Overview
Cervical cancer starts in a woman’s cervix, the lower, narrow part of the uterus. The uterus holds the growing fetus during pregnancy. The cervix connects the lower part of the uterus to the vagina and, with the vagina, forms the birth canal.
Cervical cancer develops when normal cells on the surface of the cervix begin to grow uncontrollably, and eventually form a mass of cells called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous).
This phase of the disease is called dysplasia (an abnormal growth of cells). The precancerous tissue needs to be removed to keep cancer from developing. If the precancerous cells change into true cancer cells and spread deeper into the cervix or to other tissues and organs, the disease is then called cervical cancer.
Cervical cancers are divided into two main types, named for the type of cell where the cancer started.
- Squamous cell carcinomas, which make up about 85% to 90% of all cervical cancers
- Adenocarcinoma, which make up 10% to 15% of all cervical cancers
Risk factors
The following factors can raise a person’s risk of developing cervical cancer:
Human papillomavirus (HPV) infection – The most important risk factor for cervical cancer is infection with HPV. HPV is passed from one person to another during sexual intercourse. Factors that raise the risk of being infected with HPV include becoming sexually active at an early age, having many sexual partners (or having sex with a man who has had many partners), and having sex with a man who has penile warts.
Human immunodeficiency virus (HIV) infection – Infection with HIV, the virus that causes acquired immune deficiency syndrome (AIDS), is also a risk factor for cervical cancer. When a woman is infected with HIV, her immune system is less able to fight off early cancers. Women whose immune systems have been suppressed by corticosteroid medications, kidney transplantations, or therapy for other cancers or AIDS are also at greater risk.
Herpes – Women who have genital herpes are at greater risk for developing cervical cancer.
Smoking – Women who smoke are about twice as likely to develop cervical cancer as women who do not smoke.
Age – The risk goes up between the late teens and mid-30s. Women over 40 remain at risk and need to continue having regular Pap tests.
Race – Cervical cancer is more common among blacks, Hispanics, and American Indians.
Exposure to diethylstilbestrol – Women whose mothers were given this drug during pregnancy to prevent miscarriage are also at increased risk for cervical cancer. DES was given for this purpose from about 1940-1970.
Signs & Symptoms
Blood spots or light bleeding between or following periods
Menstrual bleeding that is longer and heavier than usual
Bleeding after intercourse, douching, or a pelvic examination
Pain during intercourse
Bleeding after menopause
Increased vaginal discharge
Diagnosis as per modern science
Pap smear – A procedure to collect cells from the surface of the cervix and vagina. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to find out if they are abnormal. This procedure is also called a Pap test.
Colposcopy – A procedure to look inside the vagina and cervix for abnormal areas. A colposcope (a thin, lighted tube) is inserted through the vagina into the cervix. Tissue samples may be taken for biopsy.
Biopsy – If abnormal cells are found in a Pap smear, the doctor may do a biopsy. A sample of tissue is cut from the cervix and viewed under a microscope by a pathologist to check for signs of cancer. A biopsy that removes only a small amount of tissue is usually done in the doctor’s office. A woman may need to go to a hospital for a cervical cone biopsy (removal of a larger, cone-shaped sample of cervical tissue).
Pelvic exam –An exam of the vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. The doctor inserts one or two lubricated, gloved fingers of one hand into the vagina and the other hand is placed over the lower abdomen to feel the size, shape, and position of the uterus and ovaries. A speculum is also inserted into the vagina and the doctor or nurse looks at the vagina and cervix for signs of disease. A Pap test or Pap smear of the cervix is usually done. The doctor or nurse also inserts a lubricated, gloved finger into the rectum to feel for lumps or abnormal areas.
Endocervical curettage –A procedure to collect cells or tissue from the cervical canal using a curette (spoon-shaped instrument). Tissue samples may be taken for biopsy. This procedure is sometimes done at the same time as a colposcopy.
Staging
Stage 0 – (Carcinoma in Situ) In stage 0, cancer is found only in the first layer of cells lining the cervix and has not invaded the deeper tissues of the cervix. Stage 0 is also called carcinoma in situ.
Stage I –In stage I, cancer is found in the cervix only. Stage I is divided into stages IA and IB, based on the amount of cancer that is found.
Stage IA- A very small amount of cancer that can only be seen with a microscope is found in the tissues of the cervix. The cancer is not deeper than 5 millimeters and not wider than 7 millimeters.
Stage IB- In stage IB, cancer is still within the cervix and either:
- Can only be seen with a microscope and is deeper than 5 millimeters or wider than 7 millimeters; or
- Can be seen without a microscope and may be larger than 4 centimeters.
Stage II – In stage II, cancer has spread beyond the cervix but not to the pelvic wall (the tissues that line the part of the body between the hips). Stage II is divided into stages IIA and IIB, based on how far the cancer has spread.
Stage IIA- Cancer has spread beyond the cervix to the upper two thirds of the vagina but not to tissues around the uterus.
Stage IIB- Cancer has spread beyond the cervix to the upper two thirds of the vagina and to the tissues around the uterus.
Stage III – In stage III, cancer has spread to the lower third of the vagina and may have spread to the pelvic wall and nearby lymph nodes. Stage III is divided into stages IIIA and IIIB, based on how far the cancer has spread.
Stage IIIA- Cancer has spread to the lower third of the vagina but not to the pelvic wall.
Stage IIIB- Cancer has spread to the pelvic wall and/or the tumor has become large enough to block the ureters (the tubes that connect the kidneys to the bladder). This blockage can cause the kidneys to enlarge or stop working. Cancer cells may also have spread to lymph nodes in the pelvis.
Stage IV – In stage IV, cancer has spread to the bladder, rectum, or other parts of the body. Stage IV is divided into stages IVA and IVB, based on where the cancer is found.
Stage IVA- Cancer has spread to the bladder or rectal wall and may have spread to lymph nodes in the pelvis.
Stage IVB- Cancer has spread beyond the pelvis and pelvic lymph nodes to other places in the body, such as the abdomen, liver, intestinal tract, or lungs.
