Cervical Cancer


Overview

Cancer of the uterine cervix (the lower part of the uterus which extends slightly into the top of the vagina) is one of the most common cancers in women. An early symptom is abnormal vaginal bleeding. It has been noticed that most cases develop among women in their 30s or 40s. If cervical cancer is diagnosed at an early stage, it can result in better outcomes. Before engaging with uterine cervical cancer treatment, regular cervical screening tests can help in early detection.

What is important is that the patient promptly reports any abnormal vaginal bleeding (bleeding between periods, heavy periods, bleeding after intercourse) or vaginal discharge promptly to a doctor which will help ascertain the treatment of cervical cancer. Even in cases of post cervical cancer treatment, patients are advised to consult their respective doctors to check for any recurrence and early prevention during diagnosis.

TYPES OF CERVICAL CANCER

There are two main types of cervical cancer:

  • Squamous cell carcinoma is the most common type of cervical cancer. This develops when a skin-like cell (a squamous cell) that covers the cervix, becomes cancerous
  • Adenocarcinoma cervical cancer is less common. This is part of the glandular cervical cancer where cells develop (a cell that makes mucus) within the cervical canal thereby becoming cancerous.

Symptoms

A woman may have no symptoms when the cervical tumour is small. As the tumour becomes large, the first symptom to be seen is abnormal vaginal bleeding, which can be:

  • Bleeding between normal periods (intermenstrual bleeding)
  • Bleeding after having sex (post-coital bleeding)
  • Any vaginal bleeding in women past menopause
  • An early symptom of cervical cancer in some cases is a vaginal discharge that smells unpleasant, or discomfort or pain during sex.
  • If the cancer has spread, the symptoms may vary basis which the doctor may ask for specific tests.

All of the above symptoms can be caused by various other common conditions. If a woman develops any of these symptoms, she should have it followed-up by a doctor to determine the possibility of cervical cancer treatment.

Causes

A cervical tumour starts from one abnormal cell and then goes to other cells. This abnormal cell growth (dysplasa) occurs on the surface lining of the cervix or the endocervical canal commonly known as the opening between the uterus and the vagina. In cases where severe dysplasa is observed then it is called as CIN 3. The initial 'pre-cancerous' abnormality of cervical cells is usually caused by a prior infection with the Human Papilloma Virus.

Human Papilloma Virus (HPV) and Cervical Cancer

  • From the multiple types of HPV, two types - HPV 16 and 18 - are involved in the development of most cases of cervical cancer. Other strains cause genital warts
  • The types of HPV associated with cervical cancer are usually passed on by having sexual intercourse with an infected person
  • An infection may be devoid of symptoms, so it is impossible to tell if the woman herself or the person with whom she has sexual intercourse are infected with one of these strains of HPV
  • Within two years, 9 out of 10 infections with HPV will clear completely from the body. This means that most women who are infected with these strains of HPV do not develop cancer
  • The HPV vaccine has been introduced for girls from the age of 11
  • Studies have shown that the HPV vaccine is very effective at stopping the development of the cancer of cervix and it works better when administered at a younger age
  • However, even if a woman has had the HPV vaccine, she must regularly undergo cervical screening

Other factors that increase the risk of developing cervical cancer are:

  • Smoking: Smokers are more likely than non-smokers to develop certain cancers, including cervical cancer. If you smoke and have HPV infection, the risk is compounded. It would be advisable to avoid smoking as a mode of prevention of cervical cancer.
  • A poor immune system: People with AIDS or people taking immunosuppressant medication have an increased risk
  • Oral contraceptive pill: A possible link between the oral contraceptive pill and an increased risk of cervical cancer (if the pill is taken for more than five years) has been mooted. However, the risk of cervical cancer has been found to decline over time after women stop using oral contraceptives

Diagnosis

To confirm the diagnosis, the specialist will usually do a vaginal examination if a woman has symptoms which may indicate cervical cancer. If the doctor may feel an abnormal cervix during examination, a colposcopy (a more detailed examination of the cervix) is advised. For this test a speculum is gently put into the vagina so the cervix can be seen in detail using a magnifier (Colposcope). During a colposcopy a small piece of tissue from the cervix is taken for a biopsy. This process is vital for the diagnosis of cervical cancer detection and treatment.

To assess and confirm the extent to which the cancer may have spread the specialist may advise for a few screening tests like:

  • CT Scan
  • MRI Scan
  • Chest X-ray
  • Ultrasound Scan
  • Blood tests

This assessment is called 'staging' of the cancer. The aim of understanding cervical cancer treatment by stage is to find out:

  • The  extent to which the tumour has grown, and if it has grown to other nearby structures such as the bladder or rectum
  • Whether the cancer has spread to local lymph glands (nodes)
  • Finding out the stage of the cancer helps the specialist to advice on treatment options, and gives a reasonable indication of outlook

Treatment

Treatment options for cervical cancer which may be considered to include different types including gynaecological oncology, medical oncology, radiation oncology, or a combination of these treatments which is best determined by the specialist. In terms of modalities, the treatment advised for each case depends on factors including the stage of the cancer and the general health of the patient.

GYNECOLOGICAL ONCOLOGY FOR CERVICAL CANCER:

As part of the cervical cancer operation treatment, a surgery is conducted to remove the cervix and uterus (radical hysterectomy) which is a common course of action. In some cases where the cancer is at a very early stage(requiring treatment), it may be possible to perform removal of the cervix affected by the cancer without removing the entire uterus, for fertility preservation which keeps the pregnancy option open for the patient.  Cervical Cancer Treatment becomes ineffective when patients opt out of hysterectomy, which is the recommended treatment option.

Post the hysterectomy cancer treatment, in case the cancer has spread to other parts of the body, surgery may still be advised, often in addition to other treatments. Even if the cancer is advanced, some surgical techniques may be used to ease symptoms.

MEDICAL ONCOLOGY FOR CERVICAL CANCER:

Chemotherapy is a cervical cancer treatment using anti-cancer drugs which kill cancer cells, or stop them from multiplying. Chemotherapy may be given in addition to radiotherapy or surgery in certain situations. Nowadays concomitant chemo-radiotherapy is the preferred method of treatment for cervical cancer.

RADIATION ONCOLOGY FOR CERVICAL CANCER:

Radiation Oncology is a treatment which uses high energy beams of radiation focused on cancerous tissue, killing the cancer cells or stopping them from multiplying. Radiotherapy alone can be curative for early stage cervical cancer treatment and may be an alternative to surgery which involves laser surgery. For more advanced cancers, radiotherapy may be advised in addition to other treatments.

Two types of radiotherapy are used for cervical cancer, external and internal. In many cases both types are used:

  • External Radiotherapy - This is where radiation is targeted on the cancer from a machine. (This is a common type of radiotherapy used for many types of cancer)
  • Internal radiotherapy - This treatment involves placing a small radioactive implant next to the cancerous tumour for a short time and then it is removed in other words it is called brachytherapy.
  • Even if the cancer is advanced and a cure is not possible, radiotherapy may still have a place to ease symptoms

Radiotherapy has been a convenient option for outpatient treatment especially for patients who would not like to get into the complexity of hospital admission.

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