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Cervical Cancer

What is cervical cancer?

Cervical cancer happens when abnormal cells on the cervix – the portion of the uterus that extends into the vagina – grow out of control. Cervical cancer is usually detected through a Pap test. When diagnosed early, it can often be successfully treated.

Cancer of the cervix is the second leading cause of cancer deaths in women in developing countries. Cervical cell screens with Pap tests and follow up treatment has dramatically reduced the incidence of cervical cancer in the U.S.

There are two main types of cervical cancer:

  • Squamous cell carcinomas start in the superficial layer of cells on the lower outer part of the cervix, but near the cervical canal and account for 80 to 85% of cervical cancers.
  • Adenocarcinomas develop in the glandular cells in the cervix and account for 15-20% of cervical cancers.

What causes cervical cancer?

Recent research into the cause of cervical cancer has discovered that persistent infections with the Human Papillomavirus (HPV) are the cause of virtually all cases of cervical cancer. Cervical cancer develops slowly in cells infected with the virus. These persistent, high-risk infections can result in cervical cancer. Screening and treatment of pre-invasive lesions can prevent most cases of this disease. Most pre-cancerous treatments can be performed in the office.

What are the symptoms of cervical cancer?

Early physical signs of cervical cancer include abnormal vaginal bleeding, postcoital bleeding, discharge, and pelvic pain.

How is cervical cancer diagnosed?

Most routine cervical screening tests show abnormal cell changes long before an actual cancer develops. Abnormal cellular changes detected in a Pap test are usually removed before they can grow into a cancer. Precancerous treatments include minor procedures on the cervix, such as:

  • Biopsy
  • Laser removal (excision)
  • Freezing or Cryotherapy
  • LEEP (loop electrical excision procedure): LEEP is a procedure in which a portion of the cervix is removed to excise the abnormal cells, preventing their development into cancer. A wire loop conducts a radiofrequency wave that cuts through the tissue and seals the blood vessels at the same time.
  • Cone excision, or conization, is a procedure similar to a LEEP, in which a cone-shaped sample of tissue is removed from the cervix for treatment or diagnostic purposes. Most of these procedures can be performed in an outpatient setting.

How is cervical cancer treated?

Treatment of invasive cervical cancer depends upon the type and extent of the disease when it is diagnosed. In other words, the stage of the disease strongly dictates treatment. Most treatments consist of one or a combination of the following procedures:

  • Conization
  • Radical trachelectomy
  • Hysterectomy
  • Radical hysterectomy
  • Radiation
  • Chemotherapy

The very earliest stages of cervical cancer can be treated and cured with a simple hysterectomy (removal of the uterus), or in some cases, a conization. These tumors are small, and sometimes may only be seen under the microscope by examining biopsies or a LEEP or cone specimen.

For those in whom the cancer is confined to the cervix yet the tumor is larger, a more extensive hysterectomy, known as a radical hysterectomy, can be performed. This procedure removes some tissue around the cervix to assure all cancer is removed. In addition, lymph nodes in the pelvis are generally removed (lymphadenectomy) to remove any tumor that may have spread to these areas, and to determine the best means of treating these patients post-operatively.

In most cases, despite a radical hysterectomy, the ovaries can be preserved at the patient’s request. Some patients who want to protect future fertility may be candidates for radical trachelectomy, a procedure that removes the cancer and cervix but preserves the uterus.

Radiation in combination with chemotherapy is the preferred treatment for cancers at more advanced stages, and can also treat early stage cancers. The prognosis for patients diagnosed with cervical cancer depends upon the type, the degree of cellular abnormality, and the amount of spread or stage when first diagnosed and treated.