Invasive cervical cancer

Diagnosis of invasive cervical cancer

In industrialized countries, women who test positive by either Pap smear or HPV DNA tests then undergo diagnostic testing, with colposcopy, for example. Colposcopy is an examination of the vagina and cervix using a magnifying device with a powerful light source to identify abnormal areas on the cervix and to guide sampling of cervical tissue (biopsy).⁶⁶ Colposcopy must be performed by trained providers, and colposcopes are expensive. In addition, the biopsy samples must be transported to a laboratory staffed by a pathologist, which is often impossible in low-resource countries. If a woman has an abnormal Pap smear but no abnormal areas are seen by colposcopy, or the colposcopic examination is inadequate (i.e., the entire transformation zone is not seen), cells from the cervical canal can be sampled and sent to the laboratory. This procedure is called endocervical curettage.^20,67

Treatment of invasive cervical cancer

If detected early, invasive cervical cancer can be treated successfully; five-year survival for women with cancer in the earliest stage (stage 1A, in which the cancer has had minimal spread to the inside of the cervix) is estimated at 92%.³ Radical hysterectomy and radiotherapy are the recommended primary treatments for the early stages of cervical cancer but should not be used to treat precancerous lesions. For advanced disease, radiotherapy (radiation) is frequently used to cure or ease symptoms, but in developing countries it is not widely available or accessible. Radiotherapy aims to destroy cancer cells while preserving normal cells. Adverse effects include inflammation of the skin, diarrhea, and nausea. Its effectiveness depends on how far the cancer has spread beyond the cervix. Chemotherapy may also be used with hysterectomy and radiotherapy.^15,20

Photo: PATH/Mike Wang