Cervical cancer develops in the lining of the cervix, the lower part of the uterus that enters the vagina -birth canal. This condition usually develops over time. Worldwide, it is the second most common cancer of women. Although, it may present with vaginal bleeding, problem is that symptoms may be absent until the cancer is in advanced stages. Various strains of the human papillomavirus (HPV), a sexually transmitted infection, are responsible for the majority of cervical cancer cases.
Incidence
Cancer of the cervix is the second most common cancer in women worldwide and is a leading cause of cancer-related death in women in underdeveloped countries. Worldwide, approximately 500,000 cases of cervical cancer are diagnosed each year. The year incidence of invasive cervical cancer in the United States is approximately 13,000 cases of invasive cervical cancer and 50,000 cases of cervical carcinoma in situ- localized carcinoma! Invasive cervical cancer is more common in women middle aged and older and in women of poor socioeconomic status, who are less likely to receive regular screening and early treatment.
There is also a higher rate of incidence among African American, Hispanic, and Native American women.
Signs and Symptoms
Big problem is that early cervical cancer is often asymptomatic, which means that it does not produce any symptoms. As the cancer progresses, some signs and symptoms may appear. In women who receive regular screening, the first sign of the disease is usually an abnormal Pap test result.
Symptoms that may occur include the following:
- Abnormal vaginal bleeding which includes spotting after sexual intercourse, bleeding between menstrual periods, or increased menstrual bleeding
- Abnormal (yellow, odorous) vaginal discharge
- Low back pain
- Painful sexual intercourse (dyspareunia)
- Painful urination (dysuria)
Symptoms of cancer metastasis
Cervical cancer that has spread or -metastasized to other organs may cause
- constipation,
- blood in the urine (hematuria),
- abnormal opening in the cervix (fistula), and
- urethral obstruction- blockage in the tube that carries urine from the kidney to the bladder.
Cervical cancer risk factors
The risk factors for cervical cancer are:
- It is proven infection with the human papilloma virus- virus that causes genital warts may increase the risk of developing dysplasia and subsequent cancer. Luckily, this isn't case with all women that developed HPV infection or genital warts
- Early age at first sexual intercourse are also considered to be a risk factor.
- Multiple sexual partners
- It is proven that women whose mothers took an estrogen drug during pregnancy called DES-diethylstilbestrol are at risk of a rare form of cervical and vaginal cancer.
- Women who take birth control pills have also greater chances to develop cervical cancer! It is thought that this is because such women are more sexually active, are less likely to use condoms.
- Some scientists believe that other factors, such as smoking, may increase the risk of developing cervical cancer in those who have had HPV.
- Women whose immune systems are weakened for example- those with HIV infection or those who had received organ transplants and are taking drugs to suppress the immune system - may be at a higher risk.
- Infections with genital herpes or chronic Chlamydia infections, both sexually transmitted diseases, may increase risk.
- Poor women may be at higher risk because they are not able to afford regular pap smears.
Diagnosis of cervical cancer
Special tests are necessary to diagnose cervical pre-cancers and cancers
- Pap smears – Today, doctors believe that a Pap smear is insufficient for the diagnosis.
- Colposcopy is an examination of the cervix under magnification in order to locate an abnormality of the cervix
- Biopsy, colposcopy, or sometimes the use of LASER or other instrument allows a diagnosis to be made. This is one very effective procedure, in which the inner lining of the cervix is removed to be examined pathologically
- HPV DNA test. Doctor also may use a laboratory test called the HPV DNA test to determine whether you are infected with any of the 13 types of HPV that are most likely to lead to cervical cancer.
- When the cancer is already discovered and diagnosis has been set- and X-rays, using an instrument to look into the bladder (cystoscopy), and rectum and colon (colonoscopy) - are usually used to determine how far the cancer has spread.
Histology and staging of the cervical cancer
If we are talking about histological structure of the cervical cancer, then we should know that there are several types of malignant cervical tumors located in the cervix! These are:
- squamous cell carcinoma (about 80-85%)
- adenocarcinoma
- adenosquamous carcinomas
- small cell carcinoma
- neuroendocrine carcinoma
- melanoma
- lymphoma
Cervical cancer is staged by the FIGO staging system, which is based on clinical examination
- Stage 0 - full-thickness involvement of the epithelium without invasion into the stroma. This stage is also called carcinoma in situ
- Stage I - limited to the uterus
- IA - diagnosed only by microscopy; no visible lesions
- IA1 - Stromal invasion less than 3 mm in depth and 7 mm or less in horizontal spread
- IA2 - Stromal invasion between 3 and 5 mm with horizontal spread of 7 mm or less
- IB - visible lesion or a microscopic lesion with more than 5 mm of depth or horizontal spread of more than 7 mm
- IB1 - visible lesion 4 cm or less in greatest dimension
- IB2 - visible lesion more than 4 cm
- Stage II - invades beyond uterus
- IIA - without parametrial invasion
- IIB - with parametrial invasion
- Stage III - extends to pelvic wall or lower 1/3 of the vagina
- IIIA - involves lower 1/3 of vagina
- IIIB - extends to pelvic wall and/or causes hydro-nephrosis or non-functioning kidney
- Stage IV
- IVA - invades mucosa of bladder or rectum and/or extends beyond true pelvis
- IVB - distant metastasis
Treatment of cervical cancer
Complete treatment of cervical cancer could be separated in two different approaches! The first is pre-invasive stage and the second is invasive stage!
Pre-invasive stage
This includes all the treatments when it has affected only the outer layer of the lining of the cervix.
- Conization
This type of surgery involves removing a cone-shaped piece of cervical tissue where the abnormality is found with a scalpel
- Laser surgery
This operation uses a narrow beam of intense light to kill cancerous and precancerous cells.
- Loop electrosurgical excision procedure (LEEP)
This therapeutic technique uses a wire loop to pass electrical current remove cells from the affected part of the cervix.
- Cryosurgery
This technique involves freezing and killing cancerous and precancerous cells.
Invasive stage
- Hysterectomy
Surgery is usually recommended for younger women because it often can preserve one or both ovaries along with their estrogen production. There are two types of hysterectomy
- A simple hysterectomy — removal of the cancer, the cervix and the uterus
- A radical hysterectomy — removal of the cervix, uterus, part of the vagina and lymph nodes in the area
- Radical approach
This specific approach allows the women to preserve their fertility and it involves removing the cervix and the lower part of the uterus. Enough of the uterus is left in place that you may be able to carry a child.
- Radiation
It is proven that high-energy rays can shrink tumors by killing the cancer cells. Main thing about this is that the radiation destroys the ability of cancer cells to reproduce. Women that entered premenopause will experience menopause because their ovarian functions are destroyed by the radiation.
- Chemotherapy
Some anti-cancer drugs enter a patient’s bloodstream and travel throughout your entire body.
Chemotherapy enhances the effects of radiation in the treatment of cervical cancer.
Prevention of cervical cancer
Unlike many cancers, cervical cancer can be prevented. Prevention means avoiding the risk factors and increasing the protective factors that can be controlled so that the chance of developing cancer decreases.
- Condoms and sexual behavior
Although, condoms don't directly prevent the transmission of HPV because the virus can be transmitted through skin-to-skin contact with any infected part of the body, wearing condoms is still critical to preventing other STD infections that could weaken your immune system.
Some steps that could also reduce the risk for developing a cervical cancer are:
- Delaying first intercourse
- having fewer sexual partners
- Quit smoking
- Pap test
It is proven that routine Pap tests are the most successful and accurate method of early detection. Current guidelines suggest:
- An initial Pap test three years after you begin having sexual intercourse or at age 21, whichever comes first.
- From age 21 to 29, a regular Pap test each year or a liquid-based test every two years.
- From age 30 to 69 — if you've had three normal Pap tests in a row — a regular Pap test every two years or a liquid-based test every three years.
- From age 70 on, you may stop having Pap tests if you've had three or more normal tests in a row and no abnormal results in the last 10 years.
- Vaccine
Many medical science centers are studying a vaccine that appears to prevent cervical cancer. The vaccine works by making people immune to the human papillomavirus type 16 (HPV-16) and type 18 (HPV-18), which together cause the majority of cases of cervical cancer. Although potentially effective, the fact is that-the vaccine is experimental and won't be available to the public for several years.
