What is cervical cancer?
Cancer that begins in the cells of the cervix is called cervical cancer. The cervix is the narrow end portion of the uterus.
Usually, cervical cancer progresses gradually over time. The cervical tissue undergoes changes known as dysplasia, in which abnormal cells start to emerge in the cervical tissue. If left untreated, these abnormal cells may eventually develop into cancer cells, grow deeper into the cervix, and spread to nearby tissues.
What are the types of cervical cancer?
Cervical cancer is classified based on the cells that the tumour originated from. This includes:
- Squamous cell carcinoma, which constitutes about 90% and develops from cells of the ectocervix (the outer part of the cervix that connects to the vagina)
- Adenocarcinoma, which develops from the glandular cells
- Adenosquamous carcinomas or mixed carcinomas have features of both squamous cells and adenocarcinoma
What are the causes of cervical cancer?
- HPV (human papillomavirus), a sexually transmitted virus, is the primary cause of cervical cancer
- HPV spreads easily through sexual contact (anal, oral, or vaginal)
- All of us encounter HPV at some point in time due to the immune system, but the majority of people who have HPV aren’t aware of it
- If the body fails to prevent this infection, the cervical cells get transformed into cancerous cells
What are the risk factors for cervical cancer?
- Having sexual intercourse before the age of 18 with multiple partners
- Long-term use of oral contraceptives
- Smoking
- HPV infection
- Weak immune system
- HIV infection
What are the early signs and symptoms of cancer?
Stage 1 signs and symptoms include:
- Vaginal discharge that is either bloody or watery with a foul odour
- Vaginal bleeding after sex, in between menstruation, or post-menopause
- Heavier or longer duration periods
The following symptoms may appear if cancer has spread to adjacent tissues: - Painful urination or blood in the urine
- Diarrhoea, abdominal pain, or bleeding when you pass stools
- Fatigue, weight loss, and appetite loss
- A dull backache or leg swelling
- Abdominal and pelvic pain
What are the screening tests for cervical cancer?
The two main screening tests include:
- HPV test examines the DNA of cervical cells for HPV (high-risk or carcinogenic forms) that are more likely to result in cervical cancer
- Pap smear test collects cells from the cervix so that they can be examined in a lab to check for cancer or pre-cancerous cells
How is cervical cancer diagnosed?
Tests for symptomatic individuals or those who have abnormal cervical screening tests include:
Medical history and physical exam:
- Your doctor may ask about symptoms, family history and check for the presence of any risk factors
- They carry out a complete physical examination to determine your general state of health
- A pelvic examination and, if necessary, a pap test will also be performed on you
- Your lymph nodes are also felt to determine whether the malignancy has spread (metastasis)
Colposcopy
- Colposcopy is a procedure where your doctor examines your cervix and vagina using a magnifying device (known as colposcope)
- While using a colposcope to examine the cervix, the doctor places a speculum in the vagina to keep it open
- To make any abnormal areas easier to view, the doctor applies a thin solution of acetic acid (which is comparable to vinegar) to your cervix
- A biopsy will be performed if any abnormal areas are observed
Biopsy
Cervical pre-malignancies and cancers can be identified using a variety of biopsies:
Colposcopic biopsy
- To locate the abnormal spots, the cervix is first inspected with a colposcope.
- A tiny region of the abnormal spot on the cervix’s surface is removed using biopsy forceps
Endocervical curettage (endocervical scraping)
- In the endocervical canal (the part of the cervix closest to the uterus) a narrow device (either a curette or a brush) is introduced to remove tissue from the canal’s interior and sent for analysis
Cone biopsy
- This procedure is also called conization
- A cone-shaped section of tissue from the cervix is removed by your doctor
- The ectocervix, which is the outer part of the cervix, forms the cone’s base, and the endocervical canal forms the cone’s point or apex. The transformation zone (this is the area between the ectocervix and endocervix where cancer is most likely to begin) is also removed
- Many pre-malignancies and certain very early cancers can be entirely removed using a cone biopsy as a treatment
- The most commonly used methods for cone biopsies are:
Loop Electrosurgical Excision Procedure (LEEP), also called the Large Loop Excision of the Transformation Zone (LLETZ): tissue is removed by a thin wire loop that is heated using electricity
- Cold Knife Cone Biopsy uses a surgical scalpel or laser to remove the tissue
If the biopsy confirms the presence of cancer then there are certain tests to find out the extent of the spread of cancer:
- Cystoscopy checks whether the tumour has spread to your bladder and urethra
- Proctoscopy is the visual examination of your rectum. Your doctor checks for the spread of cervical cancer to other organs through this method
- Examination under anaesthesia to find out if cancer has spread beyond the cervix
- Imaging tests like chest X-ray, MRI, PET, and CT scan are used to find out the spread of cancer tissue to various parts of the body.
What are the stages of cervical cancer?
Stage 1: Only the cervix is affected
Stage II: Cancer has spread beyond the cervix and uterus but hasn’t reached the pelvic wall or the vagina
Stage III: The bottom portion of your vagina has been affected, and cancer may have progressed to your pelvic wall, ureters, and adjacent lymph nodes
Stage IV: Cancer has spread to the bladder, rectum, and other body regions like bones and lungs
How is cervical cancer treated?
Among the methods used to treat cervical cancer are:
Radiation therapy uses radiation beams to kill the cancer cells. Two types of radiation therapy exist:
- External beam radiation therapy (EBRT) uses a machine outside the body to target tumours with strong radiation
- Brachytherapy directly applies radiation to or near a malignant tumour
Chemotherapy
- It is usually done by administering medications via injection into your veins or by oral ingestion to kill cancer cells
- Chemotherapy uses a variety of medications, some of which can be combined
- Cycles of chemotherapy are frequently administered. The type of medicine used and the location of the cancer affect the length of the treatment as well as the frequency or schedule of chemotherapy
Surgery
Cervical cancer is usually treated with a variety of surgical procedures. The most common procedures used to treat cervical cancer include:
- Laser surgery destroys cancer cells with a laser beam
- Cryosurgery makes the cancer cells freeze
- A Simple hysterectomy removes only the uterus, leaving the surrounding tissue in place
- Radical hysterectomy with pelvic node dissection removes the uterus, surrounding tissue known as the parametrium, the cervix, a small portion of the upper part of the vagina, and pelvic lymph nodes
- Trachelectomy removes the upper part of your vagina and cervix but not the uterus
- Pelvic exenteration is similar to a radical hysterectomy but also removes part of your colon, bladder, vagina, and rectum, depending on the spread of cancer
Targeted therapy
- Specific cancer cells are eliminated by using this targeted medication therapy without harming your healthy cells
- It functions by focusing on proteins that control how cancer cells proliferate and spread
Immunotherapy
- This helps your immune system identify and eliminate cancer cells using your immune system
How can I prevent cervical cancer?
You can reduce your chances of cervical cancer by:
- Receiving regular gynaecological tests and PAP smear tests
- Avoiding sex with multiple partners
- Using condoms while having intercourse
- Avoiding smoking and alcoholism
- Getting vaccinated with the HPV vaccine
What is a cervical cancer vaccine?
What are the cervical cancer survival rates?
The five-year relative survival rate for cervical cancer patients who are diagnosed during the early stages is over 92%.