Updated: Nov 15
The cervix is part of the female reproductive system. The female reproductive system is made up of internal organs, including the vagina, uterus, ovaries and fallopian tubes. All the internal organs are located in the pelvis, which is the lower part of the abdomen between the hip bones. The cervix is the lower, narrow part of the uterus (womb). The cervix connects the main body of the uterus to the vagina (birth canal).
The cervix connects the body of the uterus to the vagina. Part of the lining of the cervix contains glands that make and release mucus. For most of the menstrual cycle and during pregnancy, the mucus is thick and stops sperm from entering the uterus. The thick mucus also helps to protect the uterus and the upper female reproductive organs from harmful bacteria. When a mature egg is released from an ovary each month (ovulation), the mucus changes and becomes thinner. The thinner mucus allows sperm to pass through the cervix into the uterus. Every month, except during pregnancy or menopause, the lining of the uterus (called the endometrium) is shed through the cervix into the vagina, then out of the body. This process is called menstruation. During childbirth, the cervix widens (dilates), allowing the baby to pass through the birth canal. The cervix also prevents objects inserted into your vagina, such as tampons or diaphragms, from slipping inside your uterus.
What is cervical cancer?
We already know the basic information about the cervix, now, we’ll be learning about cervical cancer. Cervical cancer is cancer that begins growing in or on the cervix, the neck of the uterus. Cervical cancer begins when healthy cells on the surface of the cervix change or become infected with human papillomavirus (HPV) and grow out of control, forming a mass called a tumour. When exposed to HPV, the body's immune system typically prevents the virus from doing harm. In a small percentage of people, however, the virus survives for years, contributing to the process that causes some cervical cells to become cancer cells. Long-term infection of HPV on the cervix can result in cancer, leading to a mass or tumour on the cervix. A tumour can be cancerous or benign. A cancerous tumour is malignant, meaning it can spread to other parts of the body. A benign tumour means the tumour will not spread.
At first, the changes in a cell are abnormal, not cancerous, and are sometimes called "atypical cells." Researchers believe that some of these abnormal changes are the first step in a series of slow changes that can lead to cancer. Some of the atypical cells go away without treatment, but others can become cancerous. This phase of the precancerous disease is called "cervical dysplasia", which is an abnormal growth of cells. Sometimes, the dysplasia tissue needs to be removed to stop cancer from developing. If the precancerous cells change into cancer cells and spread deeper into the cervix or to other tissues and organs, the disease is then called cervical cancer or invasive cervical cancer.
Types of cervical cancer
Cervical cancers and cervical pre-cancers are classified by how they look in the labs with a microscope. Cervical cancer can grow from the surface of the cervix seen in the vagina, called the ectocervix, or from the canal going from the vagina to the uterus, called the endocervix. There are 2 main types of cervical cancer named for the type of cell where cancer started. The main types of cervical cancers are squamous cell carcinoma and adenocarcinoma. Other types of cervical cancer are rare.
Most (up to 9 out of 10) cervical cancers are squamous cell carcinomas. This type of cervical cancer begins in the thin, flat cells (squamous cells) lining the outer part of the cervix, which projects into the vagina. These cancers develop from cells in the exocervix, most often beginning in the transformation zone (where the exocervix joins the endocervix).
Most of the other cervical cancers are adenocarcinomas. This type of cervical cancer begins in the column-shaped glandular cells that line the cervical canal. Cervical adenocarcinoma develops from the mucus-producing gland cells of the endocervix.
Less commonly, cervical cancers have features of both squamous cell carcinomas and adenocarcinomas. These are called adenosquamous carcinomas or mixed carcinomas.
Although almost all cervical cancers are either squamous cell carcinomas or adenocarcinomas, other types of cancer also can develop in the cervix. These other types, such as melanoma, sarcoma, and lymphoma, occur more commonly in other parts of the body.
If cervical cancer is detected, it will be staged, from stage 1, which means abnormal cells are found only in the tissue of the cervix to stage 4, which means cancer has spread beyond the pelvis to the lung, liver or bones. Staging your cancer can help your doctor find the right treatment for you.
Cervical cancer has four stages:
Stage 1: The cancer is small and only in the cervix. It may have spread to the lymph nodes. It hasn’t spread to the surrounding tissue, nearby organs, or anywhere else in the body.
Stage 2: The cancer is larger. It has spread to the upper two-thirds of the vagina or to the tissue around the uterus and may have spread outside of the uterus and cervix or to the lymph nodes, but still hasn’t reached other parts of your body.
Stage 3: Cancer has spread to the lower third of the vagina and/or to the pelvic wall. It may be blocking the ureters, the tubes that carry urine from the kidneys to the bladder. It hasn’t spread to other parts of your body.
Stage 4: Cancer has spread beyond the pelvis, has spread to the lining of the bladder or rectum, or has spread to other parts of the body like lungs, bones, or liver.
Cervical cancer signs & symptoms
In its early stages, cervical cancer may cause very minor symptoms or none at all. Many women with cervical cancer don’t realize they have the disease early on because it usually doesn’t cause symptoms until the late stages. When symptoms do appear, they’re easily mistaken for common conditions like menstrual periods and urinary tract infections (UTIs). Advanced cervical cancer may cause bleeding or discharge from the vagina that is not normal for you, such as bleeding after sex. Symptoms often do not begin until cancer becomes larger and grows into nearby tissue. When this happens, the most common symptoms are:
Abnormal vaginal bleeding, such as bleeding after vaginal sex, bleeding after menopause, bleeding and spotting between periods.
An unusual discharge from the vagina − the discharge may contain some blood and may occur between your periods or after menopause.
Pain during sexual intercourse
Pain in your lower back, between your hip bones (pelvis), or in your lower tummy
Heavier or longer periods than usual
Signs and symptoms seen with more advanced disease can include:
Swelling of the legs
Problems urinating (needing to urinate more often or pain during urination)
Blood in the urine
Feeling very tired
Any of these symptoms should be reported to your doctor. These signs and symptoms can also be caused by conditions other than cervical cancer. Still, if you have any of these symptoms, it is important to talk with your doctor about them even if they appear to be symptoms of other, less serious conditions. The earlier precancerous cells or cancer in the cervix is found and treated, the better the chance that cancer can be prevented or cured.
This article is written by: dr. Natalia Liau, MBBS, MSc.