Diagnosis & Staging
The cervix makes mucus that cleans and lubricates the vagina. It is about 2.5cm (1 inch) long. During childbirth, the cervix widens to allow the baby to pass from the uterus into the vagina.
Image of the cervix
Cervical cancer may also be called cancer of the cervix, carcinoma of the cervix or cervical squamous cell carcinoma (SCC).
Pre-cancerous changes to the cervix are called dysplasia, cervical intraepithelial neoplasia (CIN) or squamous intraepithelial lesion (SIL). These are changes that may eventually become cancer.
People with early stage cervical cancer often do not have any symptoms.
As the cancer advances, some common symptoms are:
- Spotting: spots of blood from the vagina, other than a normal menstrual period.
- Bleeding after intercourse (having sex).
- Discharge from the vagina, more or different than usual.
If you have any signs or symptoms that you are worried about, please talk to your family doctor or nurse practitioner.
Tests that may help diagnose cervical cancer include:
- Pap test: For more information, see What is cervical screening?
- Colposcopy: a specialist doctor will use a microscope called a colposcope to look for abnormal cells in your cervix and vagina. This test is used to confirm the diagnosis from a Pap test.
- Biopsy: a small amount of tissue is removed from your cervix. A specialist doctor (pathologist) will examine the tissue to see if it is cancer. This may be done during the colposcopy.
- Other tests you may need:
- Blood tests
- Chest X-ray or CT (computed tomography) scans: to see the ctumour and if the cancer has spread.
- Cystoscopy: a doctor uses a cystoscope (a tube with a camera and light on the end) to look at your bladder and the tube that carries urine (pee) out of your bladder (urethra). This is done to see if the cancer has spread to your bladder. The doctor may take a biopsy if they find a suspicious area.
- Sigmoidoscopy: a doctor uses a sigmoidoscope (a tube with a camera and light on the end) to look at your rectum and the lower part of your large intestine. This is done to see if the cancer has spread to your rectum or lower part of your large intestine. The doctor may take a biopsy if they find a suspicious area.
- Squamous cell carcinomas make up about 75% (75 out of 100) of cervical cancers.
- Adenocarcinoma cervical cancers are less common.
- Rare types of cervical cancer include mixed adenosquamous carcinomas and small cell carcinomas.
Staging describes the cancer. Staging is based on how much cancer is in the body, where it was first diagnosed, if the cancer has spread and where it has spread to.
The stage of the cancer can help your health care team plan your treatment. It can also tell them how your cancer might respond to treatment and the chance that your cancer may come back (recur).
- Stage 0: Pre-cancer. Tumour is only on the surface tissue of the cervix. Sometimes called CIN (Cervical Intraepithelial Neoplasia).
- Stage 1A: Tumour is only in the cervix and can only be seen with a microscope.
- Stage 1A1: Tumour is no more than 3 mm deep and no more than 7 mm wide.
- Stage 1A2: Tumour is more than 3 mm deep but not more than 5 mm deep. Tumour is not more than 7 mm wide.
- Stage 1B: The tumour is only in the cervix and can be seen without a microscope, or tumour can only be seen with a microscope but is bigger than a Stage 1A tumour.
- Stage 1B1: Tumour is less than 4 cm wide.
- Stage 1B2: Tumour is more than 4 cm wide.
- Stage 2A: The tumour has spread outside of the cervix and the uterus but has not grown into the lower part of the vagina or into the walls of the pelvis. Tumour has not grown into the tissues next to the cervix and uterus.
- Stage 2A1: Tumour is less than 4 cm wide.
- Stage 2A2: Tumour is more than 4 cm wide.
- Stage 3A: Tumour has spread to the lower part of the vagina but not into the wall of the pelvis.
- Stage 3B: One or more of the following:
- Tumour has grown into the wall of the pelvis.
- Tumour is blocking a ureter (tube that carries urine, or pee, from your kidney to your bladder) which makes your kidney larger than it should be (hydronephrosis) or stops the kidney from working properly.
- Stage 4: The tumour has spread outside of the pelvis into the bladder and rectum, or the cancer has spread to other parts of the body (distant metastasis).
For more information about staging, see About Cancer.
The grade of the cancer describes how different the cancer cells look from normal cells and how fast the cancer cells are growing. A pathologist will give the cancer a grade after looking at the cells under a microscope.
Cervical cancer can be grade 1, 2 or 3. The lower the number, the lower the grade.
Low grade: cells are abnormal but look a lot like normal cells. Low grade cancers usually grow slowly and are less likely to spread.
High grade: cells are abnormal and do not look like normal cells. High grade cancers usually grow more quickly and are more likely to spread.