Situation in Türkiye" below) remains a topic of discussion among experts.
Causes: HPV Infection
The underlying cause of the overwhelming majority of cervical cancers (approximately 99%) is persistent infection with high-risk HPV (Human Papillomavirus) . HPV is extremely common, and the vast majority of sexually active individuals encounter this virus at least once in their lifetime. Most infections are cleared spontaneously by the immune system within 1-2 years without causing any disease. However, HPV 16 and HPV 18 and certain other high-risk subtypes can cause gradual genetic changes in cervical cells when infection persists, potentially progressing to cancer — these two subtypes alone account for approximately 70% of cervical cancers.
| Factors That Increase Risk | Factors That Reduce Risk |
|---|---|
| Persistent infection with high-risk HPV | Immunization with the HPV vaccine |
| HIV/AIDS or other conditions that suppress the immune system | Protection with barrier methods such as condoms |
| Smoking | Regular cervical screening (Pap smear or HPV DNA testing) |
| Long-term use of oral contraceptives | — |
| Having given birth many times | — |
| A family history of cervical cancer | — |
Having these risk factors does not necessarily mean that cancer will develop; similarly, having no risk factors does not provide 100% protection — but persistent high-risk HPV infection is the common denominator in almost all cases.
The HPV Vaccine: A Revolution in Prevention
The HPV vaccines currently used (most commonly Gardasil 9) provide immunity against multiple high-risk subtypes, including at least HPV 16 and HPV 18. Large-scale studies in countries where the vaccine is administered have shown striking reductions in high-grade cervical lesions and HPV carriage; in some countries, cervical cancer cases have reportedly fallen to almost zero in fully vaccinated cohorts. Our separate article on the HPV vaccine discusses the mechanism and safety of vaccination in detail.
The World Health Organization (WHO), on 20 December 2022, officially updated its guidelines for individuals aged 9-20 to accept a single-dose (or two-dose) HPV vaccination schedule, and two doses 6 months apart for those aged 21 or older (at least 2 doses, preferably 3, are recommended for immunocompromised/HIV-positive individuals). This change remains WHO policy as of 2026, and more than 57 countries worldwide have adopted the single-dose schedule; on 4 October 2024, WHO also expanded the number of vaccines approved for single-dose use, including Cecolin. In addition, Gardasil 9 has been approved since 5 October 2018 for use in the 9-45 age range.
Cervical Cancer Screening
Cervical screening involves examining cell samples taken from the cervix for abnormal cellular changes or the presence of HPV, and plays a role as critical as vaccination in preventing cervical cancer. For many years, the Pap smear test was the standard method, reducing cancer rates by 60-90% and mortality by as much as 90%. The subsequently developed HPV DNA test is more sensitive than the Pap test in detecting high-grade lesions.
In the United States, the FDA, on 14 May 2024, approved vaginal self-sampling by patients for HPV testing in healthcare settings such as clinics, pharmacies and mobile units; on 9 May 2025, it approved, for the first time, self-sampling with the Teal Wand device at home . The American Cancer Society's updated screening guidelines, published on 4 December 2025, state that screening should begin at age 25 and continue through age 65, with primary HPV testing every 5 years as the preferred method. Self-collected samples are also acceptable, although clinician-collected samples are preferred.
Since 2014, Türkiye has transitioned from Pap-smear-based screening to an HPV-DNA-based national screening program : women aged 30-65 are offered, through KETEM (Cancer Early Diagnosis, Screening and Training Centers) and Family Health Centers, free HPV-DNA testing every 5 years . Participation in this program is good, and it is considered an important reason for Türkiye's relatively low incidence of cervical cancer.
Symptoms
Early-stage cervical cancer usually causes no symptoms and is generally detected through screening tests or at the CIN stage. The following symptoms may occur in advanced disease:
- Abnormal vaginal bleeding between periods, during/after sexual intercourse or during exercise
- Pelvic pain
- Abnormal vaginal discharge
- Pain or discomfort during sexual intercourse (dyspareunia)
These symptoms may also have many benign causes other than cervical cancer; however, complaints of this kind always warrant consulting a physician.
How Is It Diagnosed?
Clinical examination: The physician examines the cervix and vagina visually and, if necessary, performs a manual pelvic examination. Colposcopy: if screening results are abnormal or symptoms are suspicious, the cervix is examined in detail using a magnifying device and, if necessary, a biopsy is taken; in some cases, treatment can also be performed during colposcopy. Conization (cone biopsy): a procedure in which a cone-shaped piece of tissue is removed from the cervix for both diagnosis and treatment; it is performed under general anesthesia.
Molecular and Biomarker Tests
| Biomarker | Clinical Significance |
|---|---|
| PD-L1 CPS (22C3 pharmDx assay) | Determines eligibility for pembrolizumab combinations in metastatic/recurrent disease (CPS≥1 threshold); the vast majority of cervical cancers meet this threshold |
| MSI-H / dMMR | Is rare in cervical cancer, occurring at low single-digit rates; when detected, it offers the possibility of an exceptional response to tumor-agnostic pembrolizumab treatment |
| Tissue Factor | Is the target of tisotumab vedotin; however, because it is expressed almost universally in cervical cancer, a separate biomarker test for using this drug is not required |
Staging: The FIGO and TNM Systems
Two complementary staging systems are used in cervical cancer: The FIGO system expresses stages using Roman numerals from I to IV and is the system most widely used in clinical practice; the TNM system describes tumor size (T), lymph node spread (N) and the presence of distant metastases (M) separately. The most important innovation in the current FIGO 2018 revision is the direct inclusion of lymph node involvement detected through imaging or pathological assessment in staging, as the Stage IIIC subcategory — previous systems based staging solely on clinical examination.
Stage I: Cancer Confined to the Cervix
Stage IA1: A very small focus of cancer in cervical tissue, visible only under a microscope; the deepest invasion into surrounding tissue is 3 mm or less. Stage IA2: Another small focus detectable only under a microscope; the deepest invasion is greater than 3 mm but does not exceed 5 mm.
The following illustrations can help you better understand tumor sizing:
Stage IB is divided into substages according to tumor size and the greatest depth of invasion. Stage IB1: The tumor is 2 cm or smaller, and the deepest invasion is greater than 5 mm.
Stage IB2: The tumor is larger than 2 cm but does not exceed 4 cm. Stage IB3: The tumor is larger than 4 cm.
Stage II: Spread Beyond the Uterus, but Still Limited
In Stage II, cancer has spread to the upper two-thirds of the vagina or to the tissues surrounding the uterus. Stage IIA: cancer has spread to the upper two-thirds of the vagina, but there is no involvement of the parametrium (tissue surrounding the uterus); it is subdivided into IIA1/IIA2 according to tumor size. Stage IIB: cancer has spread to the parametrium.
Stage III: Involvement of the Pelvic Wall, Lower Vagina or Lymph Nodes
In Stage III, cancer has spread to the lower third of the vagina and/or the pelvic wall, affected kidney function and caused hydronephrosis, and/or spread to the lymph nodes. Stage IIIA: cancer has spread to the lower third of the vagina, but there is no pelvic wall involvement.
Stage IIIB: cancer has spread to the pelvic wall and/or blocked the ureters, causing hydronephrosis/kidney failure. Stage IIIC: This subcategory, the most important innovation in FIGO 2018, is divided into two groups according to lymph node involvement — IIIC1 (pelvic lymph node involvement only) and IIIC2 (para-aortic lymph node involvement, regardless of tumor size/local extent).
Stage IV: Spread Beyond the Pelvis or Distant Metastasis
Stage IVA: cancer has invaded the mucosa of neighboring pelvic organs such as the bladder or rectum.
Stage IVB: cancer has metastasized to distant parts of the body, such as the liver, lungs or bones, or to distant lymph nodes — this stage is also referred to as metastatic cancer.
Cervical intraepithelial neoplasia (CIN)is a term for abnormal changes in the squamous cells of the cervix, which are not yet cancer. CIN 1 involves abnormal cells in no more than 1/3 of the epithelium and usually regresses spontaneously. CIN 2 involves 1/3-2/3 of the epithelium, while CIN 3 affects the entire epithelium — these high-grade lesions are generally treated to prevent cancer from developing (see below).
Management of CIN
Because of its low risk of progression, CIN 1 usually does not require treatment and is monitored with regular follow-up. For high-grade lesions such as CIN 2 and CIN 3, removal of the abnormal tissue is recommended — the most commonly used method, in which a thin electrically charged wire loop removes the abnormal cells, is LEEP (Loop Electrosurgical Excision Procedure); conization may also be performed as an alternative. In some centers, cervical cryotherapy (freezing treatment) may also be used as an option.
Surgery for Early-Stage Disease
Early-stage cervical cancer (Stage IA-IIA) is usually treated surgically. In Stage IA1, a simple hysterectomy is generally sufficient if there is no lymphovascular invasion; if lymphovascular invasion is present, pelvic lymph node dissection is added. For more advanced early-stage disease (IA2, IB, IIA), the traditional approach has been radical hysterectomy (removal of the uterus, cervix, surrounding supporting tissues, upper vagina and pelvic lymph nodes).
According to the SHAPE trial (New England Journal of Medicine, 2024;390:819-829), in low-risk, early-stage patients with tumors ≤2 cm and limited stromal invasion, simple hysterectomy was found, in terms of pelvic recurrence at 3 years, to be non-inferior to radical hysterectomy . Furthermore, adverse effects such as urinary retention/incontinence were markedly less common in the simple hysterectomy arm. This result is considered a practice-changing finding, allowing the morbidity of parametrial resection to be avoided in carefully selected low-risk patients. Some centers are adopting this change cautiously because of differences in certain analyses. Our separate article comparing simple and radical hysterectomy discusses this issue in detail.
According to the SENTIX trial (Nature Cancer, July 2025), sentinel lymph node (SLN) biopsy alone using indocyanine green (ICG) without complete pelvic lymphadenectomy was found to be non-inferior in terms of recurrence at 2 years in early-stage disease. Detailed examination of SLNs (ultrastaging) detected approximately 44% of node-positive cases that standard nodal assessment might miss. This approach is supported as an option for early-stage disease in current NCCN guidelines and may help avoid adverse effects of complete lymphadenectomy, such as lymphedema.
Preserving Fertility
Because cervical cancer often affects women of reproductive age, fertility-preserving surgical options may be considered in selected patients with early-stage disease, particularly Stage IA-IB1 with small tumors, including trachelectomy (removal of only the cervix while preserving the uterus). This approach is used only in carefully selected patients with a strong desire for pregnancy, and requires a detailed discussion of the advantages and risks with the physician.
Treatment for Locally Advanced Disease
For locally advanced cervical cancer (approximately Stage IB3-IVA), the standard and gold-standard treatment is concurrent chemoradiotherapy with cisplatin-based radiosensitizing chemotherapy — both external beam radiotherapy and internal brachytherapy are part of the same treatment protocol, and the brachytherapy component is considered an indispensable element of cervical cancer chemoradiotherapy.
According to the KEYNOTE-A18/ENGOT-cx11/GOG-3047 trial, adding pembrolizumab to standard chemoradiotherapy in patients with FIGO 2014 Stage III-IVA disease received FDA approval on 12 January 2024 (regimen: pembrolizumab 200mg IV every 3 weeks for 5 cycles, concurrent weekly cisplatin 40mg/m² plus external beam radiotherapy/brachytherapy, followed by pembrolizumab 400mg IV every 6 weeks for 15 cycles). The final overall survival results, presented at ESMO 2024 on 14 September 2024 and published in The Lancet on 13 September 2024, showed that adding pembrolizumab to chemoradiotherapy significantly reduced the risk of death (overall survival at 36 months: 82,6% versus 74,8%; HR 0,67; p=0,0040). This is the first major paradigm shift in the treatment of locally advanced cervical cancer in decades.
Treatment for Metastatic/Recurrent Disease
Although a complete cure is usually not possible in metastatic or recurrent cervical cancer, treatment options can alleviate symptoms and significantly extend survival. Over the past decade, this has been the fastest-developing area of cervical cancer treatment:
According to the GOG-240 trial, adding the VEGF inhibitor bevacizumab to paclitaxel+cisplatin or paclitaxel+topotecan chemotherapy extended overall survival compared with chemotherapy alone (16,8 months versus 12,9 months) and, on 14 August 2014, received FDA approval for persistent/recurrent/metastatic cervical cancer — the first approval of a targeted therapy for this disease. Our separate article on bevacizumab discusses this drug in detail.
Pembrolizumab first received approval based on the KEYNOTE-158 trial in patients with PD-L1 CPS≥1 whose disease progressed after chemotherapy, on 12 June 2018, as a second-line treatment under accelerated approval. Later, based on the KEYNOTE-826 trial, its approval was expanded to full first-line approval in combination with chemotherapy ± bevacizumab, on 13 October 2021, for patients with PD-L1 CPS≥1. Our separate article on the FDA approval of pembrolizumab for cervical cancer discusses this issue in detail.
Tisotumab vedotin (Tivdak) initially received accelerated approval based on the innovaTV 204 trial, on 20 September 2021 ; it subsequently demonstrated an overall survival benefit over chemotherapy in the confirmatory phase 3 innovaTV 301 trial (11,5 months versus 9,5 months; HR 0,70; p=0,0038), becoming the first antibody–drug conjugate to demonstrate an overall survival benefit in recurrent/metastatic cervical cancer. Its approval was converted to full approval on 29 April 2024 . Our separate article on tisotumab vedotin discusses this drug in detail.
Although cemiplimab (Libtayo) significantly reduced the risk of death in the EMPOWER-Cervical 1/GOG-3016 trial (HR 0,69 in the squamous cell carcinoma subgroup), the manufacturer withdrew its application after failing to reach agreement with the FDA on post-approval study requirements, and cemiplimab has never received FDA approval for cervical cancer. However, the European Commission approved it on the basis of the same data, on 22 November 2022 — an interesting example of a drug being approved in one region but not another.
According to early-phase data presented at the 2026 ASCO meeting on 31 May 2026, CRB-701, a new antibody–drug conjugate targeting Nectin-4, showed promising early response rates in advanced/recurrent cervical cancer (%22,2-%37,5, depending on dose level). This is an early-phase finding involving a treatment that has not yet been approved, and suggests that the cervical cancer treatment armamentarium may expand further in the coming years.
Side Effects of Treatment
| Treatment | Common Side Effects |
|---|---|
| Surgery (hysterectomy/trachelectomy) | Difficulty urinating (a temporary catheter may be needed), pelvic floor weakness/urinary incontinence, and a risk of leg lymphedema if lymph nodes have been removed |
| Radiotherapy (external beam + brachytherapy) | Fatigue, skin irritation, bladder inflammation, diarrhea, vaginal dryness/narrowing, and permanent early menopause if the ovaries are in the radiation field |
| Cisplatin-based chemotherapy | Impaired kidney function, hearing loss/tinnitus, peripheral neuropathy, nausea/vomiting and bone marrow suppression |
| Bevacizumab | Hypertension, a risk of bleeding, delayed wound healing and, rarely, gastrointestinal perforation |
| Pembrolizumab (immunotherapy) | Immune-related adverse effects: colitis, hepatitis, pneumonitis, inflammation of endocrine glands such as the thyroid/pituitary, and skin rash |
| Tisotumab vedotin | Conjunctivitis and other ocular surface disorders requiring a specific monitoring protocol, peripheral neuropathy and bleeding |
Supportive Treatments and Rehabilitation
Cervical cancer treatments, including surgery, radiotherapy and chemotherapy, may have lasting effects on pelvic floor function, sexual health and overall quality of life; supportive care should therefore be an integral part of the treatment plan.
Pelvic Floor Rehabilitation and Lymphedema Management
Urinary incontinence and pelvic floor weakness can be managed with Kegel exercises, biofeedback training and, when necessary, the guidance of a pelvic floor physiotherapist. Following lymph node dissection or radiotherapy, lymphedema may develop and can be controlled with compression garments, manual lymphatic drainage and regular exercise.
Sexual Health and Fertility
Vaginal narrowing/dryness after radiotherapy can be managed with training in the use of vaginal dilators and lubricants; these programs are recommended to begin during the first weeks after surgery/radiotherapy. For patients wishing to preserve fertility, it is important to consult a reproductive medicine specialist before treatment and to evaluate fertility-preserving surgical options in suitable patients (see above).
Palliative Care and Psychosocial Support
In advanced disease, early involvement of a team for managing pain, vaginal discharge/bleeding and nutritional problems is recommended — the palliative care team. Psychological support and referral to support groups for anxiety, depression and changes in body image caused by diagnosis and treatment are an important part of holistic care.
Global Approval and Evidence Timeline
Bevacizumab FDA ApprovalMilestone
Based on the GOG-240 trial; the first approval of a targeted therapy for cervical cancer.
Pembrolizumab FDA Approval (2nd Line)
Based on the KEYNOTE-158 trial, in patients with PD-L1 CPS≥1.
Tisotumab Vedotin FDA Approval (Accelerated)
Based on the innovaTV 204 trial.
Pembrolizumab FDA Approval (1st Line)Milestone
Based on the KEYNOTE-826 trial; added to chemotherapy ± bevacizumab.
Cemiplimab European Approval
Based on the EMPOWER-Cervical 1 trial; never approved in the United States.
Pembrolizumab + Chemoradiotherapy FDA ApprovalMilestone
Based on the KEYNOTE-A18 trial; the first paradigm shift in locally advanced disease in decades.
FDA Approval of HPV Self-Sampling in Healthcare Settings
For the BD Onclarity and Roche cobas HPV tests.
Tisotumab Vedotin Converted to Full Approval
Based on the innovaTV 301 trial; the first ADC to demonstrate an overall survival benefit.
FDA Approval of At-Home HPV Self-Sampling (Teal Wand)
The first screening option that can be used at home.
Updated American Cancer Society Screening Guidelines
Beginning screening at age 25 and preferring primary HPV testing.
The Situation in Türkiye: TİTCK Authorization and SGK Reimbursement
Cisplatin and carboplatin have been available in Türkiye as locally produced generics for many years and are reimbursed by SGK without any restrictions.
Paclitaxel and topotecan are authorized in Türkiye, but their official Turkish Summaries of Product Characteristics (SmPCs) do not include cervical cancer as an approved indication (paclitaxel: ovarian/breast/lung cancer; topotecan: ovarian cancer/small-cell lung cancer). The paclitaxel+cisplatin/topotecan combination, which is standard in international guidelines (GOG-240), is used off-label for cervical cancer in clinical practice in Türkiye; reimbursement in this situation generally relies on the accompanying bevacizumab report.
Among the bevacizumab products authorized in Türkiye, the Summary of Product Characteristics for BEVAX explicitly includes the indication "persistent, recurrent or metastatic cervical cancer not suitable for local treatment", in combination with paclitaxel+cisplatin or paclitaxel+topotecan — meaning that the GOG-240 regimen is officially authorized in Türkiye. However, this research could not clearly verify the extent to which SGK reimbursement applies to this indication. Some legal sources state that bevacizumab is generally "not covered by SGK in most circumstances" and that active litigation is ongoing. Patients should confirm the current situation through SGK/TİTCK sources.
Cervical cancer is not among the specifically listed indications for which SGK reimburses pembrolizumab — neither the KEYNOTE-158, KEYNOTE-826 nor KEYNOTE-A18 indication is included. This is consistent with the pattern previously observed in this project for cancers such as esophageal and nasopharyngeal cancer. A patient with a similar gynecological cancer, endometrial/corpus uteri cancer, is documented to have taken legal action and won after SGK refused payment for pembrolizumab — suggesting that a similar legal process may be necessary for the cervical cancer indication.
This research found no evidence that either tisotumab vedotin (Tivdak) or cemiplimab (Libtayo) is authorized by TİTCK in Türkiye; tisotumab vedotin appears to be accessible through overseas medicine procurement services. This is a lack of verification rather than a definitive finding of "no authorization"; the current situation should be confirmed through TİTCK sources.
As of the date this guide was written, August 2026, Türkiye had not included the HPV vaccine in its national, free immunization schedule — unlike many countries. Despite several official promises since 2022, most recently in June 2025 stating that it would be added by the end of 2025, it was confirmed that no implementation plan existed as of January 2026, and the vaccine had still not been added to the national schedule as of August 2026; the issue was awaiting evaluation by a "Scientific Committee". HPV vaccination must therefore be purchased privately in Türkiye, at approximately 5.000-9.000 TL per dose; pharmacies should be consulted for current prices. Although some municipalities, including İstanbul, Ankara and others, have occasionally run local free vaccination campaigns, these do not constitute a national program.
In contrast to the finding on HPV vaccination, Türkiye's national cervical cancer screening program is strong and free: since 2014, women aged 30-65 have been offered free HPV-DNA testing every 5 years through KETEM and Family Health Centers, and participation is high, approximately 89,4% according to 2024 data. This partly offsets the gap in vaccination coverage, but it should be remembered that primary prevention through vaccination and secondary prevention through screening complement one another.
Frequently Asked Questions
- Can cervical cancer be prevented completely?
- The vast majority of cervical cancer cases can be prevented with HPV vaccination and regular screening; however, no method provides 100% protection, so vaccinated women are also advised to continue regular screening.
- Does testing positive for HPV mean I have cancer?
- No. The vast majority of HPV infections are cleared spontaneously by the immune system within 1-2 years; only a small proportion become persistent and lead to cellular changes over time.
- I have been diagnosed with CIN 1. Do I need treatment?
- Usually not — CIN 1 has a low risk of progression and regresses spontaneously in most cases; regular follow-up is sufficient. Treatment with LEEP/conization is generally recommended for high-grade lesions such as CIN 2 and CIN 3.
- What does the SHAPE trial mean? Will everyone now have a simple hysterectomy?
- No — the SHAPE trial showed that simple hysterectomy may be sufficient only in carefully selected, low-risk patients with early-stage disease and small tumors (≤2 cm); radical hysterectomy remains the standard approach for larger or high-risk tumors.
- Why is the KEYNOTE-A18 approval considered important?
- This approval demonstrated that adding immunotherapy to chemoradiotherapy, the standard treatment for locally advanced cervical cancer for decades, significantly extends overall survival — the first major paradigm shift long awaited in this field.
References:
- Sung H, et al. Global cancer statistics 2024. CA Cancer J Clin. 2026. DOI: 10.3322/caac.70090.
- Siegel RL, et al. Cancer Statistics, 2026. CA Cancer J Clin. 2026. DOI: 10.3322/caac.70043.
- WHO. Updated recommendations on HPV vaccination schedule. 20 December 2022.
- Perkins RB, et al. Updated cervical cancer screening guidelines. CA Cancer J Clin. 2026. DOI: 10.3322/caac.70041.
- Tewari KS, et al. Bevacizumab for advanced cervical cancer (GOG-240). N Engl J Med. 2014.
- Chung HC, et al. Pembrolizumab in advanced cervical cancer (KEYNOTE-158). J Clin Oncol. 2019.
- Colombo N, et al. Pembrolizumab for persistent, recurrent, or metastatic cervical cancer (KEYNOTE-826). N Engl J Med. 2021.
- Coleman RL, et al. Tisotumab vedotin in recurrent or metastatic cervical cancer (innovaTV 204). Lancet Oncol. 2021.
- Vergote I, et al. Tisotumab vedotin versus chemotherapy (innovaTV 301). N Engl J Med. 2024.
- Tewari KS, et al. Cemiplimab in recurrent or metastatic cervical cancer (EMPOWER-Cervical 1). N Engl J Med. 2022.
- Lorusso D, et al. Pembrolizumab plus chemoradiotherapy for locally advanced cervical cancer (KEYNOTE-A18). Lancet. 2024.
- Plante M, et al. Simple versus radical hysterectomy in low-risk cervical cancer (SHAPE). N Engl J Med. 2024.
- Cibula D, et al. Sentinel lymph node biopsy in cervical cancer (SENTIX). Nature Cancer. 2025.
- FDA approval notifications: self-collection HPV testing (2024, 2025), CRB-701 early-phase data (ASCO 2026).
- Relevant provisions of Türkiye's Health Implementation Communiqué (SUT) and TİTCK lists of authorized medicines.
Sources
Available from: https://www.esmo.org/content/download/6675/115556/1/EN-Cervical-Cancer-Guide-for-Patients.pdf
2. ESMO Clinical Practice Guidelines – Cervical Cancer, 2024
3. American Physical Therapy Association (APTA) – Oncology Section Guidelines
Pereira et al. (2021) – Pelvic Floor Muscle Training in Women Treated for Cervical Cancer: A Systematic Review
4. Stout Gergich et al. (2008) – Lymphedema and Physical Therapy Interventions in Cancer Survivors
5. Yoo et al. (2019) – Exercise Intervention in Cervical Cancer Survivors: Effects on Quality of Life
6. Türkiye Fizyoterapistler Derneği – Onkolojik Rehabilitasyon Rehberi, 2022
7. ESMO Patient Guide – Cervical Cancer, 2024
8. National Cancer Institute (NCI) – Nutrition in Cancer Care
9. American Institute for Cancer Research (AICR) – Diet & Cancer
10. Cancer.Net – Nutrition Recommendations During Cancer Treatment
11. Arends J et al. ESPEN Guidelines on Nutrition in Cancer Patients. Clin Nutr. 2017
12. Clinical Nutrition in Oncology – Aksoy & Demirel, 2021
13. Onkolog Diyetisyenler Derneği – Serviks Kanserinde Beslenme Rehberi, 2022
Was this article helpful?
Your feedback helps us improve our content.
