What is Cervical Cancer?

Cervical cancer is a type of cancer that grows in a woman’s cervix. Cervix is located at the end of the uterus, it connects the uterus to the vagina. Cervical cancer is caused when HPV (Human Papilloma Virus), a sexually transmitted infection develops in the cells of the cervix and some cells contribute to the process of causing cancer. In some instances, the virus persists for years in the cervix. 

The cervical tissue undergoes transformations known as dysplasia, wherein abnormal cells start to emerge in the tissue before cancer develops in the cervix. If left ignored or untreated, the abnormal cells may eventually develop into cancer cells, expand deeper into the cervix, and spread to nearby tissues. 

Cause

The sexually transmitted HPV (Human Papilloma Virus) is the primary cause of cervical cancer. Either anal, oral, or vaginal, sexual contact can transfer HPV, which can lead to cancer.  The majority of people who have HPV at some point in their lives won't be aware of it because their bodies battle the virus.  The cells in your cervix, unfortunately, have the potential to develop into malignant cells if your body doesn't battle the infection.

There are about 100 different types of HPV, and roughly 12 of them have been known to cause cancer. Cervical cancer can be prevented by early diagnosis of these HPV strains. Regular exams with your doctor can help detect cellular alterations before they progress to cancer. By shielding you from the HPV that is responsible for up to 90% of all cervical malignancies, the HPV vaccine can aid in the prevention of HPV infection.

Types

The appearance of cervical tumors and pre-cancers under a microscope in the lab is used to categorize them. Squamous Cell Carcinoma and Adenocarcinoma are the two most common forms of cervical cancer.

Squamous Cell carcinoma makes up the majority of cervical malignancies (up to 9 out of 10). Exocervical cells give rise to these malignancies. The transformation zone is where squamous cell carcinomas most frequently start (where the exocervix joins the endocervix).

Adenocarcinomas make up the majority of the other cervical malignancies. The malignancies known as adenocarcinomas originate from glandular cells. The endocervical gland cells that produce mucus give rise to cervical cancer.

Less frequently, cervical malignancies resemble squamous cell carcinomas and adenocarcinomas in their characteristics. Adenosquamous carcinomas or mixed carcinomas are the names given to these.

Symptoms

The early stage or the transformation stage of cervical cancer may not show symptoms. The symptoms may include;

• Spotting or light bleeding in between periods.
• Bloody or watery vaginal discharge with a funky smell. 
• Heavy vaginal discharge.
• Bleeding and pelvic pain during or after intercourse.
• Periods may last longer and flow may be heavier than usual.

If cancer has spread to nearby organs or tissues, the symptoms may include;

• Persistent and unexplained pelvic pain.
• Painful urination and bleeding during urination.
• Diarrhea, abdominal pain, or bleeding while pooping.
• Losing appetite and weight.
• General fatigue.
• Dull and persistent back pain and swelling in legs.

Risk factors

The following activities can contribute to the risk leading to cervical cancer;

• Not having regular screenings and Pap tests.
• People who suffer from HPV infections are at high risk.
• Other sexually transmitted infections.
• Intercourse before the age of 18 and having many sexual partners.
• Taking Oral contraceptives or birth controls pills.
• Multiple full-term pregnancies.
• Smoking or consumption of tobacco. 
• Weak immune system. 
• Family history of cervical cancer.

Prevention

Regular screenings using Pap tests and Human Papillomavirus (HPV) tests to identify any precancers can often avoid cervical cancer. Additionally, it can be avoided by getting the HPV vaccine. All teenagers should take the HPV vaccine as part of their routine vaccinations to help prevent cervical cancer. Starting at age 9, it can be taken. 

Additional actions that can be taken to prevent the risk of cervical cancer are;

• Postpone first intercourse till late teens or older. 
• Practice safe sex by using condoms, and dental dams.
• Wash the vulval area gently with water after sexual activities.
• Limit the number of sexual partners.
• Quit smoking or using tobacco.

Diagnosis of cervical cancer

To identify or diagnose cancer, doctors do a variety of tests. Tests are also performed to determine whether cancer has moved from the cervix to another part of the body. It is known as metastasis if cancer has spread. To find out which treatments would work best, doctors may also perform certain tests.

Pap test: Your doctor will extract cells from your cervix during a Pap test, which will then be evaluated in a lab for irregularities. The cervix contains aberrant cells that can be found during a Pap test, including cancerous cells and cells that have alterations that raise the risk of cervical cancer.

HPV DNA Analysis: The HPV DNA test entails checking for any of the HPV types which are most likely to cause cervical cancer in cells taken from the cervix. A Pap test and an HPV test are comparable. A sample of cervix cells is used for the test. When doing a Pap test or when the findings reveal abnormal cervical changes, the doctor may order an HPV test. High-risk HPV refers to specific types or strains of HPV, such as HPV16 and HPV18. These strains, which are more prevalent in cervical cancer patients, could support a diagnosis.

Colposcopy: To examine the cervix for any abnormalities, the doctor could do a colposcopy. Additionally, a cervix biopsy can be guided by a colposcopy. A distinctive tool called a colposcope is used during a colposcopy. Similar to a microscope, the colposcope enlarges the cervix and vaginal cells. It provides the doctor with an illuminated, magnified picture of the cervix and vaginal tissues. The examination is comparable to a speculum examination and the colposcope is not put into the body. It is safe and can be performed in the doctor's office.

Biopsy: A biopsy is the extraction of a small sample of tissue for microscopic analysis. Merely, a biopsy can definitively diagnose cancer; other tests can only hint that it may be present. The material is next examined by a pathologist. A pathologist is a medical professional who focuses on analyzing lab results and assessing cells, tissues, and organs to identify diseases. During the biopsy, if the abnormality is minor, the doctor could completely remove it. 

Punch Biopsy, which entails taking tiny samples of cervical tissue with a sharp instrument.

Endocervical Curettage involves scraping a sample of tissue from the cervix using a tiny, spoon-shaped tool (a curet) or a thin brush.

One of the following examinations may be carried out by your doctor if the punch biopsy or endocervical curettage raises any concerns:

Electrical Wire Loop, which takes a little sample of tissue using a thin, low-voltage electrified wire. Typically, local anesthetic is used for this procedure in the office.

Your doctor may perform a Cone Biopsy, also known as conization, to collect cervical cells from deeper layers for laboratory analysis. Under general anesthesia, a cone biopsy can be performed at a medical facility.

Staging: You will have additional tests to establish the extent (stage) of your cancer if your doctor finds that you have cervical cancer. The stage of your cancer will greatly influence the course of your treatment.

Staging tests consist of Imaging Tests: Your doctor can ascertain whether your cancer has spread past your cervix with the use of exams like X-rays, CT scans, MRIs, and positron emission tomography (PET).

Pelvic examination under anesthesia: If it is required for treatment planning, the doctor may perform a second examination of the pelvic region while the patient is sedated to check for signs of cancer spread to any nearby organs, such as the uterus, vagina, vulva, bladder, or rectum.

Treatment of Cervical Cancer

In the context of cancer care, many medical specialties frequently collaborate to develop a patient's comprehensive treatment plan, which incorporates a variety of therapies. An interdisciplinary team is what this is. A wide range of other medical specialists, including medical assistants, nurse practitioners, oncology nurses, pharmacists, social workers, counselors, nutritionists, and others, are part of cancer care teams.

The kind and stage of cancer, potential side effects, the patient's preferences, and general health are all factors that influence how cervical cancer is treated. Research all of your therapy options thoroughly, and be sure to get any questions answered. The desired effects of each course of treatment as well as what to expect during it should be discussed with your doctor.

Surgery: Early-stage cervical cancer is commonly treated surgically. The best course of action for you will be determined by the size and stage of your cancer as well as whether or not you plan to become pregnant in the near future.

surgical removal of only cancer, It could be possible to entirely remove extremely tiny cervical cancer using a cone biopsy. A cone-shaped portion of cervical tissue is removed during this procedure, leaving the cervix intact. If you think about having a child in the future, surgery can be considered.

Surgery to remove only cancer, With a cone biopsy, it could be feasible to completely eradicate very small cervical cancer. The cervix is left intact after a cone-shaped section of cervical tissue is removed during this treatment. You might be able to consider getting pregnant in the future if you choose this option.

Cervix removal through surgery (trachelectomy), a radical trachelectomy operation, which removes the cervix as well as some surrounding tissue, may be used to treat early-stage cervical cancer.

Removing the uterus and cervix with surgery (hysterectomy), The majority of early-stage cervical cancers are treated by performing a radical hysterectomy, which entails the removal of the uterus and cervix as well as a piece of the vagina and nearby lymph nodes. A hysterectomy can be used to treat early-stage cervical cancer and prevent a recurrence. But when the uterus is lost, pregnancy is impossible.

Radiation Therapy: High-energy x-rays or other forms of radiation are used in radiation treatment to kill cancer cells or stop them from proliferating by destroying their DNA. External radiation therapy and internal radiation therapy are the two primary types of radiation therapy (also called brachytherapy).

In addition to being utilized as a form of palliative care to ease symptoms and enhance the quality of life in persons with advanced cervical cancer, radiation treatment, both external and internal, is used to treat cervical cancer.

Chemotherapy: Chemotherapy is a treatment that uses chemicals to kill cancer cells. It can be taken as tablets or given intravenously. Both strategies are occasionally used. When treating locally advanced cervical cancer with radiation therapy, low dosages of chemotherapy are usually employed because the latter's effects may be amplified. Higher chemotherapy doses could be suggested to help manage the symptoms if the cancer is very advanced.

Targeted Treatment: Medication therapy that targets specific cancer cell defects. By exploiting these vulnerabilities, targeted pharmaceutical therapy can destroy cancer cells. Targeted drug therapy is routinely used in conjunction with chemotherapy. For advanced cervical cancer, it can be a possibility.

Immunotherapy: Immunotherapy is a type of medical treatment that helps your immune system fight cancer. Cancer may escape the immune system's attention because cancer cells produce substances that make them invisible to immune system cells. In order to function, immunotherapy must alter that process. Immunotherapy may be used if cervical cancer has spread and prior therapies have failed.

Cancer patients are not always able to recover. Cancer may be classified as incurable, distant metastatic, or terminal if it cannot be treated or managed.

Stressful as this news is, some people find it challenging to talk about advanced cancer. To convey your views, desires, and concerns, it is crucial to have frank dialogues with your medical staff. The medical staff is available to serve patients and their families and has the necessary training, experience, and knowledge to do so. It is crucial to make sure a person is physically at ease, pain-free, and emotionally supported. Consider hospice treatment if you have advanced cancer and your expectancy is shorter than six months.