Precancerous changes of the cervix (CIN, dysplasia) usually do not cause pain. They generally do not cause any symptoms and are not detected unless a woman has a pelvic exam and Pap smear test. Symptoms usually do not appear until abnormal cervical cells become cancerous. Even early stage cervical cancer may be symptomatic and discovered only by Pap smear and/or physical examination.
CIN and very early stage invasive cervical cancer is usually symptomatic and discovered because of an abnormal Pap smear. Patients with early stage cervical cancer may also have irregular vaginal bleeding, which is most often after intercourse, but heavy or irregular periods may occur. Patients with large cervical cancers or advanced stage disease may present with a foul smelling vaginal discharge, abnormal vaginal bleeding, pelvic pain or back pain.
The most common symptoms of cervical cancer are:
Bleeding between regular menstrual periods.
Bleeding after sexual intercourse, douching or a pelvic exam
Menstrual bleeding longer and heavier than usual
Bleeding after menopause
Increased vaginal discharge
DIAGNOSIS OF CERVICAL CANCER
Regular screening with a Pap smear has been effective in reducing the incidence and death rate from cervical cancer. The Pap smear is obtained by scraping a small wooden stick on the outside of the cervix a scraping the inside of the cervix (endocervix) with a small brush. The Pap smear is a screening test and does not give an absolute diagnosis. An accurate diagnosis is made by a biopsy of the cervix.
If cells that are not normal are found on a Pap smear the doctor will usually need to investigate this further. The next step is usually a colposcopic exam, which can be done in the office and allows the physician to see a magnified view of the cervix with a microscope after applying vinegar to the cervix. Areas on the cervix suspicious for abnormal cells can then be biopsied at that time. Only a very small amount of tissue is needed in this situation.
Over 50 million Pap smears are performed annually in the United States. A least 5% are abnormal requiring further investigation. The source of abnormal cells is usually the from the cervix. However, abnormalities of the uterus, ovaries, fallopian tubes, vagina and vulva may occasionally contribute to an abnormal Pap smear. The combination of a thorough pelvic history and pelvic examination as well as colposcopy and directed biopsies, if necessary, are usually required to detect both preinvasive and invasive disease. Gynecologic Oncologist are specially trained to evaluate patients for premalignant conditions of the lower genital tract (reproductive tract).
Thorough colposcopic and histologic (biopsy of tissue) evaluation should minimize complication that may lead to under-treatment and over-treatment.
Also, preservation of fertility may be a primary concern for many patients. The appropriate application of colposcopy, biopsies and therapeutic modalities can reduce complications leading to infertility.
Colposcopy results can be clinically correlated with the results of the Pap smear. Colposcopy-directed biopsy usually provides enough clinical evidence for an accurate diagnosis. If colposcopy evaluation is unsatisfactory or inconclusive, a cervical conization biopsy is required, performed via a loop electrical excision procedure (LEEP), laser or cold knife. This procedure is also used for treatment of cervical dysplasia.
STAGING CERVICAL CANCER
The staging of cervical cancer is based on the size of the lesion and the extent (location) of disease. The Gynecologic Oncologist will perform a pelvic examination to feel the extent of the tumor. Other procedures such as cystoscopy (looking into the bladder) and sigmoidoscopy (looking into the rectum) under anesthesia or other X-ray tests such as intravenous pyelography, chest X-ray, CT scan or MRI bay be obtained, if the Gynecologist Oncologist feels they are indicated.
