Cervical Cancer from Detection to Treatment
What Is Cervical Cancer?
Cervical cancer starts in the cervix, the lower part of the uterus that connects to the vagina.
Most cervical cancers are squamous cell carcinomas, while a smaller number are adenocarcinomas.
It is strongly linked to persistent infection with high-risk human papillomavirus.
Cervical cancer starts in the cervix, the lower part of the uterus that connects to the vagina.
Most cervical cancers are squamous cell carcinomas, while a smaller number are adenocarcinomas.
It is strongly linked to persistent infection with high-risk human papillomavirus.
1. Initial Evaluation
Medical History and Physical Exam
Doctor reviews symptoms
• Abnormal vaginal bleeding
• Unusual vaginal discharge
• Pelvic pain
Risk factors checked:
• HPV infection
• Early sexual activity
• Multiple partners
• Smoking
• Weakened immune system.
Pelvic Examination
Visual and manual inspection of cervix, vagina, uterus, ovaries, and surrounding organs.
May include speculum exam to view the cervix directly.
Medical History and Physical Exam
Doctor reviews symptoms
• Abnormal vaginal bleeding
• Unusual vaginal discharge
• Pelvic pain
Risk factors checked:
• HPV infection
• Early sexual activity
• Multiple partners
• Smoking
• Weakened immune system.
Pelvic Examination
Visual and manual inspection of cervix, vagina, uterus, ovaries, and surrounding organs.
May include speculum exam to view the cervix directly.
2. Screening Tests
Pap Smear
Scraping of cervical cells for microscopic examination.
Detects precancerous | dysplastic | changes or cancer cells.
HPV Test
Detects high-risk Human Papillomavirus strains responsible for most cervical cancers.
Can be done together with the Pap test.
Pap Smear
Scraping of cervical cells for microscopic examination.
Detects precancerous | dysplastic | changes or cancer cells.
HPV Test
Detects high-risk Human Papillomavirus strains responsible for most cervical cancers.
Can be done together with the Pap test.
3. Diagnostic Procedures
Colposcopy
A special microscope magnifies the cervix.
Doctor may apply acetic acid | vinegar solution | to highlight abnormal areas.
Cervical Biopsy
Punch biopsy
Small tissue sample from suspicious area.
Endocervical curettage
Tissue scraped from inside cervical canal.
Cone biopsy
Cone-shaped section of cervix removed under anesthesia - provides diagnosis and sometimes treatment.
Colposcopy
A special microscope magnifies the cervix.
Doctor may apply acetic acid | vinegar solution | to highlight abnormal areas.
Cervical Biopsy
Punch biopsy
Small tissue sample from suspicious area.
Endocervical curettage
Tissue scraped from inside cervical canal.
Cone biopsy
Cone-shaped section of cervix removed under anesthesia - provides diagnosis and sometimes treatment.
4. Imaging and Scanning
Once cancer is confirmed, imaging is done to determine spread - staging.
Pelvic MRI
Best for evaluating tumor size and local invasion.
CT Scan
Checks for lymph node involvement or metastasis.
PET-CT Scan
Detects active cancer cells in lymph nodes or distant organs.
Cystoscopy / Proctoscopy
If tumor is advanced, these are done to check bladder or rectal invasion.
Once cancer is confirmed, imaging is done to determine spread - staging.
Pelvic MRI
Best for evaluating tumor size and local invasion.
CT Scan
Checks for lymph node involvement or metastasis.
PET-CT Scan
Detects active cancer cells in lymph nodes or distant organs.
Cystoscopy / Proctoscopy
If tumor is advanced, these are done to check bladder or rectal invasion.
5. Cancer Staging | FIGO System
I - Cancer limited to cervix.
II - Spread beyond cervix but not to pelvic wall or lower vagina.
III - Spread to pelvic wall, lower vagina, or causing kidney issues.
IV - Spread to bladder, rectum, or distant organs.
I - Cancer limited to cervix.
II - Spread beyond cervix but not to pelvic wall or lower vagina.
III - Spread to pelvic wall, lower vagina, or causing kidney issues.
IV - Spread to bladder, rectum, or distant organs.
6. Multidisciplinary Treatment Planning
A team including:
• Gynecologic Oncologist
• Radiation Oncologist
• Medical Oncologist
• Pathologist
• Radiologist
• Nurse
• Nutritionist
They discuss stage, fertility wishes, and overall health to design the best treatment plan.
A team including:
• Gynecologic Oncologist
• Radiation Oncologist
• Medical Oncologist
• Pathologist
• Radiologist
• Nurse
• Nutritionist
They discuss stage, fertility wishes, and overall health to design the best treatment plan.
7. Treatment Options
➛ Early Stages | 0 - I A/B
Conization:
Removes small early lesions; preserves fertility.
Simple or Radical Hysterectomy:
Removes uterus and cervix.
Sentinel Lymph Node Mapping or Pelvic Lymph Node Dissection
To check spread.
Trachelectomy:
Removes cervix but preserves uterus.
➛ Locally Advanced Stages | II - III
Concurrent Chemoradiation
• External Beam Radiation Therapy to pelvis.
• Brachytherapy - Internal Radiation: Radioactive sources placed inside the cervix/vagina.
• Chemotherapy given weekly during radiation to enhance effect.
➛ Advanced or Metastatic Stages | IV or recurrent
Systemic Chemotherapy:
Cisplatin, Carboplatin, Paclitaxel ± Bevacizumab.
Immunotherapy:
Pembrolizumab or Cemiplimab for PD-L1–positive or recurrent cases.
Targeted Therapy:
Bevacizumab targets blood vessels that feed tumors.
Palliative Radiation or Surgery:
To control symptoms and improve quality of life.
➛ Early Stages | 0 - I A/B
Conization:
Removes small early lesions; preserves fertility.
Simple or Radical Hysterectomy:
Removes uterus and cervix.
Sentinel Lymph Node Mapping or Pelvic Lymph Node Dissection
To check spread.
Trachelectomy:
Removes cervix but preserves uterus.
➛ Locally Advanced Stages | II - III
Concurrent Chemoradiation
• External Beam Radiation Therapy to pelvis.
• Brachytherapy - Internal Radiation: Radioactive sources placed inside the cervix/vagina.
• Chemotherapy given weekly during radiation to enhance effect.
➛ Advanced or Metastatic Stages | IV or recurrent
Systemic Chemotherapy:
Cisplatin, Carboplatin, Paclitaxel ± Bevacizumab.
Immunotherapy:
Pembrolizumab or Cemiplimab for PD-L1–positive or recurrent cases.
Targeted Therapy:
Bevacizumab targets blood vessels that feed tumors.
Palliative Radiation or Surgery:
To control symptoms and improve quality of life.
8. Supportive and Adjunctive Care
➛ Pain management & anti-nausea medications during chemo/radiation.
➛ Nutritional support to maintain weight and immunity.
➛ Psychological counseling and fertility preservation discussions.
➛ Physical therapy for post-surgical recovery and lymphedema prevention.
➛ Pain management & anti-nausea medications during chemo/radiation.
➛ Nutritional support to maintain weight and immunity.
➛ Psychological counseling and fertility preservation discussions.
➛ Physical therapy for post-surgical recovery and lymphedema prevention.
9. Follow-up and Monitoring
After Treatment:
Every 3 months for first 2 years
Every 6 months for next 3 years
Annually after 5 years
Includes:
Pelvic exams and Pap smears
Imaging | CT, MRI, or PET-CT | if recurrence suspected
Monitoring for late effects - bowel, bladder, menopause-related
After Treatment:
Every 3 months for first 2 years
Every 6 months for next 3 years
Annually after 5 years
Includes:
Pelvic exams and Pap smears
Imaging | CT, MRI, or PET-CT | if recurrence suspected
Monitoring for late effects - bowel, bladder, menopause-related
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