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Understanding Cancer of the Cervix

The cervix

The cervix is the lower part of the womb (uterus) and is often called the neck of the womb. The womb is a muscular, pear-shaped organ at the top of the vagina. The lining of the womb is shed each month, and results in bleeding called a period. These periods stop temporarily during pregnancy and will normally continue until a woman has the `change of life' or menopause. Your cervix can be seen when you have a smear and can be felt when you have an internal examination by a doctor or nurse. Close to the cervix are a collection of lymph nodes. These are small glands, about the size of a bean

How is it diagnosed?

Usually you begin by seeing your GP who will examine you and arrange for any tests or x-rays that may be necessary. Your GP will refer you to hospital for these tests and for specialist gynecological advice and treatment.

Pap Smear test

The smear or Pap test is commonly used as a routine test to detect early cell changes (dyskaryosis). This is known as cervical screening and is aimed at women with no symptoms. However, it is sometimes used to help diagnose a cancer of the cervix.

Before the test you will be helped into position on the couch. The nurse or doctor will then use an instrument called a speculum to hold the vaginal walls open. Using a small spatula a sample of the cells is scraped gently from the cervix and spread onto a glass slide.

Sometimes a small brush (cytobrush) may be used instead, or a liquid may be squirted at the cervix and then drawn up into a syringe to collect some cervical cells. The sample is sent to a laboratory to be examined under a microscope, which shows up any abnormalities. A smear test may sometimes be slightly uncomfortable, but it only takes a few minutes.

Types of cancer of the cervix

There are two main types of cancer of the cervix. The most common is called squamous cell carcinoma: this develops from the flat cells which cover the outer surface of the cervix at the top of the vagina. The other type is called adenocarcinoma: this type develops from the glandular cells which line the cervical canal (endocervix). As adenocarcinoma starts in the cervical canal it may be more difficult to detect with smear tests.
The pathology report also gives other important information, such as the grade of the cancer and whether there are signs of cancer cells in the lymph or blood vessels. Some of this information, in addition to the doctor's physical examination and tests, will influence the advice you are given about the best type of treatment for you.

What are the symptoms?

The smear test can pick up changes to the cervix at an early stage (before cancer develops) and may also detect cancer at a very early stage, before any symptoms have occurred.

The most common symptom of cervical cancer is abnormal bleeding, such as between periods or after intercourse. Often there is also a smelly vaginal discharge, and discomfort during intercourse. In women who have had their menopause (who have stopped their periods) there may be some new bleeding. Of course, there are many other conditions that can produce these symptoms, but it is important that you are not shy or embarrassed to see your doctor or nurse about them. The sooner you see your doctor and the diagnosis is made, the better the chance of treatment being successful.