Cervical cancer is one of the most common cancers among women throughout the world. In the United States, it is estimated that approximately 75% of women will contract human Papillomavirus (“HPV”) infection, a sexually transmitted virus that causes cervical cancer. Carcinoma of the cervix is one of the most common malignancies in women. It accounts for 5,000 deaths in the United States each year.
Cervical cancer begins in the cervix, which is at the bottom of the uterus. The cervix connects the body of the uterus to the vagina. The part of the cervix closest to the body of the uterus is called the endocervix. The part next to the vagina is the exocervix (or ectocervix). The 2 main types of cells covering the cervix are squamous cells (on the exocervix) and glandular cells (on the endocervix). The place these 2 cell types meet is called the transformation zone. The transformation zone is the area located in the cervix where precancerous and cancerous changes are most likely to occur.
There are two main types of cells covering the cervix: flat, scale-like squamous cells (on the exocervix) and rectangular columnar glandular cells (on the endocervix). These cell type meet in what is called the transformation zone. Most cervical cancers begin in the cells lining the cervix in this transformation zone. Initially, precancerous lesions are confined above the basement membrane of the surface of the cervix. But if they progress, these cells can migrate to healthy cervical tissue as invasive carcinoma.
This typically happens quite slowly. It can take years and even decades for an HPV infection to advance to cervical cancer. This means there is usually time to head of cervical cancer before it advances.
The Development of Cervical Cancer
Cervical cancers and cervical pre-cancers are classified by how they look under a microscope. There are 2 main types of cervical cancer: squamous cell carcinoma and adenocarcinoma. About 80% to 90% of cervical cancers are squamous cell carcinomas. These cancers start in the squamous cells that cover the surface of the exocervix. Under the microscope, this type of cancer is made up of cells that resemble normal squamous cells.
The prognosis of cervical cancer largely depends on the stage of the cancer. How much of the cervix is impacted is also an important variable in the patient’s prognosis? Like most cancer, early detection is critical, and this is why so many cervical cancer malpractice cases involve the failure to promptly diagnose and treat. If cervical cancer is detected early – when it is precancerous or Stage I — the cure rates are quite promising. The five-year survival rate for early-stage cervical cancer is approximately 90%.
If cervical cancer is detected early — when it is precancerous or Stage I — the cure rates are quite promising. The five-year survival rate for early stage cervical cancer is approximately 90%. But in the latter stage, when it has spread beyond the cervix and upper part of the vagina, mortality significantly increases.
Cervical cancer is one of the few cancers that can be diagnosed early and cured with appropriate evaluation and treatment. The key to early detection is screening programs based on the Papanicolaou (Pap) smear and a pelvic examination. The Pap smear is a screening test of cells from the cervix to determine if there are abnormalities. Significant abnormalities require colposcopy and biopsy.
Cervical cancer typically originates in the cells lining the cervix. These cells do not suddenly change into cancer. The normal cells of the cervix gradually develop pre-cancerous changes that turn into cancer. There are a number of terms physicians use to describe these pre-cancerous changes, including cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL), and dysplasia. Whatever you call them, these changes can be detected by the Pap test and treated to prevent cancer from developing.
What Your Gynecologist Must Do
Gynecologists have a duty to properly screen, diagnose and treat cervical cancer in their patients. Proper screening and diagnosis include not only performing a pap smear and HPV test but also interpreting the results correctly. This screening is particularly effective at catching squamous cell cervical cancer, which is the most common. Squamous cell cervical cancer is often defeated by screening because the cells typically incubate for quite some time before they become cancerous.
There are, however, limitations to the Pap smear. A Pap smear may contain only a small number of abnormal cells among 50,000 to 300,000 normal cells. Pap smears also do not identify cervical disease in some women, which leads to a false negative that can delay treatment.
Cervical cancer diagnosed at an early stage can be treated with radiation or surgery. A surgical excision of the cervix or a hysterectomy can be curative for early-stage cervical cancer.
Cervical Cancer Misdiagnosis
Cervical cancer misdiagnosis medical malpractice lawsuit most commonly involve the giving or interpreting of Pap smears. Sometimes doctors simply fail to follow-up on a Pap smear that demands further workup. An abnormal test is not a “let’s wait and see how it goes” situation. What is required is a colposcopy and biopsy.
In other cases, the mistake is in interpreting the result not incorrectly identifying errors in the collection process that would distort the results. What happens after a Pap smear is that a trained cytotechnologist screens the smear and evaluates the sample for adequacy and any evidence of abnormal cells. The cytotechnologist will forward to a pathologist Pap smears they believe may be abnormal. Any breakdown or mistake in this process can lead to a misdiagnosis that results in a malpractice lawsuit.
You can find examples of cervical cancer misdiagnosis and the settlement and verdicts in those cases here.