Cervical Cancer
Introduction : Cervical cancer is cancer that begins on the surface of your cervix. It happens when the cells on your cervix start to change to precancerous cells. HPV (human papillomavirus) infection causes almost all cases of cervical cancer. HPV is a virus that spreads through sexual contact.
Early stages of cervical cancer don’t usually involve symptoms and are hard to detect. The first signs of cervical cancer may take time to develop.
Signs and symptoms of Stage I cervical cancer can include:
- Watery or bloody vaginal discharge that may be heavy and can have a foul odor.
- Vaginal bleeding after sex, between menstrual periods or after menopause.
- Pain during sex (dyspareunia).
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.
Some possible complications of cervical cancer include:
- Pain: Cancer can be painful when it spreads.
- Bladder and bowel changes: Cervical cancer can cause urinary problems like difficulty peeing. It can also cause constipation.
- Kidney damage: Kidney failure is a complication of advanced cervical cancer.
- Blood clots: Your risk for blood clots increases because blood becomes “sticky” when you have cancer. This may slow your blood flow and lead to a clot developing.
- Bleeding: You may experience bleeding from your vagina, rectum or bladder if cancer spreads to those organs.
- Fertility or pregnancy challenges: Depending on the treatment you have, you could lose the ability to get pregnant. Surgery on your cervix to remove cancer cells could also increase your chance of miscarriage with future pregnancies.
Most cervical cancers are caused by HPV, a sexually transmitted infection. HPV spreads through sexual contact (anal, oral or vaginal) and can lead to cancer.
In many cases, you can have no known risk factors for cervical cancer. Other times, you have one or more risk factors. Some risk factors within your control are:
- Screening history: People who haven’t had Pap tests at regular intervals are more likely to get cervical cancer (because Pap tests can detect precancerous cells).
- HPV infection: Certain types of HPV cause cervical cancer. Lowering your risk for HPV can also lower your risk for cervical cancer.
- Sexual history: Having sexual intercourse before the age of 18 and having many sexual partners may put you at higher risk of HPV infection.
- Smoking: Smoking cigarettes increases your risk of cervical cancer.
- HIV infection: People with HIV have a higher-than-average risk of developing cervical cancer.
- Having a weakened immune system: Having a weak immune system makes your body unable to fight infections.
There are some risk factors you can’t change or control. These are:
- DES (diethylstilbestrol): DES is a medication that was given to people between 1938 and 1971 to prevent miscarriage. If your birth parent took DES, you may be more likely to get cervical cancer.
- Family history: Cervical cancer may have a genetic component.
Tests to diagnose cervical cancer
If your screenings come back as abnormal, your healthcare provider will want to run more tests to confirm you have cervical cancer. The first step in that is typically a colposcopy. A colposcope magnifies the cells of your cervix so your healthcare provider can see irregular cells. If the cells look suspicious or unusual, they’ll remove a sample of cervical cells and send them to a lab for further testing.
They can use any of the following methods to get a sample of tissue from your cervix:
- Punch biopsy: Your provider uses a cutting tool with a round top to cut out the precancerous cells.
- Endocervical curettage: A procedure that involves your provider scraping the lining of your cervix with a spoon-shaped tool called a curette.
- Loop electrosurgical excision procedure (LEEP): Your provider uses an electrical wire loop to remove the abnormal cervical tissue.
- Cone biopsy: Your provider removes a slightly larger, cone-shaped piece of tissue from your cervix.
HPV test is done, which is a specific test that checks the cells of your cervix for the HPV strains that are most likely to cause cancer.
If the results from these test confirms cervical cancer, further tests will determine whether the disease has spread (metastasized). These tests might include:
- Liver and kidney function studies.
- Blood and urine tests.
- X-rays of your bladder, rectum, bowels and lungs.
- CT scans.
- MRI.
The cervical cancer treatment team includes a gynecologic oncologist. Treatment for cervical cancer is based on many factors, including the stage of the disease, your age and general health, and if you want 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 your cervix. There are two types of radiation therapy:
- External beam radiation therapy (EBRT): Aims high-powered radiation at cancer from a machine outside your body.
- Brachytherapy: Puts the radiation in or just near cancer.
Chemotherapy
Chemotherapy (chemo) uses drugs injected into your veins or taken by mouth to kill cancer cells. It enters your blood and is effective for killing cells anywhere in your 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 the cancer is in your body.
Surgery
Different kinds of surgery are used to treat cervical cancer. Your provider can remove just the cancerous tissues when the cancer is in its early stages. Some of the most common kinds of surgery for cervical cancer include:
- Laser surgery: This surgery uses a laser beam to burn off just the cancer cells.
- Cryosurgery: This surgery freezes cancer cells, destroying them.
- Hysterectomy: This surgery involves the removal of your uterus and cervix.
- Trachelectomy: This procedure removes your cervix and the upper part of your vagina but not your uterus.
- Pelvic exenteration: This is the same as a hysterectomy but also includes your bladder, vagina, rectum and part of your colon, depending on where the cancer has spread.
Some people may have a combination of treatments. Your provider may use radiation or chemotherapy to treat cancer that has spread or come back (recurred). Sometimes, your 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’re able to design better-targeted treatments that destroy these proteins.
Immunotherapy
Immunotherapy uses medicine to stimulate your immune system to recognize and destroy cancer cells. Cancer cells pretend to be healthy to hide from your immune system. Immunotherapy helps target these signals so the cancer cells can’t trick your body into thinking it’s a healthy cell.
The stage wise 5-year survival percentages
Cervical Cancer
- Stage 1: ~93%
- Stage 2: ~70–80%
- Stage 3: ~50%
- Stage 4: ~15–20%
There are some things you can do to help prevent cervical cancer. Receiving regular gynecological exams and getting Pap tests are the most important steps to take toward preventing cervical cancer. Other things you can do are:
- Get the HPV vaccine (if you’re eligible).
- Use condoms or other barrier methods when you have sex.
- Limit your sexual partners.
- Stop smoking and using tobacco products.
Regular cervical cancer screenings with a Pap test can detect most cases of cervical cancer. The goal of cervical cancer screening is to detect cell changes on your cervix before they become cancer. A Pap test, or Pap smear, involves looking at cells from your cervix under a microscope. These cells are examined for signs of precancers or other irregularities.