Considered to be the fourth most common cancer in women, Cervical cancer is regarded to be one of the leading causes of cancer death in women – especially in the developing world. Cervical cancer affects the cervix – located in the lower part of the uterus that connects to the vagina – and most commonly diagnosed in women between the ages of 35 and 44. While cervical cancer is considered to be rare in women under 30 years of age, the incidence of deaths under 30 is also growing.
While cases of cervical cancer rates have fallen in most of the developed world in the last three decades owing to an increase in screening and treatment programmes, cases in the developing world have increased especially in regions such as Central and South America, Eastern Africa as well as South and South-East Asia. Owing to a lack of medical facilities, more than 80 percent of women live in developing countries are only diagnosed when cancer has progressed to an advanced disease. Further, it has been estimated that nearly 95 percent of women living in developing countries have never been screened for cervical cancer. Cervical cancer, if left untreated, proves to be almost always fatal while also causing a tremendous amount of pain and suffering to the affected individual.
Cervical cancer is most commonly caused by infection with the human papillomavirus (HPV) – which 1 in 2 people will likely to contract at some point in their lives. HPV is a common virus which belongs to a group of more than 150-related viruses and is usually transmitted passed through the skin to skin contact – in most cases sexual intercourse. While the majority of HPV aren’t harmful, don’t lead to cancer and usually go away on their own – there are two types of HPV (types 16 and 18) termed as high-risk HPV – that are responsible behind most of the cervical cancer cases (70 percent). There are additional cancer-causing strains as well but they usually affect the mouth, tongue and the oropharynx. Besides the cervix, HPV can even cause cancer of the vagina, vulva, and penis. In addition to HPV, there are several other factors which can play a role in increasing the overall risk of contracting cervical cancer which include:
Cervical cancer is characterized by abnormal changes developing in the cells that line the cervix – or the lower part of the uterus. More often than not, the healthy or normal cells of the cervix may gradually become cancerous or in some cases, even return to normalcy and go away without any treatment. In most cases, cancer has not shown to develop from these abnormal cells alone. These changes can be detected during a Pap screening test and can be treated to prevent cancer from developing. A Pap smear test is recommended every 3 years for women ages 21 and older.
As per statistics released by the American Cancer Society in 2018, it has been estimated that nearly 13,240 new cases of invasive cervical cancer in women will be diagnosed with about 4,170 of them eventually dying from cervical cancer.
Cervical cancer can be further divided into two main types and can be distinguished or set apart by the nature of the appearance of cells under a microscope:
In some rare cases, cervical cancers have characteristics of both squamous cell carcinomas as well as adenocarcinomas. These type of cancers are usually known as mixed carcinomas or adenosquamous carcinomas. Further, there are other types of cancer which are known to develop in the cervix – for instance, metastatic cervical cancer – and then go on to spread to other various parts of the body.
Cervical cancer typically displays no signs or symptoms in early stages but as cancer grows and develops, the body tends to showcase several symptoms. This is why it is vital that women opt for regular screenings by their healthcare professional. Some of the symptoms include the following:
As cancer spreads unabated and develops into an advanced stage, other symptoms might manifest itself including:
Women who experience irregular menstrual cycles might have a hard time differentiating between unusual bleeding and normal bleeding. Therefore, it's imperative that you keep close attention to your body as only you will be able to tell if something's amiss.
It needs to be mentioned that the above-mentioned symptoms need not always be related to cervical cancer. However, that being said, if these signs or symptoms start showing up, you should visit your healthcare professional on an immediate basis to avoid any other complications. In addition, it is prudent to start regular screenings as per the recommended schedule in order to better monitor your cervical health. If at all something doesn't seem quite right, it is important to seek medical attention right away.
The main underlying cause of cervical cancer is persistent or chronic infection with one or more high-risk or oncogenic types of human papillomavirus (HPV) – a common virus that is sexually transmitted. While in most cases, types 16 or 18 of the virus causes cervical cancer, there are other types – for instance 31, 33, 45, and 58 – which also have reportedly caused cancer, albeit rarely, in certain regions. Types 6 and 11 aren’t associated with cancer but have been known to cause the formation of genital warts.
While in most cases, the incidence of new HPV infections tends to resolve by itself, persistent infections can lead to the development of precancer and cancer. More often than not, cervical HPV infections, irrespective of what type they might be, tend to be short-lived. Only a few go on to progress into precancerous lesions or invasive cancer. That said, it usually takes anywhere between 10 - 20 years for precursor lesions caused by HPV to go on and fully develop into invasive cancer. This long gestation period makes it relatively easier to vis-à-vis other cancers to prevent cervical cancer with the aid of early detection and treatment of precancerous lesions.
While invasive cervical cancer can be prevented and even cured, the outcome depends entirely on what stage the cancer was diagnosed. If left unchecked and untreated, cervical cancer certainly proves to be always fatal. Needless to say, early detection is the key as it can go a long way in protecting you from receiving a devastating diagnosis later on.
The first step to avoiding the incidence of cervical cancer is by opting for a thorough and accurate cancer diagnosis. With the help of several advanced tests and tools, your healthcare professional will diagnose if you have cervical cancer or not and thereon, develop an individualized treatment plan.
Diagnosis usually begins with the help of a pelvic exam where the doctor examines the cervix, uterus, vagina, ovaries, fallopian tubes, and rectum for any visible bumps or nodules. A speculum might be used to open the vagina in order to see the cervix more clearly.
Pap smear tests help in determining cervical health and is used for diagnosing any precancerous symptoms, such as abnormal cells or changes in the lining of the cells of the cervix. Women are usually advised to start regular Pap tests at age 21. In case of women falling in the age group between 21 to 29, a pap smear test is recommended every three years and in case of women between 30-65 of age, the recommended schedule is once every five years. In addition, HPV testing – which is an additional test for HPV infection – also needs to be undertaken. Regular Pap smears have proven to be the best method for detecting cervical cancer in the earliest stages and hence, are highly recommended. The vast majority of cervical screening results are normal and any signs of abnormal cells on Pap tests are mostly precancerous (instead of being cancerous).
In the case of women who've undergone a complete hysterectomy – where both the uterus and cervix have been removed –a Pap test or HPV test is not required. However, in the case of women who have undergone partial hysterectomies – where the cervix has been left intact – the standard screening timelines would apply to them as well just like any other woman.
Another diagnostic procedure involves the use of a special microscope – termed as a colposcope – which enables the doctor to get a magnified view of the cervix as well as the vagina and vulva. This allows the doctor to get an in-depth view of any abnormal cells or tissues which is then sent for a biopsy if needed. Colposcopy is usually recommended if either the HPV or PAP Smear test have turned out to be positive.
There are two primary types of biopsies which can be used to diagnose cervical cancer:
Imaging tests such as a CT scan, PET scan, MRI etc. can help determine the location and the size of a tumour before surgery. It can also help in figuring out if the extent to which cervical cancer has spread and if any other organs have been affected as well
It needs to be mentioned that while screening in itself does not prevent the onset of cervical cancer, it can help in detecting if the cervix is normal or if there are any abnormalities present. If at all any abnormalities are detected, screening allows doctors to treat it early and thus help in preventing the spread of cancer. The screening procedures, for the most part, are relatively quick, simple, and painless. Due to the complicated nature of cervical cancer, diagnosis requires a team effort from all parties involved to ensure that a diagnosis has been made effectively. Getting an accurate diagnosis will help the doctors in suggesting the best treatment options.
If the oncologist is of the opinion that the cells have progressed to invasive cancer, he will then decide the best course of treatment depending on what stage cancer has advanced to. Besides the stage of cancer, factors which will be taken into consideration while determining treatment includes the age, overall health, lifestyle as well as personal preferences. For instance – certain treatments for cervical cancer are known to impact the fertility of women and thereon, affect the ability to bear children. In such cases, the doctor will talk to the patient, especially if she's young, about the treatment's risks and side effects and whether that treatment will affect her ability to have children in the future. In most cases, there are 3 common treatments prescribed – surgery, radiation and chemotherapy. However, Immunotherapy and targeted therapy are also viable treatment options.
Surgery – Surgery is a suggested option if the cancer is still in stage 2. Surgery can be undertaken to remove any cancerous cells, tumours etc. which might be present in the cervix or spread beyond the cervix. There are three distinct types of surgical options which are suggested:
Radiation Therapy – Radiation therapy is used to deliver high radiation doses to cancerous cells present in the cervix while sparing healthy tissue. Radiation therapy is of two types:
Radiation therapy is more often than not used in conjunction with chemotherapy. Besides, as compared to other treatment alternatives, radiation therapy also has fewer gastrointestinal and sexual side effects.
Chemotherapy – If cancer has spread to other parts of the body, Chemotherapy is usually suggested as it plays a vital role in shrinking tumours. It involves the use of powerful medications in the form of oral drugs or injections in order to destroy cancerous cells. Although it has side effects – hair loss, nausea, vomiting amongst others – chemotherapy has proven incredibly effective in stopping the growth or spread of tumours when used in combination with other treatments.
Immunotherapy is making use of the body's own immune system to ward off malignant tumour with the help of drugs designed to stimulate the immune system cells while ensuring that healthy cells are left unaffected.
Targeted therapy – which makes use of specific receptors to target cancer cells – can also be suggested in certain situations.
Regular screening is the key to prevention. Because of the nature of cervical cancer, there are no prominent symptoms initially which makes it imperative to screen periodically for the detection of any cancerous cells. Moreover, regular screening can help in detecting early lesions, thus allowing them to be treated on time before they have a chance to progress to cancer. That said, here are some tips on prevention:
Cervical cancer is not something to be afraid of — there are excellent screening tests for cervical cancer which can go a long way in preventing and treating cervical cancer and reducing its morbidity and mortality.