Cervical Cancer

Diagnosis

Cervical cancer occurs in several forms. The most common is squamous cell carcinoma, which accounts for 85 to 90 percent of cervical cancers. Other forms include adenocarcinomas and combination cancers such as adenosquamous carcinoma.

In its early stages, cervical cancer usually has no symptoms. A Pap smear can reveal abnormal, or precancerous, changes in the lining of the cervix. If a Pap smear is abnormal, a colposcopy (examination of the cervix using a magnifying lens) and a biopsy (the collection and examination of tissue) may be performed to determine whether cancer is present.

Precancerous changes (abnormal cells or tissue growth, or carcinoma in situ) can be treated with excision or laser treatment. If invasive cancer is found, the physician will order more tests to determine the extent of the disease. These tests might include:

• A rectovaginal exam — an examination of the rectum and anus
• A cystoscopy — an examination of the bladder using a lighted tube to look for cancer
• Blood tests
• A rectosigmoidoscopy — a visual inspection of the rectum to determine if cancer is present
• A chest X-ray
• A computed tomography (CT) scan — a scan that shows if cancer has spread beyond the cervix or to nearby lymph nodes
• An intravenous pyelogram — an X-ray of the urinary system taken after a special dye is injected in a vein

Based on the physician's evaluation, the cancer will be classified into one of more than 10 substages. In general, stages for cervical cancer include:

• Stage 0 or carcinoma in situ — a preinvasive cancer. Abnormal cells are found only in the first layer of cells that line the cervix.
• Stage I — cancer confined to the cervix. It is further classified into four stages (IA1, IA2, IB1, IB2) depending on the size of the tumor and how deeply the cancer has invaded the tissue.
• Stage II — cancer that has spread beyond the uterus, but not to the pelvic sidewall or the upper third of the vagina. Such cancer may be Stage IIA or IIB.
• Stage III — cervical cancer that extends to the pelvic wall or the lower third of the vagina or causes expansion of the ureter resulting in kidney problems. It is further classified as IIIA or IIIB based on whether cancer cells have extended to the pelvic sidewall.
• Stage IV — the cancer has invaded the bladder or rectum and/or extends beyond the pelvis. It may be Stage IVA or IVB.