Cervical cancer is cancer that starts in the cervix, the lower part of the uterus (womb) that opens at the top of the vagina.

Cancer - cervix

Worldwide, cervical cancer is the third most common type of cancer in women. It is much less common in the United States because of routine use of Pap smears.

Cervical cancers start in the cells on the surface of the cervix. There are two types of cells on the cervix's surface: squamous and columnar. The majority of cervical cancers are from squamous cells.

The development of cervical cancer is usually very slow. It starts as a precancerous condition called dysplasia. This precancerous condition can be detected by a Pap smear and is 100% treatable. That is why it is so important for women to get regular Pap smears. Most women that are diagnosed with cervical cancer today have not had regular Pap smears or they have not followed up on abnormal results.

Undetected, precancerous changes can develop into cervical cancer and spread to the bladder, intestines, lungs, and liver. It can take years for precancerous changes to turn into cervical cancer. Patients with cervical cancer do not usually have problems until the cancer is advanced and has spread.

Almost all cervical cancers are caused by HPV (human papilloma virus). HPV is a common virus that is spread through sexual intercourse. There are many different types of HPV. Some strains lead to cervical cancer. (Other strains may cause genital warts, while others do not cause any problems at all.)

Other risk factors for cervical cancer include:

• Having sex at an early age
• Multiple sexual partners
• Sexual partners who have multiple partners or who participate in high-risk sexual activities
• Women whose mothers took the drug DES (diethylstilbestrol) during pregnancy in the early 1960s to prevent miscarriage
• Weakened immune system
• Poor economic status (may not be able to afford regular Pap smears)

Most ot the time, early cervical cancer has no symptoms. Symptoms that may occur can include:

• Continuous vaginal discharge, which may be pale, watery, pink, brown, bloody, or foul-smelling
• Abnormal vaginal bleeding between periods, after intercourse, or after menopause
• Periods become heavier and last longer than usual
• Any bleeding after menopause

Symptoms of advanced cervical cancer may include:

• Loss of appetite
• Weight loss
• Fatigue
• Pelvic pain
• Back pain
• Leg pain
• Single swollen leg
• Heavy bleeding from the vagina
• Leaking of urine or feces from the vagina
• Bone fractures

Precancerous changes of the cervix and cervical cancer can not be seen with the naked eye. Special tests and tools are needed to spot such conditions.

Pap smears screen for precancers and cancer, but do not offer the final diagnosis. If abnormal changes are found, the cervix is usually examined under magnification. This is called colposcopy. Pieces of tissue are surgically removed (biopsied) during this procedure and sent to a laboratory for examination.

Other tests may include:

• Endocervical curettage (ECC) to examine the opening of the cervix
• Cone biopsy

If the woman is diagnosed with cervical cancer, the health care provider will order more tests to determine how far the cancer has spread. This is called staging. Tests may include:

• CT scan
• Cystoscopy
• MRI
• Chest x-ray
• Intravenous pyelogram (IVP)

Treatment of cervical cancer depends on the stage of the cancer, the size and shape of the tumor, the age and general health of the woman, and her desire to have children in the future.

Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. There are various surgical ways to do this without removing the uterus or damaging the cervix, so that a woman can still have children in the future.

Types of surgery for early cervical cancer include:

• LEEP (loop electrosurgical excision procedure) -- uses electricity to remove abnormal tissue
• Cryotherapy -- freezes abnormal cells
• Laser therapy -- uses light to burn abnormal tissue

A hysterectomy(removal of the uterus but not the ovaries) is not often performed for cervical cancer that has not spread. It may be done in women who have repeated LEEP procedures.

Treatment for more advanced cervical cancer may include:

• Radical hysterectomy, which removes the uterus and much of the surrounding tissues, including internal lymph nodes and upper part of the vagina.
• Pelvic exenteration, an extreme type of surgery in which all of the organs of the pelvis, including the bladder and rectum, are removed

Radiation may be used to treat cancer that has spread beyond the pelvis, or cancer that has returned. Radiation therapy is either external or internal.

• Internal radiation therapy uses a device filled with radioactive material, which is placed inside the woman's vagina next to the cervical cancer. The device is removed when she goes home.
• External radiation therapy beams radiation from a large machine onto the body where the cancer is located. It is similar to an x-ray.

Chemotherapy uses drugs to kill cancer. Some of the drugs used for chemotherapy for cervical cancer include 5-FU, cisplatin, carboplatin, ifosfamide, paclitaxel, and cyclophosphamide. Sometimes radiation and chemotherapy are used before or after surgery.

National Cervical Cancer Coalition - http://www.nccc-online.org/

Many factors influence the outcome of cervical cancer. These include:

• The type of cancer
• The stage of the disease
• The age and general physical condition of the woman

Pre-cancer conditions are completely curable when followed up and treated properly. The chance of being alive in 5 years (5-year survival rate) for cancer that has spread to the inside of the cervix walls but not outside the cervix area is 92%.

However, the 5-year survival rate falls steadily as the cancer spreads into other areas.

• Some types of cervical cancer do not respond well to treatment.
• The cancer may come back (recur) after treatment.
• Women who have treatment to save the uterus have a high risk of the cancer coming back (recurrence).
• Surgery and radiation can cause problems with sexual, bowel, and bladder function.

Call your health care provider if you:

• Are a sexually active woman who has not had a Pap smear in the past year
• Are at least 20 years old and have never had a pelvic examination and Pap smear
• Think your mother may have taken DES when she was pregnant with you
• Have not had regular Pap smears (ask your health care provider how often you should have one performed)

A new vaccine to prevent cervical cancer is now available. In June 2006, the U.S. Food and Drug Administration approved the vaccine called Gardasil, which prevents infection against the two types of HPV responsible for the majority of cervical cancer cases. Studies have shown that the vaccine appears to prevent early-stage cervical cancer and precancerous lesions. Gardasil is the first approved vaccine targeted specifically to prevent any type of cancer.

Practicing safe sex (using condoms) also reduces your risk of HPV and other sexually transmitted diseases. HPV infection causes genital warts. These may be barely visible or several inches wide. If a woman sees warts on her partner's genitals, she should avoid intercourse with that person.

To further reduce the risk of cervical cancer, women should limit their number of sexual partners and avoid partners who participate in high-risk sexual activities.

Getting regular Pap smears can help detect precancerous changes, which can be treated before they turn into cervical cancer. Pap smears work very well in spotting such changes, but they must be done regularly. Annual pelvic examinations, including a pap smear, should start when a woman becomes sexually active, or by the age of 20 in a nonsexually active woman. If abnormal changes are seen, a colposcopy with biopsyshould be performed.

See also: Physical exam frequency

If you smoke, quit. Cigarette smoking is associated with an increased risk of cervical cancer.

Armstrong C. ACIP Releases Recommendations on Quadrivalent Human Papillomavirus Vaccine. Am Fam Physician. May 1, 2007;75(9);1391-1380.

Kahn JA. HPV vaccination for the prevention of cervical intraepithelial neoplasia. N Engl J Med. 2009 Jul 16;361(3):271-8.

Noller KL. Intraepithelial neoplasia of the lower genital tract (cervix, vulva): Etiology, screening, diagnostic techniques, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 28.

NCCN Clinical Practical Guidelines in Oncology: Cervical cancer. V.1.2010. National Comprehensive Cancer Network, Inc. Available at www.nccn.org. Accessed December 28, 2009.

Cervical dysplasia is the abnormal appearance of cells on the surface of the cervix when they are looked at underneath a microscope. Although this is not cancer, it is considered a precancerous condition.

Dysplasia that is seen on a Pap smear is described using the term squamous intraepithelial lesion (SIL). These changes may be graded as:

• Low-grade (LSIL)
• High-grade (HSIL)
• Possibly cancerous (malignant)

Dysplasia that is seen on a biopsy of the cervix uses the term cervical intraepithelial neoplasia (CIN), and is grouped into three categories:

• CIN I -- mild dysplasia
• CIN II -- moderate to marked dysplasia
• CIN III -- severe dysplasia to carcinoma in situ

Cervical intraepithelial neoplasia (CIN); Precancerous changes of the cervix

Most cases of cervical dysplasia occur in women ages 25 - 35, although it can develop at any age.

Almost all cases of cervical dysplasia or cervical caner are caused by human papilloma virus (HPV). HPV is a common virus that is spread through sexual contact. There are many different types of HPV. Some types lead to cervical dysplasia or cancer.

The following may increase your risk of cervical dysplasia:

• Becoming sexually active before age 18
• Giving birth before age 16
• Having multiple sexual partners
• Having other illnesses or using medications that suppress your immune system
• Smoking

There are usually no symptoms.

A pelvic examination is usually normal.

A Pap smear that shows abnormal cells or cervical dysplasia needs further testing.

• Colposcopy-directed biopsy is done to confirm the condition and determine its severity
• Cone biopsy
• Follow-up Pap smears may be done for mild abnormalities

An HPV DNA test can identify the high-risk types of HPV that are known to cause cervical cancer. This may be done:

• As a screening test for women over age 30
• For women of any age who have a slightly abnormal Pap test result

It can take 10 years or longer for cervical dysplasia to develop into cancer.

Treatment depends on the degree of dysplasia.

• Mild dysplasia (LSIL or CIN I) may go away on its own. You may only need careful observation by your doctor with repeat Pap smears every 3 - 6 months. If it lasts for 2 years, treatment is usually recommended.

Treatment for moderate to severe dysplasia or mild dysplasia that does not go away may include:

• Cryosurgery
• Electrocauterization
• Laser vaporization to destroy the abnormal tissue
• LEEP procedure using electrocautery to remove abnormal areas
• Surgery to remove the abnormal tissue (cone biopsy)

Rarely, a hysterectomy may be recommended. Women with dysplasia need consistent follow-up, usually every 3 to 6 months or as recommended by their provider.

Early diagnosis and prompt treatment cure nearly all cases of cervical dysplasia.

Without treatment, 30 - 50% of cases of severe cervical dysplasia may lead to invasive cancer. The risk of cancer is lower for mild dysplasia.

The condition may return.

Call for an appointment with your health care provider if you are age 21 or older and have never had a pelvic examination and Pap smear.

See: Physical exam frequency

Ask your health care provider about the HPV vaccine. Girls who receive this vaccine before they become sexually active reduce their chance of getting cervical cancer by 70%.

To reduce the chance of developing cervical dysplasia:

• Don't smoke, as it increases your risk of developing more severe dysplasia and cancer if you do have an HPV infection
• Get vaccinated for HPV between ages 9 and 26
• Practice monogamy
• Use condoms during intercourse
• Wait until you are 18 or older before becoming sexually active

ACOG Practice Bulletin No. 99: management of abnormal cervical cytology and histology. Obstet Gynecol. 2008;112(6):1419-1444.

Wright TC Jr, Massad LS, Dunton CJ, et al. American Society for Colposcopy and Cervical Pathology-sponsored Consensus Conference: 2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcihnoma in situ. Am J Obstet Gynecol. 2007;197(4):340-345.

Wright TC Jr, Massad LS, Dunton CJ, et al. American Society for Colposcopy and Cervical Pathology-sponsored Consensus Conference: 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol. 2007;197(4):346-355.

Kahn JA. HPV vaccination for the prevention of cervical intraepithelial neoplasia. N Engl J Med. 2009;361:271-278.

The cervix is the tissue that leads from the uterus into the vagina.

Cervical cancer is one of the most common cancers in women. It is a cancer of the epithelial tissue of the cervix. Pap smear is the screening procedure used to detect cervical cancer. Limited or early cervical cancer (carcinoma in situ, or cervical intraepithelial neoplasia, or dysplasia) requires treatment with ablation therapy, usually in the form of cervical cryotherapy, or a more extensive procedure, called conization, which removes more tissue.

Ablation therapy is frequently performed using a cryoprobe. A hollow metal probe, through which flows extremely cold liquid nitrogen, is inserted into the vagina and applied to the cervix and held in place for 5-10 minutes. This freezes, and thus destroys, the superficial tissues of the cervix which contains the dysplastic tissue.

Conization is a procedure in which a "cone" of tissue is removed. This procedure is performed for more advanced cervical dysplasia, which remains limited to the cervix (cervical intraepithelial neoplasia, high grade). It allows the surgeon to remove more cervical tissue. Conization is performed using either a knife, laser, or electrocautery. LEEP, or the loop electrosurgical excision procedure is the term used for conization electrocautery. In this procedure, an electric current is run through a loop of wire, which is used to perform the conization. It is the most common method used for conization.

If the tissue removed by conization shows residual tumor, or invasive cancer, then further treatment is necessary. This often consists of surgical removal of the uterus and cervix (hysterectomy).

Review Date: 02/28/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Almost all cervical cancers are caused by HPV (human papilloma virus). HPV is a common virus that is spread through sexual intercourse and other contact.

Male and female condoms cannot fully protect you because the virus or warts can be on the skin. Nonetheless, condoms reduce your risk, and you should still use them at all times. HPV can be passed from person to person even when there are no visible warts or other symptoms.

To further reduce the risk of cervical cancer, women should limit the number of their sexual partners and avoid partners who participate in high-risk sexual activities.

If you smoke, quit. Cigarette smoking is associated with an increased risk of cervical cancer.

Two vaccines are available to protect against four of the HPV types that cause most cervical cancer in women. The vaccine is given as a series of three shots. It is recommended for girls and women ages 9 - 26.

It is best for girls to receive the vaccine by age 11 or before becoming sexually active. However, even girls and younger women who have already been sexually active can still gain protection from the HPV vaccine.

Cervical cancer usually develops very slowly. It starts as a precancerous condition called dysplasia. This precancerous condition can be detected by a Pap smear and is 100% treatable.

That is why it is so important for women to get regular Pap smears. Most women who are diagnosed with cervical cancer today have not had regular Pap smears or they have not followed up on abnormal Pap smear results.

Screening should start at age 21. After the first test:

• Woman should have a Pap smear ever 2 years to check for cervical cancer.
• If you are over age 30 or your Pap smears have been negative three times in a row, your doctor may tell you that you need a Pap smear only every 3 years.
• If you or your sexual partner have other new partners, you should have a Pap smear every 2 years.
• After age 65 - 70, most women can stop having Pap smears as long as they have had three negative tests within the past 10 years.
• If you have a new sexual partner after age 65, you should begin having Pap smear screening again.

Smith RA, Cokkinides V, Brooks D, Saslow D, Brawley OW. Cancer screening in the United States, 2010: a review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin. 2010 Mar-Apr;60(2):99-119.

Pham H, Geraci SA, Burton MJ; CDC Advisory Committee on Immunization Practices. Adult immunizations: update on recommendations. Am J Med. 2011 Aug;124(8):698-701.

Kahn JA. HPV vaccination for the prevention of cervical intraepithelial neoplasia. N Engl J Med. 2009 Jul 16;361(3):271-8.

Review Date: 11/08/2011

Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Recent advances have increased treatment options for every stage of cervical cancer. Research into complimentary therapies have provided patients with effective ways to reduce symptoms, increase treatment efficacy, and lower the risk of recurrence. Surgical advances have made cervical cancer treatment possible for the small number of women diagnosed during pregnancy.

Stage IA1 is the most advanced form of cervical cancer where it is still possible to remove the cancer without purposely terminating the pregnancy. The only option here is cone biopsy. The removed tissue will be investigated to ensure the cancer was completely removed and had not spread to other tissues. If it has spread, fewer options will be available.

Stage 0 is also referred to cancer in situ. Most doctors consider this stage to actually be pre-cancerous because cells have not yet penetrated beyond the surface of the cervix. Numerous surgical options may be used, including:

• cone biopsy
• laser surgery
• cold knife conization
• loop electrosurgical excision
• cryosurgery

The choice of procedure at stage 0 will depend on the doctor's training, tools available, and the option deemed safest for the pregnancy. Regardless of the stage at diagnosis and success of the initial procedure, there is a risk of recurrence. The doctor will need to perform Pap smears or other investigation regularly to ensure the widest range of treatment options in case of recurrence.

Cancers at stage IB or higher have progressed beyond the surface of the cervix, and there is no effective treatment possible with continued pregnancy. Radical hysterectomy followed by radiation is the typical choice should the determination be to end the pregnancy. Other options may be available for women who would like to try to have another baby after recovery from surgery.

It may be possible to continue the pregnancy until the baby is developed enough to be delivered via Cesarean section. Neonatal care has advanced a great deal, and babies born as early as 27 weeks have good survival odds with the right staff and technology. Cervical cancer treatment can proceed according to the doctor's recommendations after delivery.

Cervical polyps are fingerlike growths on the lower part of the uterus that connects with the vagina (cervix).

The cause of cervical polyps is not completely understood. They may occur with:

• An abnormal response to increased levels of the female hormone, estrogen
• Chronicinflammation
• Clogged blood vessels in the cervix

Cervical polyps are common, especially in women over age 20 who have had children. Polyps are rare in young women who have not started their period (menstruation).

Most women have only one polyp, but some women have two or three.

• Abnormally heavy periods (menorrhagia)
• Abnormal vaginal bleeding
  • After douching
  • After intercourse
  • After menopause
  • Between periods
• White or yellow mucus (leukorrhea)

Polyps may not cause symptoms.

During a pelvic examination, the health care provider will see smooth, red or purple, fingerlike growths on the cervix. A cervical biopsy will most often show cells that are consistent with a benign polyp. Rarely there may be abnormal, precancerous, or cancer cells in a polyp.

The health care provider can remove polyps during a simple, outpatient procedure. Gentle twisting of a cervical polyp may remove it. Larger polyps may require removal with electrocautery.

Although most cervical polyps are not cancerous (benign), the removed tissue should be sent to a laboratory and checked further.

Typically, polyps are not cancerous (benign) and easy to remove. Polyps do not usually grow back. Women who have polyps are at right of growing more polyps.

Some cervical cancers may first appear as a polyp. There may be bleeding and slight cramping for a few days after removal of a polyp.

Call for an appointment if you have:

• Abnormal bleeding from the vagina
• Abnormal discharge from the vagina
• Abnormally heavy periods

Call your health care appointment to schedule regular gynecological exams and to determine how often you should receive a Pap smear .

See your health care provider to treat infections as soon as possible.

Katz VL. Benign gynecologic lesions: Vulva, vagina, cervix, uterus, oviduct, ovary. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 18.

A computed tomography (CT) scan of the cervical spine is an imaging method that uses x-rays to create cross-sectional pictures of the neck.

CAT scan - cervical spine; Computed axial tomography scan - cervical spine; Computed tomography scan - cervical spine

You will be asked to lie on a narrow table that slides into the center of the CT scanner. You will lie on your back with your arms at your sides.

Once you are inside the scanner, the machine's x-ray beam rotates around you. (Modern "spiral" scanners can perform the exam in one continuous motion.)

Small detectors inside the scanner measure the amount of x-rays that make it through the neck. A computer takes this information and uses it to create several individual images, called slices. These images can be stored, viewed on a monitor, or printed on film. Three-dimensional models of the cervical spine can be created by stacking the individual slices together.

You must be still during the exam, because movement causes blurred images. You may be told to hold your breath for short periods of time.

The scan should take 15 - 30 minutes.

Certain exams require a special dye, called contrast, to be delivered into the body before the test starts. Contrast can highlight specific areas inside the body, which creates a clearer image.

Some people have allergies to IV contrast and may need to take medications before their test in order to safely receive this substance.

Contrast can be given in different ways:

• It may be delivered through a vein (IV) in your hand or forearm.
• It may be given as an injection into the space surrounding the spinal cord.

If contrast is used, you may also be asked not to eat or drink anything for 4-6 hours before the test.

If you weigh more than 300 pounds, have your doctor contact the scanner operator before the exam. CT scanners have a weight limit. Too much weight can cause damage to the scanner's working parts.

Since x-rays have difficulty passing through metal, you will be asked to remove jewelry and wear a hospital gown during the study.

Some people may have discomfort from lying on the hard table.

Contrast given through an IV may cause a slight burning sensation, a metallic taste in the mouth, and a warm flushing of the body. These sensations are normal and usually go away within a few seconds.

CT rapidly creates detailed pictures of the body, including the cervical spine. The test may be used to:

• Evaluate birth defects of the cervical spine in children
• Evaluate other spine problems when a spine MRI cannot be used
• Evaluate the upper spine after severe trauma
• Find fracturesand other bone injuries

Results are considered normal if the cervical spine is normal in appearance.

Abnormal results may be due to:

• Birth defects of the cervical spine
• Bone problems
• Fracture

CT scans and other x-rays are strictly monitored and controlled to make sure they use the least amount of radiation. CT scans do create low levels of ionizing radiation, which has the potential to cause cancer and other defects. However, the risk associated with any individual scan is small. The risk increases as numerous additional studies are performed.

In some cases, a CT scan may still be done if the benefits greatly outweigh the risks. For example, it can be more risky not to have the exam, especially if your health care provider thinks you might have cancer.

The most common type of contrast given into a vein contains iodine. If a person with an iodine allergy is given this type of contrast, nausea or vomiting, sneezing, itching, or hives may occur. Let your doctor know if you have ever had an allergic reaction to injected contrast dye.

If you absolutely must be given such contrast, your doctor may choose to treat you with antihistamines (such as Benadryl) or steroids before the test.

The kidneys help filter the iodine out of the body. Therefore, those with kidney disease or diabetes should receive plenty of fluids after the test, and be closely monitored for kidney problems. If you have diabetes or are on kidney dialysis, talk to your health care provider before the test about your risks.

Before receving the contrast, tell your health care provider if you take the diabetes medication metformin (Glucophage) because you may need to take extra precautions.

Rarely, the dye may cause a life-threatening allergic response called anaphylaxis. If you have any trouble breathing during the test, you should notify the scanner operator immediately. Scanners come with an intercom and speakers, so the operator can hear you at all times.

Hockberger RS, Kaji AH, Newton EJ. Spinal injuries. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa: Mosby Elsevier;2006:chap 40.

Bagley LJ. Imaging of spinal trauma. Radiol Clin North Am. 2006;44:1-12, vii.

Click and drag the slider bar to view cervical dilation.

If you have previously delivered a child, your cervix looks slot-shaped at 0 centimeters, not round.

During early labor your cervix dilates from 0 to 4 centimeters. Mild contractions, about 60 to 90 seconds in length, occur every 2 to 5 minutes.

You've entered the active phase of labor, which means your cervix is dilating from 4 to 10 centimeters, contractions have grown stronger. They're occurring once every 1 and half to 3 minutes or so, and are lasting about 45 seconds long. If desired, you may get an epidural at this point.

Near the active phase of labor you arrive at the transition phase; your cervix dilates from 8 to 10 centimeters.

At 10 centimeters, your cervix is fully dilated and you are ready to start pushing with every contraction.

Review Date: 09/16/2009

Dan Sacks MD, FACOG, Obstetrics & Gynecology in Private Practice, West Palm Beach, FL. Review provided by VeriMed Healthcare Network.

Abnormal results from a routine Pap test or the appearance of cervical cancer symptoms will trigger diagnostic procedures to confirm a diagnosis. The most common of these is the colposcopy, which involves magnification and is almost entirely non-invasive, combined with biopsy of the abnormal tissue and inspection of the pelvic lymph for swelling. Cervical biopsy is the first step toward staging the cancer. If the abnormal area is relatively small, a cone biopsy may be used immediately to remove all affected tissue.

Lab tests will be run on any tissue removed. For a cone biopsy, this will include a check for positive margins. Cancer cells found at the edge of the tissue can mean there was cancerous tissue left behind. Beginning with the Pap smear, lab tests will be ordered to determine whether the abnormal cells constitute an adenoma or squamous cell growth. This determination is an important factor in defining a successful treatment plan.

There are many theories on the ultimate causes of cancer, but it is generally acknowledged to be damage to the DNA that results in rapid cellular reproduction. Damaged cells will retain some of the characteristics of their origin. Squamous cells make up epithelial tissue throughout the body, including the skin, digestive lining, vaginal lining, and the surface of the cervix.

Squamous cell cancers are the most common and relatively easier to treat than other forms. They are also the easiest to diagnose with abnormal cells appearing on the surface of the cervix. Adenomatous abnormalities, on the other hand, may be located higher in the cervical canal.

Adenomatous tissue originates in glands, which are where hormones and other biochemicals are synthesized to regulate metabolism and other processes. Adenocarcinoma is often treated more aggressively when detected early enough for surgery alone to present a high possibility of success. Doctors typically prefer to perform a simply hysterectomy after diagnosis of adenocarcinoma. This is in part due to the difficulty with differentiating the most aggressive adeno-squamous cancer from adenocarcinoma. Cone biopsy and other options may still be used first, if the goal is preserving reproductive function.

A cervical magnetic resonance imaging (MRI) scan is a noninvasive method to create detailed pictures of the part of the spine that runs through the neck area. This area is called the cervical spine. It consists of seven vertebrae and eight pairs of spinal nerves (called C1 to C8).

Unlike x-raysand computed tomographic (CT) scans, which use radiation, MRI uses powerful magnets and radio waves. The MRI scanner contains the magnet. The magnetic field produced by an MRI is about 10 thousand times greater than the earth's.

The magnetic field forces hydrogen atoms in the body to line up in a certain way (similar to how the needle on a compass moves when you hold it near a magnet). When radio waves are sent toward the lined-up hydrogen atoms, they bounce back, and a computer records the signal. Different types of tissues send back different signals.

Single MRIimages are called slices. The images can be stored on a computer or printed on film. One exam produces dozens or sometimes hundreds of images.

MRI - cervical spine; MRI - neck

You may be asked to wear a hospital gown or clothing without metal fasteners (such as sweatpants and a t-shirt). Certain types of metal can cause inaccurate images.

You will lie on your back on a narrow table, which slides into the middle of the MRI machine.

Some exams require a special dye (contrast). The dye is usually given before the test through a vein (IV) in your hand or forearm. The dye helps the radiologist see certain areas more clearly.

During the MRI, the person who operates the machine will watch you from another room. Several sets of images are usually needed, each taking 2 - 15 minutes. Depending on the type of equipment, the exam may take 1 hour or longer.

You may be asked not to eat or drink anything for 4 - 6 hours before the scan.

Before the test, tell the radiologist if you are currently receiving dialysis, as this may affect whether you can have IV contrast.

If you fear confined spaces (have claustrophobia), tell your doctor before the exam. You may be given a medicine to help you feel sleepy and less anxious, or your doctor may recommend an "open" MRI, in which the machine is not as close to the body.

The strong magnetic fields created during an MRI can interfere with certain implants, particularly pacemakers. People with cardiac pacemakers cannot have an MRI and should not enter an MRI area.

You may not be able to have an MRI if you have any of the following metallic objects in your body:

• Brain aneurysm clips
• Certain artificial heart valves
• Inner ear (cochlear) implants
• Recently placed artificial joints
• Some older types of vascular stents

Tell your health care provider if you have one of these devices when scheduling the test, so the exact type of metal can be determined.

Before an MRI, sheet metal workers or any person who may have been exposed to small metal fragments should receive a skull x-ray to check for metal in the eyes.

Because the MRI contains a magnet, metal-containing objects such as pens, pocketknives, and eyeglasses may fly across the room. This can be dangerous, so they are not allowed into the scanner area.

Other metallic objects are also not allowed into the room:

• Items such as jewelry, watches, credit cards, and hearing aids can be damaged.
• Pins, hairpins, metal zippers, and similar metallic items can distort the images.
• Removable dental work should be taken out just before the scan.

An MRI exam causes no pain. Some people may become anxious inside the scanner. If you have difficulty lying still or are very anxious, you may be given a mild sedative. Excessive movement can blur MRI images and cause errors.

The table may be hard or cold, but you can request a blanket or pillow. The machine produces loud thumping and humming noises when turned on. You can wear ear plugs to help reduce the noise.

An intercom in the room allows you to speak to the person operating the scanner at any time. Some MRIs have televisions and special headphones that you can use to help the time pass.

There is no recovery time, unless you need sedation. After an MRI scan, you can resume your normal diet, activity, and medications.

This test provides detailed pictures of the cervical spine and surrounding nerves and tissues. A cervical MRI scan may be used to evaluate or diagnose:

• Birth defects of the spine
• Infection that involves your spine
• Injury or trauma to the spine
• Multiple sclerosis
• Neck pain that is severe or does not get better after treatment by your doctor
• Neck pain and weakness, numbness, or other unusual findings on physical exam
• Severe scoliosis
• Tumor or cancer in the spine

MRI usually works better than CT in evaluating herniated discs, spinal stenosis, abscesses, bone infections, tumors, or other masses near the spinal cord. While CT is better at detecting fractures of the cervical spine, MRI can detect subtle changes in the bone that may be due to infection or tumor.

Your doctor may order this test if you have back, neck, or shoulder pain (because some of the nerves in the neck affect the shoulder area).

It may also be done before spinal surgery.

Results are considered normal if the spine and surrounding nerves are normal in appearance.

Results depend on the nature of the problem. Different types of tissues send back different MRI signals. For example, healthy tissue sends back a slightly different signal than cancerous tissue.

Abnormal results may be due to:

• Cervical spondylosis
• Bone infection (osteomyelitis)
• Disk inflammation (diskitis)
• Herniated disc(cervical radiculopathy)
• Infection of the spine
• Multiple sclerosis
• Narrowing of the cervical spine (spinal stenosis)
• Spinal cord injury or compression
• Spinal fracture
• Spinal tumor

Consult your health care provider with any questions and concerns.

MRI contains no ionizing radiation. To date, there have been no documented significant side effects of the magnetic fields and radio waves used on the human body.

The most common type of contrast (dye) used is gadolinium. It is very safe. Allergic reactions to the substance rarely occur. The person operating the machine will monitor your heart rate and breathing.

MRI is usually not recommended for acute trauma situations, because tractionand life-support equipment cannot safely enter the scanner area and the exam can take quite a bit of time.

People have been harmed in MRI machines when they did not remove metal objects from their clothes or when metal objects were left in the room by others.

Tests that may be done instead of an MRI include:

• Bone scan
• CT scan
• Neck x-ray

A CT scan may be done in emergency cases, because it is faster and usually available right in the emergency room.

Wilkinson ID, Paley MNJ. Magnetic resonance imaging: basic principles. In: Grainger RC, Allison D, Adam, Dixon AK, eds. Diagnostic Radiology: A Textbook of Medical Imaging. 5th ed. New York, NY: Churchill Livingstone; 2008:chap 5.

Introduction. In: Mettler FA Jr. Essentials of Radiology. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2005:chap 1.

Cervical means pertaining to the NECK.

So it can refer to two unrelated parts of the body:

- the neck region (e.g. cervical vertebrae)

- the cervix or neck of the uterus (e.g. cervical cancer)