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Cervical Cancer
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Cervical Cancer Overview
Cervical cancer is a type of cancer that develops in a woman’s cervix (the entrance to the womb from the vagina). Most women diagnosed with precancerous changes in the cervix are in their 20s and 30s, but the average age of women when they are diagnosed with cervical cancer is the mid 50s. It isn’t clear what causes cervical cancer, but it’s certain that HPV plays a role. Forms of HPV, a virus whose different types cause skin warts, genital warts, and other abnormal skin disorders, have been shown to lead to many of the changes in cervical cells that may eventually lead to cancer. Certain types of HPV have also been linked to cancers involving the vulva, vagina, penis, anus, tongue, and tonsils. Genetic material that comes from certain forms of HPV (high-risk subtypes) has been found in cervical tissues that show cancerous or precancerous changes.
Signs and Symptoms
- Vaginal bleeding after intercourse, between periods or after menopause
- Watery, bloody vaginal discharge that may be heavy and have a foul colour.
- Pelvin pain or pain during intercourse
Screen and Diagnosis
Pap Smear
It is done as part of a regular exam. During the procedure, cells from the surface of the cervix are collected and examined for abnormalities.
Colposcopy
It is a procedure similar to a pelvic exam. It is usually used for a patient who had an abnormal Pap smear result. The examination uses a type of microscope called a colposcope to inspect the cervix. The entire area of the cervix is stained with a harmless dye or acetic acidto make abnormal cells easier to see. These areas are then biopsied. The colposcope magnifies the cervix by eight to 15 (depends on the colposcope) times, allowing easier identification of any abnormal-appearing tissue that may need biopsy.
Cervical Biopsies
- Colposcopic biopsy – For this type of biopsy, first the cervix is examined with a colposcope to find the abnormal areas. Using a biopsy forceps, a small (about 1/8-inch) section of the abnormal area on the surface of the cervix is removed. A local anesthetic is sometimes used to numb the cervix before the biopsy.
- Endocervical curettage (endocervical scraping): This means taking a scraping of the endocervix by inserting a narrow instrument (called a curette) into the endocervical canal (the part of the cervix closest to the uterus). The curette is used to scrape the inside of the canal to remove some of the tissue, which is then sent to the laboratory for examination.
- Electrosurgical procedure (LEEP, LLETZ): In this method, the tissue is removed with a thin wire loop that is heated by electricity and acts as a small knife. For this procedure, a local anesthetic is used.
- Cold knife cone biopsy: This method is done in a hospital. A surgical scalpel or a laser is used to remove the tissue instead of a heated wire.
Imaging Study
Such as Computed tomography (CT), Magnetic resonance imaging (MRI), Positron emission tomography (PET scan)
Staging
The carcinoma is confined to the surface layer (cells lining) of the cervix. Also called carcinoma in situ (CIS).
The carcinoma has grown deeper into the cervix, but has not spread beyond it (extension to the corpus would be disregarded).
Cervical carcinoma invades beyond the uterus, but not to the pelvic wall or to the lower third of the vagina.
The tumour extends to the pelvic wall and/or involves lower third of the vagina and/or causes hydronephrosis or non-functioning kidney.
The carcinoma has extended beyond the true pelvis or has involved (biopsy proven) the mucosa of the bladder or rectum. A bullous oedema, as such, does not permit a case to be allotted to Stage IV.
Treatment
Surgery
Early-stage cervical cancer is typically treated with surgery to remove the uterus (hysterectomy). A hysterectomy can cure early-stage cervical cancer and prevent recurrence. But removing the uterus makes it impossible to become pregnant. Surgery that preserves the possibility of becoming pregnant also may be an option, if you have very early-stage cervical cancer without lymph node involvement.
Radiotherapy
Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. Radiation therapy may be used alone or with chemotherapy before surgery to shrink a tumor or after surgery to kill any remaining cancer cells.
Chemotherapy
Chemotherapy uses medications, usually injected into a vein, to kill cancer cells. Low doses of chemotherapy are often combined with radiation therapy, since chemotherapy may enhance the effects of the radiation. Higher doses of chemotherapy are used to control advanced cervical cancer that may not be curable.
Risk Factor
- Many sexual partners. The greater your number of sexual partners — and the greater your partner’s number of sexual partners — the greater your chance of acquiring HPV.
- Early sexual activity. Having sex at an early age increases your risk of HPV.
- Other sexually transmitted infections (STIs). Having other STIs — such as chlamydia, gonorrhea, syphilis and HIV/AIDS — increases your risk of HPV.
- A weak immune system. You may be more likely to develop cervical cancer if your immune system is weakened by another health condition and you have HPV.
- Smoking. Smoking is associated with squamous cell cervical cancer.
Prevention
- Get vaccinated against HPV. Vaccination is available for girls and women ages 9 to 26. The vaccine is most effective if given to girls before they become sexually active.
- Have routine Pap tests. Pap tests can detect precancerous conditions of the cervix, so they can be monitored or treated in order to prevent cervical cancer. Most medical organizations suggest women begin routine Pap tests at age 21 and repeat them every few years.
- Practice safe sex. Using a condom, having fewer sexual partners and delaying intercourse may reduce your risk of cervical cancer.
- Don’t smoke.
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