Cervical cancer starts on the surface of woman's cervix. When abnormal cells first begin to change and grow abnormally, it is called dysplasia, which is not yet cancerous. However, if undetected, these cells may become cancerous and move deeper into surrounding tissues and organs.
Today, women facing cervical cancer have better treatment options with better outcomes than they did even a few years ago. Most of the women who come to Seattle Cancer Care Alliance for treatment for cervical cancer will be treated with surgery or radiation paired with chemotherapy.
Since widespread use of the Pap smear to detect precancer of the cervix, the indicence and mortality from cervical cancer has dramatically decreased in the United States in the past 60 years. Currently, the number of women who will be diagnosed with a cervical cancer is about 11,000 per year and number of deaths is approximately 3,800 women.
Types of Cervical Cancer
There are two main types of cervical cancer: squamous cell carcinoma and adenocarcinoma. These, as well as more rare types of cervical cancer, are classified according to how they look under a microscope.
Squamous cell carcinomas. About 85 percent to 90 percent of cervical cancers are squamous cell carcinomas. They begin in the ectocervix, the part of the cervix next to the vagina.
Adenocarcinomas. The remaining 10 percent to 15 percent of cervical cancers are adenocarcinomas, which develop from the mucus-producing gland cells of the endocervix, the part of the cervix next to the body.
Adenosquamous carcinomas. This type of cancer is more rare and has features of both squamous cell carcinomas and adenocarcinomas.
The most common symptoms of cervical cancer are usually detectable after abnormal cervical cells have become cancerous and have invaded nearby tissue. According to the American Society of Clinical Oncology, these symptoms are:
- 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 sexual intercourse
- Bleeding after menopause
- Increased vaginal discharge
Precancerous changes of the cervix usually do not cause pain.
Regular Pap Tests
Regular Pap tests are important to your survival: about 90 percent of women whose cervical cancer was detected by a Pap test will survive. The figure is much lower--only 40 percent--for women whose cancer was not diagnosed until they experienced vaginal bleeding.
To diagnose cervical cancer, the doctor will perform a physical examination, a pelvic examination, and a Pap test. The doctor may also perform a colposcopy. Similar to a microscope, a colposcope magnifies the cells of the cervix and vagina.
If abnormal cells on the cervix are detected, the doctor may perform a biopsy. A gynecologist will often use a colposcope--a viewing tube attached to magnifying binoculars--to find the abnormal area and remove a tiny section of the cervix surface in an office biopsy.
If the diagnosis isn't clear, a surgeon may perform a cone biopsy--removal of a larger, cone-shaped piece of tissue. This can be done in the office or in the operating room. More than 90 percent of cervical cancers can be halted by removing the precancerous tissue in this way, and no further treatment is necessary.
To determine if cancer has invaded or spread to other organs, doctors may use a cytoscope to see the inside of the bladder or urethra; a sigmoidoscope to see the inside of the colon and rectum; or a laparoscope to see the inside of the abdomen. Other test which may be used include X-ray, computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET).
The most common cancer grading system used for gynecological cancers, which is used by Seattle Cancer Care Alliance gynecologic oncologists, is the International Federation of Gynecology and Obstetrics (FIGO) system.
Stage 0 – Refers to the "precancer," stage, which is common with cervical cancer, known as dysplasia.
Stage I – Cancer is confined to the cervix.
Stage II – Cancer has invaded nearby tissues (parametria) and upper vagina.
Stage III – Cancer has spread to the pelvic sidewalls or is blocking the ureters, the tubes that connect the kidney to the bladder.
Stage IV – Cancer has either deeply invaded the bladder or rectum or has metastasized to more distant locations, such as the lungs.
Cancer that has spread to the lymph nodes does not change the stage, but is an important prognostic factor and guides treatment planning.
It has been well established that strong strains of the human papilloma virus (HPV) are the main cause of precancer and cancer of the cervix. Some Pap smears screen both for abnormal cells and the presence of HPV. There currently is an FDA-approved HPV vaccine Gardasil (Merck) that is recommended to be given to young women to protect them from becoming infected with HPV. Other risk factors for cervical precancer and cancer are tobacco use and immune depression.