Statistics

• Cervical cancer is among the four most frequent diseases in women worldwide, with 660,000 new cases and 350,000 deaths in 2022.
• Cervical cancer is more prevalent in younger women.
• 20% of all kids who lose their mother due to cancer are victims of cervical cancer.

What is the cervix and its functions?

The cervix is a muscular, passage-like organ present in females and some intersex people. It is the lower region of your uterus that attaches to the vagina.

The cervix is an important element of the female reproductive system, serving as a route between the uterus and the vagina. It's essential for menstruation, fertility, pregnancy, and delivery. The cervix also acts as a barrier against infection.

The cervix comprises two major parts:

• The ectocervix (exocervix) is the exterior section of the cervix that may be seen during a gynecological exam. It is coated in squamous cells.
• The endocervix is the inner section of the cervix that creates a tube between the vagina and the uterus. It is lined by column-shaped glandular cells that produce mucus.

What is Cervical Cancer?

Cervical cancer begins in the cells of the cervix. The cervix is the bottom, thin end of the uterus (womb). Cervical cancer often grows slowly over time. Before cancer develops in the cervix, the cells undergo a process called dysplasia, during which aberrant cells grow in the cervical tissue. If the abnormal cells are not killed or eliminated, they may develop into cancer cells that proliferate and spread deeper into the cervix and adjacent tissues.

The squamocolumnar junction (transition zone) is the point at which the endocervix and ectocervix unite. Most cervical cancers start in this location.

Types of Cervical Cancer

The two primary kinds of cervical cancer are squamous cell carcinoma and adenocarcinoma.

• Squamous cell carcinomas account for up to 90% of all cervical malignancies. These malignancies arise from cells in the exocervix and typically originate in the transformation zone.
• The majority of the other cervical malignancies are adenocarcinomas. Adenocarcinomas are tumors that originate in glandular cells. Cervical adenocarcinoma arises from the mucus-producing gland cells of the endocervix.
• Less typically, cervical malignancies have characteristics of both, known as adenosquamous carcinomas or mixed carcinomas.

Adenocarcinoma

Adenocarcinoma is a cancer that originates in the glands that line your organs. These glands produce mucus and digestive juice. Tumors can arise when your glandular epithelial cells begin to alter or grow uncontrollably.

Squamous Cell Carcinoma

Squamous cell carcinoma, also known as cutaneous squamous cell carcinoma (CSCC), is the second most frequent kind of skin cancer. It begins with squamous cells in your skin's surface layer, the epidermis. Cancer may also develop in parts of your body with mucus membranes, such as your mouth, lungs, and anus.

Symptoms of Cervical Cancer

Cervical cancer may not present with symptoms at first. Cervical cancer may produce signs and symptoms, including:

• Vaginal bleeding occurs after intercourse, between periods, or during menopause.
• Menstrual bleeding is heavier and lasts longer than expected.
• Watery, red vaginal discharge that may be thick and foul-smelling.
• Pelvic discomfort or soreness during sexual intercourse.

Causes

Cervical cancer develops when normally functioning cells in the cervix alter their DNA. A cell's DNA includes instructions that teach it what to do. The modifications direct the cells to proliferate rapidly. When healthy cells would normally perish, the cells continue to live. This results in an abnormally large number of cells. The cells may form a mass known as a tumor. The cells are capable of invading and destroying healthy biological tissue. Over time, the cells might separate and spread throughout the body.

• Having a poor immune system may reduce the body's capacity to fight an HPV infection. Immunocompromised persons are more prone than non-immunocompromised people to have chronic HPV infections that proceed to malignancy.
• Smoking or inhaling secondhand smoke increases the chance of acquiring cervical cancer.

Diagnosis

Cervical cancer is often diagnosed using a combination of screening tests, physical examinations, and biopsy.

1. Screening tests:

• The Pap Test collects cells from the cervix and examines them under a microscope for abnormalities.
• The HPV test detects high-risk HPV strains that can cause cervical cancer.
• HPV/Pap Cotest: A combination of HPV and Pap tests can detect HPV infection and cervical cell alterations.

2. Diagnostic procedures:

• Colposcopy is a magnified inspection of the cervix with a colposcope.
• Biopsy: If abnormal cells are discovered during colposcopy, a tissue sample is obtained for microscopic analysis to determine the kind of malignancy.
• A cone biopsy or loop electrosurgical excision process (LEEP) can be used to remove a larger portion of tissue for diagnosis and therapy.

3. Imaging tests:

• CT scans use X-rays and computers to produce detailed pictures of the body.
• Magnetic resonance imaging (MRI) uses magnetic fields and radio waves to create detailed pictures of the body's soft tissues.
• PET scan: A form of scan that employs a radioactive material to detect areas of elevated cell activity, which can aid in determining cancer spread.

4. Other evaluations:

• Physical Exam: A doctor will check the cervix, vagina, and surrounding regions for obvious abnormalities or cancerous cells.
• Sentinel Lymph Node Biopsy: Can be used to see if cancer has spread to neighboring lymph nodes.

Stages of Cervical Cancer

• Stage 0 (Carcinoma in situ): Abnormal cells in the cervical lining that have not migrated to adjacent tissue. This is considered precancerous.
• Stage I: Cancer is limited to the cervix.
  • IA: Tiny tumors (seen only under a microscope)
  • IB: Larger tumors that have spread farther into the cervix.
• Stage II: Cancer has progressed beyond the cervix to adjacent locations but not to the pelvic wall or lower part of the vagina.
  • IIA: Cancer has spread to the top two-thirds of the vagina.
  • IIB: Cancer has progressed to tissues around the cervix (parametria).
• Stage III: Cancer spreads to the lower portion of the vagina, pelvic wall, or produces hydronephrosis (kidney enlargement owing to a blocked ureter).
  • IIIA: The cancer has progressed to the bottom portion of the vagina.
  • IIIB: Cancer has progressed to the pelvic wall, resulting in hydronephrosis.
  • IIIC: Cancer has spread to pelvic or aortic lymph nodes.
• Stage IV: Cancer has spread throughout the body.
  • IVA: The cancer has progressed to neighboring organs, such as the bladder or rectum.
  • IVB: Cancer has progressed to distant organs such as the lungs, liver, or bones.

Complications

Cervical cancer complications can develop during therapy or as a result of the disease itself.

Treatment-Related Complications

• Sexual dysfunction: Surgery and radiation can damage vaginal tissues.
• Bladder and bowel issues: Damage to nerves and tissues can cause incontinence.
• Early menopause: Treatment that damages the ovaries might cause early menopause.
• Fistulas: Surgery or radiation may cause abnormal holes (fistulas) between the vagina and bladder or rectum.

Cancer-related complications:

• Pain: Cervical cancer can extend to bones and nerves, resulting in extreme discomfort.
• Bleeding: Abnormal vaginal bleeding may indicate cervical cancer.
• Blood clots: Cancer and its treatment can raise the risk of blood clots.
• Fatigue: Cancer and its treatment can lead to fatigue, affecting daily activities.
• Uremia: Advanced cervical cancer can cause uremia, a condition where waste materials accumulate in the bloodstream.
• Weakened immune system: Cancer treatments can compromise the immune system.
• Neurological symptoms: Cervical cancer can sometimes migrate to the brain or spinal cord.

Treatment

Cervical cancer treatment normally consists of surgery, radiation therapy, and chemotherapy, which are often adjusted to the disease's stage.

Treatment options

• Surgery: Such as hysterectomy (removal of the uterus and cervix) or radical trachelectomy (removal of the cervix and surrounding tissue while keeping the uterus).
• Radiation treatment: Uses high-energy rays to destroy cancer cells, frequently in conjunction with chemotherapy.
• Chemotherapy: A drug-based treatment that kills cancer cells.
• Targeted Therapy: Drugs that target particular chemicals involved in cancer cell proliferation.
• Immunotherapy: Using medications to activate the immune system and kill cancer cells.

Treatment by stage

• Early-stage malignancies: Commonly treated with surgery or chemoradiation.
• Locally advanced cervical cancer: Concurrent chemoradiotherapy (CTRT) is usually employed.
• Advanced or recurring cervical cancer: Chemotherapy, targeted treatment, or immunotherapy may be utilized.

FAQs

Q. What is cervical cancer? Cervical cancer is a form of cancer that starts in the cervix. It is largely caused by chronic infection with particular strains of the human papillomavirus (HPV), a common sexually transmitted illness.

Q. What causes cervical cancer? Cervical cancer is largely caused by a prolonged infection with particular kinds of human papillomavirus (HPV). Other variables that might raise the risk include compromised immune systems, smoking, and a family history of cervical cancer.

Q. What are some symptoms of cervical cancer? Cervical cancer frequently causes no symptoms in the early stages, but as it spreads, it might produce atypical vaginal bleeding (between periods, after sex, or after menopause), watery or bloody vaginal discharge with a foul odor, pelvic discomfort, and pain during intercourse.

Q. Can cervical cancer be cured? Yes, cervical cancer may be cured, especially if discovered and treated early. Early diagnosis through frequent screening and treatment of precancerous lesions is critical for optimal outcomes.

Q. How is cervical cancer treated? Cervical cancer treatment varies depending on the stage and extent of the cancer, but it frequently includes surgery, radiation therapy, and chemotherapy. For the early stages, surgery or radiation, along with chemotherapy, may be employed.

Q. Can cervical cancer be prevented? Cervical cancer is mostly avoidable. Primary preventative measures are HPV vaccination and safe sexual behaviors. Cervical cancer screening is a secondary preventive measure that can discover pre-cancerous lesions early on.

Primary Prevention:

• HPV vaccines, especially strains 16 and 18, are very effective in preventing cervical cancer.
• Safe Sexual Practices: Using condoms and limiting sexual partners can help prevent HPV infection and cervical cancer.

Secondary Prevention:

• Regular screening with Pap and HPV tests can detect pre-cancerous abnormalities, leading to prompt treatment and prevention of cancer development.
• Early detection of cervical cancer dramatically improves treatment results.

Other Preventive Measures:

• Quitting smoking can lower the chance of acquiring cervical cancer.
• Seek medical treatment if you have any abnormal vaginal bleeding or discharge.