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Cervical Cancer: Causes, Symptoms, Treatment, and Prevention

  • 28 Aug, 2020
  • By UHAPO
  • 484

Cervix is the part of the female reproductive system which connects the vagina to the upper part of the uterus. It has an outer surface that opens into the vagina and an inner surface that faces into the uterus. Cervical cancer forms when the cells that line the cervix begin to develop abnormal changes. Over time, these mutated cells may grow out of control and form a tumor.[1],[2]

 

The cervix has two distinct parts which are covered with two different types of cells: squamous cells and glandular cells. The part of the cervix closest to the body of the uterus is called endocervix which is covered with glandular cells.

 

The part adjacent to the vagina is called ectocervix and is covered with squamous cells.  The area where the squamous cells and glandular cells meet is called the transformation zone. This is the area where most cervical cancers begin to develop.

 

The cancer of squamous cells is known as squamous cell carcinoma and is responsible for 90% of cases of cervical cancer. Whereas, cancer of the glandular cells is called adenocarcinoma of the cervix which is comparatively less common but its incidences are increasing recently. Some cervical tumors may involve both squamous cells and glandular cells. [2],[3] 

 

According to WHO, cervical cancer is the fourth leading cause of cancer in women. An estimated 570 000 women were diagnosed with cervical cancer about 311 000 women died from the disease in 2018, globally. [3]

 

All women are at risk for cervical cancer. It occurs most often in women over age 30. Almost all cervical cancer cases (99%) are linked to infection with certain types of high-risk human papillomaviruses (HPV), an extremely common virus transmitted through sexual contact. At least half of sexually active people will have HPV at some point in their lives, but few women will get cervical cancer. Long-lasting infection with HPV is the main cause of cervical cancer. Some of the other factors which can increase the risk of cervical cancer include: [1],[4]

 

  • HIV Infection

  • Smoking

  • Use of birth control pills for a longer duration of more than five years

  • Having multiple sexual partners

 

There are no symptoms of cervical cancer at an early stage. Symptoms at the advanced stage of cancer include: [2],[4] 

 

  • Vaginal bleeding between periods, after menopause or during or after sexual intercourse

  • An unusual vaginal discharge

  • Heavier periods or periods that last longer than usual

  • Pain during sexual intercourse

  • Pain in the pelvis

 

These symptoms are not specific to cervical cancer and can be seen with various other health complications. Thus, regular screening is essential for early diagnosis and preventing cervical cancer. The following tests are available to screen for cervical cancer or precancerous changes in people who don't have any symptoms.[1],[4]

 

  • Pap smear or Pap test: It is used for several decades to screen for cervical cancer. The test looks for pre-cancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately. This test has helped to decrease cervical cancer incidences significantly. However, screening for HPV infection is a more effective way of preventing cervical cancer.

 

  • HPV test: HPV test looks for the HPV virus which is responsible for causing changes and cells of the cervix leading to cervical cancer in a longer duration. A positive HPV test indicates HPV infection that may be associated with cervical cancer. This does not indicate that the person has cervical cancer but provides warning of the risk of developing cervical cancer. The results of the screening test are used to predict the level of risk for precancerous cell changes or cervical cancer. 

 

  • The other options for diagnosis include colonoscopy, biopsy, and imaging scans such as MRI, CT Scan, and PET scan. [1],[4]

 

Based on various diagnostic tools the treating gynecological oncologist will determine the stage of the disease depending on the spread of the disease. Cervical cancer is staged using the TNM system where T stands for a tumor that describes the size of the original tumor. N is for node and indicates whether the cancer is present in the lymph nodes. M is for metastasis which refers to whether cancer has spread to other parts of the body. Once the T, N, and M scores have been determined, an overall cervical cancer stage is assigned. Cervical cancer is staged 1 to 4 as follows:[2],[4]


 

Stage of Cervical Cancer

What happens?

Stage 1

The cancer is found only in the tissue of the cervix.

Stage 2

Cancer has spread outside the cervix to the upper two-thirds of the vagina or other tissue next to the cervix (parametrium).

Stage 3

Cancer has spread to the tissue on the side of the pelvis (pelvic sidewall) and/or the lower third of the vagina.

Stage 4

Cancer has spread to the bladder or rectum, or beyond the pelvis to the lungs, liver, or bones.

 

If diagnosed early and managed properly, cervical cancer is one of the most successfully treatable forms of cancer. The different treatment options include surgery, chemotherapy, and radiation therapy as well as immunotherapy. The choice of treatment depends on the spread of cancer, the size of the tumor, and whether the patient wants to become pregnant one day.[3],[4]

 

Reference:

 

  1. https://www.cdc.gov/cancer/cervical/basic_info/diagnosis_treatment.html Last accessed on 14th July 2020

 

  1. https://www.cancervic.org.au/cancer-information/types-of-cancer/cervical_cancer/diagnosing_cervical_cancer.html Last accessed on 14th July 2020 

 

  1. https://www.who.int/health-topics/cervical-cancer#tab=tab_1. Last accessed on 14th July 2020

 

  1. https://www.cancercenter.com/cancer-types/cervical-cancer/about. Last accessed on 14th July 2020