Women can greatly reduce their risk of cervical cancer by having routine Pap smears performed by their gynecologist. A pap smear is a basic test that is used to examine cervical cells. Routine pap smears can help detect abnormal cells that could potentially lead to cervical cancer, as well as existing cases of cervical cancer.

The best way to treat cervical cancer is through prevention. Pap smears can detect cervical cancer early and make treatment more effective.

Cervical cancer testing

For the majority of women, Pap smears are not painful. A Pap smear is part of a routine gynecological exam done in a doctor’s office. In a Pap smear, a doctor will scrape cells from the cervix for a sample. These cells will be examined underneath a microscope in a lab to look for cancerous cells. The cells may also be tested for HPV, which increases the risk of cervical cancer.

If a woman has HPV or an abnormal Pap smear, other tests may be recommended by her doctor:

• Colposcopy: This test uses a colposcope to take a closer look at the cervix. The instrument examines the cervix with a bright light and magnifying lens so that cervical tissue is easier to see.

• Biopsy: Many women have a cervical tissue biopsy at their doctor’s office under local anesthesia.
  
  • A punch biopsy will pinch off a small sample of cervical tissue using a sharp tool.
  • A LEEP biopsy will use an electric wire to slice off a round portion of cervical tissue.
  • An endocervical curettage biopsy will scrape a small sample of cervical tissue using a spoon-like instrument.
  • A conization biopsy will remove a cone-shaped tissue sample to determine if abnormal cells have grown underneath the surface of the cervix. This is a procedure normally performed under general anesthesia in the hospital.

These tests for cervical cancer could cause some bleeding and discharge, although patients normally heal very quickly. Women may experience some cramping, similar to PMS.

Cervical cancer staging

According to the American Cancer Society, cervical cancer is staged based on three different factors:

1. T: The extent of tumor growth.
2. N: If the cancer has spread to lymph nodes.
3. M: If the cancer has spread throughout the body.

The stages of cervical cancer will be labeled with Roman numerals I-IV in four different stages. The lower the number that is used, the less that the cancer has spread throughout the body. If the cervical cancer has a higher stage, like stage IV, it indicates that it is a serious cancer that has affected the body.

The stage of cervical cancer will be determined after exams and tests have been completed. This is normally prior to a patient undergoing surgery. If a patient is recommended to undergo surgery, then cervical cancer has likely spread and progressed to a later stage.

If cervical cancer has been treated and has returned, it is classified as recurrent cancer that could appear again in the cervix or other areas of the body.

Tumor extent (T)

Tis: The cancer cells are only found on the surface of the cervix (in the layer of cells lining the cervix), without growing into deeper tissues. (Tis is not included in the FIGO system)

T1: The cancer cells have grown from the surface layer of the cervix into deeper tissues of the cervix. The cancer may also be growing into the body of the uterus, but it has not grown outside of the uterus.

T1a: There is a very small amount of cancer, and it can be seen only under a microscope.

• T1a1: The area of cancer is less than 3 mm (about 1/8-inch) deep and less than 7 mm (about 1/4-inch) wide.
• T1a2: The area of cancer invasion is between 3 mm and 5 mm (about 1/5-inch) deep and less than 7 mm (about 1/4-inch) wide.

T1b: This stage includes stage I cancers that can be seen without a microscope. This stage also includes cancers that can only be seen with a microscope if they have spread deeper than 5 mm (about 1/5 inch) into the connective tissue of the cervix or are wider than 7 mm.

• T1b1: The cancer can be seen but it is not larger than 4 cm (about 1 3/5 inches).
• T1b2: The cancer can be seen and is larger than 4 cm.

T2: In this stage, the cancer has grown beyond the cervix and uterus, but hasn't spread to the walls of the pelvis or the lower part of the vagina. The cancer may have grown into the upper part of the vagina.

T2a: The cancer has not spread into the tissues next to the cervix (called the parametria).

• T2a1: The cancer can be seen but it is not larger than 4 cm (about 1 3/5 inches).
• T2a2: The cancer can be seen and is larger than 4 cm.

T2b: The cancer has spread into the tissues next to the cervix (the parametria)

T3: The cancer has spread to the lower part of the vagina or the walls of the pelvis. The cancer may be blocking the ureters (tubes that carry urine from the kidneys to the bladder).

T3a: The cancer has spread to the lower third of the vagina but not to the walls of the pelvis.

T3b: The cancer has grown into the walls of the pelvis and/or is blocking one or both ureters (this is called hydronephrosis).

T4: The cancer has spread to the bladder or rectum or it is growing out of the pelvis

Lymph node spread (N)

NX: The nearby lymph nodes cannot be assessed

N0: No spread to nearby lymph nodes

N1: The cancer has spread to nearby lymph nodes

Distant spread (M)

M0: The cancer has not spread to distant lymph nodes, organs, or tissues

M1: The cancer has spread to distant organs (such as the lungs or liver), to lymph nodes in the chest or neck, and/or to the peritoneum (the tissue coating the inside of the abdomen).

Stage grouping and FIGO stages

Information about the tumor, lymph nodes, and any cancer spread is then combined to assign the stage of the disease. This process is called stage grouping. The stages are described using the number 0 and Roman numerals from I to IV. Some stages are divided into sub-stages indicated by letters and numbers. FIGO stages are the same as AJCC stages, except stage 0, which doesn’t exist in the FIGO system.

Stage 0 (Tis, N0, M0): The cancer cells are only in the cells on the surface of the cervix (the layer of cells lining the cervix), without growing into (invading) deeper tissues of the cervix. This stage is also called carcinoma in situ (CIS) which is part of cervical intraepithelial neoplasia grade 3 (CIN3). Stage 0 is not included in the FIGO system.

Stage I (T1, N0, M0): In this stage, the cancer has grown into (invaded) the cervix, but it is not growing outside the uterus. The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage IA (T1a, N0, M0): This is the earliest form of stage I. There is a very small amount of cancer, and it can be seen only under a microscope. The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).

• Stage IA1 (T1a1, N0, M0): The cancer is less than 3 mm (about 1/8-inch) deep and less than 7 mm (about 1/4-inch) wide. The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).
• Stage IA2 (T1a2, N0, M0): The cancer is between 3 mm and 5 mm (about 1/5-inch) deep and less than 7 mm (about 1/4-inch) wide. The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage IB (T1b, N0, M0): This stage includes stage I cancers that can be seen without a microscope as well as cancers that can only be seen with a microscope if they have spread deeper than 5 mm (about 1/5 inch) into the connective tissue of the cervix or are wider than 7 mm. These cancers have not spread to nearby lymph nodes (N0) or distant sites (M0).

• Stage IB1 (T1b1, N0, M0): The cancer can be seen but it is not larger than 4 cm (about 1 3/5 inches). It has not spread to nearby lymph nodes (N0) or distant sites (M0).
• Stage IB2 (T1b2, N0, M0): The cancer can be seen and is larger than 4 cm. It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage II (T2, N0, M0): In this stage, the cancer has grown beyond the cervix and uterus, but hasn't spread to the walls of the pelvis or the lower part of the vagina.

Stage IIA (T2a, N0, M0): The cancer has not spread into the tissues next to the cervix (called the parametria). The cancer may have grown into the upper part of the vagina. It has not spread to nearby lymph nodes (N0) or distant sites (M0).

• Stage IIA1 (T2a1, N0, M0): The cancer can be seen but it is not larger than 4 cm (about 1 3/5 inches). It has not spread to nearby lymph nodes (N0) or distant sites (M0).
• Stage IIA2 (T2a2, N0, M0): The cancer can be seen and is larger than 4 cm. It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage IIB (T2b, N0, M0): The cancer has spread into the tissues next to the cervix (the parametria). It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage III (T3, N0, M0): The cancer has spread to the lower part of the vagina or the walls of the pelvis. The cancer may be blocking the ureters (tubes that carry urine from the kidneys to the bladder). It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage IIIA (T3a, N0, M0): The cancer has spread to the lower third of the vagina but not to the walls of the pelvis. It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage IIIB (T3b, N0, M0; OR T1-3, N1, M0): either:

• The cancer has grown into the walls of the pelvis and/or has blocked one or both ureters (a condition calledhydronephrosis) but has not spread to lymph nodes or distant sites.

OR

• The cancer has spread to lymph nodes in the pelvis (N1) but not to distant sites (M0). The tumor can be any size and may have spread to the lower part of the vagina or walls of the pelvis (T1-T3).

Stage IV: This is the most advanced stage of cervical cancer. The cancer has spread to nearby organs or other parts of the body.

Stage IVA (T4, N0, M0): The cancer has spread to the bladder or rectum, which are organs close to the cervix (T4). It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage IVB (any T, any N, M1): The cancer has spread to distant organs beyond the pelvic area, such as the lungs or liver.

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