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Cervical cancer starts in the cells of the cervix, which has two different parts covered with two types of cells. This determines the type of cervical cancer, most often squamous cell carcinomas.
In many cases human papillomavirus (HPV) plays a role in developing cervical cancer. It can cause gene defects in normal cells of the cervix. The resulting pre-cancerous cells can later develop into cervical cancer. A Pap test can identify these pre-cancerous cells.
UCHealth specialists use several tests to diagnose cervical cancer. Your doctor will determine the right tests for your case.
The cervix is located in lower part of the uterus, so it is also called the uterine cervix.
The part of the cervix closest to the body of the uterus is the endocervix, which is covered with glandular cells. The part next to the vagina is the exocervix or ectocervix, which is covered in squamous cells. These two cell types meet at the transformation zone, which is where most cervical cancer starts.
The cells here do not suddenly change into cancer—the normal cells of the cervix first undergo pre-cancerous changes that develop into cervical cancer, including cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL), and dysplasia. We can detect these changes with Pap tests. In most cases, pre-cancerous cells will go away without any treatment. However, we believe in treating all cervical pre-cancers, as this will prevent cervical cancer in most cases.
Squamous cell carcinomas. Makes up nine out of 10 cervical cancers. These cancers develop from squamous cells in the exocervix.
Adenocarcinomas. Most of the remaining cervical cancers. They develop from the mucus-producing gland cells of the endocervix.
Adenosquamous carcinomas or mixed carcinomas. In rare cases, cervical cancers have features of both squamous cell carcinomas and adenocarcinomas.
We have made recent progress in understanding how cells of the cervix develop into cancer, plus the main risk factors.
The main cause is gene defects resulting from human papillomavirus (HPV). Genes that help cells grow, divide, and stay alive are oncogenes—genes that help keep cell growth under control or make cells die at the right time are tumor suppressor genes. HPV causes the production of two proteins—E6 and E7—which turn off some tumor suppressor genes. This can allow the cervical cells to grow too much, and to develop changes in additional genes, which in some cases leads to cancer.
Fortunately, most women with HPV don’t develop cervical cancer. If you don’t know if you have HPV, we can give you an HPV test and an HPV vaccine if necessary.