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Cervical Cancer
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Vaginal Cancer

Cervical Cancer

What is Cervical Cancer ?

Cervical cancer is the third most common cancer of the female reproductive system. It's classified as either preinvasive or invasive.

Preinvasive cancer ranges from minimal cervical dysplasia, in which the lower third of the epithelium contains abnormal cells, to carcinoma in situ, in which the full thickness of epithelium contains abnormally proliferating cells (also known as cervical intraepithelial neoplasia). Preinvasive cancer is curable in 75% to 90% of patients with early detection and proper treatment. If untreated, it may progress to invasive cervical cancer, depending on the form. In invasive disease, cancer cells penetrate the basement membrane and can spread directly to contiguous pelvic structures or disseminate to distant sites by way of lymphatic routes. In 95% of cases, the histologic type is squamous cell carcinoma, which varies from well-differentiated cells to highly anaplastic spindle cells. Only 5% of cases are adenocarcinomas. Invasive cancer typically occurs between ages 30 and 50; it rarely occurs under age 20.

Causes of Cervical Cancer

Although the cause is unknown, several predisposing factors have been associated with cervical cancer: frequent intercourse at a young age (under 16), multiple sexual partners, multiple pregnancies, human papillomavirus (HPV), and other bacterial or viral venereal infections.

Signs & Symptoms of Cervical Cancer

Early cervical cancer is often asymptomatic (does not produce symptoms). In women who receive regular screening, the first sign of the disease is usually an abnormal Pap test result. Symptoms that may occur include the following:

  • Abnormal vaginal bleeding (e.g., spotting after sexual intercourse, bleeding between menstrual periods, increased menstrual bleeding)
  • Abnormal (yellow, odorous) vaginal discharge
  • Low back pain
  • Painful sexual intercourse (dyspareunia)
  • Painful urination (dysuria)

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).

Diagnostic Tests

A Papanicolaou (Pap) test identifies abnormal cells, and colposcopy determines the source of the abnormal cells seen on the Pap test.

Cone biopsy is performed if endocervical curettage is positive.

The Vira pap test, currently under investigation, permits examination of the specimen's deoxyribonucleic acid (DNA) structure to detect HPV.

Additional studies, such as lymphangiography, cystography, and major organ and bone scans, can detect metastasis.


Accurate clinical staging will determine the type of treatment. Preinvasive lesions may be treated with total excisional biopsy, cryosurgery, laser destruction, conization (followed by frequent Pap test followups) or, rarely, hysterectomy. Therapy for invasive squamous cell carcinoma may include radical hysterectomy and radiation therapy (internal, external, or both). Rarely, pelvic exenteration may be performed for recurrent cervical cancer.

Complications of surgery include bladder dysfunction, formation of lymphocytes or seromas after lymphadenectomy, and pulmonary embolism. Complications of radiation therapy include diarrhea, abdominal cramping, dysuria, and leukopenia. Combined surgery and irradiation in the abdomen and pelvis may lead to small bowel obstruction, stricture and fibrosis of the intestine or rectosigmoid, and rectovaginal or vesicovaginal fistula.

Prevention Tips

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.

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