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A cancer that could be eliminated by HPV vaccination and screening. For those who develop it, immunotherapy and a tissue-factor ADC have improved survival.
Cervical cancer is almost entirely caused by persistent infection with high-risk human papillomavirus, which makes it the one common cancer that could be eliminated: HPV vaccination prevents about 90% of cases, HPV screening finds the precancers that remain, and a minute of thermal ablation or a loop excision cures them. Around 660,000 women are diagnosed and 350,000 die each year, nine in ten of them in low- and middle-income countries where vaccination and screening have not reached. In Sweden, Scotland, and Australia, cohorts vaccinated at 12-13 show near-zero invasive cancer, and Australia expects to pass the WHO elimination threshold (4 per 100,000) around 2035.
For women who develop cancer, treatment depends on stage. Early disease is treated with open radical hysterectomy (minimally invasive surgery proved worse in the LACC trial) or, for the smallest tumours, fertility-sparing surgery, with sentinel node mapping under evaluation. Locally advanced disease is cured in roughly two-thirds by cisplatin chemoradiation with brachytherapy, and two 2023-24 trials improved on that standard for the first time since 1999: six weeks of induction carboplatin-paclitaxel (INTERLACE, 5-year OS 80% vs 72%) and pembrolizumab with chemoradiation (KEYNOTE-A18, 36-month OS 82.6% vs 74.8%). Metastatic or recurrent disease, once treated with chemotherapy alone, now has first-line chemotherapy plus a checkpoint inhibitor with or without bevacizumab (KEYNOTE-826, BEATcc, COMPASSION-16 in China), the tissue-factor ADC tisotumab vedotin in second line (innovaTV 301), and HER2-directed therapy for the minority with HER2-positive tumours.
What comes next is mostly delivery rather than discovery: single-dose HPV vaccination and self-sampled HPV testing to reach the 90-70-90 targets, screen-and-treat with portable ablation devices, AI-read colposcopy, and cheaper immunotherapy access. On the treatment side, HPV ctDNA to guide who needs maintenance therapy, TROP2 ADCs (sacituzumab tirumotecan), TIL therapy, and therapeutic HPV vaccines are in trials. The enduring problem is that the tools already exist and the women who die do not have them.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Cervical cancer is almost entirely preventable by HPV vaccination and screening, and cohorts vaccinated at 12-13 show near-zero invasive cancer.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Most high-grade ovarian cancers begin at the tip of the fallopian tube; endometrial cancer lines the uterus, cervical cancer starts at the transformation zone; each drains to a different node group.
Same organ: Adenosquamous carcinoma of the cervix, Small cell neuroendocrine carcinoma of the cervix, Bartholin gland carcinoma, Vulvar melanoma, Vaginal melanoma, High-grade serous ovarian cancer, Low-grade serous ovarian cancer, Clear cell ovarian cancer, Mucinous ovarian cancer, Adult granulosa cell tumour of the ovary, Ovarian cancer, Endometrial cancer, Vulvar cancer, Gestational trophoblastic neoplasia, Uterine sarcoma, Vaginal cancer, POLE-ultramutated endometrial cancer, Mismatch-repair-deficient endometrial cancer, p53-abnormal endometrial cancer, including uterine serous carcinoma, Endometrial cancer with no specific molecular profile, Advanced or recurrent endometrial cancer, Uterine carcinosarcoma, Early cervical cancer and fertility-sparing surgery, Locally advanced cervical cancer, Recurrent or metastatic cervical cancer, Platinum-sensitive ovarian cancer, Platinum-resistant ovarian cancer, HPV-associated vulvar squamous cell carcinoma, HPV-independent vulvar squamous cell carcinoma (p53-mutant), Vaginal squamous cell carcinoma (HPV-associated), Vaginal adenocarcinoma (including DES-associated clear cell adenocarcinoma), Low-risk gestational trophoblastic neoplasia (FIGO score 0 to 6), High-risk gestational trophoblastic neoplasia (FIGO score 7 or more, including ultra-high-risk), Placental-site trophoblastic tumour and epithelioid trophoblastic tumour
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
What helpsPembrolizumab with chemotherapy and bevacizumab first line, tisotumab vedotin second line; chemoradiation with brachytherapy cures most locally advanced disease.
Also on OnCo: Atlas of advanced disease · How cancer spreads: the metastasis stages.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
HPV vaccination age 9-14; HPV primary screening.
Cisplatin chemoradiation + brachytherapy + pembrolizumab.
Pembrolizumab-chemotherapy-bevacizumab; tisotumab vedotin.
HPV vaccination of girls (and boys) at 9-14, one or two doses per WHO; catch-up to 26 (US label to 45). Reduces invasive cancer ~90% when given before exposure.
HPV primary testing every 5 years from 25-30 (self-sampling accepted), or cytology every 3 years; VIA or HPV screen-and-treat in low-resource settings; WHO target 70% screened twice in a lifetime.
Colposcopy-directed biopsy then LEEP/LLETZ or cone excision; thermal ablation or cryotherapy where eligible; HPV test of cure at 6-12 months.
Simple hysterectomy is non-inferior to radical for low-risk IA2-IB1 ≤2 cm (SHAPE trial, 2024); cone or trachelectomy for fertility preservation; sentinel node mapping in trials (SENTICOL III).
Open radical hysterectomy with pelvic lymphadenectomy (minimally invasive approach inferior in LACC); adjuvant radiation or chemoradiation for intermediate/high-risk pathology (Sedlis, Peters criteria).
Weekly cisplatin 40 mg/m² with external-beam IMRT/IGRT followed by image-guided brachytherapy to ≥85 Gy EQD2, completed within 56 days.
Add pembrolizumab during chemoradiation and for 15 maintenance cycles (KEYNOTE-A18, approved 2024 for FIGO III-IVA), or induction carboplatin-paclitaxel weekly × 6 before chemoradiation (INTERLACE). Adjuvant chemotherapy after chemoradiation is not recommended (OUTBACK).
Pembrolizumab + cisplatin/carboplatin-paclitaxel ± bevacizumab (KEYNOTE-826, CPS ≥1 in the US); atezolizumab + chemotherapy + bevacizumab (BEATcc, region-dependent); cadonilimab + chemotherapy in China (COMPASSION-16).
Tisotumab vedotin (innovaTV 301, OS benefit); cemiplimab if immunotherapy-naive (EU); T-DXd for HER2 IHC 3+; pembrolizumab for MSI-H/TMB-high; single-agent chemotherapy; trials of sac-TMT and TIL therapy.
Pelvic exenteration in selected patients with central recurrence; re-irradiation with brachytherapy or proton therapy in specialised centres.
Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask.
Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked.