The cervix, or "neck" of the uterus, is the lowest part of the uterus, and is connected to the top of the vagina. The cervix is normally 3 cm long and 2-3 cm wide, and is visualized during a vaginal exam with the use of a speculum. The Pap smear is a test that examines cells from the cervix for cancer or pre-malignancy.
The human papillomavirus (HPV) is responsible for nearly all cervical cancers. Many cases of HPV infection, including those of high risk types, will resolve without treatment and never develop into dysplasia or cancer.
Many cervical cancers are found in the early stages through Pap smear testing, and present without significant signs. As a cervical cancer grows, however, women may notice such symptoms as:
- Irregular vaginal bleeding
- Abnormal vaginal discharge
- Bleeding during intercourse
Large cervical cancers that have spread beyond the cervix may result in signs such as:
- Bleeding with urination or bowel movements
- Pelvic, back or leg pain
- A swollen leg
- Weight loss, fatigue, or loss of appetite
Women with any of these symptoms should see their health care provider for a gynecologic examination.
Several risk factors are known to increase the likelihood for cervical cancer development. These include:
- HPV infection
- Multiple sex partners, or having sex with men who have had many partners
- Lack of routine Pap smear testing
Women with any of these risk factors should undergo annual Pap smear testing until otherwise advised by their health care provider.
Women with abnormal Pap smear results should undergo colposcopy, an office procedure that involves treatment of the cervix with dilute acetic acid (i.e., table vinegar) and subsequent magnified visualization. The acetic acid identifies areas of abnormal cells that may be biopsied. Women with abnormal findings on the cervix may undergo direct biopsy without colposcopy.
Women with invasive cervical cancer should undergo evaluation by a gynecologic oncologist.
A detailed vaginal and rectal exam is typically the initial intervention to determine the stage of the disease (where the cancer may have spread). Early stage cervical cancers may be treated by a specialized type of hysterectomy with lymph node dissection. More advanced stage cancers are typically treated with radiation that may include a small dose of chemotherapy to “sensitize” the cancer cells to radiation.