Cervical Cancer ​

Anatomy of female reproductive organs

The internal reproductive organs in females include

  • Cervix (narrow end of the uterus that forms a canal between the uterus and vagina).
  • Vagina (birth canal)
  • Uterus (womb)
  • Fallopian tubes (tubes that go to each ovary)
  • Ovaries (small glands located on either side of the uterus at the ends of the fallopian tubes)

What is Cervical Cancer?

Cervical cancer develops in the tissues of the cervix, the lower part of the uterus (womb) that connects to the vagina. Cervical cancer is usually a slow-growing cancer that may not have symptoms.

What are the different types of Cervical Cancer?

There are two main types of cervical cancer:

  • Squamous cell carcinoma accounts for about 80% to 90% of all cervical cancer cases. This type of cancer arises from the squamous cells lining the outer part of the cervix.
  • Adenocarcinoma makes up approximately 10% to 20 % of cervical cancer cases. It originates from the glandular cells in the cervical canal, which produce mucus.

In some instances, cervical cancers may have squamous cell carcinoma and adenocarcinoma characteristics, referred to as adenosquamous carcinoma or mixed carcinoma.

What is the cause of Cervical Cancer?

Cervical cancer is mainly caused by a persistent infection with the Human Papillomavirus (HPV). HPV is a common infection that spreads through sexual contact. At least half of sexually active people will have an HPV infection at some point, often without knowing it, and many may not experience any signs or symptoms. Usually, the body’s immune system clears the HPV infection on its own. However, if the body does not fight HPV infection, it can cause the normal cells of the cervix to change to cancerous cells.

What are the risk factors for Cervical Cancer?

Risk factors for cervical cancer include

  • Multiple sexual partners: The more sexual partners you or your partner have had, the higher the risk of acquiring HPV, which is the primary cause of cervical cancer.
  • Early sexual activity: Engaging in sexual activity at a young age increases the risk of HPV infection and cervical cancer.
  • Other sexually transmitted infections (STIs): Having other STIs, such as chlamydia, gonorrhea, syphilis, or HIV/AIDS, can increase the risk of HPV infection and the development of cervical cancer
  • Weakened immune system: If your immune system is compromised due to another health condition and if you have HPV, you are at a higher risk of developing cervical cancer as your body can not fight HPV infection
  • Smoking: Smoking is associated with an increased risk of squamous cell cervical cancer

What are the symptoms of Cervical Cancer?

In the early stages, cervical cancer often has no signs or symptoms. However, as the cancer progresses, the following signs and symptoms may occur:

  • Vaginal bleeding after intercourse, between periods, or after menopause
  • Watery, bloody vaginal discharge that may be heavy and have an unpleasant odor
  • Pelvic pain or pain during intercourse

In advanced stages of cervical cancer, where the cancer has spread beyond the cervix to other parts of the body, symptoms may include the following:

  • Difficult or painful bowel movements or rectal bleeding during bowel movements
  • Difficult or painful urination or blood in the urine
  • Dull backache that persists over time
  • Swelling of the legs
  • Abdominal pain
  • Persistent fatigue or feeling tired

It is important to note that various other conditions can also cause these symptoms, and experiencing them does not necessarily indicate advanced cervical cancer. It is always recommended to consult a healthcare provider for an accurate diagnosis and appropriate medical advice.

What is Cervical Cancer screening, and how do you get screened?

Cervical cancer screening is a preventive procedure that helps detect abnormal changes in the cells of the cervix before they develop into cancer or identify cervical cancer in its early stages when it is highly curable. The most common screening tests for cervical cancer are the Pap smear (Pap test) and the HPV test.

Screening guidelines

  • Cervical cancer screening is recommended to start at the age of 21, regardless of sexual activity.
  • For individuals aged 21 to 29, a Pap smear is generally recommended every three years. During this period, HPV testing is not typically required unless there are abnormal Pap smear results.
  • From the age of 30 to 65, a combination of Pap smear and HPV testing (co-testing) is often recommended. Co-testing is performed every five years.
  • Women with a history of regular screenings and consistently negative results may be able to stop cervical cancer screening after age 65. However, women with a history of cervical cancer or other risk factors may need continued screening.

What is a Cervical Cancer vaccine?

The HPV vaccine is approved for females aged 9 to 45 and provides protection against cervical cancer. It works by stimulating the immune system to fight specific types of human papillomavirus (HPV) associated with many cervical cancer cases. Ideally, the vaccine is administered before the onset of sexual activity. The vaccine is given in a series of shots, and the number of doses required depends on the age at which the first dose is received. It is advisable to consult your healthcare provider for information related to available vaccines.

How is Cervical Cancer diagnosed?

The following tests may be used to diagnose cervical cancer

Pelvic examination and sterile speculum examination: A gynecologist will look for unusual changes in the cervix, vagina, ovaries, and other nearby organs. They use an instrument called a speculum which gently spreads the vaginal walls apart, allowing for a clear view of the cervix.

Pap smear: A Pap smear is a simple and quick test where a gynecologist collects a small sample of cells from the cervix using a swab or brush. The sample is then examined under a microscope to check for any abnormal changes in the cells.

HPV test: This test is often done with a Pap smear or using the same sample collected during the Pap smear. It checks for the presence of high-risk types of human papillomavirus (HPV) that can cause cervical cancer. HPV testing is recommended for certain age groups or if there are abnormal findings in the Pap smear.

Colposcopy: If abnormalities are detected in the Pap smear or HPV test, a colposcopy may be recommended. A colposcope (a special magnifying instrument) is used to examine the cervix more closely during this procedure. This examination is similar to the speculum examination and can be done in the outpatient department.

Biopsy: A biopsy involves the removal of a small piece of cervical tissue for examination in a laboratory. It is typically done during a colposcopy or as a separate procedure if abnormalities are found. The biopsy helps to determine if cancer or precancerous cells are present and provides more detailed information about the type and stage of cervical cancer.

Additional tests, such as imaging studies (like CT scan or MRI) or further biopsies, may be recommended if cervical cancer is confirmed to evaluate the extent of cancer and whether it has spread to other parts of the body.

What are the stages of Cervical Cancer?

Stage I: Cancer is limited to the cervix and is small in size. It has not spread to other areas of the body.

Stage II: Cancer has spread beyond the cervix and uterus but has not reached the pelvic wall (the tissues that line the part of the body between your hips) or vagina.

Stage III: Cancer has advanced further, spreading to the lower part of the vagina, pelvic wall, ureters (tubes that carry urine), and nearby lymph nodes.

Stage IV: Cancer has spread to distant body parts, such as the bladder, rectum, bones, lungs, or other organs.

How is Cervical Cancer treated?

The choice of treatment depends on multiple factors such as the stage of cancer, the size and location of the tumor, the woman’s age, overall health, and desire for future pregnancy.

  • Surgery: Surgery may involve the removal of the cervix (known as a hysterectomy) or the removal of the cervix and surrounding tissues, including lymph nodes. In some cases, a trachelectomy is performed; this procedure removes the cervix and upper part of the vagina but not the uterus.
  • Radiation therapy: This treatment involves using energy beams to destroy cancer cells. There are two primary types of radiation therapy

    • External beam radiation therapy (EBRT): This method involves directing high-powered radiation beams at the cancer cells from a machine located outside the body. The radiation is carefully targeted to the cervix and surrounding areas to minimize damage to healthy tissues.
    • Brachytherapy: This technique involves placing a radiation source inside or near the cancerous tissues.

  • Chemotherapy: It involves the use of anticancer drugs to kill cancer cells. Chemotherapy is often used in combination with radiation therapy for cervical cancer treatment. Chemotherapy can be given through a vein or taken in pill form. It is usually administered in cycles, which consist of treatment periods followed by rest periods to allow the body to recover. The length and frequency of the cycles vary depending on the specific drugs used and the location of the Cancer. The healthcare team determines the treatment schedule based on factors such as the type and stage of cancer, the individual’s overall health, and the desired treatment outcome.
  • Targeted therapy: Destroys specific cancer cells without damaging healthy cells.
  • Immunotherapy: This treatment helps stimulate the body’s immune system to recognize and attack cancer cells.

Can Cervical Cancer be prevented?

Cervical Cancer can often be prevented by regular screenings by Pap test and human papillomavirus test to find out any precancerous changes in the cervix. Additionally, receiving the HPV vaccine is an effective measure for preventing cervical Cancer.

Other steps to help prevent cancer include

  • Limiting the number of sexual partners
  • Practicing safer sex with the use of condoms or other barrier methods
  • Quitting smoking

To sum up, cervical cancer is a serious disease that can be prevented. It affects the cervix, which is the lower part of the uterus. Getting regular check-ups with Pap tests and HPV tests is very important. These tests can find early signs of cervical cancer before it becomes serious. Also, getting the HPV vaccine can help prevent cervical cancer. You must talk to your healthcare provider regularly, stay informed about prevention, and take action if any problems are found. By taking these steps, you can lower your chances of getting cervical cancer and stay healthy.

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