cervical cancer
cervical cancer

The cervix is the area between the vagina and uterus. Cervical cancer begins when the healthy cells on the surface of the cervix change and grow out of control, forming a tumor. The changes in the cells at the initial stage are not cancerous, but upon progress, it may become cancerous. It can be life-threatening if it goes undetected or untreated.

RISK FACTORS FOR CERVICAL CANCER

Often risk factors influence the development of cancer, but most of them do not directly cause cancer. The following factors may develop the risk of cervical cancer:

  • Human papillomavirus (HPV) infection: HPV infection is the most common risk factor for cervical cancer. Sexual activity with the person who has HPV is the most common route for the transfer of HPV infection.
  • Pregnancy: Women who have had a first full-term pregnancy at the age 17 or who have had three full-term pregnancies are at risk for cervical cancer.
  • Family history: Women with a sister or a mother who have had cervical cancer are two or three times more likely to develop cervical cancer.
  • Sexual history: People who had sex before the age 18, sex with multiple partners, and with someone who has had multiple partners may be at risk of getting cervical cancer.
  • Weakened immune system: Women with a weak immune system have a higher risk of developing cervical cancer. People with HIV or who take medications that limit the body’s ability to fight off the infection are also at a higher risk of developing cervical cancer.

           Diethylstilbestrol (DES): If this drug is given to the women to prevent miscarriage then she is at risk of developing cervical cancer

  • Smoking: Women who smoke are at increased risk of developing cervical cancer.
  • Age: Girls younger than 15 years are less prone to cervical cancer. The risk is more among teens and women who are in the mid-30s. Women over 40 are at highest risk and need to go for regular screenings.
  • Race/Ethnicity: Cervical cancer is common among black and Hispanic women.
  • Oral contraceptives: Women who have taken contraceptives for five years or more have an increased chance to get cervical cancer.

 

SIGNS AND SYMPTOMS OF CERVICAL CANCER

There are no specific symptoms during the early stages of cervical cancer. In the advanced stage of the disease, the symptoms may be as follows:

  • Pelvic pain
  • Painful urination
  • Longer or heavier menstrual periods than usual
  • Pain during sexual (vaginal) intercourse
  • Abnormal vaginal bleeding
  • Vaginal bleeding after sex
  • Vaginal bleeding after menopause
  • Bleeding or spotting between periods
  • Other abnormal discharge

You may also experience weight loss and fatigue. As the disease progresses, there is also a risk of bone fractures.

These symptoms may not be specific for cervical cancer, and they can be caused by a variety of conditions related to the disease.

DIAGNOSIS

There are several tests to diagnose cancer, but biopsy is the more reliable test to confirm the diagnosis. The following tests may be used to diagnose cervical cancer.

  • Pap test: It is used to identify the early stages of cancer.
  • Pelvic examination: It is used to identify unusual changes in the woman’s uterus, vagina, ovaries, fallopian tubes, cervix, bladder, and the rectum.
  • HPV typing: It is similar to the Pap test. It identifies the HPV -16 and HPV-18 strains in the cervix.
  • Colposcopy: This test is used to check the cervix for abnormal areas. The test is not painful and does not have any side effects. It can also be done for pregnant women.
  • Biopsy: It can make a definite diagnosis. There are several types of biopsies.

Loop electrosurgical excision procedure (LEEP) used to identify and remove the precancers or at an early stage of cancer.

Conization may be done as a treatment to remove precancers or early-stage cancer.

  • X-ray: It is a method to create a picture of the structures inside of the body using a small amount of radiation. An intravenous urography which is a type of X-ray used to view the bladder and kidneys.
  • Computed Tomography (CT) scan: CT scan is used for identifying the tumors. It also measures the size of the tumors.
  • Magnetic resonance imaging (MRI) scan: This test is used to measure the size of the tumor.
  • Positron emission tomography (PET) scan: A PET scan combined with a CT scan is used to identify primary cancer. It is also used to identify the spread of cancer to other tissues or metastasis in the body.
  • Cystoscopy: It is used to determine whether cancer has spread to the bladder.
  • Proctoscopy: It is used to see if cancer has spread to the rectum.
  • Laparoscopy: It is used to identify whether cancer has spread to the abdominal area.

 

STAGES OF CANCER

The stage of cancer refers to the extent to which cancer has spread. It is staged using the TNM system.

  • Tumor (T) describes the original size of the tumor.
  • Lymph Node (N) indicates whether the cancer is present in the lymph nodes.
  • Metastasis (M) refers whether cancer has spread to the other parts of the body mainly the liver, bones or brain.

 

Once the T, N, and M scores are determined then, the overall cervical cancer stage is assigned.

Stage 0: In stage 0, cancer is confined to the surface of the cervix. This stage is also called as carcinoma in situ (CIS) or cervical intraepithelial neoplasia (CIN) grade III (CIN III).

Stage I: In stage I, cancer has grown deeper in the cervix. This stage is further subcategorized into two:

Stage IA: Cancer has spread less than 5mm deep and 7mm wide in the cervix which can be measured only under a microscope.

Stage IB: Cancer measures about 4cm or less across, more than 5mm deep and 7mm wide.

Stage II: In this stage, cancer has grown beyond the cervix and uterus, but not to the walls of the pelvis or vagina. This stage is subcategorized into two:

Stage IIA: Cancer has not spread to the tissues next to the cervix, but grown to the upper part of the vagina.

Stage IIB: Cancer has spread into the tissue next to the cervix and the parametria.

Stage III: In this stage, cancer has spread to the vagina (lower part) or to the walls of the pelvis, but not to the nearby lymph nodes or the other parts of the body. It is divided into two categories:

Stage IIIA: Cancer has spread to the vagina (lower third), but not to the pelvic walls.

Stage IIIB: Cancer has grown into the walls of the pelvis and/or has blocked both the ureters, but has not spread to the lymph nodes or distant sites.

Stage IV: In this stage, the disease has spread to the nearby organs or the other parts of the body. It is separated into two categories:

Stage IVA: Cancer has spread to the bladder or rectum, but not to the lymph nodes.

Stage IVB: Cancer has spread to the organs beyond the pelvis, such as the lungs or liver.

Recurrent cervical cancer: This is cancer that has come back after treatment. If there is no occurrence of cancer, then there will be another round of tests to learn about the extent of the recurrence.

TREATMENT

The treatment for cervical cancer depends on many factors including the stage of cancer when it is diagnosed. The common methods of treatment for cervical cancer are surgery, radiation therapy, chemotherapy, and targeted therapy.

Surgery

Surgery is often performed to remove cancer, especially in the early stages of cancer. Hysterectomy may be performed. Cone biopsy and a trachelectomy are the options that can be used for the small tumors in younger women to preserve fertility. The pelvic exenteration removes the uterus, surrounding the lymph nodes, and the parts of the other organs surrounding cancer.

Radiation therapy

It is another treatment for cervical cancer. In this, both the external beam radiation therapy and brachytherapy can be used. It is given as the main treatment for cancer, and is often combined with chemotherapy.

Chemotherapy

 It may be recommended together with radiation therapy for some stages of cancer. The commonly used chemotherapy drugs are cisplatin and 5-fluorouracil. Chemotherapy is the treatment of choice for recurrent cancer.

Targeted therapy

It refers to drugs that have been specifically developed or targeted to interrupt the processes that promote the growth of the cells. Bevacizumab (Avastin) is used in targeted therapy.

PREVENTIVE MEASURES

  • Vaccination for girls aged between 9 and 26
  • Maintaining one sexual partner
  • Quitting smoking
  • Practising safe sex
  • Undergoing Pap test at least once in a year

 

Cervical cancer is one of the most successfully treatable cancer types, so early detection and early treatment would save lives. Therefore, it’s important to learn more about cervical cancer aas it  would be helpful in lowering your risk of developing it.

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