Picture of a normal, healthy cervix
Note the cervical "os" or opening in the middle
Cervical Cancer
The cervix is the opening to the uterus, located about 4 inches inside a woman'svagina and it is through the cervical opening that a woman's menstrual fluids pass each month, as well as the opening through which sperm travel through toreach an egg at which time, if implantation in the uterus occurs, a pregnancy begins and a new baby begins growing. At the time of childbirth, the cervixbegins to dilate, or expand, to allow the baby to move from the uterus, andthrough and out the vagina. A cervix needs to dilate to about 10 cm before awoman can begin "pushing" the baby out.
Picture of a normal, healthy cervix
Note the cervical "os" or opening in the middle
Whatis a "Pap Smear"?
A Pap smear is a test that is done to check for changes to the cells of the cervix (the neck of the womb at the top of a woman's vagina). These changes could be early warning signs of cancer of the cervix. Cervical cancer can develop without any symptoms, so having a Pap smear is usually the only way to find the cancer at an early stage.
Most changes are due to an infection with the Human Papillomavirus (HPV) and the changes will go away without treatment, but sometimes the changes are the early stage of cervical cancer. Almost all women who develop cervical cancer have had an HPV infection, but only a very few go on to develop cervical cancer.
If the early stages of cervical cancer are picked up, simple treatment will usually prevent cancer developing further. Without early treatment, cancer of the cervix can develop into a very serious problem. Cancer of the cervix is a common cause of death in women who live in developing countries where Pap smears are not available.
Women are advised to have a Pap smear within 2 years of first sexual intercourse, and then every 2 years after that.
How is a Pap Smear Performed?
To have a Pap smear, you need to book in to see a doctorand this is usually done at the annual gynecological exam with the regularvulvovaginal exam. The Pap Smear is a very simple procedure, with little to nopain or discomfort.
Youare in a private examination room, in the usual gynecological exam position,with your feet in stirrups, and the doctor positioned between your feet, with alamp so he can view your vulva and look for any changes or abnormalities on andin the vulva.
Afterthe doctor completes the external exam, he/she will palpate and feel yourovaries and uterus and feel for anything unusual.
ThePap Smear starts with the doctor inserting an instrument called a vaginal speculum into the vagina,so that the labia can be separated and he/she can easily view your cervix. Thispart may cause some discomfort, but should not hurt.
A sample ofthe cervical cells is collected on a brush that the doctor brushes across yourcervix which he then spreads or 'smears' on a glass slide. The cells on the slide are sent to a laboratory where they are looked at, and a report is sent to the doctor or nurse within one to two weeks.
Women are asked to return to see the doctor or nurse for their results. Sometimes this may not be possible, and they might be able to phone for the results.
An 'Abnormal' Pap Smear Result:
Usually the results are normal, but sometimes some of the cells on the surface of the cervix differ from normal cells.
Often these changes are only minor, and the doctor or nurse will recommend that the woman has another Pap smear within a few months to see if further changes develop, or if the cells return to normal, which they often do.
Sometimes there are changes that may be the sign of a disease, such as an infection, or the changes might suggest that a cancer could be developing. If needed, the woman will be referred to a specialist doctor for further investigation and treatment.
Note: Pap smears are usually recommended every two years, but if you have any unusual vaginal bleeding or discharge, see your doctor as soon as possible.
Causes of cancer of the cervix (cervical cancer)
The causes of cervical cancer are not known, but some things do increase the risk of getting it. The risk increases with age, but it can occur in quite young women (over the age of about 30 years).
Almost all women who develop cancer of the cervix have been infected by the human papilloma virus (wart virus). There are over 200 types of Human Papillomaviruses. A few cause genital warts (see the topic Genital warts), but these viruses are not linked to cervical cancer. Only 3 types of HPV are linked to cervical cancer.
The HPV virus is sexually transmitted, and the risk of picking up the virus increases with the number of partners that a woman, or a woman's partner, has had. Barrier methods of contraception, such as the condom, do not seem to affect the likelihood of getting an HPV infection.
Another risk factor is smoking - women who smoke cigarettes are about twice as likely to get cervical cancer as women who don't smoke.
What is cervical cancer?
Canceris a disease in which certain body cells don't function right, divide very fast,and produce too much tissue that forms a tumor. Cervical cancer is cancer in thecervix, the lower, narrow part of the uterus (womb). The uterus is the hollow,pear-shaped organ where a baby grows during a woman's pregnancy. The cervixforms a canal that opens into the vagina (birth canal), which leads to theoutside of the body.
Ifthe Pap test finds serious changes in the cells of the cervix, the doctor willsuggest more powerful tests such as a colposcopy. In this procedure, the doctoruses a tool called a colposcope to see the cells of the vagina and cervix indetail.
Ifthere are still some concerns of precancerous cells, the doctor may use the LUMACervical Imaging System. The doctor uses this device right after a colposcopy.This system, recently approved by the FDA, shines a light on the cervix andlooks at how different areas of the cervix respond to this light. It gives ascore to tiny areas of the cervix. It then makes a color map that helps thedoctor decide where to further test the tissue with a biopsy. The colors andpatterns on the map help the doctor tell between healthy tissue and tissue thatmight be diseased.
CLINICAL STAGES OF CANCER OF THE CERVIX
Stage I - Cancer confined to the cervix
Stage IA - Invasive cancer detectable microscopically only
Stage IA1 - Invasion less than 3 mm and width less than 7 mm
Stage IA2 - Invasion more than 3 mm but less than 5 mm
Stage IB - All others, any visible cancer
Stage IB1 - Cervix less than 4 cm in diameter
Stage IB2 - Cervix greater than 4 cm
Stage II - Spread to adjacent structures
Stage IIA - Spread onto the vagina
Stage IIB - Spread laterally toward the pelvic wall
Stage III - More extensive but still within the pelvis
Stage IIIA - Extends to the lower vagina
Stage IIIB - Extends onto the pelvic wall, obstructed ureter
Stage IV - Distant spread or involvement of a pelvic organ
Stage IVA - Involves the inside of the bladder or rectum
Stage IVB - Distant metastases, i.e. lung, liver or bone
Cervicalcancer is a disease that can be very serious. However, it is a disease that youcan help prevent. Cervical cancer occurs when normal cells in the cervix changeinto cancer cells. This normally takes several years to happen, but it can alsohappen in a very short period of time. The good news is that there are ways tohelp prevent cervical cancer. By getting regular Pap tests and pelvic exams,your health care provider can find and treat the changing cells before they turninto cancer.
TheNational Cancer Institute (NCI) is the federal government's authority oncervical cancer. Contact them at 800-4-CANCER (800-422-6237) or go to thefollowing web site: http://www.cancer.gov/cancerinfo/wyntk/cervix
Moreabout Cervical Cancer
Cervical cancer is a disease in which malignant (cancer) cells form in the tissues of the cervix.
The cervix is the lower, narrow end of the uterus (the hollow, pear-shaped organ where a fetus grows). The cervix leads from the uterus to the vagina (birth canal).
Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia, in which cells that are not normal begin to appear in the cervical tissue. Later, cancer cells start to grow and spread more deeply into the cervix and to surrounding areas.
Cervical cancer in children is rare. For more information, see the PDQ summary on Unusual Cancers of Childhood.
Human papillomavirus (HPV) infection is the major risk factor for development of cervical cancer.
Infection of the cervix with human papillomavirus (HPV) is the most common cause of cervical cancer. Not all women with HPV infection, however, will develop cervical cancer. Women who do not regularly have a Pap smear to detect HPV or abnormal cells in the cervix are at increased risk of cervical cancer.
Other possible risk factors include the following:
Giving birth to many children.
Having many sexual partners.
Having first sexual intercourse at a young age.
Smoking cigarettes.
Oral contraceptive use ("the Pill").
Weakened immune system.
There are usually no noticeable signs of early cervical cancer but it can be detected early with yearly check-ups.
Early cervical cancer may not cause noticeable signs or symptoms. Women should have yearly check-ups, including a Pap smear to check for abnormal cells in the cervix. The prognosis (chance of recovery) is better when the cancer is found early.
Possible signs of cervical cancer include vaginal bleeding and pelvic pain.
These and other symptoms may be caused by cervical cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
Vaginal bleeding.
Unusual vaginal discharge.
Pelvic pain.
Pain during sexual intercourse.
Tests that examine the cervix are used to detect (find) and diagnose cervical cancer.
The following procedures may be used:
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. Avaginal speculum is also inserted into the vagina and the doctor looks at the vagina and cervix for signs of disease. A Pap test or Pap smear of the cervix is usually done. The doctor 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.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) depends on the following:
The stage of the cancer (whether it affects part of the cervix, involves the whole cervix, or has spread to the lymph nodes or other places in the body).
The type of cervical cancer.
The size of the tumor.
Treatment options depend on the following:
The stage of the cancer.
The size of the tumor.
The patient's desire to have children.
The patient’s age.
Treatment of cervical cancer during pregnancy depends on the stage of the cancer and the stage of the pregnancy. For cervical cancer found early or for cancer found during the last trimester of pregnancy, treatment may be delayed until after the baby is born.
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