Screening for Cervical Cancer
Screening for cervical cancer is the testing of
women for precancerous and cancerous developments
even in the
absence of any symptoms.
The reason for this is
that detection and treatment of
precancerous cervical lesions (dysplasia)
can actually prevent cervical cancer from
ever occurring. Additionally, if cervical cancer is
detected while in its earliest stage, the
likelihood of survival is almost 100 percent with
timely and appropriate treatment and follow-up.
Screening techniques typically include Pap smears,
HPV testing, and cervical examinations. The
frequency with which screening is performed
depend on several factors,including which tests are
used as well as the woman's age,
history of vaginal intercourse, her risk factors,
previous test results,
and previous treatments.
The Pap Smear
Pap smears are tests performed during the pelvic
examination by inserting a speculim into the vagina
so that the Cervix can be visualized and a sample of
cells can be removed from the outer portion of the
cervix using a wooden or plastic spatula. A small
brush is then used to take a second sample from
the inner part of the cervix. These samples are
immediately preserved on glass slides and are then
microscopically analyzed for the presence of cancerous
or precancerous changes. For women who have
undergone a hysterectomy with removal of the cervix,
the vaginal cuff is visually inspected and the sample
is taken from the vaginal cuff.
The HPV Test
The HPV test checks for the virus (human papillomavirus)
that can cause cells in the cervix to turn cancerous.
If precancerous or cancerous changes are detected, a
work-up is required to determine the nature of the
cancer and whether it has spread.
Cervical Cancer Diagnosis Workup
If a woman has an abnormal Pap smear, it is
appropriate to do a workup to determine whether
only precancerous changes are present in the
cervix, or whether cancer cells are already
present. If cancer cells are already present,
it must also be determined how much cancer is
present and how far the cancerous cells have
If the cancer has spread beyond the cervix,
it is said to have metastasized.
Staging the Cervical Cancer
The size and
spread of the cancer is classified as the stage
of the cancer. Knowing the stage of the cancer
is important because it is the primary factor in
the selection of treatment and in the prognosis
for the woman.
One or more of the following tests may be
necessary to identify the stage of the cancer:
is a procedure that involves the insertion
of a viewing scope (the colposcope) into the vagina
in order to magnify the region for inspection. Prior
to inserting the colposcope, a Schiller test, a rinse
of an iodine solution applied with a cotton swab,
is administered to turn abnormal cells yellow or white.
Small clusters of these abnormal cells can then be
removed for biopsy with an Endocervical Curettage.
Endocervical Curettage (ECC)
is often performed during
the colposcopy. ECC involves the scraping of cells
from the inner portion of the cervix. Since it may
not be possible to properly view the inner cervix
with the colposcope, performing an ECC may be necessary
in order to detect certain forms of cervical cancer,
such as adenocarcinoma, which grows in the upper
portion of the cervix. Together, colposcope and ECC
will identify most cervical cancers.
Loop electrocautery excision procedure (LEEP)
In this procedure, abnormal or suspicious cervical
tissue is removed with a sharp wire loop and the site
is cauterized to eliminate remaining abnormal tissue.
The area of the cervix containing abnormal cells is
known as the transformation zone.
or a cone biopsy.
This procedure uses a scalpel or laser to remove a
cone-shaped section of the cervix for biopsy.
Conization helps assess how much tissue is diseased.
Because it requires removal of part of the cervix,
it is generally recommended when other diagnostic
tests have revealed cancerous abnormalities,
invasive cervical cancer is suspected, and a
comprehensive diagnosis is necessary.
is an imaging technique that
uses sound waves to produce an image that can
be used to measure the size and position of the
CT Scan (or CAT Scan),
which stands for
computerized axial tomography, uses computerized
X-ray pictures to evaluate internal organs of the
body. The CT scan is most often used prior to
administering radiation therapy (discussed further
in order to help calculate how much radiation and
where exactly in the body the radiation should be
delivered by determining the size and position of
which stands for magnetic resonance imaging
is a non-invasive procedure that produces a
two-dimensional view of organs and structures.
The MRI images can be used to identify abnormal
nodules in bones and in the lymph nodes, a
sign that the cancer may be spreading.
is a procedure that uses a thin flexible
tube (called an endoscope) that has a lens or
camera at the end and records images of what is
seen through the camera on a computer screen,
allowing visualization of internal organs, such
as the uterus. Biopsy samples are often taken
through the endoscope during the procedure.
such as a blood test and
a urine test, can be used to check the cells
of the blood to determine the level of
functioning of the kidneys and liver. X-rays
can be used to check the status of the organs,
such as the lungs.
The cancer's stage is documented by using a standard
system which assigns letters and numbers to indicate
the size and spread of the cancer:
Grading the Cervical Cancer
Stage 0 or carcinoma in situ
Carcinoma in situ is very early cancer. When discussing
stage 0 and carcinoma in situ of the cervix or vagina,
the condition is more properly understood as a
pre-cancerous problem that has not yet behaved like
a cancer. The abnormal cells are found only in the first
layer of cells of the primary site and do not invade
the deeper tissues.
Cancer involves the primary site, but has not spread to
Cancer has spread
into surrounding structures such as
the upper part of the vagina or nearby
lymph nodes but is still inside the primary site.
spread to surrounding structures such as
the lower part of the vagina, nearby lymph
nodes, the outer layer of the womb, or
nearby structures within the pelvic area.
spread beyond the pelvic area, to such areas
as the bladder, bowel, lungs, liver, or
cancer has spread to organs close to
the pelvic area.
cancer has spread to distant organs,
such as the lungs.
Recurrent disease means that the
cancer has come back (recurred) after
it has been treated.
The malignancy (or aggressiveness) of the cervical
cancer is documented by assigning a grade
to the cancer.
The grade assigned to the cancer is based upon
the appearance of the cancer cells and how they
are arranged together.
The grade is generally determined by a
microscopic examination of cancerous cells obtained
from the cervix by a biopsy.
The cancer's grade is assigned using a standard
grading system which assigns cancer cells a score
from 1 to 3:
This is the least-aggressive type
of cancer. Cells from low-grade cervical cancer
have an appearance most like normal cells, and
tend to be slow-growing. Such cancer cells are
By the time the cancer has
become intermediate-grade, it has turned more
aggressive than a low-grade cancer.
Intermediate-grade cancer cells have an
appearance that is less like normal cells and
is often faster growing than low-grade cancer
cells. Such cells are called
This is the most aggressive type of
cancer. Cells from high-grade cervical cancer
are the least like normal cells. They
are rapid-growing and highly aggressive, often
spreading into the lymph nodes and bone. Such
cells are called
The higher the grade of the cancer, the more
difficult it is to successfully treat the cancer.
Once the diagnostic workup is completed, a proper
plan can be developed.
Law Office of Joseph A. Hernandez, P.C.
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Chestnut Hill, MA 02467
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