Cervical Cancer Overview
Cervical cancer refers to the malignant neoplasm of the cervix or cervix uteri, the inferior portion of the female reproductive system. It is the second largest cause of death due to cancer in the world and this malignancy take away about 0.3 million women’s life each year mostly in the Indian subcontinent, Latin America and Africa. Almost 90% cases of cervical cancer are caused by Human papillomavirus (HPV) infection. The recent advancement of diagnostic and treatment success along with social awareness reduces the incidence of cervical cancer.
Signs and Symptoms
Cervical cancer is mainly initiated in the cell changing area of the cervix and spreads to the lymph nodes, bladder, lungs, intestines and liver. Parametrial invasion, a tissue that separate cervix from the bladder invasion is also seen. Clinical sign and symptoms of cervical cancer depend on the location and extent of disease. This malignant cancer does not show any symptom at an early stage. But in an advanced stage of cancer following symptoms usually appears.
- Spontaneous bleeding with pain between periods, after intercourse or menopause
- Foul smelling vaginal discharge
- Heavier and longer period than usual
- Bone pain or fractures
- Leaking of urine from the vagina
- Pelvic pain
- Weight loss
- Loss of appetite
- Leg pain
Causes and Risk Factors
Cervical cancer is the third most common threat for women worldwide. But this cancer is less common in the United States due to the routine use of Pap smear, a diagnostic tool for cancer of the cervix.
A usually cervical cancer begins in the cells of the superficial part of the cervix. This superficial part consists of two types of cell: squamous and columnar. About two-thirds of all cervical cancers are from squamous cells. This malignant cancer typically develops very slowly. It usually begins as a pre-cancerous condition referred as dysplasia. Pap smear may detect this precancerous condition and is almost 100% treatable. It can take years for the development of cancer in the cervix from pre-cancerous condition. HPV (human papillomavirus) is the main causative pathogen for all types of cervical cancers. Sexual intercourse mainly spreads this killer virus. Sexual habits and forms of a woman’s life can increase the risk for cervical cancer includes having sex at an early age, having multiple sexual partners or having partners who participate in risky sexual activities. The common risk factor of cervical cancer includes
- Lack of HPV vaccination
- Very weak immune system
- Poor social and economic status
- In the early 1960s, mother took the drug diethylstilbestrol during pregnancy to prevent miscarriage
Squamous cell carcinoma accounts for about 80-85% cases of cervical cancer and about 15-25% cervical cancer are adenocarcinoma. Unusual pathological variant includes adenosquamous carcinoma, neuroendocrine tumor, small cell carcinoma, villoglandular adenocarcinoma, glassy cell carcinoma. Melanoma and lymphoma are non-carcinoma malignancy of the cervix.
Tests and Diagnosis
The early stage of cervical cancer or a precancerous condition of the cervix usually cannot be seen with the naked eye. Detection of cancer depends on special diagnostic tests and tools such as
Pap smears Test: this is for precancers and cancer, but do not predict final diagnosis.
Colposcopy: If abnormal changes are found, the cervix is examined with this tool where pieces of tissue are surgically removed and sent to a laboratory for further examination.
Cone biopsy: If the cervical cancer has found and to detect the spread of cancer following test may be carried out:
- Chest x-ray
- MRI of the pelvis
- CT scan of the pelvis
- Intravenous pyelogram (IVP)
Treatments and Medications
Treatment of cervical cancer mainly depends on the stage of the malignancy, size and shape of the cancer cell and the age of the woman and her general health.
In the early stage of cervical cancer, the cancerous tissue can be removed by the surgical procedure. There are several surgical procedures to remove cancer tissue without removing the uterus or any damage to the cervix that supports conceive a baby in the future. The common surgical procedure includes
- Electrically removal of abnormal tissue
- Freezing of abnormal cell
- Laser therapy that burn the abnormal tissue
In advance stage of cervical cancer radical hysterectomy removes the uterus with its surrounding tissue along with lymph nodes and the superior part of the vagina. In some cases uterus, cervix, and part of the vagina including fallopian tubes, ovaries are removed by surgery. Sometimes radiation therapy or chemotherapy may combine with this treatment procedure. Pelvis and its associated organs such as bladder and rectum are removed by a risky surgical process named as pelvic exenteration.
Apart from surgery, radiation therapy and chemotherapy are a suitable options to maintain fertility in the early stage of cervical cancer. Radiation therapy may prevent the spread of cancer beyond the pelvic region. In chemotherapy ifosfamide, 5-FU, carboplatin, cisplatin, cyclophosphamide and paclitaxel are used to kill the malignant cell. But there are few complications with the surgery and radiotherapy such as impairment of sexual, bladder and bowel function.
Precaution and SelfCare
If cervical cancer is monitored and treated properly, then these malignancies are completely curable. If women meet with the sign and symptoms regarding cervical cancer, she must visit health care provider without any delay. There is a vaccine available approved by USFDA to prevent early-stage cervical cancer called Gardasil, which prevents two types of HPV. Another one is Cervarix, which prevent HPV type 16 and type 18. Using a condom during sex also reduces HPV transmission to some extent. Regular use of pap smears and annual examination of the pelvis from the age of 20 must be started. Once cancer has detected, women must quit smoking as few studies said that there is a relation between cervical cancer and cigarette smoking.
Over the past decades due to the advancement of imaging technique, vaccination, improved treatment procedure including surgery and chemotherapy, women having cervical cancer gets benefit in most developed countries. But in lower or underdeveloped countries the mortality and morbidity from this malignancy is still threats women life.
 Jadon G, Joshi KS. Cervical Cancer – A Review Article. Journal of Biomedical and Pharmaceutical Research, 2012:1(1); 01-04