Cervical Cancer

Cervical Cancer

Cervical cancer is one of the top 10 cancers among women in India.



Overview

Cervical cancer is a type of malignant cancer that occurs in the Cervix. In medical terms, the cervix is the lower part of the uterus and connects the body of the uterus to the vagina (birth-canal). The ectocervix(lower part of the cervix) lies within the vagina and the endocervix(upper two thirds of the cervix) lies above the vagina. It is estimated that most of cervical cancers originate from the area where the endocervix and the ectocervix join together. If you are a woman, the cervix is the hollow cylinder (birth canal) that connects your uterus with your vagina and is the place where the fetus grows during pregnancy.

A significant number of cervical cancers are caused by the HPV virus.

As per the statistics from the National health portal of India , almost 1.25 lakh women are detected with cervical cancer and about 67,000 die from the disease every year(2012 data).


Risk Factors

Both exposure (environmental or occupational) to particular agents/substances & an individual’s susceptibility to these agents/substances are thought to contribute to one’s risk of developing Cervical cancer

Risk Factors
Persistent infection of the cervix with Human Papillomavirus (HPV)
Smoking: Both Active and passive smoking increase the risk of cancer
atients with HIV AIDs and Transplants are at an increased risk with Cervival cancer
Self/Spouse having multiple sexual partners
Prevention
HPV vaccines reduce the risk of cervical Cancer.
Vitamin A is associated with lowering risk the risk of the disease as are vitamin B12, vitamin C, vitamin E, and beta-carotene.

Symptoms

The following are the common symptoms of Cervical Cancer

Symptoms
Typically, the early stages of cervical cancer is free of symptoms
Moderate pain during sexual intercourse and vaginal discharge are symptoms of cervical cancer
Experiencing fatigue
Unexplained weight loss
Pelvic pain, back pain, leg pain, swollen legs
Bleeding after douching or after a pelvic exam is a common symptom of cervical cancer
Loss of appetite

Diagnosis

Diagnosis
Biopsy
Pap Smear test
Precancerous lesions detected during scans
Pathological tests

Understand the Pap Smear Test

A Pap smear, also called a Pap test, is a screening procedure for cervical cancer among women. It tests for the presence of precancerous or cancerous cells on the cervix. The cervix is the opening of the uterus.

During the routine procedure, cells from your cervix are gently scraped away and then examined for abnormal growth. The procedure is done at your doctor’s office. It may be mildly uncomfortable, but doesn’t usually cause any long-term pain

Pap Smear Test Recommendations by Age

Age Recommended Frequency of conducting the test
< 21 Years old, not sexually active, no known risk factor None Needed
21 Years - 29 Years Once every 3 years
30 years - 65 years Once every 3 years if your PAP Smear and HPV tests are negative.
Consult a doctor if the tests are positive
65 years and older You may no longer need Pap smear tests; talk to your doctor to determine your needs

Treatment Options

Treatment for cervical cancer depends on the stage of the disease, patients overall health and preferences.

Types of Cervical Cancer

Broadly, there are two common types of cervical cancer (listed below). There are other types of cervical cancer but these are rare.

  • Squamous cell carcinoma
    • This is currently believed to be the most common type of cervical cancer and makes up about 80-90% of the reported cases. These cancers occur in the outer surface cells of the cervix
  • Adenocarcinoma
    • This type is currently believed to be affecting ~10-20% of cervical cancer patients. These cancers occur in the glandular cells that line the lower birth canal.

Stages of Cervical Cancer

Most physicians follow the FIGO (International Federation of Gynecology and Obstetrics) guidelines while deciding on the staging of cervical cancer

Stage of Disease Description
Stage I Cancer has spread from cervical lining into the deeper tissue ; however the cancer is localized in the uterus.
  • Stage IA: Cancer is only diagnosed by microscopy; No lymph nodes are involved
  • Stage IA1: Cancerous area is up to 7 mm length X less than 3 mm width
  • Stage IA2: Cancerous area is up to 7 mm length X 3-5 mm width

  • Stage IB: The lesion / tumor is visible to the doctor
  • Stage IB1: Tumor is less than 4 cm
  • Stage IB2: Tumor is greater than 4 cm
Stage II Cancer has spread from Cervix to near by areas like the vagina or the tissue near the cervix but is still contained to the pelvic area.
  • Stage IIA: Tissue has not spread to the area next to the cervix; in medical terms called as 'parametrial area'
  • StageIIA1: Tumor is 4cm or smaller
  • Stage IIA2: Tumor is larger than 4 cm
  • Stage IIB: Tumor has spread to the 'parametrial area'
Stage III Tumor has spread to pelvic wall and/or lower third of the vagina and/or causes swelling of the kidney or stops kidney to stop functioning. It has not spread to lymph nodes in this stage.
  • Stage IIIA: Tumor has spread to lower third part of the vagina but not grown into the pelvic wall.
  • Stage IIIB: Tumor has spread into the kidneys and/or the lower pelvic wall
Stage IV This happen when the cancer has spread to other parts of the body like bladder/rectum or other lymph nodes

Treatment Options

Treatment Options Description
Surgery Surgery is often used for the treatment of cervical cancer patients. The surgery is done by a gynecologic oncologist.
  • This includes removal of tissue and some surrounding health tissue
  • Depending on the extent of spread of the disease, it may also include hysterectomy (removal of the uterus and cervix), bilateral salpingo-oophorectomy (removal of the ovaries and fallopin tubes), Exenteration (removal of the uterus, vagina, lower colon, rectum, or bladder )
Radiation therapy Radiation therapy or Radiotherapy is a treatment technique based on high energy ionizing radiations (such as gamma rays from a radioactive source like Cobalt-60, Iodine-32, high energy x-rays from a medical linear accelerator or proton/carbon ion based particle accelerators).
Chemotherapy Chemotherapy has been used traditionally for cancer treatment and chemo-therapeutic agents are one of the most commonly used drugs in oncology. Chemotherapy does not differentiate between healthy cells and cancer cells and destroys both.
Targeted Therapies Targeted therapies are designed to identify and act on specific properties exhibited by cancer cells. They do so by attaching themselves to these cells (cell proteins or cell receptors) or blocking cellular pathways eventually killing these cancer cells. A common targeted therapy used for treatment of cervical cancer is bevacizumab (Avastin), a monoclonal antibody often used in combination with cisplatin (a chemotherapy drug).

Research & Further Readings

There are many resources on the net for reading further about cancer

We have listed a few but feel free to explore further.

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