Cervical Cancer

I have realised that a lot of people don't really understand what cervical cancer is, let alone the stages and types.  I have undertaken some research and hope to make things a little bit clearer! I have provided links of useful websites at the bottom of this page.  

What is Cervical Cancer ? 

Cervical cancer is cancer of the cervix.  The cervix is the lower part of the uterus and is situated at the top of the vagina.  The cells in the cervix do not suddenly change into cancer.  Instead, the normal cells of the cervix first gradually develop pre-cancerous changes that turn into cancer.  These pre-cancerous changes can be diagnosed as cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL) and dysplasia.   

Pre-Cancerous Cells 

Cervical Dysplasia - abnormal changes in the cells on the surface of the cervix that are seen underneath a microscope.  The changes are not cancer but can lead to cancer of the cervix if not treated.  

Squamous intraepithelial lesion (SIL) - Cervical dysplasia that is seen on a Pap smear is called SIL.  These changes may be: 

• Low-grade (LSIL)
• High-grade (HSIL)
• Possibly cancerous (malignant)
• Atypical glandular cells (AGUS)

Cervical intraepithelial neoplasia (CIN) - Dysplasia that is seen via biopsy of the cervix is called CIN. CIN is grouped into three categories:

• CIN I - mild dysplasia 
• CIN II - moderate to marked dysplasia 
• CIN III - severe dysplasia to carcinoma in situ

Cancerous Cells 

There are two main types of cervical cancer: 

Squamous cell carcinoma - this starts in the squamous or skin like cells of the cervix.  This is the most common type, accounting for approximately 80% - 90% of all cervical cancers. (This statistic changes depending where you read about it - Australia, UK, America).  

Adenocarcinoma - this develops from the glandular cells and is a less common type of cervical cancer.  This type is more difficult to diagnose because it starts higher in the cervix.    

Stages of Cervical Cancer 

If a biopsy shows you have cancer, you need to know the extent (stage) of the disease to help choose the best treatment.  The stage is based on whether the cancer has invaded nearby tissues or spread to other parts of the body.  Cervical cancer spreads most often to nearby tissues in the pelvis or to lymph nodes.  It can also spread to the lungs, liver or bones.

When cancer spreads from its original place (i.e. the cervix) to another part of the body, the new tumor has the same kind of cancer cells and the same name as the original tumor.  Eg. if cervical cancer spreads to the lungs, the cancer cells in the lungs are actually cervical cancer cells.  The disease is metastatic cervical cancer, not lung cancer and is treated as cervical cancer.  To learn the extent of disease you may require further tests.    

The stage of the cancer is based on where the cancer is found and how big the tumor is in millimetres. 

• Stage 0 - This stage is also known as carcinoma in situ, or CIN III.  This is not true cancer, but a pre-cancerous stage where the abnormal cells are found in the innermost lining of the cervix and have not invaded the deeper tissues of the cervix.  These abnormal cells may become cancer and spread into nearby normal tissue.    

• Stage I - Cancer cells are found only in the cervix.  Stage I is divided into Stage IA and IB based on the amount of cancer that is found.  

• Stage IA - A very small amount of cancer is present and is only visible with a microscope.  Stage IA is divided into stages IA1 and IA2, based on the size of the tumor.  

• Stage IA1  - The cancer is not more than 3mm deep and not more than 7mm wide.  

• Stage 1A2 - The cancer is more than 3mm but not more than 5mm deep and not more than 7mm wide.  

• Stage IB - A larger amount of cancer is present and can be seen with the naked eye.   Stage IB is divided into stages IB1 and IB2, based on the size of the tumor.  

• Stage IB1 
• The cancer can only be seen with a microscope and is more than 5mm deep and more than 7mm wide. OR 
• The cancer can be seen without a microscope and is 4cm or smaller.  

• Stage IB2 - The cancer can be seen without a microscope and is larger than 4cm.  

• Stage II - The cancer has spread beyond the cervix but not to the pelvic wall (the tissues that line the part of the body between the hips) or to the lower third of the vagina.  Stage II is divided into stages IIA and IIB, based on how far the cancer has spread.  

• Stage IIA - The cancer has spread beyond the cervix to the upper two thirds of the vagina but not to the tissues around the uterus.  Stage IIA is divided into stages IIA1 and IIA2, based on the size of the tumor.  

• Stage IIA1 - The tumor can be seen without a microscope and is 4cm or smaller.  

• Stage IIA2 - The tumor can be seen without a mircoscope and is larger than 4cm.  

• Stage IIB - The cancer has spread beyond the cervix to the tissues around the uterus.  

• Stage III - The cancer has spread to the lower third of the vagina and/or to the pelvic wall, and/or has caused kidney problems.  Stage III is divided into stages IIIA and IIIB, based on how far the cancer has spread.  

• Stage IIIA - The cancer has spread to the lower third of the vagina but not to the pelvic wall.

• Stage IIIB
• The cancer has spread to the pelvic wall.  and/or 
• The tumor has become large enough to block the ureters (the tubes that connect the kidneys to the bladder).  This blockage can cause the kidneys to enlarge or stop working.  

• Stage IV - The cancer has spread to the bladder, rectum or other parts of the body.  Stage IV is divided into stages IVA and IVB, based on where the cancer is found.    

• Stage IVA - The cancer has spread to nearby organs, such as the bladder or rectum.  

• Stage IVB - The cancer has spread to other parts of the body such as the liver, lungs, bones or distant lymph nodes.  

My Diagnosis

I was diagnosed with Stage IB1 adenocarcinoma of the cervix.  My tumor was 18mm in diameter and 3mm deep with lymph vascular space invasion.  I am so lucky to have been diagnosed when I did at such an early stage and this just shows how important Pap smears are.    

Chelsea x x

Research and Sources

Cancer Council NSW 
Australian Cervical Cancer Foundation 
Cancer Council QLD 
American Cancer Society    
Guard Against Cervical Cancer         
US National Library of Medicine                      
National Cancer Institute   
Cervical Cancer Booklet - National Cancer Institute   
Gynaecological Cancer Society     
Wolters Kluwer Health - Up to date