Cervical Cancer

Content of This Page

1- Introduction

2- Causes

3- Symptoms

4- Stages of The Disease

5- Treatment

6- Prevention and Early Detection

Introduction

Cervical cancer is a type of cancer that occurs in the cells of the cervix, which is the lower part of the uterus that connects to the vagina. It’s often caused by various strains of the human papillomavirus (HPV), a sexually transmitted infection. While the body’s immune system typically prevents the virus from causing harm, in some cases, the virus can survive for years and contribute to the process that causes some cervical cells to become cancerous.

Causes

Cervical cancer is primarily caused by persistent infection with certain types of human papillomavirus (HPV). HPV is a group of more than 200 related viruses, of which around 14 are considered high-risk for causing cervical cancer. Here’s a breakdown of the causes and contributing factors:

1. Human Papillomavirus (HPV) Infection:

High-Risk HPV Types: The most common high-risk types of HPV that cause cervical cancer are HPV-16 and HPV-18. These strains are responsible for the majority of cervical cancer cases.
Transmission: HPV is usually transmitted through sexual contact, including vaginal, anal, and oral sex. It is a very common infection, and most sexually active people will contract HPV at some point in their lives. However, only a small percentage of infections persist and lead to cancer.
Persistence of Infection: In most cases, the body’s immune system clears the HPV infection naturally. However, when the infection persists, it can cause changes in the cervical cells, leading to precancerous lesions and eventually cervical cancer if left untreated.

2. Weakened Immune System:

Individuals with weakened immune systems, such as those with HIV/AIDS or those taking immunosuppressive drugs (e.g., after organ transplantation), are at a higher risk of HPV infections persisting and developing into cervical cancer.

3. Smoking:

Smoking is a significant risk factor for cervical cancer. Women who smoke are about twice as likely to develop cervical cancer compared to non-smokers. Smoking can damage the DNA of cervical cells and impair the immune system, making it harder to fight off HPV infections.

4. Long-Term Use of Oral Contraceptives:

Long-term use of birth control pills (oral contraceptives) has been associated with an increased risk of cervical cancer. The risk increases with the duration of use but tends to return to normal after stopping the pills.

5. Multiple Full-Term Pregnancies:

Having multiple full-term pregnancies can increase the risk of cervical cancer, possibly due to hormonal changes or a weakened immune response during pregnancy.

6. Early Sexual Activity:

Engaging in sexual activity at a young age increases the risk of HPV infection because the cervix is more susceptible to the virus during adolescence.

7. Multiple Sexual Partners:

Having multiple sexual partners increases the likelihood of exposure to high-risk HPV types, thereby increasing the risk of cervical cancer.

8. Family History:

A family history of cervical cancer can also increase the risk, suggesting that genetic factors may play a role in susceptibility to the disease.

9. Other Factors:

Lack of Regular Screening: Not having regular Pap tests or HPV tests increases the risk of developing cervical cancer because precancerous changes can go undetected and untreated.
Socioeconomic Factors: Limited access to healthcare, education, and screening services can increase the risk of cervical cancer in certain populations.

Symptoms

Early Symptoms:

Abnormal Vaginal Bleeding:
- Bleeding between menstrual periods.
- Bleeding after sexual intercourse.
- Bleeding after menopause.
- Heavier and longer menstrual periods than usual.
Unusual Vaginal Discharge:
- Watery, bloody, or foul-smelling vaginal discharge.
Pain During Intercourse:
- Discomfort or pain during sexual intercourse (dyspareunia).

Advanced Symptoms:

As cervical cancer progresses, it can spread to nearby tissues and organs, leading to more severe symptoms, including:

Pelvic Pain:
- Persistent pain in the pelvic area that is not related to the menstrual cycle.
Pain During Urination:
- Pain or a burning sensation when urinating, which may indicate that the cancer has spread to the bladder.
Frequent Urination or Urgency:
- A frequent need to urinate or a sense of urgency to urinate.
Lower Back Pain:
- Pain in the lower back or along the sciatic nerve.
Swelling in the Legs:
- Swelling of one or both legs, which may occur if the cancer spreads to lymph nodes or blocks blood vessels.
Unexplained Weight Loss and Fatigue:
- Significant, unintentional weight loss and persistent fatigue.
Constipation and Bowel Changes:
- Changes in bowel habits, including constipation or difficulty passing stool.

Stages of The Disease

Stage 0 (Carcinoma in Situ)

Description: This stage is also known as carcinoma in situ or CIN 3. It represents a precancerous stage where abnormal cells are found only on the surface of the cervix. These cells have not yet invaded deeper tissues.
Treatment: Often treated with surgical removal of the abnormal area, such as a LEEP (Loop Electrosurgical Excision Procedure), cryotherapy, or laser surgery.

Stage I

Description: Cancer is confined to the cervix. It has not spread to nearby tissues or organs.
- Stage IA: Microinvasive cancer that can only be seen under a microscope.
  - Stage IA1: Invasion of less than 3 mm in depth.
  - Stage IA2: Invasion between 3 mm and 5 mm in depth.
- Stage IB: Cancer is visible and may measure more than 5 mm in depth but is still confined to the cervix.
  - Stage IB1: Tumor is 2 cm or less in size.
  - Stage IB2: Tumor is between 2 cm and 4 cm in size.
  - Stage IB3: Tumor is larger than 4 cm.
Treatment: May include surgery (such as hysterectomy) and possibly radiation therapy and/or chemotherapy depending on the size and specific characteristics of the tumor.

Stage II

Description: Cancer has spread beyond the cervix but has not reached the pelvic wall or the lower third of the vagina.
- Stage IIA: Cancer has spread to the upper part of the vagina but not to the tissues around the uterus (parametrium).
  - Stage IIA1: Tumor is 4 cm or less in size.
  - Stage IIA2: Tumor is larger than 4 cm.
- Stage IIB: Cancer has spread to the tissues around the cervix (parametrium).
Treatment: May involve a combination of radiation therapy and chemotherapy, and sometimes surgery.

Stage III

Description: Cancer has spread to the lower third of the vagina or to the pelvic wall, and/or it has caused kidney problems by blocking the flow of urine.
- Stage IIIA: Cancer has spread to the lower third of the vagina but not to the pelvic wall.
- Stage IIIB: Cancer has spread to the pelvic wall and/or has caused hydronephrosis (swelling of a kidney due to a build-up of urine).
- Stage IIIC: Cancer has spread to lymph nodes in the pelvis or around the aorta.
  - Stage IIIC1: Spread to pelvic lymph nodes.
  - Stage IIIC2: Spread to para-aortic lymph nodes.
Treatment: Typically involves a combination of radiation therapy and chemotherapy.

Stage IV

Description: Cancer has spread to nearby organs or other parts of the body.
- Stage IVA: Cancer has spread to nearby organs, such as the bladder or rectum.
- Stage IVB: Cancer has spread to distant organs, such as the lungs, liver, bones, or distant lymph nodes.
Treatment: Often involves palliative care to relieve symptoms and improve quality of life. Treatment may include radiation therapy, chemotherapy, and targeted therapy.

Treatment

Stage 0 (Carcinoma in Situ)

Treatment Options:
- LEEP (Loop Electrosurgical Excision Procedure): Removes abnormal tissue from the cervix using a wire loop that carries an electrical current.
- Cryotherapy: Freezes and destroys abnormal tissue.
- Laser Therapy: Uses a laser beam to destroy or remove abnormal tissue.
- Conization (Cone Biopsy): Removes a cone-shaped section of abnormal tissue from the cervix for examination and treatment.

Stage I

Treatment Options:
- Surgery:
  - Simple Hysterectomy: Removal of the cervix and uterus, typically used for Stage IA1.
  - Radical Hysterectomy: Removal of the cervix, uterus, part of the vagina, and nearby lymph nodes, used for larger tumors (Stage IA2 or IB).
  - Trachelectomy: Removal of the cervix while preserving the uterus, an option for younger women who wish to preserve fertility.
- Radiation Therapy: Often combined with chemotherapy (chemoradiation) if surgery is not an option or to reduce the risk of recurrence after surgery.
- Chemotherapy: May be used in combination with radiation therapy (chemoradiation) for more advanced Stage IB or to shrink tumors before surgery.

Stage II

Treatment Options:
- Surgery: For early Stage IIA, a radical hysterectomy may be performed, often followed by radiation therapy and chemotherapy.
- Chemoradiation: A combination of radiation therapy and chemotherapy is commonly used, especially for Stage IIB, where the cancer has spread to nearby tissues.
- Radiation Therapy Alone: May be used if the patient cannot tolerate chemotherapy or surgery.

Stage III

Treatment Options:
- Chemoradiation: This is the standard treatment for Stage III cervical cancer, involving a combination of radiation therapy and chemotherapy.
- Brachytherapy: A form of internal radiation therapy where radioactive sources are placed directly into or near the tumor.
- External Beam Radiation Therapy (EBRT): Delivers high-energy rays from outside the body to the tumor area.
- Chemotherapy Alone: In some cases, particularly for Stage IIIC where the cancer has spread to lymph nodes, additional chemotherapy may be used after chemoradiation.

Stage IV

Treatment Options:
- Stage IVA (Local Spread to Nearby Organs):
  - Chemoradiation: A combination of chemotherapy and radiation therapy to treat the tumor locally and manage symptoms.
  - Pelvic Exenteration: A highly extensive surgical procedure that may be considered in very specific cases where the cancer is confined to the pelvis and has not spread to distant organs.
- Stage IVB (Distant Metastasis):
  - Chemotherapy: The primary treatment for metastatic cervical cancer to slow the progression of the disease.
  - Targeted Therapy: Drugs like bevacizumab (Avastin) may be used in combination with chemotherapy to block the growth of new blood vessels that supply the tumor.
  - Immunotherapy: Drugs such as pembrolizumab (Keytruda) may be used for patients with certain genetic markers or in cases where other treatments have failed.
  - Palliative Care: Focuses on relieving symptoms and improving quality of life, which may include pain management, nutritional support, and psychological support.

Prevention And Early Detection

HPV Vaccination:
- What It Is: Vaccines like Gardasil 9 protect against the most common high-risk types of HPV (including HPV-16 and HPV-18), which cause the majority of cervical cancer cases.
- Who Should Get It: The vaccine is recommended for preteens (both girls and boys) at age 11 or 12 but can be given as early as age 9. It’s also recommended for everyone up to age 26 if they haven’t been vaccinated earlier. Some adults up to age 45 may also benefit from vaccination after discussing it with their healthcare provider.
- Effectiveness: The HPV vaccine is most effective when given before an individual becomes sexually active and exposed to HPV. It can prevent up to 90% of cervical cancers.
Safe Sexual Practices:
- Condom Use: Using condoms during sexual activity can reduce the risk of HPV transmission, although it doesn’t completely eliminate the risk since HPV can infect areas not covered by a condom.
- Limiting Number of Sexual Partners: Reducing the number of sexual partners can lower the risk of HPV infection.
Regular Screening:
- Pap Smear (Pap Test): This test detects precancerous changes and cancerous cells in the cervix. It is recommended every three years for women aged 21 to 65.
- HPV Test: This test checks for the presence of high-risk HPV types. For women aged 30 to 65, co-testing (Pap smear combined with an HPV test) is recommended every five years. HPV testing alone can also be an option.
- Screening Frequency: Women under 21 typically do not need screening, and women over 65 who have had regular screenings with normal results may not need further screening.
Avoiding Smoking:
- Smoking increases the risk of cervical cancer by impairing the immune system’s ability to fight HPV infections and directly damaging cervical cells. Quitting smoking can reduce this risk.
Maintaining a Healthy Immune System:
- A strong immune system helps the body fight off HPV infections before they can cause serious damage. This includes managing chronic conditions like HIV, eating a healthy diet, staying active, and getting adequate sleep.

Early Detection

Regular Pap Smears and HPV Tests:
- Why It’s Important: Early detection of precancerous changes allows for treatment before cancer develops. Regular screening can detect cervical cancer at an early stage when it is most treatable.
- How It Works: During a Pap smear, cells from the cervix are collected and examined under a microscope to look for abnormalities. An HPV test checks for the virus that can cause these changes.
Follow-Up on Abnormal Results:
- If a Pap smear or HPV test shows abnormal results, further testing like a colposcopy (a detailed examination of the cervix) or a biopsy may be recommended to determine the extent of the abnormality and the appropriate treatment.
Education and Awareness:
- Understanding the risk factors and symptoms of cervical cancer can help women recognize potential warning signs and seek medical advice promptly.
- Public health campaigns and educational programs can increase awareness about the importance of vaccination and regular screening.
Accessibility to Healthcare:
- Ensuring that women have access to affordable and regular healthcare services, including screening and vaccination, is crucial for prevention and early detection. Community outreach and mobile clinics can help reach underserved populations.