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Cervical

In anatomy, cervical is an adjective referring to any neck-like structure, with two primary usages: the cervical region of the vertebral column in the neck, and the cervix uteri (the lower part of the uterus) in female reproductive anatomy.^[1]^[2] The cervical spine consists of the seven uppermost vertebrae (C1–C7) that support the head and allow extensive head movement, protecting the spinal cord and neurovascular structures. Detailed anatomy and clinical aspects are covered in the "Cervical in Neck Anatomy" section.^[3] In gynecology, the cervix is a cylindrical structure approximately 3–4 cm long that connects the uterus to the vagina, playing key roles in menstruation, pregnancy, and childbirth. Physiological functions, pathologies, and screening are discussed in the "Cervical in Gynecology" section.^[4]

Definition and Etymology

Definition

In medicine, "cervical" is an adjective primarily denoting relation to the neck, encompassing the cervical region of the spine and its associated structures such as muscles, ligaments, and nerves.^[2] This usage highlights the anatomical area supporting the head and facilitating movement between the skull and thoracic spine.^[5] Secondarily, "cervical" refers to the cervix uteri, the narrow lower portion of the uterus that connects to the vagina, often described as the "neck" of the uterus due to its shape.^[5] This application underscores the term's versatility in describing neck-like constrictions in organs.^[6] The adjective is commonly applied in medical contexts to specify structures, pathways, or conditions in these regions, including cervical vertebrae, cervical nerves emerging from the spinal cord, cervical lymph nodes involved in immune responses, and pathologies such as cervical radiculopathy or cervical carcinoma.^[2]^[5] These designations aid precise communication in anatomy, radiology, and oncology.^[6] Historically, "cervical" has functioned as a key descriptor in anatomical nomenclature since the late 17th century, with its first recorded English usage around the 1680s to denote neck-related features, later extending to uterine contexts by the 19th century; its roots trace to Latin cervix meaning "neck," as detailed in etymological studies.^[7]

Etymology

The term "cervical" derives from the Latin cervix, meaning "neck," a word that entered English around the 1680s via the Old French cervicale or directly from the Latin cervicalis, initially referring to anatomical features pertaining to the neck.^[7] This Latin root stems from the Proto-Indo-European kerw-o-, linked to ker- (1), denoting "horn" or "head," reflecting early associations with projecting or upper body structures.^[8] The extension of "cervical" to describe the neck-like portion of the uterus arose from anatomical analogy to its cylindrical, protruding shape, with the phrase cervix uteri appearing in medical literature by the late 17th century and the adjectival form gaining usage in the 19th century.^[8] Classical anatomy profoundly influenced the term's adoption, as Latin cervix translated the Greek auchēn ("neck") employed by physicians like Galen (c. 129–c. 216 CE) for cervical structures, a convention continued and refined by Andreas Vesalius in his 1543 De humani corporis fabrica, where it described the neck alongside analogous body parts.^[9] In contemporary usage, the term achieved precise standardization through the Terminologia Anatomica (1998), issued by the Federative Committee on Anatomical Terminology, which officially designates cervix uteri for the uterine neck and related cervical descriptors to ensure consistency in international medical nomenclature.

Cervical in Neck Anatomy

Cervical Vertebrae

The cervical vertebrae comprise the uppermost seven segments of the vertebral column, designated C1 through C7, and represent the smallest and most mobile vertebrae in the spine, facilitating extensive head and neck movements while supporting the skull's weight.^[10] These vertebrae are divided into two functional groups: the upper cervical spine (C1 and C2), which are highly specialized for rotation and stability, and the subaxial cervical spine (C3 to C7), which exhibit more typical vertebral morphology adapted for flexibility.^[11] C7, often called the vertebra prominens due to its prominent spinous process, serves as a transitional element between the cervical and thoracic regions.^[10] The atlas (C1) is uniquely ring-shaped, lacking a vertebral body or spinous process, and instead features anterior and posterior arches with lateral masses that articulate with the occipital condyles of the skull and the axis below, enabling much of the head's flexion and extension.^[11] It includes bilateral transverse foramina that transmit the vertebral arteries.^[10] The axis (C2) possesses a robust vertebral body with a superiorly projecting odontoid process (dens), which acts as a pivot for the atlas during rotational movements of the head.^[11] In contrast, C7 has a long, non-bifid spinous process that is palpable at the base of the neck and smaller or absent transverse foramina compared to superior cervical vertebrae.^[10] The intermediate vertebrae (C3 to C6) share typical cervical characteristics, including small, oval-shaped bodies that are wider transversely than anteroposteriorly, short pedicles, and bifid spinous processes that provide increased surface area for muscle and ligament attachments.^[12] These bifid processes are most consistent in C2 to C4, with prevalence decreasing caudally.^[12] Compared to thoracic and lumbar vertebrae, cervical vertebrae are notably smaller, with larger vertebral foramina to accommodate the cervical spinal cord, transverse processes bearing foramina (except often in C7), and articular facets oriented to permit greater range of motion rather than the weight-bearing stability of lower spinal segments.^[12] This design supports the lighter load of head support while allowing triplanar mobility.^[11] Embryologically, the cervical vertebrae originate from the paraxial mesoderm, specifically from somites that form along the notochord starting in the third week of gestation, with approximately 42–44 somites contributing to the axial skeleton.^[13] Each vertebra arises from sclerotomes—the ventral portions of somites—through a process of resegmentation where the caudal half of one sclerotome combines with the cranial half of the next to form intervertebral boundaries.^[13] The atlas (C1) and axis (C2) develop from distinct sclerotomal contributions, with C1 forming without a centralized body and C2 incorporating the odontoid process from the first cervical sclerotome's remnants.^[13] Ossification begins with three primary centers per vertebra around the seventh week, followed by secondary centers for additional elements by the first year of life.^[10]

Cervical Spine Structure

The cervical spine comprises seven vertebrae, designated C1 through C7, interconnected by intervertebral discs, synovial facet joints, and a series of ligaments that provide stability and flexibility. Intervertebral discs, composed of a central nucleus pulposus encased by the fibrous annulus fibrosus, separate the vertebral bodies from C2-C3 to C6-C7, acting as shock absorbers during movement. Facet joints, formed by the articulation of superior and inferior articular processes, allow for gliding motions that contribute to the spine's mobility. Principal ligaments include the anterior and posterior longitudinal ligaments, which span the anterior and posterior aspects of the vertebral bodies to limit excessive flexion and extension, respectively; the ligamentum flavum, bridging the laminae to resist separation during extension; and the interspinous and supraspinous ligaments, connecting adjacent spinous processes for additional posterior support.^[3] This structural assembly forms a lordotic curvature, concave posteriorly, which optimizes shock absorption and balances the weight of the head on the spinal column. The lordosis arises primarily from the anterior wedging of the intervertebral discs and the inherent shape of the vertebral bodies, enabling efficient load distribution while maintaining postural alignment. Individual vertebrae exhibit specialized features, such as the ring-like atlas (C1) and the odontoid process of the axis (C2), which are elaborated in the Cervical Vertebrae section. The cervical spine permits a wide range of motion, including approximately 50–60° of flexion and 70–80° of extension, 45° of lateral bending to each side, and 80° of rotation to each side, facilitated by the orientation of the facet joints and muscle attachments.^[14] These synovial joints, particularly the unique atlanto-occipital and atlanto-axial articulations at the craniovertebral junction, account for much of the rotational and nodding capabilities. Biomechanically, the cervical spine supports the approximate 10-12 pounds (4.5-5.4 kg) of head weight in an upright posture, distributing compressive forces through the vertebral bodies and discs while encasing and protecting the spinal cord within its canal. This load-bearing design, combined with ligamentous restraints, ensures resilience against daily stresses without compromising neurological integrity.^[3]^[15]

Blood Supply and Innervation

The arterial supply to the cervical neck region is provided by several key vessels that ensure oxygenation of the vertebrae, spinal cord, and surrounding musculature. The paired vertebral arteries, branches of the subclavian arteries, ascend through the transverse foramina of the C1 to C6 cervical vertebrae, delivering blood to the spinal cord via the anterior and posterior spinal arteries while also contributing segmental branches to the vertebral bodies. The ascending cervical artery, originating from the thyrocervical trunk (a branch of the subclavian artery), courses upward along the anterior aspect of the cervical vertebrae, supplying the deep prevertebral muscles such as the longus colli and longus capitis, as well as contributing to the vascular network of the vertebral column. Complementing this, the deep cervical artery arises from the costocervical trunk (another subclavian branch) and runs posteriorly, providing blood to the deep posterior neck muscles, including the splenius cervicis and semispinalis cervicis, and the posterior arches of the cervical vertebrae. Venous drainage of the cervical region occurs through a valveless network that allows bidirectional flow and positional adaptability. The internal jugular veins serve as the primary collectors for superficial and deep venous return from the neck, receiving tributaries from the anterior and external jugular veins as well as direct drainage from cervical structures. The vertebral venous plexus, a complex of interconnected veins surrounding the vertebral column within and external to the vertebral canal, drains the cervical spinal cord, vertebrae, and paravertebral tissues, ultimately emptying into the internal jugular and brachiocephalic veins; this plexus is particularly important for venous outflow in the upright posture when jugular flow is reduced. Innervation of the cervical neck region involves both somatic and autonomic components derived from spinal nerve roots that exit via the intervertebral foramina between the cervical vertebrae. The cervical plexus, formed by the anterior rami of spinal nerves C1 to C4, provides sensory innervation to the skin over the neck, angle of the mandible, and posterior scalp via superficial branches like the lesser occipital, great auricular, transverse cervical, and supraclavicular nerves, while its deep branches supply motor innervation to anterior neck muscles such as the infrahyoid group and geniohyoid. The brachial plexus, arising from the anterior rami of C5 to T1, originates in the lower cervical region and extends to innervate the upper limbs, with its roots emerging through the C4 to T1 intervertebral foramina. Autonomic innervation is mediated by the cervical portion of the sympathetic trunk, which includes the superior cervical ganglion at the C2-C3 level; postganglionic sympathetic fibers from this ganglion distribute to vascular, sudomotor, and piloerector structures in the head and neck, influencing vasomotor tone and glandular secretion.

Clinical Aspects of the Cervical Neck Region

Common Disorders

Common disorders of the cervical neck region primarily involve degenerative, inflammatory, and traumatic conditions that lead to pain, stiffness, and neurological symptoms. Cervical spondylosis, a progressive degenerative process affecting the intervertebral discs, facet joints, and ligaments, is the most prevalent, characterized by age-related wear and tear. It affects approximately 85% of individuals over 60 years old, with most cases remaining asymptomatic but some presenting with localized neck pain, stiffness, and reduced range of motion due to osteophyte formation and disc dehydration.^[16] When neural structures are compressed, it can result in radiculopathy, manifesting as radiating arm pain, paresthesia, numbness, or muscle weakness along dermatomal distributions, often exacerbated by neck extension or rotation.^[16] Risk factors for accelerated spondylosis include prior spinal trauma, smoking, obesity, physical inactivity, and occupations involving prolonged neck flexion.^[16] Cervical disc herniation frequently causes radiculopathy in younger adults, occurring when the nucleus pulposus protrudes and compresses a nerve root, leading to sharp, electric-like pain radiating from the neck to the shoulder, arm, or hand.^[17] Symptoms include sensory disturbances such as tingling or numbness, motor weakness in the affected limb, and diminished deep tendon reflexes, typically unilateral and worsening with certain head positions.^[17] This condition is most common in the third and fourth decades of life, with risk factors encompassing manual labor involving heavy lifting or vibration exposure, chronic smoking, and poor posture that strains the discs.^[17] Inflammatory disorders like rheumatoid arthritis (RA) commonly target the cervical spine, particularly the atlantoaxial joint, where synovitis erodes ligaments and bone, potentially causing instability.^[18] Up to 80% of RA patients show radiographic cervical involvement, with atlantoaxial instability developing in about 44% over five years in those initially unaffected.^[18] Symptoms often include neck pain at the craniocervical junction (reported in 69% of unstable cases), occipital headaches, and, in severe instances, myelopathy signs such as limb weakness, paresthesias, hyperreflexia, or gait instability due to spinal cord compression.^[18] As many as 33-50% of cases may be asymptomatic initially, but progression can lead to significant morbidity.^[18] Traumatic injuries, such as whiplash-associated disorder, arise from rapid hyperextension-flexion forces on the neck, damaging muscles, ligaments, and facet joints.^[19] Most commonly triggered by rear-end motor vehicle collisions, symptoms typically emerge within 24 hours and include neck pain and stiffness, headaches originating at the base of the skull, and tenderness in the shoulders or upper back.^[19] Additional manifestations may involve arm tingling or numbness, dizziness, fatigue, and reduced neck mobility, with pain intensifying during movement.^[19] Risk factors predominantly include high-impact rear-end crashes, though contact sports or physical assaults can also precipitate the injury.^[19] Across these disorders, shared risk factors include aging, which heightens degenerative changes and prevalence peaking around 70-74 years; poor posture from prolonged static positions like computer use; and repetitive strain from occupational activities involving awkward neck postures or monotonous movements.^[20] Lifetime prevalence of neck pain globally ranges from 14% to 71% in adults, with a mean of about 48.5%, underscoring its commonality as a musculoskeletal complaint.^[21]

Diagnostic and Treatment Approaches

Diagnosis of cervical neck region disorders typically begins with imaging studies to assess structural integrity and pathology. X-rays are commonly used as the initial imaging modality to evaluate alignment, fractures, and degenerative changes in the cervical spine.^[22]^[23] Magnetic resonance imaging (MRI) is the preferred method for visualizing soft tissues, intervertebral discs, spinal cord compression, and nerve root involvement, offering high sensitivity for these abnormalities.^[24]^[25] Computed tomography (CT) scans provide detailed bony anatomy, particularly useful for identifying fractures, bone spurs, or foraminal stenosis when MRI is contraindicated.^[26]^[27] Electromyography (EMG) and nerve conduction studies are employed to assess nerve function, particularly in cases of suspected radiculopathy, by detecting electrical abnormalities in muscles and nerves innervated by the cervical roots.^[28]^[29] Conservative management forms the cornerstone of treatment for most cervical disorders, aiming to alleviate pain and improve function without invasive procedures. Physical therapy, including strengthening, stretching, and manual techniques, is recommended to enhance mobility and reduce symptoms.^[30]^[31] Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed to manage pain and inflammation associated with conditions like spondylosis or radiculopathy.^[32]^[30] Cervical collars provide temporary stabilization by limiting motion, promoting rest for acute injuries or post-injury recovery.^[33]^[34] For severe cases, such as significant spinal stenosis or refractory radiculopathy, surgical intervention may be indicated. Anterior cervical discectomy and fusion (ACDF) is a standard procedure that removes damaged discs and fuses vertebrae to decompress nerves and stabilize the spine, with success rates ranging from 85% to 95% in reducing pain and improving neurological function.^[35]^[36] Rehabilitation following diagnosis or treatment emphasizes restoring range of motion and strength through guided exercises. Post-treatment protocols typically include progressive physical therapy starting with gentle neck movements and advancing to isometric exercises and functional training, often beginning 2-6 weeks after surgery to prevent stiffness and support long-term recovery.^[37]^[38]

Cervical in Gynecology

Anatomy of the Cervix Uteri

The cervix uteri, or simply the cervix, is the inferior portion of the uterus, forming a narrow, cylindrical passage that connects the uterine cavity to the vagina. It measures approximately 3 to 4 cm in length and 2 to 3 cm in diameter, with the lower half projecting into the vagina as the vaginal portion (ectocervix) and the upper half located within the pelvis.^[39]^[40] The cervix is divided into the ectocervix, which is the visible part within the vagina, and the endocervix, which lines the endocervical canal. These regions are demarcated by the external os, the rounded or slit-like opening at the inferior end of the ectocervix leading into the canal, and the internal os, the superior opening connecting the canal to the uterine cavity. The ectocervix is covered by a stratified squamous epithelium, while the endocervix is lined by a simple columnar epithelium that forms branching mucin-secreting glands within the stromal tissue. The underlying stroma consists of dense fibromuscular connective tissue rich in collagen and elastic fibers, providing structural support.^[39]^[40] Microscopically, the stratified squamous epithelium of the ectocervix comprises multiple layers: basal cells at the base, followed by parabasal and intermediate polygonal cells, and superficial flattened cells that may contain glycogen. In contrast, the columnar epithelium of the endocervix forms a single layer of tall, mucus-producing cells arranged in crypts that extend up to 5-6 mm deep into the stroma. The transformation zone, a dynamic junction where the squamous and columnar epithelia meet, is a critical microscopic feature; it is the site of epithelial remodeling and is typically located on the ectocervix during reproductive years but may shift endocervically after menopause. The cervix receives its arterial blood supply primarily from branches of the uterine arteries, which arise from the internal iliac arteries and enter at the 3 and 9 o'clock positions, forming a rich submucosal plexus; venous drainage occurs via the uterine venous plexus into the internal iliac veins.^[39]^[40] Anatomical variations occur based on parity and age. In nulliparous women, the cervix is smaller and more compact, with a round external os measuring about 1 mm in diameter. In parous women, the cervix enlarges to around 4 cm in length, the external os becomes a wider, slit-like opening approximately 1 cm long due to stretching during childbirth, and eversion of the endocervical epithelium onto the ectocervix may occur, exposing more glandular tissue. These changes are influenced by hormonal factors during pregnancy and delivery.^[39]^[40]

Physiological Functions

The cervix uteri serves as a critical barrier and gatekeeper in the female reproductive tract, forming a mucus plug that seals the cervical canal to prevent ascending infections from the vagina into the uterus during pregnancy. This plug, composed primarily of gel-forming mucins produced by endocervical goblet cells, maintains a physical and antimicrobial barrier while allowing selective passage of nutrients and immune factors. During labor, the cervical os dilates progressively from approximately 0 cm to 10 cm, enabling the passage of the fetus through the birth canal in coordination with uterine contractions.^[41]^[4]^[42] Cervical glands produce mucus whose properties change cyclically to support reproductive functions, becoming viscous and thick during the luteal phase to reinforce the barrier against pathogens, while thinning to a clear, watery consistency during the follicular phase to facilitate sperm transport toward the uterus. These variations in mucus viscosity and pH, driven by the menstrual cycle, create a selective environment that nourishes sperm and promotes their motility without compromising overall protection.^[42]^[4]^[41] In reproduction, the cervix facilitates sperm capacitation by providing a biochemical medium in the mucus that removes seminal plasma factors, enhancing sperm hyperactivation and acrosome reaction necessary for fertilization. Glandular secretions from the endocervix further support implantation by contributing nutrient-rich fluids that aid embryo attachment to the endometrial lining post-fertilization. Additionally, the endocervical lining sheds during menstruation, contributing glandular cells and mucus to the menstrual flow as the uterine endometrium is expelled through the cervical canal.^[41]^[43]^[4]

Hormonal and Developmental Influences

The cervix uteri originates from the paramesonephric (Müllerian) ducts during embryonic development. These paired ducts form in the early embryo and elongate caudally, eventually fusing in the midline to give rise to the uterus, fallopian tubes, and upper vagina, including the cervix. This fusion process typically completes by the 12th week of gestation, establishing the foundational structure of the cervix as a conduit between the uterus and vagina.^[44]^[45] During puberty, rising estrogen levels drive significant morphological changes in the cervix. Estrogen stimulates overall growth and enlargement of the cervix, increasing its volume and causing eversion of the endocervical columnar epithelium onto the ectocervix, a condition known as cervical ectropion. This exposure prompts squamous metaplasia, where the columnar cells transform into stratified squamous epithelium, stabilizing the transformation zone and adapting the cervical surface to the vaginal environment. These changes reflect the estrogen-dependent maturation of the female genital tract.^[39]^[46] Hormonal fluctuations across the menstrual cycle profoundly influence cervical mucus properties, which serve as a dynamic barrier and facilitator for reproductive processes. Under rising estrogen levels in the follicular phase, cervical mucus becomes abundant, thin, clear, and elastic, promoting sperm transport. In contrast, post-ovulatory progesterone dominance thickens the mucus, rendering it viscous, opaque, and scant, thereby impeding pathogen and sperm passage to protect the upper genital tract. These cyclic alterations are mediated by estrogen stimulating glandular secretion and progesterone inducing dehydration and cellular changes in the mucus.^[47]^[43] In the postmenopausal period, declining estrogen levels lead to atrophic changes in the cervix, mirroring those in the vagina as part of genitourinary syndrome of menopause. The cervical epithelium thins, the organ shrinks and inverts, and glandular activity diminishes, reducing mucus production and altering the local microenvironment. This estrogen deficiency elevates vaginal and cervical pH from acidic to more neutral levels, diminishing protective lactobacilli and increasing susceptibility to infections and irritation.^[48]^[49]

Pathologies of the Cervix Uteri

Infections and Inflammation

Infections and inflammation of the cervix uteri, known as cervicitis, primarily arise from sexually transmitted infections (STIs) or non-infectious irritants, leading to mucosal inflammation and potential complications if untreated.^[50] Common bacterial causes include ascending infections from Chlamydia trachomatis and Neisseria gonorrhoeae, which account for 30-50% of infectious cases, often presenting as mucopurulent cervicitis.^[50] Bacterial vaginosis (BV), characterized by an imbalance in vaginal flora, predisposes women to cervicitis by facilitating the ascent of pathogens like chlamydia or gonorrhea, and is frequently associated with cervicitis, with BV detected in 30-45% of non-chlamydial/non-gonococcal cervicitis cases in some studies.^[51] Viral infections, particularly human papillomavirus (HPV), contribute as a cause of cervical inflammation, especially in persistent cases leading to epithelial changes.^[52] Inflammatory responses in the cervix often manifest as chronic cervicitis, involving persistent glandular inflammation and ectropion (eversion of the endocervical epithelium), which exposes columnar cells to the vaginal environment and causes erosion-like appearances.^[50] Nabothian cysts, benign mucus-filled retention cysts, form when nabothian glands are blocked due to chronic inflammation or squamous metaplasia, typically remaining asymptomatic but occasionally enlarging to cause pressure effects.^[53] Symptoms of cervical infections and inflammation vary but commonly include abnormal vaginal discharge (mucopurulent or increased), post-coital bleeding, and dyspareunia (painful intercourse), though up to 70% of cases are asymptomatic.^[52] Untreated infections, particularly chlamydial or gonococcal cervicitis, can ascend to cause pelvic inflammatory disease (PID), increasing risks of infertility and ectopic pregnancy.^[54] Epidemiologically, bacterial cervicitis has a prevalence of 30-40% among women attending STI clinics (high-risk populations), with global STI estimates from the World Health Organization indicating 129 million new chlamydia infections and 82 million gonorrhea cases in 2020 (with no significant updates as of 2025), predominantly causing cervicitis in women aged 15-24.^[50]^[55] HPV infections, a key viral contributor, have a global prevalence exceeding 10% in women, often leading to inflammatory lesions.^[56] Prevention through STI screening and safe sexual practices is essential to mitigate these conditions.^[54]

Neoplastic Conditions

Neoplastic conditions of the cervix encompass both benign and malignant growths, with the latter predominantly driven by human papillomavirus (HPV) infection. Benign neoplasms are relatively common and typically non-life-threatening, while malignant ones represent a major global health concern due to their potential for invasion and metastasis.

Benign Neoplasms

Cervical polyps are the most common benign neoplasm of the cervix, arising from the endocervical mucosa as finger-like projections that are often vascular and pedunculated. They frequently occur in women of reproductive age and during pregnancy, with an estimated prevalence of up to 10% among those undergoing gynecological examinations. The etiology is multifactorial, involving chronic inflammation, infection, and hormonal influences, particularly elevated estrogen levels that promote endometrial and cervical proliferation. Cervical leiomyomas, also known as fibroids, are less common in the cervix compared to the uterine corpus but represent benign smooth muscle tumors that can cause symptoms such as bleeding or prolapse if large. These tumors arise from the proliferation of cervical smooth muscle cells and are estrogen-sensitive, often regressing postmenopause.

Malignant Neoplasms

Malignant neoplasms of the cervix primarily include squamous cell carcinoma, which accounts for approximately 80-85% of cases, and adenocarcinoma, comprising about 10-20%. Both types are strongly linked to persistent infection with high-risk HPV genotypes, with nearly all cervical cancers attributable to HPV, and types 16 and 18 responsible for over 70% of cases. Persistent HPV infection disrupts cellular regulation through viral oncoproteins E6 and E7, leading to genomic instability and malignant transformation. Additional risk factors include smoking, which introduces carcinogens that exacerbate HPV effects; immunosuppression, as seen in HIV-positive individuals; and early age of sexual debut or multiple sexual partners, increasing HPV exposure. The progression of cervical neoplasia typically begins with cervical intraepithelial neoplasia (CIN), graded from 1 (mild dysplasia) to 3 (severe dysplasia/carcinoma in situ), serving as precancerous lesions. Most CIN1 lesions regress spontaneously, but persistent high-risk HPV infection can lead to progression through CIN2 and CIN3 to invasive carcinoma, a process that generally spans 10-20 years. Early detection through screening can identify these precursor lesions, allowing intervention to prevent advancement to malignancy. Staging of cervical cancer follows the International Federation of Gynecology and Obstetrics (FIGO) system, revised in 2018 to incorporate imaging for better prognostic accuracy. Stage I confines the tumor to the cervix, subdivided into IA (microscopic invasion ≤5 mm depth) and IB (visible or deeper invasion); Stage II extends beyond the uterus but not to the pelvic wall or lower third of the vagina; Stage III involves the lower vagina, pelvic sidewall, or causes hydronephrosis; Stage IVA invades adjacent organs like the bladder or rectum; and Stage IVB indicates distant metastasis. This staging guides management and predicts outcomes, with earlier stages offering higher survival rates.

Screening and Prevention

Screening for cervical cancer primarily involves cytological evaluation through the Pap smear, which detects abnormal cells in cervical samples, recommended every three years for individuals aged 21 to 29 using cervical cytology alone.^[57] For those aged 30 to 65, options include high-risk human papillomavirus (hrHPV) testing alone every five years, co-testing with cytology and hrHPV every five years, or cytology alone every three years, with screening ceasing after age 65 if there is adequate prior history.^[58] Liquid-based cytology enhances sample quality by reducing obscuring factors like blood and mucus compared to conventional methods. Abnormal results prompt colposcopy, a magnified visual examination of the cervix to identify precancerous lesions for biopsy if needed.^[57] The American College of Obstetricians and Gynecologists (ACOG) endorses these approaches, while the World Health Organization (WHO) recommends hrHPV DNA testing in a screen-and-treat strategy starting at age 30 for resource-limited settings to accelerate elimination efforts.^[59] Prevention strategies center on reducing exposure to high-risk HPV, the primary cause of cervical cancer, through vaccination with Gardasil 9, a nine-valent vaccine that prevents over 90% of infections from HPV types 16 and 18, which account for about 70% of cases.^[60]^[61] Administered in two or three doses ideally before sexual debut, it also targets five other oncogenic types.^[62] Additional measures include safe sex practices, such as consistent condom use and limiting sexual partners, which lower HPV transmission risk by up to 70%.^[63] Smoking cessation is crucial, as tobacco use doubles cervical cancer risk by impairing immune clearance of HPV; quitting reduces this elevated risk over time.^[64] Implementation of these guidelines has led to substantial global reductions in cervical cancer incidence, with organized screening programs achieving up to a 70% decrease in cases and mortality in high-uptake populations.^[65] Emerging technologies enhance accessibility and accuracy; AI-assisted cytology systems improve detection of precancerous lesions by analyzing slides with over 90% sensitivity, aiding overburdened labs in low-resource areas.^[66] Self-sampling kits for HPV testing, approved for at-home or clinic use without pelvic exams, boost participation among underserved groups by increasing convenience and privacy, with comparable accuracy to clinician-collected samples.^[67]^[68]

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Cervical Neck Pain or Cervical Radiculopathy - Radiologyinfo.org
In chronic neck pain, x-rays are usually appropriate as initial imaging. MRI without contrast may be appropriate.Missing: disorders | Show results with:disorders
[22]
Cervical MRI scan - UCSF Health
Apr 24, 2023 · A cervical MRI (magnetic resonance imaging) scan uses energy from strong magnets to create pictures of the part of the spine that runs through the neck area ( ...
[23]
Cervical Spine (Neck): What It Is, Anatomy & Disorders
Jan 18, 2022 · Your cervical spine is the first seven stacked vertebral bones of your spine. This region is more commonly called your neck.
[24]
Causes and Diagnoses of Cervical Spine Disorders
Image tests may be used to help diagnose the source of your pain, including: X-rays · Magnetic resonance imaging (MRI) · Computed tomography (CT) scans.
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EMG (Electromyography) - Cleveland Clinic
Electromyography (EMG) is a diagnostic test that evaluates the health and function of your skeletal muscles and the nerves that control them.
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[PDF] practice parameter for needle electromyographic evaluation - AANEM
Cervical radiculopathy is a common cause of morbidity. Its management often requires clinical, electrodiag- nostic, and radiological evaluation, ...
[27]
Nonoperative Management of Cervical Radiculopathy - AAFP
May 1, 2016 · Nonoperative treatment includes physical therapy involving strengthening, stretching, and potentially traction, as well as nonsteroidal anti-inflammatory drugs ...Abstract · Physical Examination · Other Causes of Cervical... · Imaging
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Conservative Treatment for a Cervical Herniated Disc - Spine-health
Conservative treatments for cervical herniated disc include rest, pain medications, physical therapy, and spinal injections.Activity Modification · Physical Therapy · Injections
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Cervical spondylosis - Diagnosis & treatment - Mayo Clinic
For people with cervical spondylosis, chiropractic adjustments can help relieve neck pain and stiffness. The chiropractor may manipulate your spine or perform ...
[30]
Cervical Collar for Neck Support: Uses, Tips, Side Effects - Healthline
Dec 17, 2019 · A cervical collar is used to support and protect your neck and spinal cord. These types of collars are typically used for the treatment of neck injuries, neck ...Uses · Different types · Side effects · Tips for wear
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When should a cervical collar be used to treat neck pain? - PMC - NIH
A hard cervical collar and a firm mattress are the standard means of immobilizing patients with documented unstable injuries in the ED or ICU before application ...
[32]
ACDF (Anterior Cervical Discectomy & Fusion) Surgery
Feb 18, 2024 · The success rate of ACDF surgery is 85% to 95%. If your goal is to significantly reduce pain and get back to your regular activities, there's a ...
[33]
Anterior Cervical Discectomy and Fusion Outcomes over 10 Years
Feb 1, 2018 · Patient self-reported success ranged from 85% to 95%. Over the long term, additional surgery for pseudarthrosis (10%) occurred in the early ...
[34]
Exercises After Your Neck Surgery
The exercises in this resource will help make your neck and shoulder muscles stronger and more flexible. This will help your shoulder and neck move and work ...
[35]
Rehabilitation after cervical and lumbar spine surgery - PMC
Aug 1, 2023 · Formal spine exercise rehabilitation should then begin at 2–3 months postoperatively, with soft-tissue mobilization, neural mobilization, joint ...
[36]
Anatomy of the uterine cervix and the transformation zone - NCBI
The cervix is a fibromuscular organ that links the uterine cavity to the vagina. Although it is described as being cylindrical in shape, the anterior and ...
[37]
The Cervix - Structure - Function - Vascular Supply - TeachMeAnatomy
The cervix is the lower portion of the uterus, forming the narrow canal that connects the vagina with the uterine cavity.Anatomical Structure · Functions · Neurovascular Supply
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https://pmc.ncbi.nlm.nih.gov/articles/PMC10441252/
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Cervix: Anatomy, Function, Changes & Conditions - Cleveland Clinic
Jun 15, 2022 · Cervix. Your cervix is a small canal that connects your uterus and vagina. It allows fluids to leave and enter your uterus.
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Physiology, Uterus - StatPearls - NCBI Bookshelf - NIH
Jul 30, 2023 · Lymph from the uterine body and cervix drains to the external and internal iliac lymph nodes, while the fundus of the uterus drains to the para ...
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Physiology, Menstrual Cycle - StatPearls - NCBI Bookshelf
Sep 27, 2024 · The uterine outflow tract, including the cervix and vagina, must remain patent to allow the outflow of menstrual fluid at the culmination of ...
[42]
Embryology, Mullerian Ducts (Paramesonephric Ducts) - NCBI - NIH
Mar 6, 2023 · The Müllerian, or paramesonephric, ducts are structures that are critical in the development of the internal genital portions of the female reproductive system.
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[PDF] Imaging of Müllerian Duct Anomalies1
Fusion of the müllerian ducts normally occurs be- tween the 6th and 11th weeks of gestation to form the uterus, fallopian tubes, cervix, and proximal two-thirds ...
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Chapter 1: An introduction to the anatomy of the uterine cervix
This chapter deals with the gross and microscopic anatomy of the uterine cervix and the physiology of the transformation zone.
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The Normal Menstrual Cycle and the Control of Ovulation - NCBI - NIH
Aug 5, 2018 · Cervix. The mucous secreting glands of the endocervix are affected by the changes in steroid hormone concentration. Immediately after ...
[46]
Cervical Ectropion - StatPearls - NCBI Bookshelf
May 31, 2023 · Cervical ectropion is a benign gynecological condition and is regarded as a normal variant that frequently occurs in women of the reproductive age group.Missing: parous anatomy
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Genitourinary Syndrome of Menopause - StatPearls - NCBI Bookshelf
Oct 5, 2024 · When estrogen levels decline, this process is disrupted, resulting in an atrophic vaginal epithelium with reduced secretions and a less ...
[48]
Cervicitis - StatPearls - NCBI Bookshelf - NIH
Jan 21, 2025 · Symptoms range from being asymptomatic to presenting mucopurulent discharge, cervical tenderness, and systemic signs. Infectious causes include ...Continuing Education Activity · Introduction · Etiology · Treatment / Management
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Cervicitis: Background, Etiology, Epidemiology - Medscape Reference
Oct 22, 2025 · A review of more than 27,000 women from 48 published reports found an overall global prevalence of 7.3% for M genitalium urogenital infection ...
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Cervicitis - Symptoms and causes - Mayo Clinic
Jan 31, 2023 · Most often, cervicitis causes no signs and symptoms, and you may only learn you have the condition after a pelvic exam performed by your doctor ...
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Nabothian Cyst - StatPearls - NCBI Bookshelf
Feb 17, 2025 · These cysts are usually asymptomatic and are often discovered incidentally during routine pelvic exams or cervical screenings. Although ...
[52]
Urethritis and Cervicitis - STI Treatment Guidelines - CDC
Because cervicitis might be a sign of upper genital tract infection (e.g., endometritis), women should be assessed for signs of PID and tested for C.Missing: epidemiology | Show results with:epidemiology
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[PDF] Chlamydia, gonorrhoea, trichomoniasis and syphilis
Conclusion Global estimates of prevalence and incidence of these four curable sexually transmitted infections remain high.
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Cervical Cancer Screening - ACOG
Women who are 21 to 29 should have a Pap test alone every 3 years. HPV testing alone can be considered for women who are 25 to 29, but Pap tests are preferred.
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Updated Cervical Cancer Screening Guidelines - ACOG
Apr 12, 2021 · There are now three recommended options for cervical cancer screening in individuals aged 30–65 years: primary hrHPV testing every 5 years, cervical cytology ...
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New recommendations for screening and treatment to prevent ...
Jul 6, 2021 · WHO suggests using either of the following strategies for cervical cancer prevention: HPV DNA detection in a screen-and-treat approach starting ...
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Efficacy of GARDASIL®9 (Human Papillomavirus 9-valent Vaccine ...
Efficacy of GARDASIL 9 in 16‐ through 26‐year‐old girls and women was assessed in an active comparator-controlled, double‐blind, randomized clinical study that ...
[58]
HPV Vaccine Efficacy - CDC
All HPV vaccines have been found to have high efficacy (close to 100%) for prevention of HPV vaccine type-related persistent infection, cervical ...
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Gardasil 9 Vaccine Protects against Additional HPV Types
Mar 2, 2015 · The efficacy rate of the 9-valent vaccine was 96.7 percent. Gardasil 9 was as effective as Gardasil at generating an antibody response against ...
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Cervical Cancer Prevention | The University of Kansas Cancer Center
Getting the HPV vaccine; Getting a Pap test; Using condoms; Not smoking; Limiting the number of sexual partners. Cervical cancer screening. Your chances for ...
[61]
Risk Factors for Cervical Cancer - American Cancer Society
Jul 1, 2025 · Learn about the risk factors for developing cervical cancer, such as HPV infection, smoking, and having a family history of cervical cancer.Missing: progression | Show results with:progression
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Eliminating Cervical Cancer: the Impact of Screening and ... - CDC
Jul 24, 2025 · This test has become the standard in cervical cancer screening in developed countries and has led to a 70% decrease in incidence and mortality ...
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AI-assisted cervical cytology precancerous screening for high-risk ...
Aug 11, 2025 · In the study, we developed an artificial intelligence-assisted cervical cancer screening system targeting populations at high risk of squamous ...
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HPV Tests with Self-Collection in a Health Setting Approved - NCI
Jul 24, 2024 · People can now be offered the option to collect a vaginal sample themselves for HPV testing if they cannot have or do not want a pelvic exam.
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Self-Sampling Devices for HPV Testing - NCBI Bookshelf - NIH
Dec 14, 2021 · These self-sampling tests may help to improve accessibility and acceptability of cervical cancer screening in certain populations. Several ...Background · The Technology · Availability · Technical Considerations