Cervical Cancer (cont.)

Medical Author:

Christopher J Ware, MD

Coauthor:

Michelle S Nathan, MD

Medical Editor:

Patrick Taylor, MD, FAAEM

Medical Editor:

Francisco Talavera, PharmD, PhD

Medical Editor:

Jerry R. Balentine, DO, FACEP

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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Cervical Cancer Diagnosis

As with all cancers, early diagnosis is key to successful treatment and cure. Treating precancerous changes that affect only the surface of a small part of the cervix is much more likely to be successful than treating invasive cancer that affects a large portion of the cervix and has spread to other tissues.

The most important progress that has been made in early detection of cervical cancer is widespread use of the Papanicolaou test (Pap smear).

• The Pap smear is done as part of a regular pelvic examination.
  
  
• Named after the pathologist who developed the test, the Pap smear is a quick, painless, and relatively inexpensive way of screening women for precancerous or cancerous changes in their cervix.
  
  
• Cells from the surface of the cervix are collected on a slide and examined. Any abnormality found on a Pap smear mandates further evaluation.

Diagnosis of cervical cancer requires that a sample of cervical tissue (called a biopsy) be taken and analyzed under a microscope.

• This tissue sample can be obtained in a number of ways.
  
  
• A cervical biopsy is usually done by a specialist in diseases of women's reproductive and sexual organs (a gynecologist).
  
  
• The biopsy is examined by a physician who specializes in diagnosing diseases by looking at cells and tissues under a microscope (a pathologist).

Colposcopy is a procedure similar to a pelvic examination.

• The examination uses a type of microscope called a colposcope to inspect the cervix. The entire area of the cervix is stained with a harmless dye to make abnormal cells easier to see.
  
  
• The colposcope magnifies the cervix by 8-10 times, allowing easier identification of any abnormal-appearing tissue that may need biopsy.
  
  
• This procedure can usually be done in your gynecologist's office.
  
  
• These abnormalities may be an early step in the slow series of changes that can lead to cancer.

Sometimes a larger biopsy is needed to fully check for invasive cervical cancer.

• The loop electrosurgical excision procedure (LEEP) technique uses an electrified loop of wire to take a sample of tissue from the cervix.
  
  
• This procedure can often be performed in your gynecologist's office.

A cone biopsy is performed in the operating room while you are under anesthesia.

• A small cone-shaped sample of your cervix is removed for examination.
  
  
• Like LEEP, cone biopsy procedures result in tissue samples in which the types of cells and how much they have spread to underlying areas can be more fully determined.

Precancerous changes

Over the years, different terms have been used to refer to abnormal changes in the cells on the surface of the cervix. These changes are now most often called squamous intraepithelial lesion (SIL). "Lesion" refers to an area of abnormal tissue; intraepithelial means that the abnormal cells are present only in the surface layer of cells. Changes in these cells can be divided into 2 categories.

• Low-grade SIL: Early, subtle changes in the size and shape of cells that form the surface of the cervix are considered low grade.
  
  
  • These lesions may go away on their own, but over time, they may become more abnormal, eventually becoming a high-grade lesion.
    
    
  • SIL is also called mild dysplasia or cervical intraepithelial neoplasia 1 (CIN 1).
    
    
  • These early changes in the cervix most often occur in women aged 25-35 years but can appear in women of any age.
  
  
• High-grade SIL: A large number of precancerous cells, which look very different from normal cells, constitute a high-grade lesion.
  
  
  • Like low-grade SIL, these precancerous changes involve only cells on the surface of the cervix.
    
    
  • These lesions are also called moderate or severe dysplasia, CIN 2 or 3, or carcinoma in situ.
    
    
  • They develop most often in women aged 30-40 years but can occur at any age.

Precancerous cells, even high-grade lesions, usually do not become cancerous and invade deeper layers of the cervix for many months, perhaps years.

Some laboratories may still use an older system for describing abnormalities. This system classifies changes into 1 of 5 groups, 1 being the most mild changes and 5 being the most severe.

Ask you health care provider if you do not understand the way the result of your Pap smear is reported.

Invasive cancer

If abnormal cells spread deeper into the cervix or to other tissues or organs, the disease is then called cervical cancer, or invasive cervical cancer. Cervical cancer occurs most often in women aged 40 years or older.

If the biopsy results show invasive cancer, a series of tests will be performed, all designed to see whether the cancer has spread and, if so, how far.

• A chest x-ray looks for spread to the lungs.
  
  
• Blood tests can indicate whether the liver is involved. A CT scan may be necessary if results are not definitive.
  
  
• Special x-rays or a CT scan can be used to look at the bladder.
  
  
• The vagina and rectum are also examined, sometimes under anesthesia.

These tests are used to "stage" the cancer.

• By finding out how far it has spread, your health care providers can make a reasonable guess about your prognosis and the kind of treatment you will need.
  
  
• Cervical cancer is staged from stage 0 (least severe) to stage IV (metastatic disease, the most severe).
  
  
• Staging is based on size and depth of the cancerous lesion, as well as degree of spread.