Cervical Cancer - Causes and Prevention

What Is Cervical Cancer?

Cervical cancer is the second largest cancer affecting women's health. It is a type of cancer that begins in the cells in the cervix, present in the lower part of the uterus (womb). The cervix connects the uterus's body (the upper part where a fetus grows) to the vagina (birth canal). Cancer can occur when the cells in the body start to grow out of control.

Cervical cancer is usually caused by various strains of the human papillomavirus (HPV), which is a sexually transmitted infection. When a person is exposed to HPV, the body's immune system typically prevents the virus from harming the body. In a very small number of people, however, this virus will survive for years and cause some of the cervical cells to become cancer cells. The risk of developing cervical cancer can be reduced by screening tests and getting vaccinated against HPV infection.

What Causes Cervical Cancer?

Cervical cancer is caused by HPV (Human Papillomavirus), and it mainly affects young women. Surprisingly, HPV is not only transmitted through sexual exposure but also by:

• Sharing common toilet seats.

• Using bed sheets in hotels and common places.

• Using towels in hotels and common areas.

• Oral sex.

Human Papillomavirus (HPV):

Human papillomavirus (HPV) is the cause of almost all cases of cervical cancer in women who the virus has previously infected. HPV is a group of viruses and not a single virus. There are over 100 different types of HPV. HPV can spread during sexual intercourse and even through other types of sexual activity like skin-to-skin contact of the genital areas or by using sex toys.

Some types of HPV will not cause any noticeable symptoms, and the infection will cure on its own without any treatment. But others can cause genital warts but are not linked to a high risk of acquiring cervical cancer. Almost 15 types of HPV are considered to increase the risk of getting cervical cancer. The two types of HPV that have the highest risks to cause the majority of cervical cancers are HPV 16 and HPV 18.

The HPV that can cause cervical cancer will stop the cells from working usually and cause them to reproduce uncontrollably, leading to the formation of a cancerous tumor. As most types of HPV do not cause any symptoms, the other partner could have the virus for months or years without their knowledge.

What Are The Premalignant Cervical Abnormalities?

It will take many years for cancer in the cervix to develop and for the cells in the cervix to show changes. These cervical abnormalities are cervical intraepithelial neoplasia (CIN) or cervical glandular intraepithelial neoplasia (CGIN), depending on the affected cells. CIN and CGIN are precancerous conditions. Precancerous conditions do not pose an immediate warning to a person's health. But if they are not screened and treated, they can develop into cancer. But, still, even if a person develops CIN or CGIN, the chances of it changing to cervical cancer are very minimal. The changes that are discovered during cervical screening can be treated successfully. The progression from HPV infection to the development of CIN or CGIN and then into cervical cancer is a very slow process, often taking about 10 to 20 years.

What Are The Risk Factors Associated with Cervical Cancer?

HPV infection is very common but cervical cancer being relatively uncommon suggests that only a tiny proportion of women are vulnerable to cervical cancer after an HPV infection.

The additional risk factors that affect a woman's chance of contracting cervical cancer include:

• Women who smoke are more likely to develop cervical cancer than those who do not smoke; this may be because of the harmful effects of chemicals found in tobacco on the cells of the cervix.

• Women with weakened immune systems.

• Women taking the oral contraceptive pill for more than five years.

• Women have more than five children or have them at an early age (under 17 years old).

• Mothers taking the hormonal drug Diethylstilbestrol (DES) while pregnant.

The hormonal changes that occur during pregnancy can make the cervix more susceptible to the effects of HPV. But the reason behind the link between cervical cancer and childbirth is not clear.

How Is Cervical Cancer Diagnosed?

I. Tests to Identify Cancerous Changes:

• HPV Typing Test: HPV DNA (deoxyribonucleic acid) testing will look for the virus (human papillomavirus) that causes these cell changes. If the test is positive it means there is the presence of high-risk HPV. But since not all women having HPV develop cervical cancer, more tests are needed to confirm cervical cancer.

• Pap Smear Test: Pap smear is a screening test for early detection of cervix cancer. It is such a simple and painless office procedure that every lady should come forward for this. It takes ten years for any abnormal changes in the smear to develop into cancerous changes. So it is such a large protection and an eye-opener. The Pap test or Pap smear test will look for precancerous cell changes on the cervix that may turn into cervical cancer if not treated properly.

II. Tests to Confirm Cervical Cancer:

• Sterile Speculum Examination - Using a specialized instrument called a speculum the doctor will examine the cervix, vulva, uterus, vagina, ovaries, and the surrounding regions for any unusual changes.

• Colposcopy - A special instrument called a colposcopy is used to view the cells of the cervix and vagina in a magnified version similar to a microscope.

• Biopsy - Cervical tissues are removed with the help of curettes or wire hooks and sent for microscopic examination to evaluate the cells and tissues. Bleeding, discharge, and cramps are often present.

• X-ray - These can help view any abnormal tumors, if present. But they do not provide enough information or details about cancer.

• CT (Computed Tomography) - CT scans use X-rays to picture any tumors, if present, and also help determine their size.

• MRI (Magnetic Resonance Imaging) - These use magnetic fields to measure the size of tumors with a clearer picture. Usually, a contrast dye is administered prior to the procedure.

How to Prevent Cervical Cancer?

• Vaccination for the prevention of cervical cancer is available these days. This vaccine not only protects against cervical, vulvar, and vaginal cancer but also against genital warts. After 21 years of age, every woman should undergo Pap Smear testing yearly to detect any early changes in the cervix (mouth of the uterus).

• Cervical cancer vaccination is against HPV 6, 11, 16, and 18 (deadly strains causing dysplastic and precancerous lesions). It gives protection against CIN grade 1, 2, 3, AIS, Vulvar intraepithelial neoplasia, and vaginal intraepithelial neoplasia.

• Starting age for vaccination is 9 -12 years, and catch-up is given in adolescent girls and young women between 13 and 26 years. It is best given before sexual exposure. The earlier the vaccination is given, the better it is. The vaccination schedule is 0, 2, and 6 months; three doses are given over six months. It is administered in the deltoid region (intramuscularly).

Apart from that some additional actions may also be taken to prevent cervical cancer which includes -

• Practicing safe sex using protection (condoms).

• Limiting the number of sexual partners.

• Not indulging in sexual intercourse with individuals having multiple partners.

• Quitting smoking.

• Having first sexual intercourse in the late teens or older can also increase the risk of cancer.

Conclusion:

Cervical cancer is one of the most commonly seen cancers in women. However, this can be prevented by taking necessary precautions, and with early diagnosis, it can be treated easily. The survival rate depends upon the stage and severity of the condition, therefore the patient should be aware of the symptom and should consult the doctor without any hesitation.

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