What Is the Most Aggressive Type of Cervical Cancer?

Cervical cancer often does not have symptoms in the early stages. Symptoms of cancer of the cervix usually do not start until the cancer grows and spreads (metastasizes) into nearby tissue. When symptoms of cancer of the cervix occur, they may include: 

• Abnormal vaginal bleeding
  • Bleeding and spotting between periods
  • Menstrual periods that are longer or heavier than usual
  • Bleeding after vaginal sex
  • Bleeding after menopause
  • Bleeding after douching 
  • Bleeding after sexual intercourse
• Unusual vaginal discharge 
  • May occur between periods or after menopause
  • May contain blood 
  • Pain in the pelvic region
  • Pain during sex

Symptoms of advanced cervical cancer may include:

• Problems urinating or having a bowel movement
• Leg swelling
• Blood in the urine

The cause of cervical cancer is often unknown but it is believed it may be due to genetic changes (mutations). 

Some types of human papillomavirus (HPV) infection are the biggest risk factor for cervical cancer; however, HPV is not a risk factor for small and large cell cervical cancers.

Additional risk factors for developing cervical cancer include: 

• Sexual history
  • Becoming sexually active before 18 years old
  • Many sexual partners
  • A partner who is considered high risk (someone with HPV infection or who has many sexual partners)
• Chlamydia infection 
• A weakened immune system such as from human immunodeficiency virus (HIV) or taking immunosuppressant drugs 
• Smoking
• Family history of cervical cancer 
• Long-term use of oral contraceptives (birth control pills)
• Age younger than 20 years at first full-term pregnancy 
• Having multiple (3 or more) full-term pregnancies 
• A diet low in fruits and vegetables 
• Economic status
  • Low-income women may not have easy access to some health care services, including cervical cancer screening with Pap tests and HPV tests, which means they may not get screened or treated for cervical pre-cancers
• Use of diethylstilbestrol (DES) 

Cervical cancer is diagnosed with regular screenings. 

• Pap smear (Pap test) is a test that collects cells from the cervix to check for abnormal cervical cells that can lead to cervical cancer
  • Many patients with small and large cell cervical cancers can have normal Pap smears before the tumor is detected
• HPV test 
  • Since HPV does not cause small and large cell cervical cancers it is not helpful in diagnosis of these types of cervical cancers
  • Usually used in 2 situations:
    • The primary HPV test is preferred for cervical cancer screening in women age 25-65 years 
    • Some HPV tests are part of a co-test, when the HPV test and the Pap test are done at the same time to screen for cervical cancer

Treatment for small and large cell cervical cancers usually involves a combination of surgery, chemotherapy (“chemo”), and/or radiation.

Patients may also participate in clinical trials, but because small and large cell cervical cancers are so rare, finding eligible patients to participate in clinical trials can be difficult. 

Other treatments for cervical cancer may include one or more of the following:

• Chemoradiation, which is chemotherapy given along with radiation to help it work better
• Targeted therapy 
• Immunotherapy