Overview
The cervix forms the lower, narrow portion of the uterus and leads from the uterus to the vagina. The uterus and cervix lie in the pelvis, on top of the vagina, in between the rectum and bladder.
The surface layer of the cervix is mostly composed of squamous cells. It is these cells where cancer typically begins to develop slowly. In cervical cancer, the cervix undergoes a transformation known as dysplasia, in which abnormal cells appear in cervical tissue. This is known as precancerous condition. In time, if left undetected and untreated, these cancer cells start to grow and spread more deeply into the cervix and surrounding tissue.
How is cervical cancer diagnosed?
Doctors who care for women routinely perform pelvic examinations and Pap smears to screen for cancer in the cells on the surface of the cervix. During a Pap smear, a sample of cells from the cervix is taken and examined under the microscope. Abnormal results from a routine Pap smear should not be cause for alarm. Approximately 6% of all annual Pap smears will produce an abnormal result and this result rarely indicates the presence of cervical cancer.
Cells taken from the surface of the cervix can appear abnormal, but may not be cancer. These abnormal cells, however, may be the first step in a series of changes that lead to cancer and are the reason additional testing may be advised. Abnormal cells, sometimes called precancerous cells, typically involve only the surface of the cervix.
I had an abnormal Pap smear, now what happens?
If physicians feel more information is needed following an abnormal Pap smear, they may use a colposcope (lighted microscope) to better visualize the cervix or perform a biopsy, which is the removal of a sample of tissue from the cervix in order to evaluate cervical cells under a microscope. If the doctor cannot determine whether the abnormal cells are only on the surface of the cervix, an endocervical curettage (or ECC) or conization may be recommended. During an ECC, a small amount of tissue is scraped away from inside the cervical opening. A conization or cone biopsy removes a cone-shaped sample of tissue from the cervical canal. Conization can also serve as the primary treatment for precancerous cells. This procedure can be either done in the office with local anesthesia, known as “LEEP” (Loop Electrosurgical Excision Procedure) or performed under sedation in the operating room known as CKC (Cold Knife Conisation).
Infrequently, it may still remain unclear whether the abnormal cells are confined to the cervix or arise from inside the uterus. In this situation, a dilatation and curettage (D&C) may be recommended. During a D&C, a small sample of the uterine lining or endometrium is taken from the inside of the uterus.
Treatment of cervical cancer during pregnancy depends on the stage of the cancer and the stage of the pregnancy. For early stage cervical cancer found early or for cancer found during the last trimester of pregnancy, treatment may be delayed until after the baby is born.
How do I know if my cervical cancer has spread?
As with other cancers, cervical cancer is described in terms of its presence in and beyond the cervix. The stage of the cancer describes the extent to which it has spread beyond the cervix, if at all:
Stage 0: Precancerous lesion involves only the cells on the surface of the cervix.
Stage I: Cancer is confined to the cervix, and may be evident only under microscopic evaluation (stage IA) or apparent by visible or physical examination (stage IB).
Stage II: Cancer has spread beyond the cervix to involve the tissues surrounding the cervix or the upper portion of the vagina.
Stage III: Cancer spreads beyond the cervix to the lower vagina or to the sides of the pelvis, or causes a blockage of drainage from the kidney, a condition called hydronephrosis.
Stage IV: Cancer invades structures adjacent to the cervix such as the bladder or rectum or has spread to other parts of the body such as the liver or lungs.
Recurrent/Relapsed: Cervical cancer is still detected or has returned (recurred/relapsed) following an initial treatment with surgery, radiation therapy, and/or chemotherapy.
What role does human papillomavirus or HPV play in cervical cancer?
HPV infection is the major risk factor in the development of cervical cancer. Infection of the cervix with HPV is the most common cause of cervical cancer. Not all women with HPV infection will develop cervical cancer. Women who do not have regular Pap smears to detect HPV or abnormal cells in the cervix are at increased risk of cervical cancer. As with any type of cancer, the longer cancer goes undetected, the worse the prognosis.