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Cervical Cancer

Definition


Disease: Cervical Cancer Cervical Cancer
Category: Gynecological diseases
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Disease Definition:

One of the most common cancers that affect a woman's reproductive organs is cervical cancer. Most cases of cervical cancer are partly caused by the various strains of human papillomavirus (HPV), which is a sexually transmitted infection.

A woman's immune system typically prevents the virus from doing harm when she’s exposed to HPV. But in some cases, before the virus eventually converts some cells on the surface of the cervix into cancer cells, it survives for years. Women over the age of 30 have the highest risk of developing cervical cancer.

Over the last 50 years, the death rate from cervical cancer has decreased greatly thanks to Pap test screening for the most part. Young women can take a vaccine to prevent cervical cancer.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Regular screening is so important because early cervical cancer produces no signs or symptoms in general, and so the woman may not experience any cervical cancer symptoms. The following signs and symptoms of more advanced cervical cancer may appear as the cancer progresses:

 

  • Watery, bloody vaginal discharge that may be heavy and have a foul odor
  • Vaginal bleeding after intercourse, between periods or after menopause
  • Pelvic pain or pain during intercourse


A woman should see a doctor if she experiences pain during intercourse or any unusual bleeding between periods.

When does the patient no longer need to be screened, how often the screening needs to be done and when to begin screening for cervical cancer are questions that should be discussed with the doctor. Girls between the ages of 13 and 15 are recommended to visit an obstetrician-gynecologist to discuss sexual activity and ways to prevent sexually transmitted infections including HPV.

Causes:

When healthy cells acquire a genetic mutation that turns normal cells into abnormal ones, cancer begins. Eventually dying at a set time, healthy cells grow and multiply at a set rate, while cancer cells grow and multiply out of control without dying. A mass (tumor) is formed by the accumulating of abnormal cells. Cancer cells can break off from an initial tumor to spread elsewhere in the body (metastasize); they can also invade nearby tissues.

Here are the two main types of cervical cancer:

 

  • Adenocarcinomas: These cancers make up 10 to 20% of cervical cancers; they occur in the glandular cells that line the upper portion of the cervix.
  • Squamous cell carcinomas: This type accounts for 80 to 90% of cervical cancers and it begins in the thin, flat cells that line the bottom of the cervix called the squamous cells.


Very rare cancers can occur in other cells in the cervix. Sometimes both types of cells are involved in cervical cancer.

The factor that causes squamous cells or glandular cells to become abnormal and develop into cancer is still not understood. But the role of the sexually transmitted infection called human papillomavirus (HPV) is certain. Though HPV is a very common virus and most women with HPV never develop cervical cancer, but evidence of HPV is found in nearly all cervical cancers. So whether a woman will develop cervical cancer or not may also depend on other risk factors such as her lifestyle choices, environment or genetic makeup.

The risk of cervical cancer may increase due to certain factors, including:

 

  • Cigarette smoking: The risk of precancerous changes as well as cancer of the cervix can increase by tobacco use, though the exact mechanism that links cigarette smoking to cervical cancer is not clear. Smoking and HPV infection may work together in causing cervical cancer.
  • Early sexual activity: As immature cells seem to be more susceptible to the precancerous changes that HPV can cause, the risk of HPV increases by having sex before the age of 18.
  • A weak immune system: One is more likely to develop cervical cancer when having an HPV in addition to a weakened immune system due to another health condition, despite the fact that most women who are infected with HPV never develop cervical cancer.
  • Many sexual partners: The greater a woman’s number of sexual partners, and the greater her partner's number of sexual partners, the greater is her chance of acquiring HPV.
  • Other sexually transmitted diseases (STDs): A woman will have a greater chance of having HPV if she has other STDs such as HIV/AIDS, syphilis, chlamydia or gonorrhea.

Complications

Complications:

Infertility is a distressing side effect of treatment for many women, particularly those who have yet to begin a family. It is often impossible for a woman who has been treated for invasive cervical cancer to become pregnant. If a woman with cervical cancer wants to get pregnant in the future, she should discuss it with her doctor.

Fertility-sparing surgery may be a treatment option for a specific subgroup of women with early cervical cancer. The uterus could be preserved by a surgical procedure called radical trachelectomy to remove only the cervix and surrounding lymphatic tissue.

Though there may be added risks to this surgery and it is not appropriate for every woman, but using radical trachelectomy can cure cervical cancer as suggested by studies of this technique. Future pregnancies, which are possible, must be managed carefully because a higher incidence of miscarriage and premature birth can be caused by removing the cervical tissue.

Preserving fertility is, in most cases, more successful than trying to restore fertility after treatment. Before the treatment begins, a woman can discuss her concerns about infertility with her doctor.

Treatments:

LIMITED AND NONINVASIVE CANCER:
Treatment to remove the abnormal area of cells is typically required in the treatment of cervical cancer that's confined to the outside layer of the cervix. No additional treatments are needed for most women in this situation. Removing procedures of the noninvasive cancer include:

  • Cryosurgery:

Freezing and killing cancerous and precancerous cells are involved in this technique.

  • Hysterectomy:

Removal of the cancerous and precancerous areas, the uterus and the cervix, are involved in this major surgery. Only in certain selected cases of noninvasive cervical cancer is hysterectomy usually done.

  • Loop electrosurgical excision procedure (LEEP):

To remove cells from the mouth of the cervix by passing electrical current that cuts like a surgeon's knife, a wire loop is used in this technique.

  • Cone biopsy (conization):

To remove a cone-shaped piece of cervical tissue where the abnormality is found, the doctor uses a scalpel during this surgery.

  • Laser surgery:

To kill cancerous and precancerous cells, this operation uses a narrow beam of intense light.

INVASIVE CANCERS:
Invasive cancer is the one that invades deeper than the outside layer of cells on the cervix, requiring more extensive treatment. Several factors including the patient's own preferences about treatment, her other health problems and the stage of the cancer are some of the factors that are involved in determining the treatment for cervical cancer. Some of the options are:

 

  • Surgery: Early stage of cervical cancer is typically treated with surgery to remove the uterus called hysterectomy. The removal of the cancer, the uterus and the cervix is involved in a simple hysterectomy. Only when the cancer is very early stage and invasion is less than 3 millimeters (mm) into the cervix will simple hysterectomy be an option. When there's an invasion of greater than 3 mm into the cervix and no evidence of tumor on the walls of the pelvis, the standard surgical treatment is a radical hysterectomy, which involves removal of part of the vagina, uterus, cervix and lymph nodes in the area.

Removing the uterus makes it impossible to become pregnant, though hysterectomy can prevent cancer from coming back and can cure early-stage cervical cancers. Recovery will take about six weeks. Difficulty with bowel movements and urination and pelvic pain are included in the temporary side effects of radical hysterectomy.

 

  • Radiation: Radiation therapy kills cancer cells by using high-powered energy. This can be done in two ways: internal radiation therapy, in which devices filled with radioactive material are placed near the cervix; and external radiation therapy, in which external beam radiation is used.  Radiation therapy is as effective as surgery for early-stage cervical cancer. The most effective treatment for women with more advanced cervical cancer is radiation combined with cisplatin-based chemotherapy.

Bladder irritation, upset stomach, diarrhea, nausea and narrowing of the vagina, which can make it difficult to have intercourse, are all included in the side effects of radiation to the pelvic area. As a result of radiation therapy, premenopausal woman may stop menstruating and begin menopause.
 

  • Chemotherapy: Cancer cells are killed with strong anti-cancer medications in chemotherapy. Killing quickly growing cells, including cancer cells, chemotherapy drugs travel throughout the body as they are usually injected into a vein, and they can be used alone or in combination with each other. To enhance overall treatment effectiveness, the chemotherapy drug called cisplatin is often combined with radiation therapy. The drugs determine the side effects of chemotherapy; but the usual side effects include hair loss, nausea, fatigue and diarrhea. In premenopausal women, certain chemotherapy drugs may cause infertility and early menopause.

Prognosis:

Not Available

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