Cervical Cancer (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Cervical cancer facts
- What is cervical cancer?
- How do women get cervical cancer? What causes cervical cancer?
- What are the symptoms and signs of cervical cancer?
- What are the risk factors for cervical cancer?
- What are cervical cancer screening guidelines?
- What tests are used to diagnose cervical cancer?
- What are the stages of cervical cancer?
- What is the treatment for cervical cancer?
- What are methods of treatment for cervical cancer?
- Can cervical cancer be prevented? What is the cervical cancer vaccine?
- What kind of support is available to women with cervical cancer?
- What is the prognosis and survival rates for women with cervical cancer?
- What research is being done on cervical cancer?
- Find a local Oncologist in your town
What are cervical cancer screening guidelines?
The US Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) recommend that all women between the ages of 21 and 65 receive screening every 3 years. A Pap smear obtained during a routine pelvic examination is the typical screening procedure, but when a Pap smear is combined with an HPV test, screening every 5 years is acceptable for women aged 30 and above.
Women who have had a total hysterectomy for a benign condition no longer have a cervix, and thus do not need to be screened for cervical cancer. However, women who have had a subtotal hysterectomy still have a cervix and should be screened according to guidelines.
Certain conditions and special situations may change the frequency of screening, such as a history of abnormal Pap smears.
What tests are used to diagnose cervical cancer?
As described above, Pap testing is done to screen for cervical cancer. If abnormal cells are detected on the Pap smear, a colposcopy procedure is then performed. Colposcopy uses a lighted microscope to examine the external surface of the cervix during a pelvic examination. If abnormal areas are noted, a small tissue sample (biopsy) is taken for examination by a pathologist to look for precancerous changes or cancer. Colposcopy requires no special anesthesia and is similar to having a Pap smear in terms of discomfort.
The transformation zone of the cervix (see above) cannot always be visualized well during colposcopy. In this case, a sample of cells may be taken from the interior canal of the cervix, known as an endocervical curettage or scraping. Another option is conization, or removal of a cone-shaped portion of the cervix around the cervical canal. This tissue can be removed with a thin loop of wire that is heated by an electrical current, known as loop electrosurgical excision procedure (LEEP), also called a large loop excision of the transformation zone (LLETZ). LEEP is performed in the doctor's office with a local anesthetic. Another possibility is to have the cone-shaped tissue fragment removed in an operating room under general or regional anesthesia, referred to as a cold knife conization.
After a conization or biopsy procedure, the pathologist studies the tissue to determine if precancerous changes (referred to as cervical intraepithelial neoplasia grades 1 to 3, depending on its extent) or cancer are present.
If cancer is present, depending on the size and extent of the tumor, other tests might be done to help determine the extent to which the tumor has spread. These additional tests can include chest x-rays, or CT or MRI imaging studies. Cystoscopy (examination of the interior of the urinary bladder using a thin, lighted scope) or proctoscopy (examination of the rectum) may be necessary. An examination under anesthesia allows the doctor to perform a manual pelvic examination without causing pain to help determine the degree of spread of the cancer within the pelvis.
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