What is Cervical Cancer?
The cervix is the neck of the womb (uterus). It connects the body of
the uterus to the vagina (birth canal). The outside of the cervix and the vagina
are covered by a layer of flat cells called squamous cells. The canal of the cervix is lined by tall column-like cells columnar
cells. These two cell types, squamous cells
and columnar cells, meet at a place called the squamo-columnar junction or
the transformation zone. This junction may be on the outside of the cervix where
it is easy to see. It is in this transformation zone that abnormal growth or
dysplasia develops. The cervix plays an important role in maintaining
a normal pregnancy. In non-pregnant women, the cervix has no obvious function.
When cervical cancer develops, the cells of the cervix become abnormal and
grow out of control, and the
cancer can spread to other parts of the body. But
if abnormal cells are caught early, which they often are through the cervical
screening programme, cancer can be prevented or treated.
What is Cervical Cancer?
Cervical cancer is the sixth most common cancer in
Cervical cancers do not form suddenly. Normal cervical cells gradually
develop precancerous changes that turn into cancer. This process usually takes
many years but sometimes can happen in less than a year.
Most cervical cancers start at the transformation zone. Cervical
intraepithelial neoplasia (CIN) is the term used to describe these abnormal
changes. CIN is classified according to the degree of cell abnormality.
Low-grade CIN indicates a minimal change in the cells and high-grade CIN
indicates a greater degree of abnormality.
CIN may progress to squamous intraepithelial lesion (SIL; condition that
precedes cervical cancer) or to carcinoma in situ (cancer that does not extend
beyond the epithelial membrane). SIL is also classified as low-grade or
high-grade. High-grade SIL and carcinoma in situ may progress to invasive
carcinoma (cancer that has spread to healthy tissue).
Types of Cervical Cancer:
There are 2 main types of cervical cancers: squamous cell carcinoma
About 80% to 90% of cervical cancers are squamous cell carcinomas, which are
composed of cells that resemble the flat, thin cells called squamous cells that
cover the surface of the endocervix. Squamous cell carcinomas most often begin
where the ectocervix joins the endocervix.
10% to 20% of cervical cancers are adenocarcinomas. Adenocarcinomas are
becoming more common in women born in the last 20 to 30 years. Cervical
adenocarcinoma develops from the mucus-producing gland cells of the endocervix.
Less commonly, cervical cancers have features of both squamous cell carcinomas
and adenocarcinomas. These are called adenosquamous carcinomas or mixed
Causes of Cervical Cancer:
The exact cause of cervical cancer is not known, but certain things appear to
increase the risk.
Human papilloma virus (HPV)
Specific types of the human
papilloma virus are linked with 95% of cases of cervical cancer. This virus is
passed from one person to another by skin-to-skin sexual contact. This means
that body fluid is not needed to pass on the virus, but contact is enough to
pass it on
Sexual pattern & behaviour
Starting to have sex at an early age may expose the cervix to HPV at an
especially susceptible time. Plus, the more sexual partners a woman has, the
greater the risk of getting HPV. A history of sexually transmitted disease (STD)
can be another primary cause.
The contraceptive pill may increase the risk of cervical cancer because
barrier methods such as condoms, which give some protection from HPV, are less
likely to be used.
Women who smoke cigarettes are twice as likely to develop cervical cancer.
Chemicals in cigarette smoke may increase the risk by damaging cervical cells.
Unhealthy diet pattern
It is thought that diet can affect the risk. Also
overweight women are
more likely to develop this cancer. A healthy diet is recommended, including
fruit, vegetables, fibre-rich and starchy foods.
immune system increases the risk. Causes of immune deficiency
include autoimmune diseases, such as rheumatoid arthritis, and human
immunodeficiency virus (HIV) infection.
History of abnormal cells
If abnormal cells (dyskaryosis) have previously been found on the cervix,
women are at a higher risk.
Women who have had many full-term pregnancies have an increased risk of
developing cervical cancer.
Family history of cervical cancer:
Recent studies suggest that women whose mother or sisters have had cervical
cancer are more likely to develop the disease themselves. Some researchers
suspect this familial tendency is caused by an inherited condition that makes
some women less able to fight off HPV infection than others.
However, many women who have cervical cancer do not appear to have any of
these risk factors.
Signs & Symptoms of cervical cancer:
There are no obvious signs or symptoms of cervical cancer. It tends to grow
slowly over time.
Abnormal cells found on the end of the cervix during a cervical smear test
are generally at an "early warning" pre-cancer stage, and do not cause any
symptoms. These early abnormal cells are called cervical intraepithelial
neoplasia (CIN). Treating CIN prevents cancer developing.
If abnormal cells do develop into cervical cancer, it can cause these
Abnormal vaginal bleeding, such
as between periods or after intercourse bleeding between menstrual
periods, increased menstrual bleeding
Vaginal bleeding after the
Smelly vaginal discharge - pale,
pink, brown, blood streaked, and foul-smelling
Discomfort and pain during intercourse (dyspareunia)
Painful urination (dysuria)
It is important for women experiencing any of these symptoms to see a doctor,
even though their cause is usually not cervical cancer.
Cervical cancer that has spread (metastasized) to other organs may cause
constipation, blood in the urine (hematuria), abnormal opening in the cervix
(fistula), and ureteral obstruction (blockage in the tube that carries urine
from the kidney to the bladder).
Diagnosis of cervical cancer includes a Papanicolaou test
(Pap smear) and pelvic examination. The American Cancer Society
recommends that all women begin having annual Pap smears at the age of 18, or
when they become sexually active. After three consecutive negative tests, health
care practitioners may perform the test less often (e.g., every 2 or 3 years).
The American College of Obstetrics and Gynecology recommends a yearly Pap smear
for all women who are sexually active.
In a Pap smear, the health care practitioner removes cells from the surface
of the cervix using a spatula, cotton swab, or brush. The cells are placed on a
glass slide for microscopic evaluation in a laboratory. For accurate results,
the test should be performed 2 weeks after the end of a menstrual period and at
least 48 hours after sexual intercourse.
Some health care practitioners confirm the presence of cervical lesions with
colposcopy. After the Pap smear is performed, the cervix is washed with a
diluted vinegar solution and examined for abnormalities using a light and a
magnifying device (a colposcope). If abnormal areas are detected, further
evaluation is necessary, regardless of the results of the Pap smear. Colposcopy
takes a few minutes to perform and may not be covered by insurance.
In a pelvic examination, the vagina and adjacent organs are examined visually
and bimanually (using both hands). Visual examination is performed using a
speculum (instrument that is warmed and used to separate tissue) inserted into
the vagina. Next, the organs are palpated (felt with the fingers) by inserting
gloved fingers of one hand into the vagina and placing the other hand on the
Other Diagnostic Tests
If low-grade CIN is detected, the Pap smear is repeated in 3-6 months and the
patient is tested for HPV infection. If high-grade CIN is detected, colposcopy
and biopsy may be performed. In colposcopy, abnormal lesions on the cervix are
examined using a magnifying device. In biopsy, cells are removed for microscopic
If invasive cervical cancer is suspected, or if the colpscopy and Pap smear
results differ, cone biopsy or endocervical curettage may be performed.
In cone biopsy, a larger, cone-shaped sample of cervical tissue is removed and
examined for cancer cells. In endocervical curettage, the lining of the cervical
canal is scraped and examined for cancer cells.
Once a diagnosis of cervical cancer is made, the cancer is staged.
involves a pelvic examination, blood tests, and imaging procedures. Blood tests
may include a complete blood count (CBC) and serum chemistry to evaluate kidney
and liver function.
Imaging procedures may include the following:
Stages of Cervical Cancer
Stage 1: Cancer cells are only found in the cervix.
Stage 2: The cancer has begun to spread beyond the cervix into
Stage 3: The cancer has spread deeper into other tissues of the
pelvis, for example into the lower part of the vagina or nearby lymph nodes. It
may press against a ureter (the tubes that drain kidneys), blocking it and
preventing the kidney from draining.
Stage 4: The cervical cancer cells have spread to other organs such as
the bladder, bowel or, more rarely, beyond the immediate area of the pelvis to
the lungs, liver or bones.
Treatment of Cervical Cancer:
Treatment options for cervical cancer include surgery, radiotherapy and
chemotherapy. There are many factors that determine the type of treatment
recommended. These include a woman’s age and general health, as well as the
exact type and stage of cancer.
In early stages of the
disease either surgery (hysterectomy) or
radiotherapy, or a combination of both might be appropriate. For more advanced
disease, radiotherapy is necessary, and may be used in combination with
In cases of cervical intraepithelial neoplasia (CIN), abnormal tissue may be
removed using loop electrode excision (using wire loops heated by electric
current) or cone biopsy. Carcinoma in situ may be removed using loop electrode
excision, cryosurgery, or laser ablation. In cryosurgery, liquid nitrogen is
circulated through a probe, which is applied to cancerous tissue. Freezing
temperatures destroy the cancer cells. Laser ablation involves using a laser
(device that emits intense heat and light at close range) to remove cancerous
Surgical treatment for invasive cervical cancer is radical hysterectomy,
which is the removal of the uterus, fallopian tubes, ovaries, adjacent lymph
nodes, and part of the vagina. If cancer has spread (metastasized) to lymph
nodes in the abdomen, lymphadenectomy (surgical removal of lymph nodes) may also
be performed. It is a major surgical procedure and is
performed under general anaesthesia. A hospital stay of 5 to 7 days is
common for an abdominal hysterectomy, and complete recovery takes about 4 to 6
weeks. Complications are unusual but could include excessive bleeding, wound
infection, or damage to the urinary and intestinal systems. A radical
hysterectomy and pelvic lymph node dissection are the usual treatment for stages
IA2, IB, and IIA cervical cancer, especially in young people.
Radiation therapy uses high energy x-rays to kill cancer cells. These x-rays
may be given externally in a procedure that is much like having a diagnostic
x-ray. This is called external beam radiation therapy. This treatment usually
takes 6 to 7 weeks to complete.
The skin in the treated area may look and feel sunburned, but this gradually
fades to a tanned look, returning to a normal appearance in 6 to 12 months.
The second type of radiation therapy is called brachytherapy. It may be given
as a capsule of radioactive material placed in the vagina near the tumor, or the
radioactive material may be placed in thin needles that are inserted directly in
the tumor. Both of these are done with the patient under anesthesia.
Brachytherapy is completed in just a few days.
Many women also notice tiredness, upset stomach, or loose bowels. Pelvic
radiation therapy may cause vaginal stenosis (narrowing of the vagina by scar
tissue), which might make intercourse painful. Premature menopause and problems
with urination may also occur.
If you are having side effects from radiation, discuss them with your cancer
care team. There are things you can do to get relief from these symptoms or to
keep them from happening, such as using vaginal dilators to manage vaginal
Systemic chemotherapy uses anticancer drugs that are injected into a vein or
given by mouth. These drugs enter the bloodstream and reach all areas of the
body, making this treatment potentially useful for cancers that have spread to
Drugs most often used in treating cervical cancer include cisplatin,
paclitaxel, ifosfamide, hydroxyurea, fluorouracil, and irinotecan. If
chemotherapy is chosen, you may receive a combination of drugs. Chemotherapy
drugs kill cancer cells but also damage some normal cells, which can lead to
Chemotherapy side effects depend on the type of drugs, the amount taken, and
the length of time you are treated. Temporary side effects of chemotherapy might
Nausea and vomiting
Loss of appetite
Most side effects of chemotherapy (except premature menopause and
infertility) disappear once treatment is stopped. Hair will grow back after
treatment ends. Premature menopause can be treated with hormones.
healthy lifestyle and environment can help you
Avoiding sexual activity that increases the risk for HPV infection, not
smoking, and having regular Pap smears can help prevent most cases of cervical
cancer. Using barrier contraception (e.g., condoms) and limiting the number of
sexual partners may prevent HPV infection.
Cervical cancer vaccines (also called Human Papillomavirus or
HPV vaccines) protect against the virus that causes almost all cervical
Dated 19 January 2013