Cervical Cancer Symptoms by Stage

Cervical cancer symptoms are often absent in the early stages and may only become apparent when the disease is more advanced. Abnormal vaginal bleeding is the most common symptom overall, often accompanied by vaginal pain and an abnormal discharge.

The symptoms of cervical cancer can vary by the cancer stage, ranging from Stage 1 where the tumor is localized to Stage 4 where the tumor has spread to distant organs (metastasized). Many of these symptoms are non-specific and easily missed. This is why early detection with a Pap smear is essential to catching cancer when it is most treatable.

Stage 1 Symptoms

Stage 1 cervical cancer is the earliest stage where cancer cells have grown from the surface of the cervix into deeper tissues of the cervix but without spreading to nearby lymph nodes or sites outside of the cervix.

At this stage, cervical cancer is almost always asymptomatic (without symptoms) or subacute (with notable symptoms).

If symptoms develop, a person may experience:

• Bleeding or spotting between periods
• Pelvic pressure or discomfort

Stage 2 Symptoms

Stage 2 cervical cancer occurs when cancer has grown beyond the cervix and uterus but has not spread to the pelvis, vaginal walls, nearby lymph nodes, or distant sites.

At this stage, the spread of cancer to the uterus and the tissues surrounding the uterus (called the parametrium) can trigger notable symptoms, such as:

• Abnormal uterine bleeding
• Heavier or longer periods
• Bleeding or spotting between periods
• Bleeding after vaginal sex
• Unusual vaginal discharge
• Pelvic pain
• Bleeding after menopause

Even at this stage, the symptoms are often subacute and easily dismissed.

Stage 3 Symptoms

Stage 3 cervical cancer occurs when cancer has spread to the lower part of the vagina or the pelvic walls. Although cancer has not yet spread to distant sites, there may be cancer cells in nearby lymph nodes.

Symptoms of stage 3 cervical cancer often arise when the tumor is large enough to compress nearby ureters (the tubes that transfer urine from the kidneys to the bladder), disrupting the flow of urine. It can also place pressure on lymphatic vessels and parts of the intestine, causing obstruction.

Symptoms of stage 3 cervical cancer may include:

• Abnormal vaginal bleeding
• Vaginal discharge
• Pelvic pain
• Difficulty with urination
• Blood in urine
• Problems having a bowel movement
• Leg swelling due to lymphedema
• Painful vaginal sex
• Unintended weight loss
• Back pain

Roughly one in three cases of cervical cancer is diagnosed when it has progressed to stage 3. This is by far the most common stage at which cervical cancer is diagnosed.

Stage 4 Symptoms

Stage 4 cervical cancer occurs when cancer has grown into nearby organs or has metastasized. The most common sites of metastasis are the lungs, bone, liver, and brain. In up to one in 10 cases, metastasis will affect multiple organs.

The involvement of other organs accounts for many of the possible symptoms of stage 4 cervical cancer, including:

• Abnormal vaginal bleeding
• Pelvic pain
• Abdominal pain
• Back pain
• Urination problems
  
• Shortness of breath
• Chest pressure
• Dizziness
• Fatigue and weakness
• Lethargy
• Bone pain or fractures
• Abdominal swelling
• Spitting up blood
• Rapid weight loss

Around one in seven cervical cancer diagnoses are made at stage 4. At this stage, cancer is incurable but treatments are available to prevent progression of the disease, ease symptoms, and extend survival.

Preventive Measures

While cervical cancer cannot be diagnosed based on symptoms, the lack of symptoms does not mean that you don't have cervical cancer. Each year, around 13,000 new cases are diagnosed, most often in those who only sought care when symptoms were apparent. Many of these people likely did not adhere to cancer screening recommendations, which include a routine Pap smear and HPV testing.

Because early diagnosis of cervical cancer almost invariably affords better outcomes, the U.S. Preventive Services Task Force (USPSTF) and American Cancer Society (ACS) recommend Pap testing starting at age 21, followed by Pap testing every three years to age 65.

In addition to Pap screening, the ACS also recommends HPV testing starting at age 25, followed by an HPV test every five years through age 65. You can also do HPV/Pap co-testing every five years or continue with routine Pap smears every three years as usual.

Additional preventive measures include:

• HPV vaccination: An HPV vaccine is available that can reduce your risk of the most common high-risk HPV types. If you have not been vaccinated at age 11 or 12, you can receive the vaccine up to age 26. Some people ages 26 to 45 may also benefit. Speak with your provider.
• Practicing safe sex: While condoms and dental dams only provide partial protection against HPV, they are still an important part of an overall STD prevention strategy. This should also include limiting your number of sex partners.
• Quitting smoking: Studies have shown that nicotine can increase the risk of cervical cancer compared to not smoking by promoting the spread of abnormal dysplastic cells. If you can't quit smoking on your own, ask your provider about smoking cessation aids that can help.

Finally, it is important to recognize that irregular vaginal bleeding and pain are never "normal." Experts advise that symptoms like these should be seen by a healthcare provider without hesitation. This includes having heavier or prolonged periods, bleeding after sex, or vaginal bleeding after menopause.

Summary

Cervical cancer is often asymptomatic during the early stages but can cause abnormal vaginal bleeding, irregular periods, vaginal discharge, and pelvic pain as the disease progresses.

As the tumor grows and starts to affect other organs, urination problems, leg swelling, and back pain can occur. In the most advanced stages, bone pain, breathing problems, fatigue, and unintended weight loss are common.

Cervical Cancer Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

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