Types, Tests, and Cancer Prevention

Cervical cancer starts in the cervix, which is the passageway between the vagina and the uterus. Cervical lesions are patches of abnormal cells growing on the cervix.

Sometimes, cervical lesions are made of precancerous cells. Other times, cervical lesions contain cancerous cells.

Thanks to regular screening methods, cervical cancer is not as common as it used to be. The National Cancer Institute estimates that 14,100 people in the United States will be newly diagnosed with cervical cancer in 2022. This will make up about 0.7 percent of all new cancer diagnoses.

Keep reading to learn about the different types of cervical cancer lesions and how they’re diagnosed and treated.

Precancerous cervical lesions happen when cells in the cervix begin to develop abnormal changes. This means they have the potential to develop into cancerous lesions.

Most precancerous cervical lesions go away on their own, without causing any problems. But in some people, these precancerous lesions develop into cancer. Treating precancerous lesions can prevent cervical cancer.

A doctor might use a variety of medical terms when talking about precancerous cervical lesions, including:

• cervical dysplasia
• cervical intraepithelial neoplasia (CIN)
• squamous intraepithelial lesion (SIL)

When examined under a microscope, precancerous cervical lesions are classified into one of three categories. These categories depend on how much of the cervix appears abnormal:

• CIN1 (mild dysplasia): Only a few of the cells appear abnormal. This type will often go away on its own without treatment.
• CIN2 and CIN3 (moderate dysplasia): More of the cells are abnormal. Because this type sometimes goes away on its own, you may choose to get regular screenings instead of treatment after talking with your doctor.
• High grade SIL (severe dysplasia): This is the most serious type. It needs to be treated right away.

Cancerous cervical lesions are classified according to the location of the cancerous cells. These can include cells of the:

• Exocervix: This is the outer part of your cervix that faces down into your vagina. It’s the part that a doctor looks at as a part of a pelvic exam. The cells of the exocervix are called squamous cells.
• Endocervix: This is the inner part of your cervix that faces up toward the uterus. The cells here are called glandular cells.

As such, the main types of cervical cancers are:

• Squamous cell carcinoma: Squamous cell carcinoma begins in the cells of the exocervix, often at the meeting point between the exocervix and endocervix.
• Adenocarcinoma: Adenocarcinoma begins in the glandular cells of the endocervix.
• Adenosquamous carcinoma: Adenosquamous carcinoma affects both squamous and glandular cells in the cervix.

Overall, squamous cell carcinoma is the most common type of cervical cancer. According to the American Cancer Society, it accounts for 9 out of 10 cervical cancers.

The main cause of cervical lesions is an infection with human papillomavirus (HPV). According to the Centers for Disease Control and Prevention (CDC), HPV causes more than 9 out of 10 cervical cancers.

Not all types of HPV can cause cervical cancer. There are about 14 types of HPV that are considered high risk and are responsible for the majority of cancers that are caused by HPV.

HPV infection is very common. Most people contract HPV at some point after becoming sexually active. While the immune system typically clears the infection, sometimes high risk types of HPV can remain and lead to cancer.

The good news is that cervical cancer is now a very preventable cancer because of the HPV vaccine. A 2020 study found that, when given before age 17, the HPV vaccine reduced the risk of cervical cancer by almost 90 percent.

Cervical cancer risk factors

In addition to HPV infection, other risk factors for cervical cancer are:

• having a family history of cervical cancer
• smoking
• having a weakened immune system
• taking birth control pills for a long time
• currently or previously having chlamydia, a sexually transmitted infection (STI)
• factors related to pregnancy, such as being 17 years or younger at the time of your first full-term pregnancy or having three or more full-term pregnancies
• factors related to sexual history, which can raise the risk of contracting HPV, such as:
  • having had many sexual partners
  • becoming sexually active at a younger age
  • having a sexual partner who has a known HPV infection or who has had many sexual partners

Cervical cancer screening is vital in preventing cervical cancer. This can include an HPV test, a Pap test, or both.

The HPV test uses a sample of cervical cells to test for HPV. While it doesn’t specifically detect cervical lesions, it can alert your doctor to the presence of a high risk type of HPV that could lead to precancerous or cancerous changes in the future.

A Pap test also uses a sample of cells collected from the cervix. The cells are examined under a microscope to check for abnormal changes.

The current American Cancer Society cervical cancer screening guidelines are that all people with a cervix between the ages of 25 and 65 get a primary HPV test every 5 years.

If HPV primary testing isn’t available, HPV-Pap co-testing every 5 years, or a Pap test every 3 years, may also be used.

What if my screening result is abnormal?

If the results of your HPV or Pap test come back abnormal, your doctor may do a colposcopy or cervical biopsy. These are two procedures that let them examine the cells of your cervix more closely to check for precancer or cancer.

During a colposcopy, a doctor uses a speculum to open the vagina so they can see the cervix. They then insert a device called a colposcope that has a light and a magnifying glass to help them get a better view of the cervix.

It’s possible that a biopsy may be taken during the colposcopy. In a biopsy, a small sample of cervical cells is removed. The sample is then examined in a lab for signs of precancerous or cancerous cells.

Symptoms of cervical lesions

Precancerous cervical lesions often don’t cause symptoms. Because of this, many people don’t know they have them.

The same can be said about early cancerous lesions. Overall, most people with cervical cancer don’t have symptoms until the cancer has become more advanced. Some of the most common symptoms can include:

• abnormal vaginal bleeding, including:
  • after sex
  • between periods
  • menstrual periods that are much heavier or longer than usual
• after menopause
• vaginal discharge that may contain blood or may smell foul
• pain after sex
• pelvic pain

The fact that precancerous and early cervical cancer lesions don’t typically lead to symptoms makes regular cervical cancer screenings very important for early detection.

For some people, precancerous cervical lesions will go away without treatment. However, if you do have precancerous cervical lesions, getting treatment can go a long way in preventing them from becoming cancerous in the future.

Treatment involves removing the precancerous lesions. This can be accomplished in a few ways.

Ablation-based treatments work by destroying precancerous lesions. This can be done using cold (cryotherapy) or heat (laser surgery).

Excisional treatments remove the precancerous lesions. This can be done with a scalpel that removes a cone-shaped section of tissue (cold knife conization) or by using a thin wire loop containing an electrical current (LEEP).

It takes a long time to develop cervical cancer. According to the World Health Organization (WHO), it can take 15 to 20 years for cervical cancer to develop.

However, the WHO also notes this time frame is different for people with weakened immune systems. This can include people who are:

• living with HIV
• taking immunosuppressive drugs
• organ or bone marrow transplant recipients
• undergoing cancer treatments, like chemotherapy

In people with a weakened immune system, the WHO states cervical cancer can develop in a shorter span of time — about 5 to 10 years.

Precancerous cervical lesions are abnormal changes in cells of the cervix that are not yet cancerous. Some precancerous lesions go away on their own. Others will need to be treated to prevent cancer from developing.

Cervical lesions are mainly caused by HPV infection. Screening tests can detect HPV as well as abnormal changes to cervical cells. An HPV vaccine is available that can greatly reduce the risk of HPV infection and cervical cancer.

It’s not common for precancerous or early cancerous cervical lesions to cause symptoms. This makes regular cervical cancer screenings all the more vital for detecting and treating these lesions early.

What Is a Precancerous Cervical Lesion?

One of the best ways to prevent cervical cancer is to have regular Pap tests, which can detect a precancerous cervical lesion so that it can be removed before it becomes cancer. Pap tests take a sample of your cervical cells for examination in a lab. If the results of this cervical cancer screening test are abnormal, you may have changes in the cells of your cervix that could indicate a precancerous cervical lesion.

A precancerous cervical lesion, which is also called an intraepithelial lesion, is an abnormality in the cells of your cervix that could eventually develop into cervical cancer.

There are two main types of cervical cells, squamous and glandular, and abnormalities can occur in either type. The most common types of precancerous cervical lesions include:

• Atypical squamous cells. If your doctor tells you that you have atypical squamous cells, it means that abnormalities have been detected in the squamous cells of your cervix. This can indicate that you have a human papillomavirus (HPV) infection, another infection, or possibly precancerous cells of another cause. Your doctor may recommend further testing to determine what the abnormalities mean for you. In some cases, this may simply mean a repeat Pap test in a few months. A Pap test with this kind of finding may be reported as “atypical squamous cells of uncertain significance,” abbreviated as ASCUS.
• Squamous intraepithelial lesion (SIL). This lesion means that you have changes on your cervix that may be precancerous. SIL lesions are classified as either low-grade (LSIL) or high-grade (HSIL), with high-grade lesions being more likely to progress to cervical cancer.
• Atypical glandular cells. These signal a possible precancerous lesion in the upper area of your cervix or inside the uterus.

Testing and Treating a Precancerous Cervical Lesion

A Pap test screens for cancer or a precancerous condition; it is not used to diagnose a condition. So if your Pap test indicates that you might have a precancerous cervical lesion, your doctor probably will recommend further testing. The screening recommended for you depends on a number of factors, including your age, menopausal status, Pap test results, and whether you are pregnant. Follow-up testing may include one or more of the following:

• Repeat Pap test. Some women just need another Pap test within a few months to see if the abnormality is still present.
• HPV testing. Since many abnormalities are caused by an HPV infection, your doctor may recommend that your cervical cells be tested for HPV. Some types of HPV infection clear on their own and don’t tend to cause precancerous changes or cancer, but others, if not cleared by the body, are more likely to cause cancer.
• Colposcopy. This test allows your doctor to get a better look at your cervix through a magnifying device.
• Cervical biopsy. This involves removing a small sample of your cervical tissue and sending it to a lab for testing.
• Endometrial sampling. This involves taking a sample of your endometrium, or uterine lining, for study in a lab.

If this testing determines that you do, in fact, have a precancerous cervical lesion, there are treatments that can help reduce the chances that the lesion will develop into cervical cancer. Treatment options for a precancerous cervical lesion include:

• Loop electrosurgical excision procedure (LEEP). A thin, electrically charged wire is used to remove abnormal lesions from your cervix.
• Freezing (cryotherapy). Some precancerous cervical lesions can be destroyed by freezing them with a cold probe; this causes them to eventually shed from your cervix.
• Laser treatment. The precancerous cervical lesion is destroyed with a beam of laser light.
• Conization. A small, cone-shaped piece of tissue containing the abnormal area of the cervix is removed surgically.

It can be scary to find out that you have a precancerous cervical lesion, but keep in mind that having a lesion does not mean that you will get cervical cancer. In fact, early treatment of a precancerous cervical lesion can almost always help women avoid getting cervical cancer.

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Diseases of the cervix. Diagnosis and treatment of diseases of the cervix – Gynecology – clinic of gynecology

Diseases of the cervix is not just a small gynecological problem, but a real risk of developing oncology.

In most cases, diseases of the cervix are almost asymptomatic and are detected during a woman’s visit to the doctor for a routine examination. That is why all women, at least twice a year, are recommended to undergo preventive examinations by a gynecologist.

Occasionally, changes in the cervix may appear as bleeding from the genital tract unrelated to the menstrual cycle, often occurring after sexual intercourse or exercise. This serves as a mandatory reason for an unscheduled visit to the doctor.

The cause of diseases of the cervix can be hormonal disorders, severe traumatic childbirth, abortion, past infectious and inflammatory diseases, general weakening of the immune system.

Diagnosis of diseases of the cervix

The main means of timely diagnosis of diseases of the cervix is ​​a regular examination by a gynecologist. To do this, in addition to visual examination of the cervix in the mirrors, more accurate examination methods are used, such as colposcopy (examination of the cervix using a special microscope) and a cytological examination of a scraping from the cervix (PAP test).

The cervix is the part of the uterus that is visible through the vagina. Inside it is the cervical canal, which leads to the uterine cavity. There are 2 parts of the cervix: internal – endocervix (facing towards the cervical canal) and external – exocervix (located from the side of the vagina). The surface of the endocervix is ​​normally covered with a columnar epithelium, and the exocervix is ​​covered with a flat epithelium. Only in girls, up to a certain age, the cells of the cylindrical epithelium extend beyond the inner part of the cervix and cover the outer part of the cervix. This version of the norm is called “congenital erosion”.

The area located at the junction of the outer and inner parts of the cervix is ​​called the transformation zone. This is an extremely important area, which is a source of reserve cells. This type of cells that can turn into both squamous and cylindrical epithelium cells. It is here that various processes most often occur that can cause various diseases of the cervix.

Diseases of the cervix

The main pathologies of the cervix include:

• erosion of the cervix is ​​a change in which an area of ​​cylindrical epithelium cells of various sizes is determined in the outer part of the cervix (exocervix). Most often, cervical erosion looks like a “wound” or damaged area;
• leukoplakia of the cervix – this whitish spot on the cervix can be compared with a kind of callus. This disease is most often viral in nature. Leukoplakia can progress with the development of precancerous conditions.
• endometriosis – proliferation of cells of the inner layer of the uterine wall outside it;
• polyps – the occurrence of neoplasms of various structures on the mucous membrane of the cervical canal.
• ectropion is an eversion of the cervical canal towards the vagina. Most often occurs after childbirth.
• retention cyst of the cervix (nabotovy cysts) – the appearance of closed and dilated glands in the cervix, filled with secrets accumulated in them;
• papillomas and condylomas of the cervix – viral manifestations on the cervix;
• cervical dysplasia is a precancerous disease characterized by the presence of atypical cells with a high risk of malignancy.
• cervical carcinoma – cancer of the cervix.

Treatment of diseases of the cervix

Among the various options for the treatment of diseases of the cervix, modern medicine prefers the radio wave method. The time has passed when “cauterization” left scars and was a contraindication for nulliparous patients. Now it is possible to cure the disease and eliminate the threat of developing cervical cancer with the help of an effective and painless radio wave procedure on the Surgitron apparatus.

This technique is the gold standard for the treatment of cervical diseases, suitable for nulliparous patients, performed on an outpatient basis by experienced gynecological surgeons.

Diseases of the cervix: how they are diagnosed and treated

Diseases of the cervix: how they are diagnosed and treated

The cervix extends at one end into the vagina, and at the other into the uterine cavity itself. The inner walls of the organ have a very thin layer of epithelium, which means that the tissues are easily damaged and become vulnerable to bacteria and various viruses. In the absence of appropriate preventive monitoring, you can miss important symptoms of the development of diseases and, as a result, not have time to prevent the development of cancer problems on the cervix and other serious problems.

Types of pathologies

All diseases of the cervix have different symptoms and are caused by a variety of viruses or bacteria. There are also some pathologies provoked by tissue trauma. Among the most common diagnoses are the following:

• Cervicitis. It consists in an inflammatory process that is asymptomatic or accompanied by pus and mucous secretions with abdominal pain. Appears against the background of viral infections, can develop under the influence of Escherichia coli or parasites, and can also be caused by streptococci and staphylococci entering the organ
• Erosion . Violation of the integrity of the mucosa on the surface of the external pharynx of the neck. It looks visually like a reddened spot. Occurs due to inflammation and hormonal disorders, may be the result of injury. Painful during sex, during menstruation or urination, may cause purulent and unusual discharge
• Ectopia (pseudo-erosion). At the same time, the epithelium receives a bright red color, outwardly the spots are similar to erosive ones. Congenital and completely asymptomatic ectopia does not require treatment, you just need to see a doctor. Traumatic or infectious requires appropriate treatment
• Cyst (closed nabothian cyst). Occurs when the mucosal glands on the cervix are clogged and look like small light balls containing mucus. They are removed by radio waves, and it is also permissible to open and drain damaged areas, after which tissues can be cauterized.
• Dysplasia. The cellular structure on the mucous membrane of the cervix is ​​disturbed, a pathological change in tissues occurs. The causes of the problem are erosion and ectopia, which were not treated in a timely manner. It can also occur against the background of leukoplasty or human papillomavirus. No symptoms at first, but then lingering pains in the lower abdomen
• Leukoplakia. It is a keratinization of the mucosa on the cervix, outwardly similar to white spots or a film with a milky tint. May be accompanied by ichor after sex or mild pain. Women with this diagnosis cannot bear pregnancy. The causes of the disease are hormonal disruptions, trauma to the mucous membrane or infection
• Ectropion. Injury to the mucosa during abortion or childbirth sometimes leads to ecversion of the mucosa into the vagina. Accompanied by pain in the lower abdomen, as well as menstrual irregularities in a woman
• Polyps. Benign small tumors are formed on the cervical mucosa of the cervix and are clearly visible during examinations. It is possible to eliminate polyps by curettage (hysteroresectoscopy)
• Condylomatosis. Appears in the form of overgrown connective tissues on the surfaces of the mucous membrane of the cervix, which provokes the occurrence of cancer in the end. The cause of the problem is the human papillomavirus, which can be transmitted sexually. Accompanied by itching and burning, bleeding, treated systemically

Diseases of the cervix cannot be self-treated at home, and wrong approaches cause negative consequences, provoking serious complications. Sometimes the pathology of the cervix is ​​so difficult to diagnose that the doctor, even after examination, cannot draw appropriate conclusions about the diagnosis without special tests in a professional laboratory. Treatment in each case is individual and is prescribed after the diagnosis is strictly under the supervision of doctors.

Diagnosis of diseases of the cervix

In order to correctly determine what kind of pathology of the cervix the patient has, it is necessary to fully examine the person and conduct the following studies:

• Cytological examination. It includes scraping of the epithelium, which allows to determine the development of cancerous or even precancerous diseases
• Swabs for infections and flora. Materials for examination are collected from the mucosa, after which, during the laboratory examination, the tissues are stained with special means. This allows you to determine the presence of fungal infections and bacteria in the body
• Colposcopy. Detailed examination using a binocular-like colposcope with built-in illumination. This allows you to view and enlarge the examined areas in detail, and a twenty-fold increase provides the corresponding result. Colposcopes can be either digital or optical or video colposcopes
• Biopsy. At the same time, some tissues are taken in order to be studied separately later. This is one of the most accurate and correct methods for diagnosing diseases and pathologies of the cervix. A biopsy allows you to examine the cervix to detect early cancer or precancerous cells
• Cervicoscopy.