Cervical Cancer

Cervical cancer refers to cancer of cells of the cervix - lower part of the uterus that connects to the vagina.

Most cervical cancers are a result of exposure to a sexually transmitted virus called Human Papillomavirus (HPV).

Normally, immune system is strong enough to prevent the virus from doing harm but in a small group of women, the virus survives for years eventually converting normal cervical cells into cancer cells.

Vaccines against HPV are available which can help reduce the risk of developing cervical cancer.

Early-stage cervical cancer may go unnoticed as there are no perceivable signs or symptoms.

Advanced cervical cancer present with the following signs and symptoms:

• Post intercourse vaginal bleeding or that, between periods or after menopause
• Watery, bloody vaginal discharge often heavy with a foul odour
• Pelvic pain or pain during intercourse

When to see a doctor?

Talk to your doctor if any signs or symptoms bothers you.

The exact cause of cervical cancer is still a mystery but role of HPV is definitive. Most women with the virus never develop cervical cancer which means other environmental and lifestyle related factors also determine whether you'll develop cervical cancer.

Cervical cancer begins when healthy cells turn into cancer cells under the influence of mutated genes. Unlike healthy cells, cancer cells grow and multiply rapidly and cause accumulation of abnormal cells that form a mass called tumor. Cancer cells are notorious and invade nearby tissues sometimes spreading (metastasize) elsewhere in the body.

Types of cervical cancer

The main types of cervical cancer are:

Squamous cell carcinoma: This type accounts for most cases of cervical cancer. The cancer begins in squamous cells that line outer part of the cervix.
Adenocarcinoma: This type of cervical cancer begins in the column-shaped glandular cells that line the cervical canal.

Sometimes, both types of cells are involved in cervical cancer. Cancer in other cell types is a rare occurrence.

Making a diagnosis of Cervical cancer is done by performing several tests.

See your doctor if any signs or symptoms bother you. If suspected of having cervical cancer, the doctor may refer you to specialist of gynecologic cancers (gynecologic oncologist).

Here's some information to help you get ready for your appointment and what to expect from your doctor.

What you can do?

• Make sure you follow any pre-appointment instructions. Ask your doctor if there's anything you need to do prior to the visit, such as restrict your diet.
• Make a list of your symptoms, include all medical information and other health conditions.
• Mention all key personal information, including the factors that put you at risk for STI, such as early sexual activity, multiple partners or unprotected sex.
• Make a list of all your medications, vitamins or supplements.

Questions to ask your doctor

• What's the cause of my symptoms?
• What are the tests I should go through? What are the treatment options and their possible side effects?
• What is the prognosis for my condition?
• What’s the frequency of follow-ups?

Feel free to ask any additional question that’s in your mind at the time of visit.

What to expect from your doctor?

Your doctor may ask you the following questions:

• What are the symptoms and how severe are they?
• When was the first time you started experiencing the symptoms?
• Have you noticed any changes in the symptoms?
• Have you had regular Pap tests since you became sexually active?
• Have you ever been treated for a cervical condition or diagnosed with an STI?
• Have you ever taken immunosuppressant?
• Are you a smoker?
• Do you want to have children in the future?

Early diagnosis often results better prognosis. Screening for cervical cancer and precancerous changes at age 21 is recommended.

Screening tests include:

• Pap test: Your doctor collect cells by scraping cervix and the sample is sent to lab for examination. A Pap test can detect cancer cells as well as other cellular changes that increase the risk of cervical cancer.
• HPV DNA test: This test detects DNA of Human Papillomavirus, a virus linked to cervical cancer. This test may be an option for women age 30 and older, or for younger women with an abnormal Pap test.

Diagnosis

The diagnosis begins with physical examination of your cervix if cervical cancer is suspected.

Special magnifying device called “colposcope” is used to look for abnormal cells. If any problem is observed during colposcopy, a sample of cervical cells (biopsy) is scraped and sent to lab for further testing.

To obtain tissue, your doctor may use:

• Punch biopsy: a sharp tool is used to scrape small samples of cervical tissue.
• Endocervical curettage:a small, spoon-shaped instrument (curet) or a thin brush is used to scrape samples of cervical tissue.

In case you find these methods bothering, talk to your doctor about other methods such as:

• Electrical wire loop
• Cone biopsy
• Staging

Once diagnosed with cervical cancer, further tests should be performed to determine the cancer stage.

Treatment choice and outcomes depend on the cancer stage.

Staging exams include:

• Imaging tests: X-rays, CT scans, magnetic resonance imaging (MRI) and positron emission tomography (PET) provide visual imagery that help to determine whether cancer has spread beyond your cervix.
• Visual examination: Doctor examines your bladder and rectum to determine the extent of cancer.

Stages of Cervical Cancer

• Stage I. Cancer is limited within cervix.
• Stage II. Cancer is present in the cervix and upper portion of the vagina.
• Stage III. Cancer has spread to the lower portion of the vagina or internally to the pelvic side wall.
• Stage IV. Cancer has spread to nearby organs, such as the bladder or rectum, or it has spread to other areas of the body, such as the lungs, liver or bones.

The choice of treatment option for Cervical cancer depends upon a number of factors like stage of cancer, your general health, and your preferences. Consult with your doctor to determine which treatment is best suited for you.

It may be treated with:

Surgery

Surgical removal of uterus (hysterectomy) is the best approach for treating Early-stage cervical cancer as it provides effective cure and prevents recurrence.

Your doctor may recommend:

• Simple hysterectomy: This is applicable only when the cancer is at its earliest stage. This procedure involves removal of cervix and uterus along with the cancer.
• Radical hysterectomy. The cervix, uterus, part of the vagina and lymph nodes in the area are removed with the cancer.

When the cancer is at the earliest stage, surgical options to preserve uterus may be considered.

Radiation

Radiation therapy utilizes high energy, ionizing radiation to shrink or kill cancer cells.

There are two types of radiation therapy:

• External beam radiation therapy, in which the radiation from external source is directed at the affected part of the body.
• Brachytherapy, in which a device filled with radioactive material is placed inside vagina, for a few minutes

Note that menstruation could cease as a result of as a result of radiation therapy. Talk to your doctor about methods for saving eggs in case you wish to get pregnant in future.

Chemotherapy

Chemotherapy uses chemical compounds to kill cancer cells. Low dose chemotherapy combined with radiation therapy may be used to enhance their effectiveness. Advanced cervical cancer may be controlled by higher doses of chemotherapeutic agents.

Follow-up: Ask your doctor how often you should have follow-up visits.

Some common prevention tips for Cervical cancer are:

• Get vaccinated against HPV: HPV plays a definitive role in cervical cancer. HPV vaccination reduces risk of cervical cancer. It is available for females aged 9 to 26 and is most effective when administered before they become sexually active.
• Have routine Pap tests: Women are recommended to start 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.
• If you are smoker, quit and if you are not, don’t start.

Lifestyle modifications are necessary in order to cope with Cervical cancer.

Every woman has her own unique way to deal with the shock and trauma of having cervical cancer. Following tips might help you better cope the situation:

• Learn enough about cervical cancer to make decisions about your care.
• Ask a friend or family member to accompany you during appointments.
• Ask your health care team for further sources of information like websites, brochures.
• Socialize and stay close to family and friends. Open up in front of friends and family to let them know what type of help you want.
• The goals you set for treatment outcome should be realistic as over expectation always hurts.

There are several risk factors associated with Cervical cancer, which include:

• Multiple sexual partners: Greater the number, greater is the risk.
• Early sexual activity: Premature sex is a known risk factor of HPV.
• Sexually transmitted infections (STIs): Having other STIs such as chlamydia, gonorrhea, syphilis and HIV/AIDS is a major risk factor of HPV.
• A weak immune system: HPV might become active in people with weak immune system.
• Smoking: Smoking and squamous cell cervical cancer are closely linked.