Overview
Cervical cancer starts in a woman's cervix, which is the lower, narrow part of the uterus.
Cancer of the cervix is the third most common gynecologic cancer in the US after cancers of the endometrium and ovary. The American Cancer Society estimated that 11,270 women in the United States would be diagnosed with invasive cervical cancer in 2009 and as many as 4,070 women will die from the disease (ACS Cancer Facts & Figures, 2009). Many of these deaths could be prevented with regular screening and early treatment.
Anatomy of the Cervix
To understand cervical cancer, it helps to have an understanding of the anatomy of the cervix.
A little more than an inch long, the cervix is the narrow end of the uterus that opens into the upper part of the vagina. In pregnancy, the cervix helps hold the uterus closed. Several weeks prior to labor and childbirth, the cervix thins and begins to expand, or dilate. At delivery, the cervix opens completely to allow the movement of the baby through the birth canal.
The bulk of the cervix, or stroma, is formed by connective tissue. This is covered by a surface layer called the epithelium.
The epithelium is made up of two different types of cells. The epithelium of the endocervical canal (the inner surface of the cervix) is comprised of tall glandular cells that produce cervical mucus. The epithelium on the outer aspect of the cervix that can be seen at the top of the vaginal canal (the ectocervix) is formed by layers of flat, disc-like cells called squamous cells. The area where the squamous cells meet the glandular cells is called the transformation zone.
The transformation zone is the area that is most susceptible to the changes that can lead to cancer.
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Tumor Types
Cervical Dysplasia or Cervical Intraepithelial Neoplasia
 Also called cervical dysplasia, cervical intraepithelial neoplasia (CIN) is not cancer, but represents early changes on the surface of the cervix that may develop into cancer. Nearly half the time, cervical dysplasia will go away on its own.
Pap tests can detect cervical dysplasia. However, no test can predict whether CIN will develop into cancer, which is why early detection and treatment of any abnormality is so important.
When diagnosed, cervical intraepithelial neoplasia is graded as being low-grade, moderate-grade, or high-grade. It has been estimated that about 330,000 cases of high-grade dysplasia (CIN 2 or 3) and over 1 million cases of low-grade dysplasia (CIN1) are diagnosed in the US each year. It is most commonly diagnosed in women ages 25 to 35, but can develop at any age.
Cervical Cancer
Noninvasive carcinoma
 Early forms of cancer, when it remains contained within its original location without having spread into nearby tissues, are often referred to as noninvasive cancer or "in situ" cancer. In the case of these types of cancers, including cervical carcinoma in situ (or adenocarcinoma in situ if it is comprised of glandular cells), a thin layer called a basement membrane separates the culprit cells (the cervical epithelial cells) from the adjacent tissue (the cervical stroma).
Eliminating cervical cancer while it is noninvasive makes a complete cure almost a certainty. Without treatment, however, carcinoma in situ often develops into invasive cervical cancer, where the basement membrane is penetrated and the stroma is affected. If the cancer goes untreated and becomes invasive, the odds of curing it decline rapidly.
Population research has shown that cervical carcinoma in situ occurs most often in women between 30 and 40 years of age.
Invasive cervical cancer
 By definition, invasive cervical carcinoma has penetrated the basement membrane. Once it has passed through the basement membrane, the cancer can grow into the stroma and then can continue to spread. Cervical cancer staging is based on how far the cancer has spread.
Cancers that grow on the vaginal-facing surface of the cervix (the ectocervix) may appear as an ulcer and may have protruding components. Tumors that grow in the cervical canal (endocervix) may remain hidden from view, but can enlarge the cervix, causing it to become "barrel-shaped."
Most women diagnosed with cervical cancer are under the age of 50, although nearly 20% of women diagnosed are over the age of 65. Cervical cancer is not common in women under the age of 20.
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Symptoms
Cervical dysplasia and early stages of cervical cancer usually have no symptoms. An abnormal Pap smear is often the first indication that something may be wrong. The test itself does not confirm cervical intraepithelial neoplasia (CIN) or cervical cancer; however, it does indicate that some cervical cells are abnormal.
In more advanced cervical cancer, the most common symptom is irregular vaginal bleeding. Two-thirds of women with advanced cervical cancer experience bleeding between periods, with heavier or lighter amounts than normal menstrual flow, or are troubled by bleeding following intercourse. Eventually the bleeding becomes constant. In some women, however, cervical cancer can spread to other areas in the body before any bleeding occurs.
Other indicators of advanced disease may include pain in the pelvic area, legs, and back, and discomfort while urinating (caused by pressure from a tumor), or blood in the urine.
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Treatment
The type of treatment selected will depend upon tumor grade and stage as well as your general health. Three types of treatment are commonly used for cervical cancer: surgery, radiation, and chemotherapy.
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