Cervical Cancer – the cancer of the cervix is a form of cancer that arises in the cells of the cervix. The cervix is the lower portion of the uterus connecting to the vagina. This occurs because of abnormal growth of cells, which are capable of spreading or invading other body parts.
Several strains of human papillomavirus (HPV) – a sexually transmitted infection (STI), are one of the key causes of cervical cancer.
When exposed to the HPV, the immune system of the women normally prevents the virus from doing any harm. However, in a small group of women, the virus endures for years, contributing to the procedure causing some cells on the cervix’s surface to become cells of cancer.
The risk of developing cervical cancer can be reduced by having tests and receiving vaccines that protect against HPV infection.
Types of Cervical Cancer:
Cervical cancer is classified by how they appear to look under a microscope. The form of cancer one has, determines the treatment and prognosis.
The key types of cervical cancers are discussed under:
Squamous Cell Carcinoma:
Squamous Cell Carcinoma is also called epidermoid carcinoma. This form of cervical cancer results from squamous cells. This type begins in the flat, thin cells, which form the surface of skin lining on the outer portion of the cervix, which projects into the vagina. Many cervical cancers are squamous cell carcinoma.
This form of cervical cancer starts in the column-shaped glandular cells, which line the cervical canal. Cervical adenocarcinoma grows from the mucus-producing cells of glands of the endocervix. This type of cervical cancer seems to have become common in the past 20-30 years.
Small Cell Carcinoma:
Small cell carcinoma is also known as oat-cell carcinoma or small-cell lung cancer. This form of cervical cancer is highly evil cancer, which most commonly occurs inside the lung. Also, it can sometimes occur in other body parts, such as the cervix.
This type of cervical cancer contains two types of cells namely, gland-like cells and squamous cells – flat, thin cells lining certain organs of the body. This is one of the rarest types of cancer.
Symptoms of Cervical Cancer:
Cervical cancer, generally, may not produce signs or symptoms. Particularly, early-stage cervical cancers such as precancerous changes normally do not show symptoms. The symptoms may develop while the cells of cervical cancer start invading surrounding the tissues. The symptoms of more-advanced cervical cancer are:
- Abnormal vaginal bleeding right after intercourse, menopause or between periods.
- Bloody, watery vaginal discharge that may have a foul smell and may be heavy.
- Pain during intercourse or pelvic pain
- Heavier or longer periods than usual
If you find these systems then you should consult a doctor immediately.
Causes of Cervical Cancer:
Cervical cancer starts when healthy cells obtain a genetic change, i.e. mutation, which causes them to turn into abnormal cells.
Healthy cells grow and reproduce at a defined rate, in due course, dying at a defined time. However, cancer cells grow and reproduce out of control, and they do not die. The collecting abnormal cells form a tumour or mass. Cancer cells attack nearby tissues. These tissues can detach from a tumour to metastasize or spread to other parts of the body.
It is not yet clear what is the main cause of cervical cancer; however, it is certain that HPV has a major role to play. HPV is common and many women with this virus never develop cancer. This means other factors, such as one’s lifestyle choices or one’s environment, also ascertain whether one can develop cervical cancer or not.
Dysplasia is an abnormal-appearing cell, which is not cancer but might be precancerous. Dysplasia of the cervix spotted at the time of the Pap test is termed as Squamous Intraepithelial Lesion (SIL). Another term to classify precancerous changes in the cervix seen on the tissue samples like biopsies is Cervical Intraepithelial Neoplasia (CIN).
Risk Factors for Cervical Cancer:
Infections, with one of the high-risk HPV kinds, can be a major cause of cervical cancer. However, since not all people infected with HPV will develop cervical cancer, it is probable that other factors also play a crucial role in the development of cancer. Some of these risk factors for cervical cancer include:
- HIV infection
- Tobacco smoking
- Immune system suppression
- Current or past chlamydia infection
- Having three/full-term pregnancies
- Family history of cervical cancer
- Use of oral contraceptive over a longer period of time
- Having full-time pregnancy before 17 years of age
Cervical Cancer Prevention:
In order to reduce the risk of cervical cancer, one can have the following precautionary things:
- Have routine PAP test: A PAP test can detect precancerous conditions of cervix, so they can be treated or monitored so as to prevent cervical cancer. Many medical organisations recommend women to begin regular PAP tests at the age of 21 and repeat it after regular intervals.
- Vaccination against HPV: Vaccinations against HPV are available for women and girls aged 9 to 26 years. These vaccines are the most effective if given to females before becoming sexually active.
- Do not smoke.
- Practice safe sex: Having fewer sexual partners, using a condom, and delaying sex may reduce the risk of cervical cancer.
Cervical Cancer Screening:
If cervical cancer is detected in its early stage, it has a higher chance of successful treatment. Many guidelines recommend that females begin screening for the precancerous changes at an age of 21 and cervical cancer.
Screening tests for cervical cancer include:
HPV DNA Test:
This test involves the testing cells accumulated from the cervix for the infection with any of the forms of HPV, which are most probably to lead to cervical cancer. Women who have attained the age of 30 or more or even younger ladies can treat the HPV DNA test as an option with an abnormal PAP test.
The doctors brush and scrape the cells from the cervix that are examined in a laboratory for any abnormality, during a PAP test. Normal cells including cancer cells and the cells showing changes, which increase the cervical cancer risk are detected in a PAP test.
Diagnosis of Cervical Cancer:
If the doctor suspects cervical cancer, He/she is likely to be with a thorough test of the cervix. Colposcope, a special type of magnifying tool is used to examine the abnormal cells.
During the examination under the colposcope, the doctor takes a sample of cervical cells (biopsy) for lab testing. In order to obtain the tissue, the doctor may use:
Punch biopsy involved the use of a sharp instrument to pinch off the small samples of cervical tissues.
A thin brush or a small, spoon-shaped tool called Endocervical curettage is used to scrape samples of tissues from the cervix.
Cervical Cancer Staging:
If the doctor finds out that the patient has cervical cancer, she/he has further tests to ascertain the extent or the stage of cancer. The stage of cancer is a prime factor to decide the sort of treatment.
Staging examination includes:
Visual examination of the rectum and bladder of the patient is carried out. Special scopes to see inside the rectum and bladder may be used by the doctor.
Imaging test: Tests including CT scans, X-rays, Positron Emission Tomography (PET), and Magnetic Resonance Imaging (MRI) are conducted. These tests help the doctor to determine whether cancer has spread beyond the cervix.
Cervical Cancer Stages include:
Stage I . Cancer is limited to the cervix.
Stage II. Cancer is there in the cervix and the upper part of the vagina.
Stage III. Cancer has spread internally to the sidewall of the pelvic or to the lower part of the vagina.
Stage IV: Cancer has moved to nearby organs, such as the rectum or bladder, or it has moved to other body parts such as bones, liver, or lungs.
Treatments for Cervical Cancer:
Cervical cancer treatment is carried out basis numerous factors including the stage of cancer and other health issues and the preferences of the patient. Chemotherapy, radiation or surgery, or a combination of all three may be used.
Treatment of early-stage cervical cancer starts with surgery. A surgery, called hysterectomy, is carried out to remove the affected parts of the uterus or the whole uterus. Early-stage cancer can be cured by hysterectomy and it can be prevented by recurrence too. However, one cannot become pregnant if the uterus is removed.
The doctor may recommend:
- Simple hysterectomy – The uterus and cervix are removed together with cancer. This is generally an option only for very early-stage cervical cancer.
- Radical hysterectomy – The part of vagina, uterus, cervix, and lymph nodes in the affected portion is removed along with cancer.
- One also has an option of minimally invasive surgery for early-stage cervical cancer.
- Surgery preserving the probability of becoming pregnant can also be an option if the patient has very early-stage cancer without the involvement of lymph node.
High-powered energy beams, namely protons or X-rays, to kill the cancer cells, are used in radiation therapy. This therapy can be used with chemotherapy or alone before surgery to minimise a tumour or post-surgery to kill the remaining cancer cells (if any).
Internally, the doctor places a device, which is filled with radioactive material inside the vagina of the infected, generally for a few minutes (brachytherapy).
Externally, the doctor directs the radiation beam at the affected area of the patient’s body. This is often known as external beam radiation therapy.
Both internally as well as externally:
Premenopausal females may stop their menstruation and begin menopause because of the radiation therapy. If the woman might want to get pregnant after the radiation treatment, ask the doctor about ways for the preservation of eggs before the beginning of the treatment.
Medications are used in chemotherapy. These are usually injected into veins to kill the cancer cells. Radiation therapy often combines with low doses of chemotherapy, as the effects of radiation may be enhanced by chemotherapy. The doctors use higher doses of chemotherapy to control advanced cervical cancer, which may not be curable.
After the completion of the treatment, the doctor will suggest regular check-ups. Ask the doctor how often the patient must have a follow-up examination.
Palliative Care/ Supportive Care:
Supportive/Palliative care is a specialised medical treatment focusing on offering relief from symptoms of serious sickness including pain. Supportive care specialists work with the patient, their family and the other doctors to provide an add-on layer of help and support, which complements the ongoing care of the patient.
A team of doctors, other specially trained professionals, and nurses provide palliative care. This team intend to enhance the quality of life for patients and their families. The doctors offer this type of care alongside other treatments or curative treatments the patient may be receiving.
There is a lot of misinformation about HPV and cervical cancer. Here are some very common myths encountered by specialists with their own patients:
Myth #1: Cervical cancer cannot be prevented.
Reality: One can prevent cervical cancer. Screening of cervical cancer can find the abnormal or affected cells on the cervix before they turn into cancer. If such changes are detected and treated in their early stage, doctors can prevent cervical cancer.
Myth #2: Anyone with active sexual life can get HPV.
Reality: The most common sexually transmitted infection (STI) is Human Papillomavirus (HPV). It is not necessary that HPV spread via sexual intercourse. Intimate skin-to-skin contact can also spread HPV.
Myth #3: HPV cause infertility.
Reality: HPV can cause complications in pregnancy, but it does not affect the ability to conceive or infertility.
Frequently Asked Questions (FAQs):
1). Is radiation a cause of cervical cancer?
Ans. Radiation is often used in the diagnosis of cervical cancer. Radiation is successful means to cure cancer. These are absolutely safe and proper uses. However, radiations are extremely perilous if not handled with care.
2). Is Cervical Cancer hereditary?
Ans. It is not necessary that cervical cancer is inherited. Cervical cancer usually occurs because of infection with human papillomavirus (HPV). HPV is transmitted sexually.
3). What are the side effects of Chemotherapy and Radiation?
Ans. Firstly, all the side effects are not permanent. The symptoms or side effects vary depending on the site of the radiation treatment.