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Cervix

Reviewed March 2012

This information should not be used for self-diagnosis or in place of a qualified physician’s care.

Table of Contents
      Cervical cancer Diagnosis Library Resources
What causes it and who gets it?     Types and Stages Recommended Websites
Can I help to prevent it? Treatment Videos
Screening for this cancer Follow-up after treatment Can I help with research at BCCA?
Signs and Symptoms Living with cancer     
  • Guidelines for treating this cancer have been developed by the Gynecology Tumour Group.
  • For health professional information on treating this cancer, please see our Cancer Management Guidelines (Uterine Cervix).
  • For newly diagnosed patients, we offer  Taking it Step by Step: a guide for women diagnosed with gynecological cancer. This BC guide was created by survivors and health care professionals of the BC Cancer Agency and covers all aspects of the patient journey.
  • Cervix cancer is also called carcinoma of the cervix, cervical cancer, cervical squamous cell carcinoma (SCC).
  • Pre-cancerous changes to the cervix are called dysplasia, cervical intraepithelial neoplasia (CIN) or squamous intraepithelial lesion (SIL).
  • The cervix is part of the female reproductive system. It is the narrow, lower part of the uterus (womb) that serves as a canal between the uterus and vagina. It is about 2.5cm long.
  • The cervix makes mucus that cleans and lubricates the vagina. During childbirth, the cervix widens to allow the baby to pass from the uterus into the vagina.

What causes it and who gets it?
Listed below are some of the known risk factors for this cancer.  Not all of the risk factors below may cause this cancer, but they may be contributing factors.

  • All women who have ever been sexually active (touching or intercourse) are at risk of cervical cancer.
  • Almost all cervical cancers are caused by certain types of the Human Papillomavirus (HPV).
    •  There are more than 100 types of HPV and about 40 can infect the genital area. About 15 types of genital HPV can cause cervical cancer.
    • HPV is one of the most common sexually transmitted infections (STIs). Most adults have HPV some time in their lives and it usually goes away within 24 months without any problem.
    • In some women, the dysplasia (abnormal cells caused by HPV) does not go away. Over time these abnormal cells in the cervix can change into cervical cancer. 
  • Risk factors for HPV infection:
    • Starting sexual activity at a young age
    • Multiple sexual partners
    • A sexual partner who has had multiple partners
    • Not using condoms
  • Risk factors for HPV progressing to cervical cancer:
    • Weakened immunity, for example because of HIV / AIDS, or drugs taken for an organ transplant.
    • Smoking
  • Cervical cancer is probably not affected by heredity (family or genetic history).
  • Cervical cancer can start to develop at a younger age than many cancers and affects women over a wide age range. Most women diagnosed with cervical are between the ages of 30 and 60.
  •  Statistics
    •  BC
    • Canada

Can I help to prevent it?

  • Limit your sexual partners
  • Use condoms
  • Don’t smoke
  • Vaccination for girls and women, prior to beginning sexual activity

Vaccination

  • A vaccine is available that protects against two types of Human Papillomaviruses that cause most cervical cancers.
  • The vaccine is recommended for girls and women between the ages of 9 and 26 years before they come in contact with HPV.
  • The vaccine may also benefit women who are sexually active and have not yet been infected with HPV. The vaccine prevents HPV infection but it does not get rid of it once the infection occurs.
  • In women who have never been infected with HPV, the vaccine:
    • Protects against 7 out of 10 cases of cervical cancer
    • Is safe, effective and has few side effects
  • For more information call your local public health unit or speak to your family physician.  You can also find information at http://www.immunizebc.ca/default.htm.

Screening for this cancer

  • Pre-cancerous and cancerous cells in the cervix can be found through routine physical exams that includes a Pap test, the current method used for cervical cancer screening.
  • The Pap test is named after its inventor Dr. Georgios Papanicolaou. The test detects pre-cancerous changes in the cervix and cervical cancer before symptoms appear.
  • Cervical cancer can be prevented from developing when abnormal cells are found and treated early through regular Pap test screening.
  • When abnormal cells are removed before cancer develops, the cure rate is 100 per cent.
  • For cancer limited to the surface tissue of the cervix, the cure rate is 80 to 90 per cent.

See our Cervical Cancer Screening program for information on:

  • Do you need a Pap test? How often?
  • At what age can screening stop?
  • Is screening necessary if you have had a hysterectomy?
  • Where do you go for a Pap test?
  • How do you prepare for a Pap test?
  • How is a Pap test done?
  • Pap test results

Signs and Symptoms

  • Women with abnormal cells in the cervix and early stage cervical cancer often do not experience any symptoms.
  • As the cancer advances, the more common symptoms are:
    • Spotting: spots of blood from the vagina, other than a normal menstrual period.
    • Bleeding after intercourse
    • Discharge: from the vagina, more or different than your usual.

Diagnosis
These are tests that may be used to diagnose this type of cancer.

  • Pap test: as described (above) for Screening.
  • Colposcopy is used to confirm the diagnosis from the Pap test.
    • The vagina and cervix are examined with a magnifying instrument called a colposcope.
    • The magnification allows for more accurate identification of the type and extent of the abnormal cells.
    • Colposcopy clinics are located throughout the province.
  • Biopsy: removing the suspicious area (lesion, or tissue) so the cells can be examined with a microscope or other tests.
  • Other tests may be recommended by your doctor, possibly including:
    • Blood tests at a lab
    • Chest X-ray or CT scans
    • Cystoscopy: viewing the bladder through a scope.
    • Sigmoidoscopy: viewing the lower intestine and rectum through a scope. 

For more information on tests used to diagnose cancer, see our Recommended Websites, Diagnosis section. 

Types and Stages

Types

  • Squamous cell cervical cancer account for about 75 per cent of all cervical cancers
  • Adenocarcinoma cervical cancer
  • Other rare types ( mixed adenosquamous carcinomas, small cell carcinomas)

Stages
Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world.  In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.

  • T describes the site and size of the main tumour (primary);
  • N describes involvement of lymph nodes;
  • M relates to whether the cancer has spread (presence or absence of distant metastases).

     Stage 0 Pre-cancer, or cancer limited to the surface tissue of the cervix. Sometimes called CIN, Cervical Intraepithelial Neoplasia.
Stage I Cancer limited to the cervix, growing into the underlying tissue, divided into sub-stages by size and / or spread within the cervix area.
Stage II The cancer extends beyond the cervix, into the upper vagina, but not into the pelvic wall.
Stage III  The cancer is in the pelvic wall and/or the lower third of the vagina.
Stage IV
                
The cancer extends beyond the pelvis into the bladder and rectum, or has moved into a distant site.

Treatment 
Cancer therapies can be highly individualized – your treatment may differ from what is described below.

Treatment by Stage

Stage 0 – pre-cancerous abnormal cells (dysplasia)

Before treatment:

Patients go for colposcopy to assess the degree and extend of any abnormal cells in the cervix. 

Loop Electrosurgical Excision (LEEP)

  • A fine wire loop electrode is used to remove the abnormal cells.
  • Done in a physician’s office or clinic, with a local anesthesia.
  • Increased but small risk of future pregnancy problems.

Laser

  • A high-energy beam of light is used to vaporize the abnormal cells.
  • Extremely precise and minimal effect on the surrounding normal tissue.
  • Done in a clinic, without need for local anesthesia.
  • Patients may experience a sensation of heat or warmth, but this passes rapidly as the procedure is completed.
  • More rapid healing compared to other treatment methods.
  • Unlikely to affect a woman’s fertility or ability to carry a pregnancy.
  • Not recommended during pregnancy.
  • If a biopsy (sample) specimen is required, laser may not be recommended.

Cone biopsy (conization)

  • A cone-shaped sample of tissue is removed from the cervix using a scalpel or laser.
  • Used for treatment when the precancerous cells are too far up the cervical canal to be reached with other methods.
  • Usually requires hospital day surgery, done under local anesthetic.
  • Increased but small risk of future pregnancy problems.

Hysterectomy

  • Surgical removal of the cervix, uterus and sometimes the fallopian tubes and ovaries.
  • Chosen under certain circumstances, and for women who have other gynecological conditions, for which a hysterectomy is an appropriate treatment option, and who do not want to have future pregnancies.

Cryotherapy / cryosurgery is no longer used in BC as it has a higher long term risk of later cancer than laser or LEEP.

After treatment of pre-cancers (with laser, cone biopsy, LEEP):

      • Patients may feel menstrual-like cramps after treatment.  Aspirin, Ibuprofen or a similar mild pain medication can be used to relieve discomfort.
      • There is usually a bloodstained or yellow-coloured vaginal discharge for several weeks following these procedures.
      • To prevent infection while the cervix heals do not put anything into the vagina - no tampons, no douches. You should not have intercourse for several weeks following treatment.
      • Contact your doctor if you have heavy bleeding, or bleeding with clots, fever, or persistent, increasing pain.

Stage I - IIa – Treatment will be tailored to individual patients depending on biopsy results

Surgery

  • Cone biopsy may be used for early stage cancer if future pregnancy is desired
  • Simple hysterectomy
  • Radical hysterectomy and removal of pelvic lymph nodes

Radiotherapy

  • Radiotherapy may be the primary treatment or may be used with surgery.
  • Radiation is directed at the cancer with an external beam, or from inside the body (brachytherapy, Selectron treatment).

Stage II, III, IV

Radiotherapy is usually the primary treatment (as above).

Further surgery may be considered if disease persists after radiation.

Chemotherapy

  • Chemotherapy is an option when cancer re-occurs or has spread to other sites.
  • Some chemotherapy drugs are used in combination with radiotherapy, as a radiation sensitiser (improves outcomes).

Follow-up after Treatment

  • Guidelines for follow-up after treatment are covered on our website.
  • You will be returned to the care of your family doctor or specialist for regular follow-up. If you do not have a family physician, please discuss this with your BC Cancer Agency oncologist or nurse.
  • Follow-up testing is based on your type of cancer and your individual circumstances.
  • The BCCA Survivorship Research Centre focusses on the issues that cancer survivors can face.

Living with cancer
We know that cancer and its treatment can present unique challenges: from everyday concerns like diet, money and housing, to emotional concerns. The needs of our patients and their families and friends can be very diverse. Please explore this very useful part of our website. Here is some of what's included in this section:

Library Resources

  • The BC Cancer Agency Library has many resources about cancer, coping, talking to children, and more.  Please visit the Library in your Centre, call a librarian, or visit the Library online to see the many resources available.
  • Automatically get a bibliography of books, videos and other items available through our library.
  • Library Pathfinders are a good starting point to resources on types of cancer and living with cancer. They list books, videos, pamphlets, websites and support services.

Recommended websites
The BC Cancer Agency has selected and evaluated these useful websites for your further information.

Videos
View BC Cancer Agency videos on cancer-related topics.

How can I help with research at BCCA?

Patients play a vital role in research to fight cancer. Here are a few ways that you can help:



This information has been reviewed and approved by a member of the Gynecology Tumour Group.