CERVICAL CANCER
It is a malignant tumor of the cervix, the lowermost part of the uterus (womb). it begins on the surface of your cervix. It happens when the cells on the cervix begin to change to precancerous cells. Not all precancerous cells will turn to cancer, but finding these problematic cells and treating them before they can change is critical to preventing cervical cancer. There are two main types of cancer of the cervix, squamous cell carcinomas and adenocarcinomas. About 80% to 90% of cervical cancers are squamous cell carcinomas, while 10% to 20% are adenocarcinoma.
Various strains of the human papillomavirus (HPV), a sexually transmitted infection play a role in causing most cervical cancer. When exposed to HPV, the body’s immune system typically prevents the virus from the virus from doing harm in a small percentage of people, however, the virus survives for years, contributing to the process that causes some cervical cells to become cancer cells.
What is the cervix?
The cervix is the lowest part of the uterus (where a baby grows during pregnancy). It looks a little bit like a donut and connects the uterus to the opening of the vagina. It's covered in tissues made up of cells. These healthy cells are what can grow and change to pre-cancer cells.
Causes of Cervical Cancer
Cervical cancer begins when healthy cells in the cervix develop changes (mutations) in their DNA. A cell's DNA contains the instructions that tells a cell what to do. Healthy cells grow and multiply at a set rate, eventually dying at a set time. The mutations tell the cells to grow and multiply out of control, and they do not die. The accumulating abnormal cells form a mass (tumor). Cancer cells invade nearby tissues and can break off from a tumor to spread (metastasize) elsewhere in the body.
It is not clear what causes cervical cancer, but it is certain that HPV plays a role. HPV is very common, and most people with the virus never develop cancer. This means that other factors such as one’s environment or lifestyle choices can also determine whether one will develop cervical cancer.
Types of Cervical Cancer
The type of cervical cancer that a person has helps determine the prognosis and treatment. The main types of cervical cancer are:
Squamous cell carcinoma: This type of cervical cancer begins in the thin, flat cells (squamous cells) lining the outer part of the cervix, which projects into the vagina. Most cervical cancers are squamous cell carcinomas.
Adenocarcinoma: This type of cervical cancer begins in the column-shaped glandular cells that line the cervical canal.
Sometimes, both types of cells are involved in cervical cancer. Very rarely, cancer occurs in other cells in the cervix.
Common Signs and Symptoms of Cervical Cancer
Early stages of cervical cancer don't usually involve symptoms and are hard to detect. The first signs of cervical cancer may take several years to develop. Finding abnormal cells during cervical cancer screenings is the best way to avoid cervical cancer.
Signs and symptoms of stage 1 cervical cancer can include:
Watery or bloody vaginal discharge that may be heavy and can have a foul odor.
Vaginal bleeding after intercourse, between menstrual periods or after menopause.
Menstrual periods may be heavier and last longer than normal.
If cancer has spread to nearby tissues or organs, symptoms may include:
Difficult or painful urination, sometimes with blood in urine.
Diarrhea, or pain or bleeding from your rectum when pooping.
Fatigue, loss of weight and appetite.
A general feeling of illness.
Dull backache or swelling in your legs.
Pelvic/abdominal pain.
If one experiences abnormal bleeding, vaginal discharge or any other unexplained symptoms, you should have a complete gynecological examination that includes a Pap test.
Risk factors
The risk factors for cervical cancer include:
Many sexual partners. The greater the number of sexual partners one has and the greater your partner's number of sexual partners the greater your chance of acquiring HPV.
Early sexual activity. Having sex at an early age increases one’s risk of HPV.
Other sexually transmitted infections (STIs). Having other STIs such as; chlamydia, gonorrhea, syphilis and HIV/AIDS increases the risk of HPV.
A weakened immune system. One may be more likely to develop cervical cancer if your immune system is weakened by another health condition and you have HPV.
Smoking. Smoking is associated with squamous cell cervical cancer.
Exposure to miscarriage prevention drug. If an individual’s mother took a drug called diethylstilbestrol (DES) while pregnant in the 1950s, the individual may have an increased risk of a certain type of cervical cancer called clear cell adenocarcinoma.
Prevention
To reduce your risk of cervical cancer:
Ask your doctor about the HPV vaccine. Receiving a vaccination to prevent HPV infection may reduce your risk of cervical cancer and other HPV-related cancers. Ask your doctor whether an HPV vaccine is appropriate for you.
Have routine Pap tests. Pap tests can detect precancerous conditions of the cervix, so they can be monitored or treated in order to prevent cervical cancer. Most medical organizations suggest beginning routine Pap tests at age 21 and repeating them every few years.
Practice safe sex. Reduce your risk of cervical cancer by taking measures to prevent sexually transmitted infections, such as using a condom every time you have sex and limiting the number of sexual partners you have.
Don't smoke. If you don't smoke, don't start. If you do smoke, talk to your doctor about strategies to help you quit.
Treatment for Cervical Cancer
The cervical cancer treatment team includes a gynecologic oncologist (a doctor who specializes in cancers of female reproductive organs). Recommended treatment for cervical cancer is based on many factors including the stage of the disease, age and general health, and if one wants children in the future. The treatments for cervical cancer are radiation, chemotherapy, surgery, targeted therapy and immunotherapy.
Radiation
Radiation therapy uses energy beams to kill cancer cells on the cervix. There are two types of radiation therapy:
External beam radiation therapy (EBRT): Aims high-powered radiation at cancer from a machine outside the body.
Brachytherapy: Puts the radiation in or just near cancer.
Chemotherapy
Chemotherapy (chemo) uses drugs that are injected through the veins or taken by mouth to kill cancer cells. It enters the blood and is effective for killing cells anywhere in the body. There are several drugs used for chemo and they can be combined. Chemo is often given in cycles. The length of the cycle and the schedule or frequency of chemotherapy varies depending on the drug used and where cancer is located.
Surgery
Different kinds of surgery are used to treat cervical cancer. Some of the most common kinds of surgery for cervical cancer include:
Laser surgery: This surgery uses a laser beam to burn off cancer cells.
Cryosurgery: This surgery freezes cancer cells.
Cone biopsy: A surgery in which a cone-shaped piece of tissue is removed from the cervix.
Simple hysterectomy: This surgery involves the removal of the uterus but not the tissue next to the uterus. The vagina and pelvic lymph nodes are not removed.
Radical hysterectomy with pelvic lymph node dissection: With this surgery, the uterus, surrounding tissue called the parametrium, the cervix, a small portion of the upper part of the vagina and lymph nodes from the pelvis are removed.
Trachelectomy: This procedure removes the cervix and the upper part of the vagina but not the uterus.
Pelvic exenteration: This is the same as a radical hysterectomy but includes the bladder, vagina, rectum and part of the colon, depending on where cancer has spread.
In its earliest stages, the disease is curable by removing the cancerous tissue. In other cases, the health provider may perform a simple hysterectomy or a radical hysterectomy.
Some people may have a combination of treatments. The provider may use radiation or chemotherapy to treat cancer that has spread or come back (recurred). Sometimes the provider will use radiation and chemotherapy before or after surgery.
Targeted therapy
Targeted drug treatment destroys specific cancer cells without damaging healthy cells. It works by targeting proteins that control how cancer cells grow and spread. As scientists learn more about cancer cells, they are able to design better-targeted treatments that destroy these proteins.
Immunotherapy
Immunotherapy uses medicine to stimulate the immune system to recognize and destroy cancer cells. Cancer cells can also avoid being attacked by the immune system by sending off a signal. Immunotherapy helps to target these signals so the cancer cells cannot trick the body into thinking it is a healthy cell. Clinical trials are another treatment option. They are controlled research studies to test new treatments for cancer. Some people use alternative treatments like diet, herbs, acupuncture and other methods to supplement their cancer treatment.
How to Get Screened for Cervical Cancer
Most people should have regular cervical cancer screenings. Screenings include Pap tests, testing for HPV or a combination of both tests. These are the cervical screening cancer guidelines:
Cervical cancer screening should begin at age 21 years, regardless of sexual history. Some healthcare providers are willing to delay this until age 25.
For those 21 to 29 years of age, screening is recommended every three years with only a Pap test (no HPV test).
For people 30 years and older, co-testing with Pap and HPV should be done every five years, or Pap test alone every three years.
Routine Pap testing should be discontinued (stopped) in those who have had a total hysterectomy for benign conditions and who have no history of CIN (cervical intraepithelial neoplasia) grade 2 or higher.
Cervical cancer screening can be discontinued at age 65 in those who have two consecutive normal co-test results or three consecutive normal Pap test results in the past 10 years, with the most recent normal test performed in the past five years.
People who have been adequately treated for CIN grade 2 or higher will need to continue screening for 20 years, even if it takes them past the age of 65.
People 65 to 70 years of age or older who have had three or more normal Pap tests in a row and no abnormal Pap test results in the last 20 years should stop having cervical cancer screening.
Those who have had a total hysterectomy (removal of the uterus and cervix) should also stop having cervical cancer screening unless they have a history of cervical cancer or pre-cancer. People who have had a hysterectomy without removal of their cervix should continue to follow the guidelines above.
Complications of Cervical Cancer
Complications of cervical cancer can happen as a side effect of treatment. They can also be a result of advanced cervical cancer. Side effects of cervical cancer treatments can include:
Early menopause
Narrowing of the vagina
Lymphoedema
Emotional impact
Early menopause
If one’s ovaries are removed or damaged during radiotherapy, you will have an early menopause. This is if one has not already been through it. Most women experience the menopause naturally in their early fifties.
Symptoms of the menopause include:
No longer having monthly periods or the periods becoming much more irregular
hot flushes
vaginal dryness
loss of sex drive
mood changes
night sweats
Special medication can relieve these symptoms.
These drugs help produce the hormones oestrogen and progesterone. This is known as hormone replacement therapy (HRT).
Lymphoedema
The lymph nodes in the pelvis may be removed. This can sometimes disrupt the lymphatic system. One of the things the lymphatic system does is drain excess fluid from the body's tissue. A disruption to this process can lead to a build-up of fluid in the tissue. This is called lymphoedema. This can cause certain body parts to become swollen. In cases of cervical cancer, usually the legs will become swollen. There are exercises and massage techniques that can reduce the swelling. Wearing special bandages and compression garments can also help.
Emotional impact
The emotional impact of living with cervical cancer can be significant. Many report experiencing a 'rollercoaster' effect. For example, one may feel down when you receive a diagnosis. But you may be happy when removal of the cancer has been confirmed. One may then feel down again as you try to come to terms with the after-effects of the treatment. This type of emotional disruption can sometimes trigger depression.
Typical signs of depression include:
feeling sad
feeling hopeless
losing interest in things you used to enjoy.
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