Cervical Cancer: abnormal growth of the tissues of the cervix

Cervical cancer is a disease in which malignant cells form in the tissues of the cervix. It is the fourth most common cancer in women, and if diagnosed early, It is one of the most successfully treatable forms of cancer. Cervical cancer staging is from stage 0 to stage IV.

Stage 0 includes precancerous conditions, stage 1 has carcinoma confined to the cervix, stage 2 has carcinoma beyond the cervix, stage 3 has extended into the pelvic wall, and stage 4 includes carcinoma involving the mucosa of the bladder and rectum.

What Causes Cervical Cancer?

Though the cause of cervical cancer is unknown, it was found to be linked to DNA mutations. Cervical cancer may occur due to the following reason:

Studies have linked the role of HPV with cervical cancer.
Persistent infection with Human papillomaviruses (HPV) – turn off tumor suppressor genes.
This further leads to cancerous growth affecting the cells lining the cervix.

What are the Risk factors?

HPV infection
Weakened immune system ( E.g. in HIV infection )
Being sexually active at a young age ( before age 18)
Having many sexual partners (6 or more)
Long-term use of oral contraceptives
Multiple full-term pregnancies
Diethylstilbestrol (cervical clear cell adenocarcinoma)

Signs and symptoms

Vaginal bleeding after intercourse, between periods or after menopause.
Watery, bloody vaginal discharge may be heavy and have a foul odour.
Pelvic pain or pain during intercourse.
Blood spots or light bleeding between or following periods.
Menstrual bleeding that is longer and heavier than usual.
Problems in urinating or having a bowel movement.

What are the Complications?

Early menopause, Painful sex, Lymphoedema, Severe pain, Kidney failure, Blood clots, Pulmonary embolism, Bleeding, Fistula (an abnormal connection between two body parts), Emotional impact etc.

Diagnosis: How to diagnose Cervical cancer?

Medical history – Check for symptoms and other risk factors.
Physical examination – Pelvic exam
Diagnostic tests – The tests performed are:
- Screening tests: 1. Pap smear test – a procedure to collect cells from the surface of the cervix and view them under a microscope to check for abnormal cells. 2. HPV test – Testing cells collected from the cervix for infection with any of the types of HPV that are most likely to lead to cervical cancer.
- Colposcopy : Examination of the cervix using colposcope.
- Biopsy: Removal of a small amount of tissue for examination under a microscope to look for precancerous cells or cancer cells ( Punch biopsy, LEEP, Conization, ECC)
- Imaging tests: CT CT scan: A procedure that makes a series of detailed pictures of areas inside the body Chest X-ray: An X-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. MRI : A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. PET scan :
- A procedure to find malignant tumour cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein.
- The PET scanner rotates around the body and shows where glucose is used.
- Malignant tumor cells appear brighter in the picture because they are more active and take up more glucose than normal cells.
Other diagnosis test includes a urine test, a blood test to check for microRNA-466 and tumor markers and intravenous urography (x-ray of the urinary system).

Treatment: How is Cervical cancer treated?

For early stages of cervical cancer either surgery or radiation therapy combined with chemotherapy may be used. For advanced stages radiation therapy combined with chemotherapy is a primary treatment.

Surgery: 1. For precancerous conditions – Cryosurgery, Laser ablation, Conization. 2. For invasive cervical cancer – Total hysterectomy: Surgery to remove the uterus, including the cervix. Radical hysterectomy: Remove the uterus, cervix, part of the vagina, and a wide area of ligaments and tissues around these organs. Radical trachelectomy: Surgery to remove the cervix, nearby tissue and lymph nodes, and the upper part of the vagina. Pelvic exenteration: Same as radical hysterectomy with pelvic lymph node dissection.
Radiation therapy:
- 1. External radiation therapy uses a machine outside the body to send radiation toward cancer.
- 2. Internal radiation therapy uses a radioactive substance placed directly into or near the cancer.
Chemotherapy :
- Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
- The following drugs are approved to treat Cervical Cancer –
- Bevacizumab, cisplatin, carboplatin, Bleomycin Sulfate, Hycamtin, Keytruda (Pembrolizumab), Pembrolizumab.

Prevention: Can we prevent it?

Prevention of Cervical cancer –
- Regular cervical screening
- HPV vaccine: Gardasil
- Quit smoking
- Practice safe sex by using barrier methods, e.g. condom
- limiting the number of sexual partners

Living with Cervical cancer –
- Avoid lifting and heavy housework ( after hysterectomy)
- Use contraception ( to avoid pregnancy during treatment)
- Fatigue ( ask for practical help)
- Exercises and massage techniques etc.

When to see a doctor? :

It is wise to consult with a gynaecologist immediately if observed any symptoms like abnormal vaginal bleeding or painful sexual intercourse. The typical consultation fee for a gynaecologist ranges from Rs. 500 to Rs. 1500 in India.