Overview of Cervical Cancer
Cervix is the part, which lies below the uterus. It connects the body of the uterus to the vagina. The place where these two parts meet is called transformation zone. Usually, in this zone some of the cells become cancerous and multiply abnormally without a known cause and spread deep into the cervix and other organs leading to cervical cancer. It is the third most commonly occurring cancer in women. The onset of the disease is usually above the age of 40 years. The disease can be easily detected through cytological studies called Pap smear.
Cervical cancer usually begins from the precancerous stages and takes several years to develop into cancer. If detected in this early stage, cervical cancer can be cured completely.
Occurence of cervical cancer in different groups: Epidemiological studies suggest that living styles of the population worldwide is related to the onset of cervical cancer.1 Epidemiological studies have shown that human papillomavirus (HPV) which is a sexually transmitted infection is an important etiological agent for cervical cancer.2 It is estimated that about 400,000–500,000 cases of cervical cancer are diagnosed each year worldwide. Lifetime risk of being diagnosed with cervical cancer is 0.78%. Life time risk of dying from cervical cancer is 0.26%.3
The incidence of cervical cancer has decreased in developed countries due to awareness about Pap smear test screening. In developing countries, Pap smear test may not be available, due to which the women in developing countries undergo progression of the disease without getting detected.
Types of Cervical Cancer
There are two main types of cervical cancer.
- Squamous cell carcinoma—This is the cancer of the squamous cells of the cervix. Majority of the cervical cancer known are squamous cell carcinomas. This condition originates at the exocervix and joins the endocervix.
- Adenocarcinoma—Although it occurs infrequently, off late, the incidence of adenocarcinomas has increased. The site of adenocarcinoma is the mucus producing gland cells of the endocervix.
- Adenosquamous carcinomas or mixed carcinoma—This is a rare type of cervical carcinoma, which has characteristics of both squamous cell carcinoma and adenocarcinomas.
Signs and symptoms of cervical cancer
Causes and risk factors of cervical cancer
The causes and risk factors of cervical cancer include:
- Tobacco smoking increases the risk of HPV infection. Presence around someone who smoke also increases the risk.1
- Having an impaired immune system caused due to human immunodeficiency virus (HIV) leads to increased risk of HPV infection.
- Infection with high-risk types of human papillomavirus (HPV), which is a sexually transmitted disease.
- Using birth control pills for several years.2
- Having multiple sexual partners.
- Infection with genital herpes.
- Women who take drugs like diethylstilbestrol during pregnancy to prevent miscarriage.
- The risk increases in women who are above 65 years of age.
Risk factors for cervical cancer
Diagnosis of cervical cancer
Diagnosis of cervical cancer is based on symptoms observed.
A Pap smear test is the usual screening test done to detect the presence of cancer cells in the cervix.1
If cervical cancer is suspected, the physician may suggest few diagnostic tests to confirm like:
Colposcopy and cervical biopsy—This is done for the detection of cancer causing cells on the surface of the cervix.
Colposcopy and cervical biopsy
Endocervical biopsy—For the detection of abnormal cells on the cervical canal.
Cone biopsy or loop electrosurgical excision procedure—A sample of cervical tissue is removed for microbiological examination.
Colposcopy and cervical biopsy are also recommended for pregnant women to confirm cervical cancer.
Following are some of the tests to know the stage of cervical cancer.2
- Cone biopsy or loop electrosurgical excision procedure is useful in determining the spread of cancer in the cervical tissue.
- Cystoscopy, to know the spread of cancer to the urinary system.
- Proctoscopy, to know the metastasis of the disease to the colon.
- Intravenous pyelogram, to check the blockage of the kidneys.
- Chest X-ray, to detect the spread of the disease.
After confirming the disease and knowing the stage of the disease condition, the following tests help in suggesting the treatment required.
- Complete blood count to check for anemia.
- Chemistry screen done to measure certain electrolytes, urea, albumin etc., which are essential for the functioning of the kidneys.
- Computed tomography (CT) scan of the abdomen and pelvis taken to check the metastasis of the disease to the liver, lymph nodes and other organs.
- Magnetic resonance imaging (MRI) of the abdomen and pelvis suggested depending on the spread of the disease.
- Positron emission tomography (PET) may be required to know to which organs the cancer has spread.
Treatment of Cervical Cancer
Based on the diagnosis and stage of the cancer, the physician may suggest a single therapy or combination of therapies.
If cervical cancer is detected in the early stages, there are different surgical methods to cure it without removing the uterus or damaging the cervix like:
Loop electro-surgical excision procedure—This surgical procedure uses electricity to remove the cancer cells.
Cryotherapy—This technique involves freezing the cancer cells.
Laser therapy—Here, high frequency light is used to destroy the cancer cells.
If the cervical cancer has progressed in an advanced stage, then following methods can be opted.
Surgery: Hysterectomy is done to remove the uterus and the cervix. If the disease condition is in an advanced stage, then radical hysterectomy can be considered. Radical hysterectomy removes the uterus and the surrounding tissues including the internal lymph nodes and the upper part of the vagina. In most severe conditions, pelvic exenteration is considered where the organs of the pelvic including the bladder and the rectum are removed.
Radiation Therapy: This therapy is considered if the cancer has spread beyond pelvis. Radiation therapy may be external or internal. External radiation therapy involves exposing to high frequency radiation emitted by radioactive substances. Internal radiation therapy involves using a device filled with radioactive substances and placing it inside the woman’s vagina adjacent to the cervical cancer.
Chemotherapy: In this therapy, drugs are used to kill the cancer cells. Some of the chemotherapic drugs used are, 5-FU, Cisplatin, Carboplatin, Ifosfamide, Paclitaxel, and Cyclophosphamide.1
Side effects of treatment:
Treatments used to cure cervical cancer cause side-effects and this depends on the type of treatment considered, age and overall health.
Side-effects of surgery depend upon the stage of the cancer and the type of surgery.
Side-effects of radiation therapy include:
- Skin irritation
- Changes in bowel and urinary habits.
Side-effects of chemotherapy include:
- Loss of appetite
- Mouth scores
To prevent recurrence of the disease condition, frequent follow-up test like CT scan of abdomen and pelvic may be suggested.2
Complementary Therapies of Cervical Cancer
Complementary therapy may be considered along with the standard treatment modalities, but should not be substituted. Some of them like acupuncture, herbs, meditation, yoga, vitamins and nutritional supplements can be considered.
Early diagnosis helps in complete curing and managing. Cervical cancer sometimes cannot be prevented if the risk factors are high. The condition can be prevented or managed in the early stages by the following:
- Pap smear tests done at regular intervals if the physician suspects the presence of abnormal cells.
- Frequent pelvic examinations.
- Smoking cessation has been advised, as smoking is one of the major risk factors.
- Studies have shown that the vaccine Gardasil is a very effective against cervical cancer and genital warts.11 HPV Vaccine for cervical cancer
- Safety measures to be taken to prevent sexually transmitted diseases like HPV infection.12,13
- Women should limit their sexual partners.
- Leading a healthy lifestyle with healthy habits.
Written by: Healthplus24 team
Date last updated: October 03, 2012