Everything You Should Know About Cervical Cancer

Cervical cancer

Did you know that more than 77,000 new cervical cancer diagnoses are made annually in India? Nearly half of these cases result in fatalities. 

In this article, we outline important information about treatment, symptoms, and causes, helping you understand more about cervical cancer.

What is Cervical Cancer?

The cervix is found in the lower part of the uterus, connecting the upper part to the vagina

The cervix has two parts: ectocervix, which is the outer part, and endocervix, which is the opening of the cervix. 

The endocervix is lined with glandular cells that are responsible for producing cervical mucus. The ectocervix is covered in thin squamous cells, flat cells found in the lining of the cervix. 

The transformation zone of the cervix is the location where both the endocervix and ectocervix join. This is the most common site for cancer to develop. The transformation zone location can change with age or after giving birth. 

Cervical cancer develops when healthy cells start developing abnormal changes. These changes are described as precancerous. Your doctor may refer to these precancerous changes as cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL), and dysplasia.

Once a sample of tissue from the lining of the cervix has been collected, any abnormalities seen are graded on a scale of 1 to 3:

  • CIN1: Also referred to as mild dysplasia or low-grade SIL, indicates not too much of the tissue is showing abnormalities. 
  • CIN2 or CIN3: Also known as moderate to severe dysplasia or high-grade SIL, is a more severe form of pre-cancer.

Cervical cancer begins with precancerous cells, but not all cases will develop into cancer. Treating precancerous cells can prevent nearly all cervical cancers.

Different Types of Cervical Cancer

Precancerous and cervical cancer types are determined in the lab and characterized by how they appear under a microscope.

Adenocarcinoma and squamous cell carcinoma are common types of cervical cancer.

Squamous Cell Carcinoma: Squamous cells are found in the ectocervix, and squamous cell carcinomas often originate in the transformation zone. 

Adenocarcinomas: This is when the cancer forms in the glandular cells found in the endocervical canal and further forms in mucus-secreting glands throughout the body. This is a less common type of cervical cancer.

Adenosquamous Carcinomas: This is a very rare form of cervical cancer that involves both squamous cell carcinomas and adenocarcinomas. Other uncommon cervical cancers include melanoma, sarcoma, and lymphoma, which can occur more commonly in other parts of the body.

Causes of Cervical Cancer

Cervical cancer develops over some time, making it one of the more preventable types of cancers. Regular Pap tests and screenings are necessary measures, especially for women over the age of 30.

So what causes cervical cancer?

Cancer develops when abnormal cells continue to grow uncontrollably and divide, gradually forming lumps and tumors. 

Common causes that increase the chances of cervical cancer are:

  • Human papillomavirus (HPV): This is the most common cause of cervical cancer. There are hundreds of various types of HPV strains that increase the risk of cervical cancer. However, the majority of HPV infections resolve on their own. Women who experience persistent infection are at higher risk as cervical cells can start developing abnormalities.
  • Number of sexual partners: HPV is a sexually transmitted infection (STI) and can be spread through skin on skin and sexual contact. Women who have had many sexual partners are at higher risk of contracting HPV infection.
  • Smoking: Tobacco is an HPV cofactor that can increase the risk of both precancerous and cancer cells.
  • Weak immune system: Existing conditions like HIV or AIDS can lead to cervical cancer. The use of immunosuppressants medication is also a contributing factor.
  • Birth control pills: Taking some type of contraceptive pills for a more extended period can marginally increase your risk.
  • Sexually transmitted diseases (STDs): Chlamydia, gonorrhea, and syphilis can increase your risk of developing cervical cancer.

Symptoms of Cervical Cancer

Early stages of cervical cancer very rarely cause any symptoms. This is why regular Pap tests, HPV tests, and screenings are critical to detecting cervical cancer early.

It is essential to contact your healthcare provider if you have experienced or are experiencing any of the symptoms mentioned above. These symptoms can be related to other health problems, so it is important to visit your doctor.

Stages of Cervical Cancer

Staging is done to assess how advanced the cancer is to help decide on the best treatment options. It is done using imaging tests that include CT scans, chest X-rays, ultrasounds of the abdomen, or PET scans.

A 4-stage approach is commonly used to stage cervical cancer.

Stage 0: Precancerous cells are detected.

Stage 1: Cancer cells have spread deeper into the cervix’s tissue, or into the uterus and lymph nodes.

Stage 2: Cancer has spread to the pelvis walls from the cervix and uterus. It could have spread to the lymph nodes nearby.

Stage 3: Cancer cells have spread to the lower part of the vagina or pelvis walls. The ureters, which are the tubes that pass urine from the bladder, may have blockages. 

Stage 4: Cancer has spread to the bladder or rectum from the pelvis. Lymph nodes can be affected. If cancer progresses in stage 4, it can start spreading to other organs, including the liver, bones, and lungs.

What is the meaning of screening for cervical cancer. 

Early detection can increase the success of cervical cancer treatment.

Cervical cancer routine screening is recommended for women from the age of 21.

Here are the recommended timelines for HPV and cervical cancer screening.

Screening cannot diagnose cancer but can detect any abnormal changes in cells. HPV DNA testing can determine if there are any high-risk HPV strains in the cells of the cervix, which can develop into cancer.

A doctor can do a biopsy to diagnose cancer. A biopsy involves removing a small part of cervical tissue to be examined for cancer cells. This procedure is done under general anesthesia.

Treatment for Cervical Cancer

Surgery

Surgery depends on the stage of cancer, the size, and if you are planning to have children.

Small tumors can be removed surgically with a cone biopsy, which involves only removing the cervical tissue.

A trachelectomy is a procedure that removes the cervix and surrounding tissue and may be recommended to treat early-stage cervical cancer.

Both of these procedures allow for a possible future pregnancy.

However, a hysterectomy that can remove early-stage cancer and prevent cancer from coming back involves removing the cervix, uterus, and some parts of the vagina. This will also prevent any future pregnancies.

Radiation

Radiation therapy can be used with chemotherapy to treat advanced cervical cancer. It used high-energy beams like X-rays to kill cancer cells. Radiation therapy can be given both externally and internally. 

It can also be considered as a treatment option post-surgery to prevent a recurrence. 

Chemotherapy

Chemotherapy uses drugs and medication to kill cancer cells. It can be used with radiation therapy for advanced localized cervical cancer. The dosage used will depend on how advanced the cancer is.

Targeted Therapy

This type of therapy uses targeted drugs to block cancer cells and kill them. Targeted therapy is commonly used in combination with chemotherapy to treat advanced cervical cancer. The most common targeted medicine used is bevacizumab. That’s a vegf inhibitor. 

Immunotherapy

Immunotherapy is a drug treatment that can boost your immune system to help fight cancer. This treatment may be recommended if other treatments fail or for an advanced form of cervical cancer.

Supportive Care

Palliative care helps cancer patients find relief from pain and other symptoms. Specialists work with the patient and family to provide support during treatment. This treatment focuses on prolonging life and improving the quality of life for cancer patients.

Women over the age of 21 primarily, should ensure they are getting their routine screenings as recommended by their doctor. Early detection is crucial in treating cancer successfully.  

If you are experiencing any of the symptoms above, please contact your doctor.

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