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Cervical Cancer

Cervical cancer originates from unusual cell proliferation in the cervix’s lining, a tubular structure connecting the uterus and vagina. Squamous cell carcinoma, the most frequent type, represents 70% of cervical cancer incidents. On the other hand, adenocarcinoma, accounting for roughly 25% of cases, presents diagnostic challenges as it develops in the upper part of the cervix. Each year in the UK, cervical cancer is diagnosed in about 3,200 women, and around 850 women succumb to this disease annually.

Types of cervical cancer

Cervical cancer is categorized by the specific cell type where the cancer originates. The primary varieties of cervical cancer include:

Squamous cell carcinoma: Originating in the squamous cells, which are thin and flat cells lining the cervix’s outer area, this type is the most common form of cervical cancer.

Adenocarcinoma: This cancer type starts in the columnar glandular cells lining the cervical canal.

In some cases, cervical cancer may involve both squamous and glandular cells. Although rare, cancer can also develop in other cell types within the cervix.

Prevalence

Annually, approximately 14,000 individuals in the United States receive a cervical cancer diagnosis. The most common age range for diagnosis is between 35 and 44 years, with the average age being 50. Each year, cervical cancer claims the lives of about 4,000 people. However, the mortality rate is decreasing, thanks to effective screening methods and the implementation of the HPV vaccine.

 

In 2023, it is estimated that over 900 individuals were diagnosed with cervical cancer. Since the inception of the National Cervical Screening Program in 1991 and the introduction of a nationwide Human Papilloma Virus (HPV) vaccination program in 2007, there has been a significant reduction in the incidence of cervical cancer.

Symptoms

Precancerous alterations in the cells of the cervix often do not manifest with noticeable symptoms. Detecting any abnormal cells with potential to progress into cancer requires undergoing a cervical screening test. When these early cell changes evolve into cervical cancer, common indications might include:

– Unusual vaginal bleeding, such as bleeding between menstrual periods

– Menstrual cycles that are unusually long or heavy

– Discomfort during sexual intercourse

– Noticeable changes in vaginal discharge, which could include an increase in quantity, a strong or abnormal odor, or a different color

– Postmenopausal vaginal bleeding

– An increase in vaginal discharge, sometimes watery or bloody, often accompanied by a foul smell

– Experiencing pelvic pain

– Persistent or unexplained pelvic or back pain

Remember, cervical cancer remains relatively rare, particularly among women who regularly participate in smear test programs. While these symptoms could be attributed to other health conditions, it’s crucial to consult a doctor if they persist or cause concern. This advice is vital for anyone with a cervix, regardless of their sexual orientation or gender identity.

Diagnosis

Cervical cancer typically evolves gradually over several years. Initially, the cells in the cervix undergo numerous changes, shifting from their normal state to a condition where they appear irregular or abnormal. These cells might either resolve on their own, remain unchanged, or potentially progress into cancer cells.

Routine gynecological screenings are key in identifying both cervical cancer and the precancerous cells that could eventually lead to it. Most health organizations recommend starting these screenings at age 21, with follow-ups every few years.

The Pap test, also known as a Pap smear, involves collecting cells from the cervix for examination to identify pre-cancerous changes or other abnormalities.

If an abnormal result is returned from a Pap test, additional testing, such as an HPV test, may be required. This test checks for HPV infections in cervical cells, which are often linked to cervical cancer.

Further examination, including a biopsy of the cervical tissue, might be necessary if there’s a suspicion of cancer. Various methods, like punch biopsy or endocervical curettage, may be used to obtain tissue samples. Alternatively, techniques such as wire loop or conization might be employed.

The HPV DNA test checks for the presence of HPV types most likely to cause cervical cancer.

Should cervical cancer be suspected, a comprehensive cervical examination is usually the first step. This includes using a colposcope, a magnifying instrument, to look for signs of cancer.

During a colposcopic exam, a doctor may perform:

– Punch biopsy, where small samples of cervical tissue are removed with a sharp instrument.

– Endocervical curettage, involving scraping tissue from the cervix using a curette or brush.

Further tests may be necessary if these initial results are worrisome. These could include:

– Electrical wire loop or LEEP, where a low-voltage wire is used to take a tissue sample, typically done with local anesthesia.

– Cone biopsy or conization, a more in-depth procedure for sampling deeper layers of cervical cells, often conducted in a hospital setting under sedation.

If a biopsy confirms cancer, additional tests are conducted to determine if it has spread. This stage may involve liver and kidney function tests, blood and urine analyses, and X-rays of various organs. This evaluation is part of the cancer staging process.

How do you know if you have cervical cancer?

The majority of individuals remain unaware of having cervical cancer until it is officially diagnosed by a healthcare professional. Diagnosis involves a sequence of tests and biopsies conducted by your healthcare provider. Initial indications of cervical cancer are often subtle and typically detectable only by a medical professional. Signs and symptoms are more pronounced and likely to occur in the advanced stages of cervical cancer.

Can you feel cervical cancer with your finger?

Cervical cancer cannot be felt with a finger, as cancer cells are microscopic and require specialized equipment for detection. If you notice a lump or unusual growth in your vagina, it might indicate a polyp or cyst. It’s important to contact your healthcare provider immediately for an examination if you discover any such abnormality.

Staging

-Stage I: In this stage, the cancer is confined to the cervix and is relatively small, with no spread to other areas.

– Stage II: At this stage, the cancer has extended beyond the cervix and uterus, but not yet reached the pelvic wall or vagina.

– Stage III: The cancer has progressed to the lower vagina and possibly to the pelvic wall, ureters (the tubes leading urine from the kidneys), and nearby lymph nodes at this stage.

– Stage IV: This advanced stage indicates that the cancer has moved to other parts of the body such as the bladder, rectum, and possibly distant areas like bones or lungs.

How is cervical cancer treated?

In the UK, over half of the cervical cancer cases diagnosed are in their earliest stages (microinvasive or stage 1A), treated effectively through local procedures like cell removal. This can be performed under local or brief general anesthesia.

For cancers at stage 1B or higher, more comprehensive surgical approaches may be required, influenced by specific conditions and considerations like future fertility aspirations. If cancer spreads beyond the cervix, a combination of chemotherapy and radiation may be necessary.

Treatment Modalities

The treatment strategy depends on the stage of the disease. Early-stage and non-bulky diseases (under 4cm) typically involve surgery, possibly followed by chemoradiation therapy.

For smaller tumors, a cone biopsy might be sufficient; larger or more advanced cases may necessitate a hysterectomy (the surgical removal of the uterus).

Locally advanced diseases are usually treated with a combination of radiation therapy and chemotherapy (cisplatin).

Metastatic diseases are managed through chemotherapy (platinum/fluorouracil) or exclusively palliative care.

 

Surgical Options

Early-stage cervical cancers that are contained within the cervix are often treated surgically. The type of surgery depends on the cancer’s size, its stage, and fertility considerations. Options include:

– Surgery focusing only on cancer removal, like a cone biopsy for very small cancers.

– Trachelectomy, removing the cervix and some surrounding tissue, potentially preserving fertility.

– Hysterectomy, removing the cervix, uterus, part of the vagina, and nearby lymph nodes, typically for cancers that haven’t spread beyond the cervix.

Minimally invasive hysterectomy might be suitable for microinvasive cancers, involving smaller abdominal incisions, quicker recovery, but with varying effectiveness compared to traditional methods.

 

Radiation Therapy

Radiation therapy employs powerful energy beams, such as X-rays or protons, to destroy cancer cells. It’s often used in conjunction with chemotherapy for cervical cancers extending beyond the cervix or post-surgery to reduce recurrence risks.

Radiation therapy can be applied externally (external beam radiation therapy) or internally (brachytherapy), sometimes using both methods.

 

Chemotherapy

Chemotherapy, using potent drugs to eradicate cancer cells, is often paired with radiation therapy for cervical cancer extending beyond the cervix, enhancing radiation’s effectiveness. Higher doses might be used for advanced cancer symptom management or pre-surgery to shrink tumors.

 

Targeted Therapy

Targeted therapy focuses on attacking specific cancer cell chemicals, causing cell death, often combined with chemotherapy, particularly for advanced cervical cancer.

 

Immunotherapy

Immunotherapy bolsters the immune system’s ability to identify and destroy cancer cells. It’s considered for advanced cervical cancer where other treatments have been ineffective.

 

Palliative Care

Palliative care aims to improve life quality during serious illness, addressing pain and symptom relief. It involves a specialized team and can be integrated with other cancer treatments, helping patients feel better and potentially prolonging life.

Risk factor

Around eight out of 10 women will become infected with genital HPV at some time in their lives. Most women who have the HPV infection never get cervical cancer; only a few types of the HPV result in cervical cancer.

Virtually all cervical cancer cases stem from prolonged infections with certain high-risk strains of the human papillomavirus (HPV), the principal risk factor for this cancer. Smoking is another significant risk factor.

Evidence suggests that prolonged use of contraceptive pills (over five years) slightly elevates the risk of cervical cancer in individuals with HPV. However, the risk increase is minimal, and contraceptive pills have been found to lower the risk of other cancers like ovarian and uterine cancers.

Additional risk factors include:

– Tobacco smoking, which heightens the risk of cervical cancer. Smokers with HPV infections tend to have more persistent and less resolvable infections.

– Having multiple sexual partners. The more sexual partners you and your partners have, the higher the likelihood of contracting HPV.

– Engaging in sexual activity at an early age, which raises the risk of HPV infection.

– Other sexually transmitted infections (STIs) also elevate HPV risk, potentially leading to cervical cancer. These include herpes, chlamydia, gonorrhea, syphilis, and HIV/AIDS.

– A compromised immune system can make you more susceptible to cervical cancer, especially if you have HPV.

– Exposure to diethylstilbestrol (DES), a drug used between 1939 and 1971 to prevent miscarriages, may increase the risk of a specific type of cervical cancer, clear cell adenocarcinoma, if your parent took it during pregnancy.

While around 80% of women are likely to contract genital HPV at some point, the majority who acquire HPV do not develop cervical cancer. Only a few HPV types are responsible for causing cervical cancer.

Risk factor

Around eight out of 10 women will become infected with genital HPV at some time in their lives. Most women who have the HPV infection never get cervical cancer; only a few types of the HPV result in cervical cancer.

Virtually all cervical cancer cases stem from prolonged infections with certain high-risk strains of the human papillomavirus (HPV), the principal risk factor for this cancer. Smoking is another significant risk factor.

Evidence suggests that prolonged use of contraceptive pills (over five years) slightly elevates the risk of cervical cancer in individuals with HPV. However, the risk increase is minimal, and contraceptive pills have been found to lower the risk of other cancers like ovarian and uterine cancers.

Additional risk factors include:

– Tobacco smoking, which heightens the risk of cervical cancer. Smokers with HPV infections tend to have more persistent and less resolvable infections.

– Having multiple sexual partners. The more sexual partners you and your partners have, the higher the likelihood of contracting HPV.

– Engaging in sexual activity at an early age, which raises the risk of HPV infection.

– Other sexually transmitted infections (STIs) also elevate HPV risk, potentially leading to cervical cancer. These include herpes, chlamydia, gonorrhea, syphilis, and HIV/AIDS.

– A compromised immune system can make you more susceptible to cervical cancer, especially if you have HPV.

– Exposure to diethylstilbestrol (DES), a drug used between 1939 and 1971 to prevent miscarriages, may increase the risk of a specific type of cervical cancer, clear cell adenocarcinoma, if your parent took it during pregnancy.

While around 80% of women are likely to contract genital HPV at some point, the majority who acquire HPV do not develop cervical cancer. Only a few HPV types are responsible for causing cervical cancer.

What can women do minimise their risks ?

In the UK, girls in year 8 (ages 12 and 13) are offered the HPV vaccine to help guard against cervical cancer. This vaccine is highly effective but does not offer complete protection. Gardasil 9, the newer version, prevents about 90% of cervical cancers, while the older version covers around 70%.

Hence, it’s crucial for women to continue attending regular cervical screenings, even if vaccinated, to enhance their protection and minimize risk. Smear tests are vital in detecting and addressing harmful cells before they turn cancerous, playing a key role in preventing the onset of cervical cancer.

Women above 25 are advised to undergo a smear test every three years. Given the lengthy development time of cervical cancer (around 15 years), this interval allows for five smear tests, significantly aiding in early abnormality detection.

However, it’s important to note that smear tests, being screening tools, may sometimes yield false negatives. They indicate a ‘low risk’ rather than ‘no risk’. Therefore, women experiencing any previously mentioned symptoms should consult their GP, gynaecologist, or practice nurse for further evaluation.

Preventing cervical cancer

Inquire with your physician about the HPV vaccine, which can significantly lower your risk of cervical cancer and other cancers caused by HPV. Discuss with your healthcare provider whether the HPV vaccine, especially Gardasil 9 that covers nine HPV types responsible for about 90% of cervical cancers, is suitable for you.

– Regularly schedule Pap tests. These tests are crucial for identifying precancerous changes in the cervix, which can then be monitored or treated to prevent the development of cervical cancer. Most health organizations recommend starting Pap tests at 21 and having them periodically every few years.

– Engage in protected sexual practices. One of the effective ways to decrease the risk of cervical cancer is to take steps to avoid sexually transmitted infections. This can involve using condoms consistently during sexual activity and being selective about sexual partners.

– Avoid smoking. If you are a non-smoker, it’s best to continue avoiding tobacco. If you currently smoke, seek advice from healthcare professionals about strategies to help you quit smoking.

Prognosis for cervical cancer

Treatment for cervical cancer may make it more difficult, or impossible, to become pregnant. If fertility is important to you, talk to you doctor before treatment commences.

A doctor cannot precisely foresee the progression of a disease as it varies based on individual factors. Nonetheless, they can provide a prognosis, an estimation of the disease’s likely outcome. This is based on factors such as the type of cervical cancer, test results, tumor growth rate, and personal aspects like age, overall health, and medical history.

Early detection of cervical cancer significantly enhances the chances of successful treatment. The majority of women diagnosed with early-stage cervical cancer are likely to be cured.

Over the past four decades, cervical cancer survival rates in the UK have seen improvement, closely linked to the cancer’s stage at diagnosis. Most women are diagnosed at stage 1 or 2, with over 96% surviving for 5 years or more following the diagnosis and treatment of stage 1 cervical cancer.

Cervical cancer treatments may impact fertility, sometimes making pregnancy difficult or impossible. If fertility matters to you, it’s crucial to discuss this with your doctor before starting treatment.

Is there a cure for cervical cancer ?

Cervical cancer, while not curable, is notably treatable, particularly when diagnosed in its early stages.

Does cervical cancer affect fertility ?

Pregnancy remains a possibility even after treatment for cervical cancer, but some treatment options may affect fertility. It’s important to have a conversation with your healthcare provider regarding cervical cancer treatments and your wish to conceive. They can provide insights into how these treatments might influence your ability to become pregnant, outlining potential risks and side effects on fertility.

What are the survival rates for cervical cancer ?

For individuals diagnosed with cervical cancer in its initial stage, the five-year relative survival rate surpasses 90%. Nearly half of cervical cancer cases are detected early. When the cancer extends to other tissues or organs, the five-year survival rate stands at 58%.