Cervical Cancer

Cervical cancer begins in the cells of the cervix, which is the lower part of the uterus that connects to the vagina. It is primarily caused by persistent infection with certain types of human papillomavirus (HPV), a sexually transmitted virus. Cervical cancer often develops slowly, and its progression can be monitored and prevented with regular screenings.

Types of Cervical Cancer

  1. Squamous Cell Carcinoma:
    • The most common type, originating in the squamous cells lining the cervix.
    • Accounts for about 70-90% of cervical cancer cases.
  2. Adenocarcinoma:
    • Begins in the glandular cells that produce mucus and other fluids.
    • Accounts for about 10-20% of cervical cancers.
  3. Adenosquamous Carcinoma:
    • A combination of squamous cell carcinoma and adenocarcinoma.
    • Less common and often more aggressive.
  4. Small Cell Cervical Cancer:
    • A rare, aggressive form that is similar to small cell lung cancer.
  5. Other Rare Types:
    • Includes neuroendocrine tumors and carcinosarcoma (malignant mixed Müllerian tumor).

Risk Factors for Cervical Cancer

  1. Human Papillomavirus (HPV) Infection:
    • Persistent infection with high-risk HPV types (especially HPV-16 and HPV-18) is the primary cause of cervical cancer.
  2. Sexual Activity:
    • Early sexual activity and having multiple sexual partners increase the risk of HPV infection.
  3. Smoking:
    • Tobacco use is a known risk factor that can damage cervical cells and make them more susceptible to cancer.
  4. Weakened Immune System:
    • Conditions like HIV/AIDS or immunosuppressive medications can increase susceptibility to HPV infection and cervical cancer.
  5. Family History:
    • A family history of cervical cancer or other related cancers can increase risk.
  6. Certain Medications:
    • Long-term use of oral contraceptives and medications that suppress the immune system may be associated with an increased risk.
  7. Low Socioeconomic Status:
    • Limited access to healthcare and screening may increase the risk due to late-stage diagnosis.
  8. Chronic Conditions:
    • Certain conditions like diabetes can be associated with an increased risk of cervical cancer.

Symptoms of Cervical Cancer

In the early stages, cervical cancer may not present noticeable symptoms. As the disease progresses, symptoms may include:

  • Abnormal Vaginal Bleeding: Bleeding between periods, after sexual intercourse, or after menopause.
  • Unusual Vaginal Discharge: Discharge that may be watery, pink, or foul-smelling.
  • Pelvic Pain: Pain during intercourse or persistent pelvic pain.
  • Painful Urination: Discomfort or pain while urinating.
  • Pain during Intercourse: Discomfort or pain during sexual activity.
  • Swelling in the Legs: In advanced cases, swelling in the legs may occur due to lymph node involvement.

Diagnosis of Cervical Cancer

Several methods are used to diagnose and stage cervical cancer:

  1. Pap Smear (Pap Test):
    • A screening test that detects abnormal cells in the cervix before they develop into cancer.
    • Recommended for women starting at age 21 and continuing every 3-5 years, depending on age and results.
  2. HPV Testing:
    • Detects the presence of high-risk HPV types that are linked to cervical cancer.
    • Often performed alongside a Pap smear in women over 30.
  3. Colposcopy:
    • A procedure where a colposcope (a special microscope) is used to examine the cervix more closely after abnormal Pap results.
  4. Biopsy:
    • A sample of cervical tissue is removed and examined under a microscope to confirm the presence of cancer cells.
    • Types include endocervical curettage (ECC), cone biopsy, and excisional biopsy.
  5. Imaging Tests:
    • CT scan, MRI, and PET scan may be used to determine the extent of cancer spread and help in staging.

Staging of Cervical Cancer

Cervical cancer is staged based on how far the cancer has spread:

  • Stage 0: Carcinoma in situ, cancer cells are confined to the surface layer of the cervix.
  • Stage I: Cancer has invaded the cervix but has not spread beyond it.
  • Stage II: Cancer has spread beyond the cervix to the upper part of the vagina or the surrounding tissues.
  • Stage III: Cancer has spread to the lower part of the vagina or the pelvic sidewall, and/or there is cancer in the lymph nodes.
  • Stage IV: Cancer has spread to distant organs such as the bladder, rectum, or other parts of the body.

Conclusion

Cervical cancer is highly preventable through vaccination, regular screening, and lifestyle modifications. Early detection through Pap smears and HPV testing is crucial for successful treatment and improved outcomes. Advances in treatment options, including surgery, radiation, and targeted therapies, have significantly improved the prognosis for many women with cervical cancer.