What is Cervical Cancer?
Cervical cancer happens when cells change in a woman?s cervix, which connects her uterus with her vagina. This cancer can affect the deeper tissues of her cervix and may spread to other parts of her body (metastasize), often the lungs, liver, bladder, vagina, and rectum.
Most cases of cervical cancer are caused by infection with human papillomavirus (HPV), which is preventable with a vaccine.
Cervical cancer grows slowly, so there?s usually time to find and treat it before it causes serious problems. It kills fewer and fewer women each year, thanks to improved screening through Pap tests.
Women 35 to 44 years old are most likely to get it. More than 15% of new cases are in women over age 65, however, especially those who haven?t been getting regular screenings.
Cervical Cancer Types
There?s more than one kind of cervical cancer.
- Squamous cell carcinoma. This forms in the lining of your cervix. It?s found in up to 90% of cases.
- Adenocarcinoma. This forms in the cells that produce mucus.
- Mixed carcinoma. This has features of the two other types.
Symptoms of Cervical Cancer are :
Intercourse pain, or dyspareunia, can cause problems in a couple's sexual relationship. In addition to the physically painful sex occurs just before, during or after intercourse, there is also the possibility of negative emotional effects. So the problem should be addressed as soon as it arises.
Cervical Cancer can be caused due to:
Most cervical cancer cases are caused by the sexually transmitted human papillomavirus (HPV). This is the same virus that causes genital warts.
There are about 100 different strains of HPV. Only certain types cause cervical cancer. The two types that most commonly cause cancer are HPV-16 and HPV-18.
Being infected with a cancer-causing strain of HPV doesn?t mean you?ll get cervical cancer. Your immune system eliminates the vast majority of HPV infections, often within two years.
HPV can also cause other cancers in women and men. These include:
HPV is a very common infection. Find out what percentage of sexually active adults will get it at some point in their lifetime.
What kind of precaution should be taken in Cervical Cancer?
To reduce your risk of cervical cancer:
- Ask your doctor about the HPV vaccine. Receiving a vaccination to prevent HPV infection may reduce your risk of cervical cancer and other HPV-related cancers. Ask your doctor whether an HPV vaccine is appropriate for you.
- Have routine Pap tests. Pap tests can detect precancerous conditions of the cervix, so they can be monitored or treated in order to prevent cervical cancer. Most medical organizations suggest beginning routine Pap tests at age 21 and repeating them every few years.
- Practice safe sex. Reduce your risk of cervical cancer by taking measures to prevent sexually transmitted infections, such as using a condom every time you have sex and limiting the number of sexual partners you have.
- Don't smoke. If you don't smoke, don't start. If you do smoke, talk to your doctor about strategies to help you quit.
How it can be spread?
After you?ve been diagnosed, your doctor will assign your cancer a stage. The stage tells whether the cancer has spread, and if so, how far it?s spread. Staging your cancer can help your doctor find the right treatment for you.
Cervical cancer has four stages:
- Stage 1: The cancer is small. It may have spread to the lymph nodes. It hasn?t spread to other parts of your body.
- Stage 2: The cancer is larger. It may have spread outside of the uterus and cervix or to the lymph nodes. It still hasn?t reached other parts of your body.
- Stage 3: The cancer has spread to the lower part of the vagina or to the pelvis. It may be blocking the ureters, the tubes that carry urine from the kidneys to the bladder. It hasn?t spread to other parts of your body.
- Stage 4: The cancer may have spread outside of the pelvis to organs like your lungs, bones, or liver.
Treatment for the Cervical Cancer
Early cervical cancer diagnosis improves the success rate of treatment.
The U.S. Preventive Services Task Force (USPSTF) recommend the following as routine screening:
Under 21 years: The USPSTF do not recommend screening.
From 21?29 years: People should undergo screening every 3 years for cervical cancer.
From 30?65 years: The frequency depends on the type of screening. The USPSTF recommend one of the following:
- screening for cervical cancer every 3 years, or
- screening for HPV every 5 years, or
- screening for both HPV and cervical cancer every 5 years
Over 65 years: The USPSTF do not recommend screening for those who have had adequate screening in the past, unless they have a high risk of cervical cancer.
People who have had a hysterectomy with removal of the cervix do not need screening, unless they have had precancerous lesions or cervical cancer in the past.
These are the overall screening recommendations, but a doctor can advise each person about their screening needs.
Cervical smear test
The American Cancer Society estimate that healthcare professionals will make over 13,000 new diagnoses of invasive cervical cancer in 2019. The disease will be fatal in around 4,000 women. However, regular screening could prevent most of these deaths.
Screening does not detect cancer but looks for abnormal changes in the cells of the cervix. Without treatment, some abnormal cells can eventually develop into cancer.
HPV DNA testing
This test determines whether the individual has any of the types of HPV most likely to cause cervical cancer. It involves collecting cells from the cervix for lab testing.
The test can detect high-risk HPV strains in cell DNA before any anomalies become clear in the cervical cells.
If there are signs and symptoms of cervical cancer, or if the Pap test reveals abnormal cells, a doctor may recommend additional tests.
- Colposcopy: This is visual examination of the vagina using a speculum and a colposcope, a lighted magnifying instrument.
- Examination under anesthesia (EUA): The doctor can examine the vagina and cervix more thoroughly.
- Biopsy: The doctor takes a small section of tissue under general anesthesia.
- Cone biopsy: The doctor takes a small, cone-shaped section of abnormal tissue from the cervix for examination.
- LLETZ: Diathermy using a wire loop with an electric current helps remove abnormal tissue. The healthcare professional then sends the tissue to the lab for checking.
- Blood tests: A blood cell count can help identify liver or kidney problems.
- CT scan: A medical professional might use a barium liquid to show up any cellular abnormalities.
- MRI: Special types of MRI may be able to identify cervical cancer in its early stages.
- Pelvic ultrasound: High-frequency sound waves create an image of the target area on a monitor.
Treatment for cervical cancer depends on several factors, such as the stage of the cancer, other health problems you may have and your preferences. Surgery, radiation, chemotherapy or a combination of the three may be used.
Early-stage cervical cancer is typically treated with surgery. Which operation is best for you will depend on the size of your cancer, its stage and whether you would like to consider becoming pregnant in the future.
Options might include:
- Surgery to cut away the cancer only. For a very small cervical cancer, it might be possible to remove the cancer entirely with a cone biopsy. This procedure involves cutting away a cone-shaped piece of cervical tissue, but leaving the rest of the cervix intact. This option may make it possible for you to consider becoming pregnant in the future.
- Surgery to remove the cervix (trachelectomy). Early-stage cervical cancer might be treated with a radical trachelectomy procedure, which removes the cervix and some surrounding tissue. The uterus remains after this procedure, so it may be possible to become pregnant, if you choose.
- Surgery to remove the cervix and uterus (hysterectomy). Most early-stage cervical cancers are treated with a radical hysterectomy operation, which involves removing the cervix, uterus, part of the vagina and nearby lymph nodes. A hysterectomy can cure early-stage cervical cancer and prevent recurrence. But removing the uterus makes it impossible to become pregnant.
Minimally invasive hysterectomy, which involves making several small incisions in the abdomen rather than one large incision, may be an option for early-stage cervical cancer. People who undergo minimally invasive surgery tend to recover more quickly and spend less time in the hospital. But some research has found minimally invasive hysterectomy may be less effective than traditional hysterectomy. If you're considering minimally invasive surgery, discuss the benefits and risks of this approach with your surgeon.
Radiation therapy uses high-powered energy beams, such as X-rays or protons, to kill cancer cells. Radiation therapy is often combined with chemotherapy as the primary treatment for locally advanced cervical cancers. It can also be used after surgery if there's an increased risk that the cancer will come back.
Radiation therapy can be given:
- Externally, by directing a radiation beam at the affected area of the body (external beam radiation therapy)
- Internally, by placing a device filled with radioactive material inside your vagina, usually for only a few minutes (brachytherapy)
- Both externally and internally
If you haven't started menopause yet, radiation therapy might cause menopause. If you might want to consider becoming pregnant after radiation treatment, ask your doctor about ways to preserve your eggs before treatment starts.
Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. It can be given through a vein or taken in pill form. Sometimes both methods are used.
For locally advanced cervical cancer, low doses of chemotherapy are often combined with radiation therapy, since chemotherapy may enhance the effects of the radiation. Higher doses of chemotherapy might be recommended to help control symptoms of very advanced cancer.
Targeted drug treatments focus on specific weaknesses present within cancer cells. By blocking these weaknesses, targeted drug treatments can cause cancer cells to die. Targeted drug therapy is usually combined with chemotherapy. It might be an option for advanced cervical cancer.
Immunotherapy is a drug treatment that helps your immune system to fight cancer. Your body's disease-fighting immune system might not attack cancer because the cancer cells produce proteins that make them undetectable by the immune system cells. Immunotherapy works by interfering with that process. For cervical cancer, immunotherapy might be considered when the cancer is advanced and other treatments aren't working.
Supportive (palliative) care
Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care.
When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.
Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.
Possible complication with Cervical Cancer
Complications of cervical cancer can occur as a side effect of treatment or as the result of advanced cervical cancer.
If your ovaries are surgically removed or are damaged during treatment with radiotherapy, it will trigger an early menopause if you haven't already been through it. Most women experience the menopause naturally in their early fifties.
Narrowing of the vagina
Radiotherapy to treat cervical cancer can often cause your vagina to become narrower, which can make having sex painful or difficult.
There are 2 main treatment options if you have a narrowed vagina. The first is to apply a hormone cream to your vagina. This should increase moisture within your vagina and make having sex easier.
The second is to use vaginal dilators, sometimes called vaginal trainers. These are tampon-shaped plastic tubes that come in many different sizes. You insert one into your vagina, usually starting with the smallest size.
Dilators are designed to help stretch the vagina and make it more supple. As you get used to the smaller sizes, you can work your way up to slightly larger ones.
It's usually recommended to use dilators for 5 to 10 minutes at a time on a regular basis during the day over the course of 6 to 12 months.
Your specialist cancer nurse or radiographers in the radiotherapy department should be able to give you more information and advice.
You may find that the more times you have sex, the less painful it becomes. However, it may be several months before you feel emotionally ready to be intimate with a sexual partner.
If the lymph nodes in your pelvis are removed, it can sometimes disrupt the normal workings of your lymphatic system.
One of the functions of the lymphatic system is to drain away excess fluid from the body's tissue. A disruption to this process can lead to a build-up of fluid in the tissue, called lymphoedema. This can cause certain body parts to become swollen ? usually the legs, in cases of cervical cancer.
There are exercises and massage techniques that can reduce the swelling. Wearing specially designed bandages and compression garments can also help.
The emotional impact of living with cervical cancer can be significant. Many people report experiencing a "rollercoaster" effect.
For example, you may feel down when you receive a diagnosis but happy when removal of the cancer has been confirmed. You may then feel down again as you try to come to terms with the after effects of your treatment.
This type of emotional disruption can sometimes trigger depression. Typical signs of depression include feeling sad and hopeless, and losing interest in things you used to enjoy.
Contact your GP if you think you may be depressed. There are a range of effective treatments available, including antidepressant medication and talking therapies, such as cognitive behavioural therapy (CBT).
1 https://www.mayoclinic.org/diseases-conditions/cervical-cancer/symptoms-causes/syc-20352501 2 https://www.webmd.com/cancer/cervical-cancer/understanding-cervical-cancer-prevention 3 https://www.healthline.com/health/cervical-cancer 4 https://www.cdc.gov/cancer/cervical/basic_info/index.htm 5 https://www.who.int/health-topics/cervical-cancer 6 https://www.medicalnewstoday.com/articles/159821 7 https://www.nccc-online.org/hpvcervical-cancer/cervical-cancer-overview/ 8 https://www.nhs.uk/conditions/cervical-cancer/complications/