Cervical cancer originates in the cells of the cervix, the lower part of the uterus that connects to the vagina. People may seek medical images of this condition due to a recent diagnosis, personal concern, or a desire to understand it better. This article provides an educational visual guide, using medically accurate representations to show how the cervix appears in healthy, precancerous, and cancerous states. Content Warning: This article contains graphic medical images and descriptions for educational purposes.
Visualizing a Healthy Cervix
A healthy cervix has a uniform, pink appearance, reflecting its rich blood supply. Its surface is smooth and covers the cylindrical or conical-shaped lower portion of the uterus. This structure measures approximately 3 to 4 centimeters in length and 2.5 to 3.5 centimeters in diameter, though size can vary with age and hormonal status.
At the center of the cervix is the external os, the opening that connects the vagina to the endocervical canal leading into the uterus. In women who have not given birth, the os appears as a small, round hole. After a vaginal delivery, it takes on a more linear, slit-like shape.
The cervix is covered by two main types of cells. Squamous epithelium, which is composed of flat, layered cells, covers the outer part of the cervix visible in the vagina (the ectocervix). Columnar epithelium, made of taller, mucus-secreting cells, lines the endocervical canal. The area where these two cell types meet is called the squamocolumnar junction (SCJ), an important region for cervical health screenings.
Identifying Precancerous Changes
Precancerous conditions of the cervix involve abnormal cell growth that is not yet cancerous. These changes, known as cervical intraepithelial neoplasia (CIN) or squamous intraepithelial lesions (SIL), are asymptomatic and discovered through routine Pap tests. Visually, a cervix with precancerous lesions may look healthy to the naked eye.
To make these abnormal areas visible, clinicians apply a 3-5% acetic acid solution (similar to vinegar) to the cervix. This causes abnormal cells, which have a higher density of cellular proteins, to coagulate and turn white—a reaction known as acetowhitening. The density of this white color correlates with the severity of the cellular changes; low-grade lesions (CIN 1) appear as thin, faint white patches, while high-grade lesions (CIN 2 or 3) look densely acetowhite.
These acetowhite areas signal which parts of the cervix require further investigation. Low-grade lesions represent early cellular changes and may resolve on their own, while high-grade lesions are considered more advanced and have a greater likelihood of progressing to cancer if left untreated. The identification of these patches guides decisions about monitoring or treatment.
The Appearance of Invasive Cervical Cancer
When precancerous cells penetrate deeper into the cervical tissue or spread to other organs, it is classified as invasive cervical cancer. Unlike precancerous changes, invasive cancer creates visible abnormalities on the cervix. These changes are the source of clinical symptoms, such as abnormal vaginal bleeding, particularly after intercourse or between periods.
The visual presentation of invasive cancer can vary significantly. It may appear as an exophytic growth, which is a tumor that grows outward from the surface of the cervix. These masses may have a cauliflower-like or warty texture. They are fragile and may bleed easily upon contact.
In other instances, the cancer may manifest as an ulcerative lesion. This looks like a crater or an open sore on the cervical surface. Alternatively, the entire cervix may become enlarged, hardened, and irregularly shaped, a condition known as a “barrel cervix.” This infiltration by cancerous tissue makes the cervix firm and immobile. A cervix with invasive cancer may appear dense and chalky white after the application of acetic acid, though this effect can sometimes be hidden by bleeding.
Medical Imaging and Diagnostic Procedures
To view the cervix, a clinician first inserts a speculum into the vagina to hold the vaginal walls apart. While a direct naked-eye view is possible, a more detailed examination requires a procedure called a colposcopy.
A colposcope is a magnifying instrument that looks like a pair of binoculars on a stand. It is positioned at the vaginal opening and provides a magnified, well-lit view of the cervix. This tool does not touch the body but allows the clinician to inspect the cervical surface for any abnormalities that might be invisible to the naked eye.
If irregularities are identified, the colposcope guides the clinician in performing a biopsy. This involves taking a small tissue sample from the abnormal area. The tissue is then sent to a laboratory for microscopic analysis, which provides a definitive diagnosis of whether precancerous cells or invasive cancer is present.