What is Cervical Cancer?
Cervical cancer is a deadly cancer that begins in the lower end of the uterus that contacts the upper vagina called uterine cervix. Cervical cancer remains a major cause of cancer-related death in women in developing countries without access to Pap testing for cervical cancer or vaccines against human papillomaviruses (HPVs). Cervical cancer has a very high cure and survival rate if detected early. HPV Vaccination is also effective against cervical cancer.
What causes cervical cancer?
Most cervical cancers are caused by infection that has been left untreated for a long time. There are over 100 types of HPVs, and only certain types have been linked to cancers. Most people with HPV infection do not develop cancer. Other HPV types cause nonthreatening warts on the skin or genitals. HPVs can also cause cancers in men and women, affecting the throat, mouth, and anus.
HPV infection is spread through sexual or skin-to-skin contact. HPV infection is very common, the infection resolves on its own in some women. However, in others, HPV infection can linger, causing precancerous changes in the cells of the cervix. These changes can be detected by regular cervical cancer screening called Pap smear testing.
There are some cells called dysplasia that appear normal, but may be precancerous. Dysplasia of the cervix identified at the time of Pap testing is referred to as a squamous intraepithelial lesion (SIL). Cervical intraepithelial neoplasia (CIN) is another term used to categorize precancerous changes in the cervix that are seen on tissue samples such as biopsies. Precancerous changes in the cervix such as CIN and SIL can typically be treated, which can prevent the development of cervical cancer.
What are the symptoms of cervical cancer?
There may be no symptoms in early stage of cervical cancer. The precancerous changes produces little or no symptoms at all. Symptoms may begin to manifest when the cervical cancer cells start to attack surrounding tissues.
Symptoms and signs of cervical cancer include:
- Vaginal bleeding after sex
- Abnormal vaginal bleeding
- Vaginal bleeding after menopause
- Bleeding or spotting between periods
- Longer or heavier menstrual periods than usual
- Abnormal vaginal discharge
- Painful sexual intercourse
It is important to note that these symptoms are not specific for cervical cancer and can be caused by a variety of other illnesses.
What are the risk factors for cervical cancer?
Cervical cancers are caused by infection with one of the high-risk HPV types. However, since not all people who are infected with HPV will develop cancer. Other factors also play a major role in the development of cervical cancer. They include;
- Excessive smoking of tobacco
- HIV infection
- Immune system suppression
- Chlamydia infection in past or present
- Long-term use of oral contraceptives
- Having three or more full-term pregnancies
- Giving birth before age 17
- Family history of cervical cancer
What are guidelines for cervical cancer screening?
All women between the ages of 21 and 65 are expected to receive cervical cancer screening every three years. A Pap smear test is obtained during a routine pelvic examination. When this test is combined with an HPV test, screening every five years is acceptable for women above 30 years.
Women who have had undergone hysterectomy for a benign condition no longer have a cervix, and thus do not require cervical cancer screening. However, women who have had a subtotal hysterectomy still have a cervix and should be screened.
What tests are used to diagnose cervical cancer?
Pap smear test is performed to screen for cervical cancer. If abnormal cells are found on the Pap smear, a colposcopy procedure is then performed. Colposcopy uses a lighted microscope to inspect the external surface of the cervix during a pelvic examination. If abnormal areas are detected, a small tissue sample (biopsy) is taken for examination by a pathologist to look for precancerous changes or cancer. Colposcopy isn’t painful and requires no special anesthesia.
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Another method is conization, which involves the removal of a cone-shaped portion of the cervix around the cervical canal. This tissue can be removed with a thin loop of wire that is heated by an electrical current, known as loop electrosurgical excision procedure (LEEP). LEEP is performed in the doctor’s office with a local anesthetic.
After a conization, the pathologist examines the tissue to chieck if precancerous changes are present. If cancer is present, depending on the size and extent of the tumor, other tests might be carried out to help determine the degree to which the tumor has spread. These additional tests can include chest X-rays, or CT or MRI imaging studies. Examination of the interior of the urinary bladder using a thin, lighted scope, a process called cystoscopy may be needed. An examination under anesthesia permits the doctor to carry out a manual pelvic examination without causing pain to help check the extent to which the cancer has spread within the pelvis.
What are the stages of cervical cancer?
The stage of any cancer refers to the extent to which it has spread in the body at the time of diagnosis. The stages of cervical cancer are as follows:
- Stage 0: This stage is not a true invasive cancer. The abnormal cells are only on the surface of the cervix, as in CIN 3. This stage is not included in the FIGO system and is referred to as carcinoma in situ (CIS).
- Stage I: There is a small amount of tumor present that has not spread to any lymph nodes or other sites.
- Stage II: The cancer has spread beyond the cervix and uterus, but has not attacked the pelvic walls or the lower part of the vagina.
- Stage III: The cancer has grown into the lower part of the vagina or the walls of the pelvis. The tumor may be blocking the tubes that carry urine from the kidneys to the bladder, called ureters. There is no spread to other sites in the body.
- Stage IV: This is the most advanced stage, in which the cancer has spread to the bladder or rectum, or to sites in other areas of the body.
What is the treatment for cervical cancer?
The treatment for cervical cancer depends upon many factors, including the stage of the cancer when it is diagnosed. Different specialists may be involved in the treatment team, including:
- Gynecologic oncologist, a physician who specializes in treating cancers of the female reproductive organs, including surgery to remove cancers
- Radiation oncologist, a physician who uses radiation to treat different kinds of cancer
- Medical oncologist, a specialist in the use of chemotherapy and other medical therapies to treat cancer
Surgery is often performed to remove the early-stage tumors. A process called hysterectomy, which involves removal of the uterus, may be performed. Cone biopsy (removal of the inside of the cervix where most tumors begin) and a trachelectomy (removal of the upper vagina and cervix) are options that can be carried out for small tumors in order to preserve fertility in younger women. For more advanced cancers, a procedure known as pelvic exenteration, which involves the removal of the uterus, surrounding lymph nodes, and parts of other organs surrounding the cancer, may be performed.
Radiation therapy employs two major types for the treatment of cervical cancer; external beam radiation and brachytherapy. For external beam radiation therapy, radiation is administered from an outside source of radiation. If radiation therapy is given as the main treatment for the cancer, it is often combined with chemotherapy. Side effects of radiation therapy include diarrhea, skin changes, fatigue, vaginal irritation & discharge, menstrual changes, nausea and vomiting.
Chemotherapy may be used together with radiation therapy (chemoradiation) for some stages of cervical cancer. It may also be given before or after radiation treatment. Chemotherapy drugs frequently used for cervical cancer include cisplatin and 5-fluorouracil. Chemotherapy may also be the treatment of choice for cervical cancer that has returned after treatment. Side effects of chemotherapy include hair loss, fatigue, mouth sores, and vomiting.