About A Cervical Cancer Diagnosis

January is cervical cancer awareness month.

According to National Cancer Institute, there were more than 12,000 women who received a cervical cancer diagnosis last year. Cervical cancer develops in the cervix, the narrow outer end of the uterus that extends into the vagina. When diagnosed early, cervical cancer is generally curable and patients have an excellent chance of recovery. Penn Medicine physicians and scientists are working together to develop new ways to diagnose and treat cervical cancer.

Types of Cervical Cancer

There are two types of cervical cancer:

• Squamous cell carcinoma. The most common type of cervical cancer consisting of flat, thin cells called squamous cells that cover the surface of the cervix.
• Adenocarcinoma. Develops in the mucus-producing glands of the endocervix or opening to the uterus.

About a Cervical Cancer Diagnosis

Women with early cervical cancers and pre-cancers usually have no symptoms. Symptoms often do not begin until the cancer becomes invasive and grows into nearby tissue. When this happens, the most common symptoms are:

• Abnormal vaginal bleeding, such as bleeding after sex (vaginal intercourse), bleeding after menopause, bleeding and spotting between periods, and having (menstrual) periods that are longer or heavier than usual. Bleeding after douching or after a pelvic exam may also occur.
• An unusual discharge from the vagina -- the discharge may contain some blood and may occur between your periods or after menopause.
• Pain during intercourse.

A cervical cancer diagnosis can only be made after a biopsy. If a biopsy shows that cancer is present, your doctor may order certain tests to see how far the cancer has spread.

Staging Cervical Cancer

In order to guide treatment and offer some insight into prognosis, cervical cancer is staged into different groups. There are a few different staging systems, but the most popular one for cervical cancer is the FIGO system (International Federation of Gynecologists and Obstetricians). The FIGO system is a clinical staging system which means that the cancer is staged by a doctor's physical examination and the results of a biopsy. The FIGO staging system is for invasive cervical cancers, not pre-cancerous lesions.

A simplified version of the FIGO staging system is:

Stage IA - microscopic cancer confined to the cervix
Stage IB - cancer visible by the naked eye confined to the cervix
Stage II - cervical cancer invading beyond the uterus but not to the pelvic wall or lower 1/3 of the vagina
Stage III - cervical cancer invading to the pelvic wall and/or lower 1/3 of the vagina and/or causing a non-functioning kidney
Stage IVA - cervical cancer that invades the bladder or rectum, or extends beyond the pelvis
Stage IVB - distant metastases (spread to other areas of the body such as the lung or liver)

Cervical Cancer and HPV

About half of the women diagnosed with cervical cancer are between the ages of 35 and 55. The majority of cases are caused by exposure to the human papillomavirus (HPV), a common sexually transmitted disease. HPV affects up to 80 percent of females and males in their lifetime. Many cases of HPV clear on their own, but certain types of HPV can cause cervical, vulvar and vaginal cancer in females.

Cervical cancer treatment at Penn Medicine is provided by the Jordan Center for Gynecologic Cancers. As part of Penn’s Abramson Cancer Center, the Jordan Center takes a multidisciplinary approach to care, combining the expertise of Abramson Cancer physicians and scientists from the Penn’s division of gynecologic oncology, the Joan Karnell Cancer Center and the Penn Ovarian Cancer Research Center.