Introduction:
A cervix is found at the narrow lower end of the womb (uterus) located at the top region of the vagina in the female reproductive tract. The cervix area connects the uterus to the vagina through the cervical canal. The cervical canal is the passage between the uterine and the vaginal cavity. The menstrual blood escapes from the uterus to the vagina through the cervical canal, and sperm are transported from the vaginal cavity into the uterine cavity through this canal. Cancer that occurs in the cells of the cervix is called cervical cancer.
What Is Cervical Cancer?
Before the appearance of cancer cells, cells in the cervix undergo dysplasia (abnormal development or growth of cells in cervical tissue). If the abnormal tissues or cells are not removed or destroyed, these cells develop into cancer cells, grow rapidly, and spread deeper from the cervix into the surrounding areas. The cervix is divided into two main parts:
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The Exocervix - The exocervix, also called the ectocervix, is the outer portion of the cervix. It consists of flat, thin squamous cells. The exocervix can usually be seen during a gynecological examination.
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The Endocervix - The endocervix is the inner portion of the cervix that forms a passway that connects the vagina through the uterus. It is covered in column-shaped glandular cells.
The endocervix and exocervix are connected by a region in between known as the transformation zone. Most cervical cancers begin from the squamous cells located in the transformation zone.
What Causes Cervical Cancer?
Individuals who have multiple partners and indulge in unprotected sex tend to get infected by HPV (human papillomavirus) at some point in their lives. Not all sexually active people are affected by HPV. The immune system of the body usually controls the HPV infection eliminating the infection over time. But at times, a long-term HPV infection leads to changes in the cells of the cervix, and when left untreated, they develop into cancer. High-risk HPV causes cervical cancer and other types of cancers as well. HPV 18 and HPV 16 are the two major high-risk HPV types that cause most cervical cancers.
What Are the Types of Cervical Cancer?
The three main types of cervical cancer are:
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Cervical Adenocarcinoma - Cervical adenocarcinoma develops from the column-shaped glandular cells at the endocervix. Mesonephroma or clear-cell adenocarcinoma, is another rare type of adenocarcinoma.
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Squamous Cell Carcinoma - Squamous cell carcinoma develops from the thin flat squamous cells lining the exocervix. The majority of cervical cancers are squamous cell carcinomas.
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Mixed Carcinoma - Mixed carcinoma is cervical cancer containing cervical adenocarcinoma and squamous cell carcinoma features.
What Are the Signs and Symptoms of Cervical Cancer?
Symptoms seen in the early stages of cervical cancer include:
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Vaginal bleeding after menopause, after sex, and in between periods.
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Vaginal discharge containing blood or a watery discharge with a strong odor.
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Pain during sex or pain in the pelvic region.
Symptoms seen in advanced stages of cervical cancer include:
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Painful or difficult bowel movements or rectal bleeding during bowel movements.
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Blood in the urine or pain or difficulty in urination.
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Fatigue (feeling tired).
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Abdominal pain.
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Leg swelling.
Some of these symptoms can also be associated with other conditions. It is always recommended to consult a healthcare professional before associating any of these symptoms with cervical cancer.
Who Is at More Risk for Cervical Cancer?
When a person has a high-risk HPV infection, certain other factors can cause persistent infections that lead to cell changes, thereby increasing the risk of cervical cancer. Some of those factors are:
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Smokers or Passive Smokers - People who smoke or breathe in cigarette smoke (second-hand smoking or passive smoking) are more at risk for cervical cancer.
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Weakened Immune System - People with weak immune systems face trouble fighting infections. Therefore infections like HPV tend to persist, and prolonged periods of HPV infection inside the body ultimately end in cervical cancer. Immunocompromised individuals, like those with HIV infection or those taking medications to suppress the immune response (for treating an autoimmune disease or cancer).
What Are the Screening Tests Done for Cervical Cancer?
Screening for cervical cancer should be done as a part of routine health care. Routine cervical cancer screening tests include a Pap smear and HPV tests. These tests can detect precancers or any abnormal cell changes. Cervical cancer screenings are recommended from the age 20s and above.
1. HPV Tests - HPV test is done by using a special tool to scrape the area of the cervix and remove cells for testing. HPV tests can detect whether any high-risk HPV cells are present in the cervical cells. An HPV test can result in a positive or negative test.
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Positive Test Results: A positive result denotes presence of a high-risk HPV infection. The doctor will recommend the next step based on the specific test.
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Negative Test Results: A negative test result indicates an absence of any high-risk HPV infection was found.
2. Pap Tests - Pap test is done the same way as an HPV test; by using a special tool to scrape the area of the cervix and remove cells for testing. Pap tests can show whether the cells are normal or abnormal. Sometimes it can come out unsatisfactory as well.
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Normal Results: A normal result suggests no abnormal growth of cells or malignancy. It is also called a negative test result.
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Abnormal Results: An abnormal result suggests the presence of abnormal cells in the cervix. It is also called a positive test result. An abnormal-looking cell does not necessarily mean cancer. In case of a positive test result, the healthcare provider may suggest further monitoring, tests, and treatments.
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Unsatisfactory Results: An unsatisfactory result means that the sample taken must not have had sufficient cells or the cells must have been hidden by mucus or clumped up together. The healthcare professional will ask the patient to do the test in another two or four months.
How Is Cervical Cancer Diagnosed?
Some of the procedures that are used to diagnose cervical cancer include:
1. Colposcopy - In the colposcopy procedure, the doctor gently inserts a speculum (a metal instrument used to dilate a canal for inspection) to open the vagina and visualize the cervix. The cervix is smeared with a vinegar solution, showing the abnormal areas. An instrument called a colposcope would then be inserted close to the vagina. The colposcopy procedure includes a biopsy as well.
2. Biopsy - A tissue sample is removed from the cervix to be viewed under a microscope by the pathologist to detect any signs of cancer. The biopsies done usually to check for cervical cancer are given below:
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Endocervical Curettage - In this procedure, a curette (spoon-shaped instrument) removes tissue or cells from the cervical canal.
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Punch Biopsy - Here, a sharp, circular, and hollow instrument is used to remove a round, small piece of tissue.
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Cone Biopsy - It is a surgical procedure where sizable cone-shaped tissue is removed from the cervix and the cervical canal. This procedure is also known as conization.
What Are the Treatment Options for Cervical Cancer?
The treatment options for cervical cancer are dependent on factors like the overall health of the patient and the stage the cancer has progressed to. The treatment plan will include treatment goals, information about the cancer, treatment options, possible side effects, and length of the treatment. Some treatment options include:
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Surgery: Surgery is done to treat early-stage cervical cancer. The type of surgery depends on the size of cancer and the area where it is seen. In early-stage cancer, a simple hysterectomy (a surgical procedure done to remove the uterus and cervix but not the surrounding tissues) or radical hysterectomy (surgical removal of the uterus, cervix, and surrounding tissues) is commonly done.
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Radiation Therapy: In radiation therapy, high-powered energy beams like protons or X-rays kill cancer cells. Radiation therapy and chemotherapy are the primary treatment for locally advanced cervical cancers.
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Chemotherapy: Here, drug treatments that use chemicals to slow or kill cancer cells are undertaken. The drugs are given in either pill form or intravenously (through the vein).
Can Cervical Cancers Be Prevented?
Cervical cancers can be prevented and cured if detected early.
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HPV vaccination is the most effective and safe way to prevent cervical cancer. HPV infection is a sexually transmitted infection, so HPV vaccination offers the best protection when given to a person before they become sexually active. The vaccination is usually recommended from age 9 to age 26 for both men and women. Since HPV vaccinations fail to protect against certain types of HPV, it is recommended to undergo routine cervical screening tests.
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Another way to prevent or decrease the risk of HPV transmission is by using condoms during sexual activity. However, even condoms can fail to completely prevent them as there are areas not covered by condoms that can lead to exposure.
Conclusion
Cervical cancer is a commonly occurring malignancy in women. HPV vaccination and regular screenings like a Pap smear and HPV testing can detect the abnormality in an early stage. Detecting the malignancy in an early stage can improve the chances of treating the malignancy successfully.
