Cervical Cancer

Cervical cancer is a type of cancer that begins in the cervix, the lower part of the uterus (womb) that connects to the vagina. The cervix is made up of two types of cells: squamous cells and glandular cells. Most cervical cancers start in the squamous cells and are referred to as squamous cell carcinoma. Another less common type is adenocarcinoma, which originates in the glandular cells of the cervix.

Cervical cancer is preventable and treatable, especially when detected early. It is primarily caused by persistent infection with certain strains of the human papillomavirus (HPV), a group of viruses that are commonly transmitted through sexual contact.

Causes and Risk Factors

The leading cause of cervical cancer is HPV infection, particularly infection with high-risk HPV types, such as HPV-16 and HPV-18. These high-risk HPV strains can cause changes in the cervical cells that, over time, may lead to cancer. However, not all HPV infections lead to cervical cancer, and most HPV infections resolve on their own without causing harm.

Other risk factors for cervical cancer include:

  • Multiple sexual partners: Having many sexual partners increases the risk of HPV infection.
  • Early sexual activity: Being sexually active at a young age can increase exposure to HPV.
  • Weakened immune system: Women with weakened immune systems (e.g., due to HIV infection or immunosuppressive medications) are at higher risk.
  • Smoking: Smoking damages the immune system and may increase the risk of cervical cancer in women who have HPV.
  • Chronic HPV infection: Persistent infection with high-risk HPV strains increases the risk of cervical cancer.
  • Long-term use of oral contraceptives: Prolonged use of birth control pills (for more than five years) may slightly increase the risk.
  • History of sexually transmitted infections (STIs): A history of certain STIs, like chlamydia, may increase the risk of cervical cancer.
  • Lack of screening: Women who do not get regular Pap smears or HPV testing are at higher risk of undetected abnormalities that can progress to cancer.

Symptoms

In the early stages, cervical cancer may not cause any noticeable symptoms. As the cancer progresses, symptoms may include:

  • Abnormal vaginal bleeding: This can include bleeding between periods, after sex, or after menopause.
  • Unusual vaginal discharge: The discharge may be watery, thick, and may have a foul odor.
  • Pelvic pain: Pain during intercourse or in the pelvic area can be a symptom.
  • Painful urination: In advanced stages, cancer may affect the bladder, causing painful urination.
  • Leg pain or swelling: In some cases, cervical cancer can cause fluid buildup and swelling in the legs.

Because these symptoms are similar to those of other, less serious conditions, they are not always immediately recognized as signs of cervical cancer.

Diagnosis

Cervical cancer is typically diagnosed through a combination of screening tests and medical evaluation:

  1. Pap Smear (Pap Test):
    • A Pap smear is a routine screening test used to detect abnormal changes in cervical cells that may lead to cancer. During the test, a healthcare provider collects cells from the cervix to check for precancerous changes or infections like HPV.
  2. HPV Test:
    • An HPV test is used to detect the presence of high-risk HPV types. The test may be done at the same time as a Pap smear in women over the age of 30 or in women with abnormal Pap smear results.
  3. Colposcopy:
    • If abnormal results are found on a Pap smear or HPV test, a colposcopy may be done. This involves using a special microscope to examine the cervix more closely and take biopsies of any suspicious areas.
  4. Biopsy:
    • A biopsy involves removing a small sample of tissue from the cervix for examination under a microscope to confirm the presence of cancer.
  5. Imaging tests:
    • If cervical cancer is diagnosed, imaging tests such as ultrasound, CT scans, or MRIs may be used to determine the extent of cancer spread (staging).

Stages of Cervical Cancer

Cervical cancer is staged based on how far the cancer has spread:

  • Stage 0: Cancer is confined to the surface of the cervix (carcinoma in situ).
  • Stage I: Cancer has spread to the cervix but is still confined to the uterus.
  • Stage II: Cancer has spread beyond the cervix to nearby tissues, such as the vagina or upper part of the uterus.
  • Stage III: Cancer has spread to the lower part of the vagina or the pelvic wall.
  • Stage IV: Cancer has spread to distant organs, such as the bladder, rectum, or other parts of the body.

Treatment

Treatment for cervical cancer depends on the stage of the disease, the patient’s overall health, and other factors. Treatment options include:

  1. Surgery:
    • In early stages (stage I), surgery may involve removing the cervix and sometimes the uterus (hysterectomy). For more advanced cases, a radical hysterectomy, which removes the cervix, uterus, surrounding tissues, and sometimes lymph nodes, may be necessary.
  2. Radiation therapy:
    • Radiation therapy uses high-energy rays to target and kill cancer cells. It is often used in combination with chemotherapy for advanced-stage cervical cancer or when surgery is not an option.
  3. Chemotherapy:
    • Chemotherapy uses drugs to kill cancer cells or stop them from growing. It may be used alongside radiation therapy for advanced stages of cervical cancer or as the main treatment for widespread cancer.
  4. Targeted therapy:
    • Targeted therapy involves using drugs that specifically target cancer cells and their growth mechanisms. This treatment may be used in some cases of advanced cervical cancer.
  5. Immunotherapy:
    • Immunotherapy is a newer treatment that helps the body’s immune system recognize and fight cancer cells. It is still being explored as a treatment option for cervical cancer, particularly in cases where the cancer is advanced or has not responded to other treatments.

Prevention

Cervical cancer is largely preventable through regular screening and vaccination:

  1. HPV Vaccination:
    • The HPV vaccine is one of the most effective ways to prevent cervical cancer. The vaccine protects against the most common types of HPV that cause cervical cancer (HPV-16 and HPV-18). Vaccination is recommended for both boys and girls, ideally before they become sexually active, but it can also be administered to adults up to age 45.
  2. Regular Screening (Pap Smears and HPV Testing):
    • Regular screening through Pap smears and HPV tests can detect abnormal cell changes before they become cancerous. The American Cancer Society recommends that women begin Pap screening at age 21, and continue every 3 years until age 30. From age 30 to 65, women should have a Pap smear combined with an HPV test every 5 years, or a Pap smear alone every 3 years. Women over 65 may no longer need screening if they have had consistent negative test results.
  3. Smoking cessation:
    • Stopping smoking can reduce the risk of cervical cancer, especially in women with HPV.
  4. Safe sexual practices:
    • Using condoms and reducing the number of sexual partners can lower the risk of HPV infection.

Prognosis

The prognosis for cervical cancer depends on the stage at diagnosis. When detected early, cervical cancer is highly treatable, and the 5-year survival rate for women diagnosed with early-stage cervical cancer can be over 90%. For more advanced stages, the survival rate decreases, but treatment options such as surgery, chemotherapy, and radiation can still provide meaningful outcomes.

Conclusion

Cervical cancer is a preventable and treatable disease, particularly with early detection through routine screening and vaccination. Regular Pap smears, HPV testing, and vaccination can significantly reduce the risk of developing cervical cancer. If you have concerns about cervical cancer or risk factors, it is essential to talk to a healthcare provider about screening, prevention, and treatment options.