Cervical cancer is a global health problem, affecting women of all races and ethnicities. It is the fourth most common cancer in women around the world. Each year, there are about 570,000 new cases and 311,000 deaths.
In developed countries, the incidence of cervical cancer has decreased in recent decades due to the widespread use of cervical cancer screening programs, such as the Pap smear test. However, in developing countries, cervical cancer remains a significant public health problem due to limited access to screening and treatment services.
What I have written here is an exhaustive guide to cervical cancer for patients. For the nitty-gritty details, however, I advise you to speak with an expert oncologist or gynecologist.
Risk Factors For Cervical Cancer
Cervical cancer is a type of cancer that affects the cervix, which is the lower part of the uterus that opens into the vagina. There are several things that can increase a person’s risk of getting cervical cancer, and I have listed these below.
Infection With The Human Papillomavirus (HPV)
This virus is the main cause of cervical cancer, and it is often spread through sexual contact. High-risk HPV 16 and 18 are the cause of more than 75% of cases.
Smoking
Smoking increases the chance of getting cervical cancer because it contains many chemicals that are bad for your health and can damage the DNA in cells, including cells in the cervix. Chemicals in tobacco smoke can also weaken the immune system, making it less able to fight off HPV infections, which are a major risk factor for cervical cancer.
In addition to making it more likely that a woman will get cervical cancer, smoking can also make it worse for women who already have it. If a woman has cervical cancer and smokes, she is more likely to have advanced cancer and a worse outlook than a woman who does not smoke.
Prolonged Use Of Birth Control Pills
Oral contraceptives, which are also called birth control pills, are a type of hormonal birth control that works by stopping ovulation. They have synthetic versions of the hormones estrogen and progesterone, which can change how cells in the body, including cells in the cervix, grow and develop.
Studies have found that taking birth control pills for more than five years may make you more likely to get cervical cancer. The exact way this happens is not fully understood, but it is thought that the hormones in birth control pills may change the way cervical cells grow and divide, making them more vulnerable to the HPV virus, which is a known risk factor for cervical cancer.
But it’s important to keep in mind that the overall risk of cervical cancer from birth control pills is still pretty low and that for many women, the benefits of birth control pills outweigh the risks. Also, the higher risk of cervical cancer that comes with taking birth control pills seems to go down after a woman stops taking them.
Having Many Full-term Pregnancies
Multiple pregnancies do not cause cervical cancer on their own. Several pregnancies may, however, increase the risk of cervical cancer, according to some studies.
During pregnancy, changes in hormones can affect how cells in the cervix grow and develop, making them more likely to get infected with the HPV virus, which is known to increase the risk of cervical cancer. Also, repeated trauma to the cervix during childbirth can cause changes in the cells that may make it more likely that the woman will get cervical cancer in the future.
Even if a woman has had multiple pregnancies, her risk of getting cervical cancer is still pretty low, and regular cervical cancer screenings can help find any changes in the cervix early.
Weak Immune System
People with weak immune systems, such as those with HIV/AIDS, are more likely to get HPV infections and have a higher risk of cervical cancer.
Exposure to DES
DES is a synthetic form of estrogen that was given to some pregnant women in the past to prevent miscarriage. Women exposed to DES have a higher risk of cervical cancer.
Overall, it’s important to have regular cervical cancer screenings, such as a Pap smear test or HPV test, to catch any changes in the cervix early and prevent cervical cancer.
Symptoms Of Cervical Cancer – What To Look Out For
If you experience any of the following symptoms, it’s important to see a doctor as soon as possible:
Abnormal vaginal bleeding: This can include bleeding between periods, after sex, or after menopause. It’s important to note that some women may also experience light spotting or staining.
Pelvic pain: This can include pain during sex or a constant ache in the lower back or pelvis. If you have pain in your pelvic area, it’s important to see a doctor to determine the cause.
Increased vaginal discharge: This can be watery, bloody, or have an unusual odor. If you notice any changes in your discharge, it’s important to see a doctor to determine the cause.
Pain during urination: This can be a sign of a urinary tract infection, which is common in women with cervical cancer. If you have pain or burning when you urinate, it’s important to see a doctor to determine the cause.
Fatigue: Cancer cells can use up a lot of energy, making a person feel tired and weak. If you feel tired or weak for no apparent reason, it’s important to see a doctor to determine the cause.
It’s important to remember that these symptoms can also be caused by other, less serious conditions, such as a urinary tract infection or an irritable cervix. But if you have any concerns about your health, it’s always best to see a doctor for a proper diagnosis.
Stages of Cervical Cancer
Cervical cancer typically develops slowly over a period of several years. During this time, abnormal cells grow in the lining of the cervix, and if left untreated, can eventually lead to cancer.
The stages of cervical cancer called the 2018 FIGO staging, are determined by the size and location of the cancerous cells. There are four main stages of cervical cancer, as I have discussed below.
Stage 0: Also known as carcinoma in situ, this is the earliest stage of cervical cancer. The abnormal cells are only in the surface layer of the cervix and have not invaded deeper into the tissue.
Stage 1: At this stage, cancer is strictly limited to the cervix. Stage 1 is divided into two sub-stages: Stage 1A, where the cancer is less than 3mm deep; and Stage 1B, where the cancer is deeper than 3mm but less than 5mm.
Stage 2: At this stage, cancer has spread beyond the uterus and into the surrounding tissues. This may include the upper 2/3rds of the vagina, the parametrium (the tissue around the cervix), or the pelvic wall. Stage 2 is also divided into two sub-stages: Stage 2A, where cancer has spread to the upper two-thirds of the vagina but not the parametrium; and Stage 2B, where cancer has spread to the parametrium but not to the pelvic wall.
Stage 3: At this stage, cancer has spread to the lower part of the vagina or the pelvic wall, or it may be blocking the ureters (tubes that carry urine from the kidneys to the bladder). Stage 3 is also divided into two sub-stages: Stage 3A, where cancer has spread to the lower part of the vagina but not the pelvic wall; Stage 3B, where cancer has spread to the pelvic wall or is blocking the ureters (kidney tubes); and Stage 3C includes the involvement of lymph nodes.
Stage 4: This is the most advanced stage of cervical cancer. At this stage, cancer has spread to other body parts, such as the bladder, rectum, or distant organs like the liver or lungs. Stage 4 is divided into two sub-stages: Stage 4A, where cancer has spread to nearby organs; and Stage 4B, where cancer has spread to distant organs.
Screening For Cervical Cancer
Screening for cervical cancer is recommended for women who are or have been sexually active. It is usually recommended to start at age 21, or within three years of becoming sexually active.
The American College of Obstetricians and Gynecologists recommends the following cervical cancer screening schedule as shown in the table below.
Women < 21 years: No routine screening required, despite sexual activity.
Women aged 21-29 years: Pap test every 3 years
Women aged 30-65 years: Pap test and human papillomavirus (HPV) test every 5 years, or just a Pap test every 3 years
Women aged 65 years and older: Women who have had regular, normal Pap tests with no recent abnormal results may stop cervical cancer screening. Women who have had a hysterectomy also do not need one if their results have been negative for over 15 years.
It’s important to note that screening recommendations may vary depending on individual risk factors, such as having a history of abnormal Pap tests, a weakened immune system, or exposure to diethylstilbestrol (DES) before birth.
Women who have had a hysterectomy should also talk to their doctor about whether they still need cervical cancer screening.
It is recommended that women discuss their individual cervical cancer screening needs with their gynaecologist.
Investigations
The investigation of cervical cancer usually begins with a pelvic exam and a Pap test (also known as a cervical smear test) to check for abnormal cells in the cervix.
A pap smear is a screening test to detect abnormal cells on the cervix that could lead to cervical cancer. Here are the steps to do a pap smear:
- Schedule an appointment with your healthcare provider.
- Refrain from sexual intercourse, douching, or using tampons 24 hours before the test.
- Undress from the waist down and lie on your back on an examination table.
- Your healthcare provider will insert a speculum into your vagina to hold it open.
- They will use a small brush or spatula to collect cells from the cervix.
- The collected cells are then sent to a laboratory for analysis.
- Your doctor will inform you of the results, usually within a few days.
Note: The steps may vary slightly depending on your healthcare provider and their preferred method for collecting the sample.
If abnormal cells are found, further testing may be needed to determine if cancer is present.
These tests may include:
HPV Test
This test checks for the presence of human papillomavirus (HPV), which is the main cause of cervical cancer.
Colposcopy
This is a procedure that allows the doctor to get a closer look at the cervix and identify any abnormal areas.
During a colposcopy, the doctor will use a special magnifying device to look at the cervix and may take a sample of tissue (biopsy) for testing.
Endocervical curettage (ECC)
This is a procedure that involves removing a sample of cells from the endocervical canal (the canal that leads from the cervix to the uterus) for testing.
Cone biopsy
This is a procedure that involves removing a cone-shaped piece of tissue from the cervix for testing.
If cancer is confirmed, further testing may be done to determine the extent (stage) of cancer and if it has spread to other parts of the body. These tests may include a CT scan, MRI, or PET scan.
It’s important to note that the specific tests and investigation for cervical cancer may vary based on a woman’s individual circumstances and the stage of her cancer. A doctor or specialist in women’s health can provide more information and help determine the best course of action for each individual case.
Treatment Of Cervical Cancer
The treatment of cervical cancer depends on the stage (extent) of cancer and may include one or more of the following:
Surgery
Cancerous tissue in the cervix can be removed through surgery. This can include a simple procedure to remove just the abnormal tissue or a more extensive procedure to remove the cervix and surrounding tissue.
Radiation Therapy
Cervical cancer is typically treated with radiation therapy. It employs the use of X-rays and other forms of high-energy radiation to destroy cancer cells and reduce the size of tumors.
While treating cervical cancer, radiation therapy may be used alone or in conjunction with other treatments such surgery and chemotherapy. What kind of radiation therapy a woman receives could be determined by factors like her cancer stage and her personal health history.
Cervical cancer treatment often consists of one of two forms of radiation therapy:
External-beam radiation therapy: In this type of radiation therapy, the radiation is sent to the cancerous tissue in the cervix by a machine that is outside the body. Typically, patients receive treatment for a few weeks, five days a week.
Brachytherapy: This is a type of radiation therapy that involves putting a small device inside the vagina near the cancerous tissue. The gadget directs radiation to malignant tissue while minimizing exposure to healthy tissue. The course of treatment could last multiple days.
Fatigue, skin irritation, and vaginal dryness are just some of the possible adverse effects of radiation therapy. However, medicine and other forms of supportive care can typically reduce or eliminate these unwanted consequences.
It’s important to remember that radiation therapy isn’t always needed to treat cervical cancer. Whether or not a woman needs radiation therapy depends on her personal situation and how far along her cancer is.
Chemotherapy
Chemotherapy refers to the use of medications in the treatment of cancer. When treating cervical cancer, chemotherapy can be used either alone or in conjunction with other treatments such as surgery and/or radiation therapy.
Drugs used in chemotherapy are often administered in cycles, with treatment followed by a period of rest. The drugs can be given intravenously (through a vein) or orally (in pill form).
In the case of cervical cancer, the chemotherapy medications used to treat the disease may differ from patient to patient and from stage to stage. Chemotherapy medications like cisplatin, carboplatin, paclitaxel, and topotecan are frequently used to treat cervical cancer.
Common negative reactions to chemotherapy include feeling ill, losing your hair, feeling tired all the time, and even getting sick more often. But most of the time, these side effects can be managed with medicine or other care.
It’s vital to keep in mind that chemotherapy isn’t always required for the treatment of cervical cancer; whether or not a woman undergoes chemotherapy depends on her unique situation and the stage of her cancer.
Targeted Therapy
This involves using drugs that target specific molecules involved in the growth and spread of cancer cells.
Molecular targets are the focus of targeted therapy, a form of cancer treatment that use medications to halt the progression of the disease. Treatments like these aim to kill cancer cells while sparing healthy tissue as much as possible.
Drugs used in targeted therapy for cervical cancer are effective because they stop the signals that fuel tumor development and cell division. By doing this, these drugs can slow or stop the growth of cancer cells, which will eventually cause the cancer cells to die.
Targeted therapy can be used alone or in conjunction with other therapies including surgery, radiation therapy, or chemotherapy, and is typically administered in the form of a tablet or injection.
It’s important to remember that not all women with cervical cancer will be good candidates for targeted therapy, and that the drugs used will depend on the woman’s situation and how far along her cancer is.
In addition to these treatments, a woman may also need supportive care to manage symptoms and side effects. This could include dealing with pain, getting help with nutrition, and getting counseling to help deal with the emotional and mental effects of cancer.
Preventing Cervical Cancer
Cervical cancer is frequently preventable by taking steps to lower your risk of developing the disease. Here are some steps you can take to reduce your risk:
The HPV vaccine can protect against infection with the HPV types most likely to cause cervical cancer. The vaccine is recommended for girls and boys as young as 11 or 12, as well as women and men as young as 26 and 21 who have not yet been immunized.
Regular Pap tests and HPV tests can help detect abnormal cells in the cervix before they become cancerous. Women should begin getting regular screenings when they reach the age of 21, or when they become sexually active.
Use a barrier method of contraception, such as condoms, to reduce the risk of HPV infection.
Don’t smoke: Cigarette smoking increases the risk of cervical cancer.
Consume a healthy diet: Eating a diet rich in fruits, vegetables, and whole grains may help lower the risk of cervical cancer.
Limit alcohol consumption: Excessive alcohol consumption increases the risk of cervical cancer.
It is critical to remember that while these steps can help lower your risk of developing cervical cancer, they do not guarantee prevention. Even if you have received the HPV vaccine and/or are taking steps to reduce your risk, regular screenings are still required.
Closing Remarks
Cancer of the cervix is a serious health problem that affects women all over the world. But there are things women can do to lower their risk of getting cervical cancer. For example, they can get regular tests for cervical cancer and have safe sex to avoid getting HPV.
If cervical cancer is found early, it can often be treated successfully with surgery, radiation therapy, chemotherapy, or a combination of the three. But it’s important for women to know the signs and symptoms of cervical cancer and to go to their doctor if they have any health concerns.
Finally, it is critical for women to maintain their overall health, which includes eating a nutritious diet, getting regular exercise, and not smoking, as all of these things can increase their risk of acquiring cervical cancer. Cervical cancer can be prevented and treated if people know about it, get screened, and get the right care.
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