Cervical cancer is a cancer that happens in the cells of the cervix, the lower part of the uterus that connects to the vagina. Long-lasting infection with some types of human papillomavirus (HPV) is the leading cause of cervical cancer. HPV is a common virus that is passed from one human to another during intercourse. Around half of sexually active people will have HPV at some point in their lives, but only a few women get cervical cancer.
Cervical cancer occurs mostly in women over the age 30. >15% of new cases are in women over the age 65, and especially those who have not been getting regular screenings. It is highly preventable because vaccine and screening tests to prevent HPV infections are available. When the cancer is found early, it is highly treatable and associated with good quality of life and a long survival.
Types of cervical cancer
The three main types of cervical cancer are:
- Squamous cell carcinoma – This type of cancer starts in the flat, thin cells (squamous cells) lining the outer part of the cervix, that projects into the vagina. A lot of the cervical cancers are squamous cell carcinomas.
- Adenocarcinoma – This type of cancer starts in the column-shaped glandular cells that line the cervical canal.
- Mixed carcinoma – This type of cancer has features of the two above types.
An early-stage cervical cancer generally shows no signs or symptoms. They show at a much-advanced cervical cancer which include:
- Vaginal bleeding after intercourse, after menopause or between periods
- Watery, bloody vaginal discharge that might be heavy and have a foul smell
- Pain during intercourse or pelvic pain
You should make an appointment with the doctor if any of the above signs or symptoms concern you.
Causes and diagnosis
Cervical cancer starts when healthy cells in the cervix develop changes (mutation) in their DNA. A cell’s DNA contains the instructions that guide a cell what to do. Healthy cells multiply and grow at a set rate, eventually dying at a set time. The mutations tell the cells to grow and multiply out of control and they do not die. The accumulating abnormal cells form a mass also known as a tumor. Cancer cells invade nearby tissues and can break off from a tumor to also spread elsewhere in the body.
It is certain that HPV plays a role in causing cervical cancer. It is very common, however, that most people with HPV never develop cancer. This means that other factors, such as environment or lifestyle choices, also determine whether you will develop cervical cancer.
Cervical cancer screening can be done through high-risk HPV testing and Papanicolaou test (Pap smear). A Pap smear is a part of a woman’s regular pelvic examination. The doctor collects cells from the surface of the cervix and a technician looks at them under a microscope. If he spots anything unusual, the doctor will take out a bit of cervical tissue in a procedure called a biopsy.
Other methods can also find changes in the cervix. These include:
- A colposcopy – the doctor may use it if a Pap smear detects unusual cells. They stain the cervix with a harmless dye so the cells are easier to see. Then they use a microscope called a colposcope that magnifies the cervix by eight to 15 times, to find unusual cells for biopsy. This procedure is usually done in the gynecologist’s office. You may need another biopsy later if the colposcopy detects signs of invasive cancer.
- Loop electrosurgical excision procedure (LEEP) – the doctor uses an electrified loop of wire to take a sample of tissue from the cervix.
- Conization – which is removal of part of the cervix in the operating room while you are under anesthesia. They might use a scalpel (cold knife conization), a LEEP, or a laser. These are usually outpatient procedures, hence you can return home the same day.
Stages and treatment options
A 4-stage system is the most useful and common way to stage cervical cancer:
- Stage 0 – When precancerous cells are present
- Stage 1 – When cancer cells have grown from the surface into the deeper tissues of the cervix, and possibly into the uterus and to the nearby lymph nodes
- Stage 2 – When the cancer has now moved beyond the cervix and uterus but not as far as the lower part of the vagina or the walls of the pelvis. It may or may not affect the nearby lymph nodes
- Stage 3 – When the cancer cells are present in the walls of the pelvis or the lower part of the vagina, and it may be blocking the ureters and tubes that carry urine from the bladder. Again, it may or may not affect nearby the lymph nodes
- Stage 4 – When the cancer affects the rectum or bladder and is growing out of the pelvis. It may or may not affect the lymph nodes. In stage 4, it will spread to distant organs, including the bones, liver, lungs, and lymph nodes
Cervical cancer is very much treatable if you catch it early. The four main treatments are:
- Surgery – The reason for surgery is to remove as much of the cancer as possible. Sometimes doctors remove just the area of the cervix that contains cancer cells. For cancer that is more widespread, surgery may include removing the cervix and other organs in the pelvis.
- Chemotherapy – It uses drugs to kill cancer cells throughout the body. Doctors usually give this treatment in cycles. You will get chemo for a certain period of time. Then the treatment is stopped to give the body time to recover.
- Radiation therapy – Radiation kills cancer cells using high-energy x-ray beams. It can be done through a machine outside of the body. It can also be delivered from inside the body using a metal tube placed in the vagina or uterus.
- Targeted therapy – Bevacizumab (Avastin) is a newer drug that works in a different way from radiation and chemotherapy. It blocks the growth of new blood vessels that help the cancer survive and grow. This drug is often given with chemotherapy.
Fertility and cervical cancer
Radiation therapy or surgery for cervical cancer may mean you are unable to conceive children. A lot of women experience a sense of loss when they learn that their reproductive organs will be removed or will no longer work. You may feel extremely upset if you are no longer able to have kids and may worry about the impact of this on your relationship. Even if you were not planning to have children, you may feel some distress.
- Having a trachelectomy, where only the cervix is removed, is a good option for some women. It will still be possible to get pregnant after this procedure, but you will be at higher risk of having the baby prematurely or having a miscarriage. Your doctor can always discuss these risks with you.
- In case you require radiation therapy but your ovaries need not be treated, one or both the ovaries may be surgically moved higher in the abdomen and out of the field. It is called ovarian transposition or relocation (oophoropexy), and this may help the ovaries keep working properly.
Side effects of treatment
It may take some time to recover from treatment for cervical cancer. You may find the cancer affects you physically and emotionally affected by it. Some of the commonly known side effects of cervical cancer treatment are:
- Bladder problems
- Bowel changes
- Lymphoedema (long-term chronic condition that causes swelling in the body’s tissues)
- Heart disease and osteoporosis (disease that weakens the bones and increases the risk of fracture)
Survivorship and prevention of cervical cancer
Stress disorders and mood, body image and the fear of recurrence can affect the quality of life of cervical cancer patients. Studies reveal that persistent cancer-specific distress is significantly higher in patients with lower spiritual well-being, younger age, more reproductive concerns, worse mental state, and poor maladaptive coping and social support. Social support is highly essential in coping with cancer diagnosis, treatment and emotions that follow. It cannot be more emphasized how instrument having emotional support from partners, children, family, and friends can help a person cope up with the after-effects of the treatment and overall journey.
Cervical cancer can be prevented by having regular screenings to find any symptoms and treat them, as well as receiving HPV vaccine. Some additional actions that can help prevent cervical cancer include:
Some other actions people can take to help prevent cervical cancer include:
- Quit smoking
- Limit the number of sex partners
- Use condoms
- Avoid sexual intercourse with people who have had a lot of partners
All women should talk to their doctors about cervical cancer and fix on an appropriate screening schedule. For women at high risk for having cervical cancer, screening is recommended at an earlier age, and more often than for women who have an average risk of cervical cancer.