Dr Sarthak Sidapara

Cervical Cancer

What is Cervical Cancer?

When cancer starts in the cervix, it is called cervical cancer. All women are at risk for cervical cancer. It occurs most often in women over age 30. Long-lasting infection with certain types of human papillomavirus (HPV) is the main cause of cervical cancer. Screening tests and the HPV vaccine can help prevent cervical cancer. Receiving the HPV vaccine for girls between 9 and 45 years old can also be helpful. When cervical cancer is found early, it is highly treatable and associated with long survival and good quality of life.

Cervical cancer Signs & Symptoms

Generally, early-stage cervical cancer does not generate any signs or symptoms. However, during the advanced stage of cervical cancer, there are some signs and symptoms including:

  • After intercourse, vaginal bleeding
  • Heavy vaginal discharge which has a smelly odor
  • Bleeding after menopause
  • Pain during intercourse
  • Pelvic pain

Cervical cancer causes

When healthy cells in the cervix changes start to exist (mutations) in the DNA, cervical cancer begins. A cell’s DNA carries the directions that inform a cell what to do.

Healthy cells start to grow and multiply at an adjusted rate, in the end, die at a set time. The mutations inform the cells to grow and multiply uncontrollably, and they continue to live. Increasing abnormal cells form a tumor. Cancer cells occupy nearby tissues and can separate from a tumor to spread (metastasize) in other parts of the body.

There is no clear view on what causes cervical cancer, but it is definite that Human Papillomavirus (HPV) plays a role in causing cervical cancer. HPV’s very common, and people who get infected with this virus generates a chance of developing cancer. Other factors such as your environment or your lifestyle also decide whether you will get cervical cancer.

Types of cervical cancer

Two main types of cervical cancer help you to determine the course of a disease and the treatment requirements are:

  1. Squamous cell carcinoma – This type of cervical cancer starts in the thin, flat cells (squamous cells) edging the outer part of the cervix (exocervix), which extends into the vagina. Nearly 90% of cervical cancers are squamous cell carcinomas.
  2. Adenocarcinoma – This type of cervical cancer starts in the glandular cells (column-shaped) that edge the cervical canal.

In some cases, both types of cells get involved in cervical cancer. Exceptionally, cancer occurs in other cells in the cervix.

Cervical cancer risk factors

  • Human papillomavirus (HPV) infection
  • Having sex with various partners
  • Smoking
  • Birth control pills (oral contraceptives) used for a long time
  • Having given birth to three or more children
  • Getting involved in early sexual contact

Complications of cervical cancer

  • Early Menopause – Menopause occurs when your ovaries stop producing estrogen and progesterone hormones.
  • Narrowing of the vagina – Radiotherapy used to treat cervical cancer causes the vagina to become narrow which makes sex painful or difficult.
  • Lymphoedema – If the lymph nodes in your pelvis are removed, the normal functioning of your lymphatic system gets disrupted.

Screening test for cervical cancer

The women who are in their 20s and 30s, cervical dysplasia occurs more often. Death from cervical cancer is rare in women who are younger than 30 years and in women (of any age) who have regular screenings along with the Pap test. The Pap test is used to diagnose cancer and the changes that can cause cancer. The possibility of death from cervical cancer increases with age. Recently, deaths from cervical cancer are spotted a bit higher in black women who are below 50 years than in white women who are below 50 years. Deaths from cervical cancer are likely to be twice in black women older than 60 years as compared to white women older than 60 years. Some tests are used for screening different types of cancer when a person does not have symptoms. Studies prove that screening for cervical cancer helps in decreasing the death rate caused by the disease. Cervical cancer tests include:
  • Bimanual pelvic examination: In this, the doctors check a woman’s body for any abnormal changes in her cervix, uterus, vagina, ovaries, and other nearby organs.
  • Pap test: In this doctors gently scrapes the outside of the cervix and vagina, to take samples of cells for testing.
  • HPV typing test: This test is similar to the Pap test. The samples of cells from the patient’s cervix are tested.
  • A Pap test to screen for cervical cancer: After positive Pap test results, an HPV test is done. An HPV test performed with or without a Pap test for screening cervical cancer. Self-collected samples for an HPV test. Screening tests for cervical cancer are further considered in clinical trials.

Cervical cancer stages

  • Stage 1: The cancer is only in the neck of the womb (cervix) and has not grown into deeper tissues or spread to distant sites.
  • Stage 2: Cancer has spread beyond the cervix and uterus but has not spread to the walls of the pelvis or the lower part of the vagina. It has not spread to the lymph nodes or the distant parts.
  • Stage 3: Cancer has spread to the lower parts of the vagina or the walls of the pelvis. But, cancer may be blocking the ureters. It may or may not have spread to the nearby lymph nodes.
  • Stage 4: Cancer has spread to the bladder or rectum (back passage) or distant organs including the lungs or bones. Cancer may have also spread to the organs outside the pelvic area and the lymph nodes.

Treatment options by stage

  • Stage 1: Surgery is the main treatment. Some people also need chemoradiotherapy.
  • Stage 2: The main treatments combine chemotherapy and radiation therapy. In some worst cases, a patient needs to undergo a radical hysterectomy followed by a session of radiation therapy.
  • Stage 3: Chemotherapy and radiation therapy are given eventually. Sometimes, surgery is also conducted to remove pelvic lymph nodes afterward internal radiation therapy.
  • Stage 4: The main treatments include chemo-radiotherapy. With this treatment, external radiotherapy is done for 5 consecutive days every week for around 5 weeks. If required, a boost of brachytherapy is done at the end of the course.

Cervical cancer prevention

Going for regular screenings to find any cancerous cells can help to prevent cervical cancer and treat them. Receiving the HPV vaccine can also be helpful.

This HPV vaccine used to prevent cervical cancer caused by HPV for people between 9 and 45 years old. This vaccine can prevent the infection caused by HPV16, HPV18, and 5 other types of HPV related to cancer.

To help prevent cervical cancer, girls are recommended to receive the HPV vaccination. Consult a health care provider about the suitable schedule for vaccination as it may differ based on several factors, including age and vaccine availability.

People can take some additional actions to help prevent cervical cancer including:

  • Delay first sexual intimacy until they are in their 20s or older
  • Limit the number of sex partners
  • Have safe sex by using condoms and dental dams
  • Avoid sexual intimacy with people who have had many partners
  • Avoid sexual intimacy with people suffering from genital warts or who have other symptoms
  • Quit smoking

Cervical cancer during pregnancy

Pregnancy and Early-Stage Cervical Cancer
If your doctor detects cervical cancer in its early stages, you continue safely with your pregnancy. The treatment gets postponed for several weeks after the delivery; only then you will be able to receive treatment with a hysterectomy (removal of the uterus and cervix) or cone biopsy (removal of part of the cervix), based on the progression of cancer.

Pregnancy and Advanced Cervical Cancer
For women whose cervical cancer is in the advanced stage, treatment decisions become critical. Your doctor will discuss the possibilities with you. If serious cervical cancer is observed, your pregnancy might get terminated.

Survival rates for cervical cancer

The chance to survive for at least five years after getting diagnosed with cervical cancer:

Stage 1 – 80-99%
Stage 2 – 60-90%
Stage 3 – 30-50%
Stage 4 – 20%

Cervical cancer treatment costs

On average, cervical cancer treatment costs about $10000 to $30000 per month. In India, the cervical cancer treatment modalities i.e. radiotherapy, brachytherapy, chemotherapy, and surgery, ranges from Rs. 74000 to Rs. 222000.