Cervical cancer starts at the opening of the womb, known as the cervix. In its early stages, it might not show any symptoms. As it progresses, symptoms can include pelvic pain, unusual bleeding in the middle of periods, and discharge from the vagina with a strong smell.
The cervix is the lower, narrow part of the uterus, which is often described as the neck of the womb.
According to the American Cancer Society, by the end of 2019, healthcare providers in the United States were expected to diagnose 13,170 new cases of cervical cancer. Sadly, over 4,200 females in the U.S. were predicted to die from this disease that year.
The main cause of cervical cancer is the human papillomavirus. The good news is that the HPV vaccine can prevent HPV infection.
Initially, the Centers for Disease Control and Prevention suggested the vaccine for individuals 9 to 26 years old. Now, the CDC also advises that the vaccine is available for everyone, who is 26 to 45 years old and did not get it as a preteen.
Early Signs and Symptoms
There may be no noticeable symptoms in the early stages of this cancer. This lack of symptoms underscores the importance of regular cervical smear examinations, also known as Pap tests.
A Pap test is a preventive measure designed not to identify cancer itself but to identify any cell modifications that could suggest the early stages of cancer. By catching these changes early, individuals can take timely action to address potential issues before they develop into cancer.
If cervical cancer does progress, some common symptoms may include bleeding in the middle of periods and post-menopausal women or bleeding after sexual practice. Other symptoms can include unusual pain during sexual practice, discharge from the vagina with a strong smell, and tinged with blood.
It is important to note that these symptoms can also be caused by other conditions, such as infections. Therefore, anyone experiencing these symptoms should consult a healthcare provider for a thorough evaluation.
Stages
Determining the stage of cervical cancer is crucial for deciding the most effective treatment options. Staging involves evaluating how far the cancer has extended, whether it has infected nearby structures or other organs
The most commonly used system for staging cervical cancer is the 4-stage system:
- 0 Stage: At this stage, only precancerous cells exist. These cells are not yet invasive.
- 1st Stage: Cancer cells have developed beyond the surface of the cervix into deeper tissues. They may have spread to the uterus and surrounding lymph nodes.
- 2nd Stage: The cancer has extended beyond the uterus but has not reached the pelvic walls or the lower area of the vagina.
- 3rd Stage: Presence of the cancer cells in the lower area of the vagina or the pelvic walls. The cancer may be obstructing the ureters, which are the tubes that transport urine from the bladder. It might or might not affect nearby lymph nodes.
- 4th Stage: The cancer has spread to the rectum or bladder and is developing outside the pelvis. In the later part of the 4th Stage, it can spread to far organs such as the liver, lungs, bones, and other lymph nodes.
Regular screening and prompt medical attention, if symptoms arise, are essential for early intervention and improving survival chances.
Causes
Cervical cancer results from the uncontrolled growth and division of abnormal cells. Normally, our body cells have a lifespan. New cells replace them when they die. However, abnormal cells can disrupt this process in two main ways: they either do not die as they should or continue to divide uncontrollably. This excessive cell buildup forms a lump or tumor. The exact reasons why cells become cancerous are still not fully understood.
Several factors can increase the chance of developing cervical cancer:
- HPV (Human Papillomavirus): HPV is a sexually transmitted virus, with over 100 various kinds. At least 13 of these types are known to potentially lead to cervical cancer.
- Multiple Sexual Partners or Early Sexual Activity: HPV transmission typically occurs through sexual contact. Females who have had most sexual partners or who became sexually active at an early age are at higher chance for HPV infection and, consequently, cervical cancer.
- Weakened Immune System: Individuals with AIDS or HIV, as well as those who have gone through organ transplants and use immunosuppressive medicines, have a higher risk of cervical cancer.
- Smoking: Smoking is linked to an increased risk of cervical cancer, along with other types of cancer.
- Birth Control Pills: The use of certain contraceptive pills has been associated with a slightly increased risk of cervical cancer.
- Other Sexually Transmitted Diseases: Infections like gonorrhea, chlamydia, and syphilis can increase the likelihood of getting cervical cancer.
- Socio-economic Status: Cervical cancer rates are often higher in lower-income areas.
Treatment
Treatment options for cervical cancer include surgery, chemotherapy, radiotherapy, or a combination of these methods. The choice of treatment relies on several elements, including the stage of the cancer, also the patient’s age, and overall health.
For early-stage cervical cancer, where the disease is confined to the cervix, the treatment success rate is generally high. As the cancer extends further from its original site, the likelihood of successful treatment tends to decrease.
Early-Stage Treatment Options
In cases where the cancer has not spread beyond the cervix, surgery is a common treatment option. Following surgery, radiation therapy might be used to eliminate any remaining cancer cells and decrease the risk of the cancer returning. Radiation therapy can also be used to shrink the tumor before surgery, although this is less common.
Radiation Therapy
Radiation therapy, also called radiation oncology, uses high-energy X-rays or radiation to rule out cancer cells. When aimed at the pelvic area, radiation therapy may cause side effects such as nausea, diarrhea, stomach upset, bladder discomfort, vagina narrowing, disrupted menstrual cycles, and too-soon menopause. Some side effects may not appear until after treatment ends.
Chemotherapy
Chemotherapy involves the use of drugs to destroy cancer cells. It is used to target cancer cells that surgery could not remove or to alleviate symptoms in advanced cancer cases. Side effects of chemotherapy can include hair loss, diarrhea, nausea, infertility, fatigue, and early menopause, depending on the specific drugs used
Cervical Cancer Clinical Trials
For some patients, participating in a clinical trial might offer the best treatment alternative. Clinical trials are essential for cancer research as they test new treatments to determine their effectiveness and safety compared to existing methods. Participants in clinical trials contribute to advancing cancer treatment and research. For more information on current clinical trials, visit official resources to explore available options.
Diagnosis
Early diagnosis of cervical cancer significantly improves treatment success rates. The American Cancer Society also known as ACS provides specific guidelines for routine checking based on age
- Below 25 years: The American Cancer Society does not recommend cervical cancer screening for individuals under 25
- Ages 25–65 years: It is recommended that people in this age group go through an HPV test every 5 years to check for cancer in the cervix.
- Over 65 years: For individuals over 65, screening is generally not recommended if they have had sufficient screening in the past, unless they are at high chance for cervical cancer.
Females who have had a hysterectomy with elimination of the cervix typically do not need screening unless they have a history of precancerous lesions or cervical cancer. While these are general recommendations, a doctor can provide personalized advice based on individual screening requirements.
Cervical Smear Test
In 2019, the ACS estimated that more than 13,000 new cases of cervical cancer would be diagnosed, with around 4,000 deaths expected. Regular monitoring could prevent many of these deaths. Monitoring aims to detect abnormal changes in cervical cells, not cancer itself. If untreated, some abnormal cells can become cancerous.
HPV DNA Testing
HPV DNA testing checks for high-risk kinds of HPV that are likely to cause cancer. The test involves taking cells from the cervix and analyzing them in a lab. This test can identify high-risk HPV in cell DNA before visible abnormalities appear in cervical cells.
If the Pap test shows abnormal cells or if there are symptoms of cervical cancer, further tests may be recommended:
- Colposcopy
- Examination Under Anesthesia
- Biopsy
- Cone Biopsy
- Large Loop Excision of the Transformation Zone (LLETZ)
- Blood Tests
- CT scan
- MRI
- Pelvic Ultrasound
Prevention
To reduce the risk of developing cervical cancer, several preventive measures can be taken. Getting the HPV vaccine can lower the likelihood of cervical cancer by protecting against the most harmful strains of HPV, though it doesn’t cover all types.
Using condoms during sex helps prevent HPV infection, and having fewer sexual partners and delaying the start of sexual activity can further reduce risk. Regular cervical screening can detect cell changes early, allowing for timely treatment before cancer develops or spreads. Additionally, quitting smoking decreases the risk, especially for those already infected with HPV.
Summary
Cervical cancer treatment options include surgery, radiotherapy, and chemotherapy, with the choice depending on the cancer stage, age, and health. Early-stage cancer often has a good prognosis, while advanced stages require more extensive treatment and may include palliative care.
Regular screening, such as Pap tests and HPV DNA testing, is crucial for early detection. Preventive measures include the HPV vaccine, safe sex practices, regular screening, having fewer sexual partners, delaying sexual activity, and quitting smoking. These steps help reduce the risk of developing cervical cancer and improve overall outcomes.
