This article has been reviewed and approved by Dr Niti Raizada for authenticity and medical correctness on 24 Jul 2020

All about Cervical Cancer

Cervical cancer occurs when some cells in your cervix start dividing without control. Cervix is the part of your uterus that connects it to the vagina.

The most common cause of cervical cancer is the Human papillomavirus (HPV) infection. It usually spreads through sexual contact. In most women, the immune system of the body can kill the virus. But in some, this does not happen, and the virus remains active to cause cancer.

It is the fourth most common cancer in women. It usually occurs in those between the age of 20 and 50. Your risk of it is highest between the age of 35 to 45. It is rare in those below 20 and above 65.

Unusual bleeding from the vagina is the most common early sign. There are ways to detect cervical cancers in the early stages. A Pap smear test is a simple test that helps to identify it. Since most of the women get treatment in the early stages, the mortality rate is low. 

Surgical removal of the cancerous area is the most common treatment. If cancer has spread outside the cervix to the uterus, you will have your uterus removed.

The survival chances of cervical cancers are excellent if treated at its early stages.

Causes of cervical cancer

The exact cause of cervical cancer is not very clear. Most of those who have it also have HPV infections of the cervix. Experts believe that the virus may change the DNA of some cells in the cervix. It causes them to divide faster to cause cancers. It is still not clear as to why these changes occur.

Some other factors can also increase your risk of cervical cancers. These may be within your control or out of it.

Risk factors of cervical cancer

Risk factors are things that increase your chance of getting a disease. You can change some that are under your control and decrease your chances. Also, there are some others that you cannot change.

Some of the common risk factors for cervical cancers are

HPV infections- Almost all women with cervical cancers have a history of HPV infections. In most women, HPV does not cause any problems, while in some, it causes warts in the genitals or skin. But in a few, they cause cervical cancers. One of the most significant issues with HPV is that it is difficult to detect as there are no symptoms.HPV usually spreads through sexual contact. 

Apart from this, the other risk factors include

  • Your immunity- If you have problems with immunity, you are at high risk. A few things that can reduce your immunity are HIV infections, Using steroids for a long time, and using drugs that suppress your immunity.
  • Your age- Those between the age of 30 and 50 are at the highest risk. It is rare in those below 20. Almost twenty percent of cases are in those above 65.
  • The number of children you have- The risk is more in those who have three or more children. Also, those having children at a younger age, say below 18 years, are more at risk. The risk is less in those who do not have children. The reasons for this is not clear
  • Smoking- If you smoke, you are two times more at risk
  • Using birth control pills- Your risk depends on how long you have been using it. Those using it for more than ten years are two times more at risk. Your risk will start dropping once you stop using it.
  • Having a family history 
  • Having a history of vaginal, kidney or urinary cancers

Signs and symptoms of cervical cancer

Cervical cancer will have very few signs and symptoms at the early stages. You will have symptoms only when it grows. Some of the common signs include

  • Bleeding from vagina
  • Having more extended and heavy periods
  • Pain during sex
  • Bleeding from the vagina soon after sex
  • Pain in the pelvis area

As the cancer advances in stage, you will have other symptoms as well. These include

  • Blood in urine
  • Swelling of the legs
  • Problems while passing urine

 

These signs may happen due to many other reasons as well. So if you belong to the risk group, you need to see a doctor very early. 

Stages of cervical cancer

There are four stages

Stage 0: Some cells in the cervix show some changes

Stage 1: Cancer has spread from the cervix to other areas of the uterus. It may also have spread to lymph nodes close to it.

Stage 2: Cancer has spread outside the uterus. But it does not involve the walls of the pelvis or the lower part of the vagina.

Stage 3: Cancer has spread to the lower part of the vagina and also the walls of the pelvis. 

Stage 4: Cancer has reached the urinary bladder or rectum and has also spread to distant organs.  

Your treatment will depend on the stage of your disease.

Diagnosis of cervical cancer

If you have any signs of cervical cancer, your doctor will suggest a Pap smear test. 

Pap smear test- Your doctor will collect a smear of your cervix with the help of a cotton swab. After taking the sample, the doctor will send it to the lab to look for any changes in the cells. You will have the test in the doctor's office without much discomfort.

If the results are negative, your doctor will rule out cervical cancer. But, if it is positive, you will need some other tests as well.

Colposcopy- During this, your doctor will look into your cervix for any issues. The doctor will use a microscope called a colposcope for this. The doctor will put a drop of acetic acid in the cervix, which helps to show any abnormal areas more clearly.

If the doctor finds any problems, you will have a biopsy

Biopsy- A biopsy helps the doctor to confirm or rule out cancers. Your doctor will take a tissue sample from the cervix with the help of special instruments. The sample will go to the lab where the pathologist looks for the presence of cancer cells.

There are different techniques for doing a cervical biopsy. They include

  • Colposcopic biopsy 
  • Endocervical curettage 
  • Cone biopsy

 

A biopsy also helps the doctor to know the stage and type of cancer you have. It also helps the doctor to plan your treatment.  

You will have a few other tests if your cancer is in the advanced stages. It is to look for the spread of cancer to other areas of the body.  

These include

  • Cystoscopy- To look for spread into the urinary bladder
  • Proctoscopy- To look for spread into the rectum
  • Chest Xrays- For looking into the lungs for cancer
  • PET/CT scans - It helps to know if cancer has spread to other organs of the body  

Treatments for cervical cancer

Your treatment for cervical cancer will depend on the stage of the disease. 

Radiation therapy for cervical cancer

Radiation therapy uses x-rays to destroy cancer cells. You may only have radiation therapy if the cancer is in the early stages. In those with large cervical tumors, radiation usually follows surgery

You will have radiation therapy for cervical cancers that have spread to other parts of the body.

The two common types of radiation therapy for cervical cancer are;

  • External beam radiation therapy or EBRT 
  • Internal radiation therapy or brachytherapy

External beam radiation therapy

You will have radiation from a machine that is close to your body as in an X-ray. But the dose and the duration of radiation will be higher.

You will have the treatment in sessions. Each session will last only for a few minutes and will be painless. You will have about 4 or 5 sessions in a week for 4 to 5 weeks.

Side-effects of radiation therapy

Radiation therapy has a lot of side effects. Most of these will disappear once the treatment is over. Some of the common ones are

  • Tiredness or Fatigue
  • Stomach upsets
  • Nausea and vomiting
  • Peeling or flaking of the skin on the area of radiation
  • Urinary problems like pain, bleeding, etc. while passing urine
  • Vaginal pain
  • Menstrual problems
  • Anemia
  • Lower counts of RBCs, WBCs, blood platelets

Brachytherapy

It is a type of internal radiation therapy where the doctors place beads or pellets with radioactive material close to the tumor. 

There are two types of brachytherapy 

  • LDR brachytherapy- You will have this in a hospital over a few days. The doctors will place the pellets close to the tumor with the help of instruments. The pellets will deliver slow doses of radiation to destroy the tumor.
  • HDR brachytherapy – You will have this as an out-patient procedure. The doctor will place a source of radiation close to the tumor for a few minutes. It will deliver high doses of radiation on to the tumor. 

 

Some of the side effects are

  • Tiredness or Fatigue
  • Stomach upsets
  • Nausea and vomiting
  • Peeling or flaking of the skin on the area of radiation
  • Urinary problems like pain, bleeding, etc. while passing urine
  • Vaginal pain
  • Menstrual problems
  • Anemia
  • Lower counts of RBCs, WBCs, blood platelets

Complications of radiation therapy

  • Vaginal stenosis- It is a condition where the vagina gets narrow due to scar tissue that forms over it
  • Rectal stenosis and rectal bleeding- It occurs in those in whom the cancer is close to the rectum.
  • Urinary problems- You may have pain and bleeding while passing urine. 
  • A weakness of the pelvic bones- You may easily fracture a bone that has become weak due to the effects of radiation
  • Swelling of the legs

Chemoradiation for cervical cancer

It combines chemotherapy and radiation to treat cervical cancers. In some, this works better than having radiotherapy and chemotherapy alone.

You will have chemo drugs during specific days of your radiation treatment. The dose of the medicine and the radiation will depend on your condition. 

Since both the treatments have side effects, you will naturally feel more tired while having these together.

Biologic therapies for cervical cancer

Targeted therapy

It uses drugs to kill cancer cells in the body. The drugs can target the cancer cells while causing little damage to other 'healthy' cells. It does so by identifying some 'markers' in the cancer cells.

You will have the treatment for some days of a week for a few weeks. You will have fewer side effects than chemotherapy.

Immunotherapy

It uses medicines to boost the immune system to help it identify the cancer cells from normal cells. By doing so, the immune system in the body destroys the cancer cells. 

Cancer cells have the ability to 'mask' themselves as healthy cells to prevent a reaction from the immune system of your body. Medicines help the immune system to identify this disguise. 

In some immunotherapy will have some complications. A highly stimulated immune system may sometimes attack other healthy organs in the body. You will have problems if this happens to organs like the liver, lungs, kidneys, etc. 

Surgeries for cervical cancer

The type of surgery that you will have depends on 

  • The size of the tumor
  • How far it has spread beyond the uterus
  • Your health 

 

Cryosurgery- Your doctor will use a cold probe to do the surgery. He or she will place the probe in the tumor area. The intense cold from the probe destroys the cancer cells

Laser surgery- During this, the surgeon will focus laser beams on the tumor. The heat from the beams kills the cancer cells.

If the tumor is a bit large, you will have a small surgery called conization.

Conization- During this, the surgeon will remove the tumor in the shape of a cone. The cone base will be in the lower part of the cervix, and the tip will be up.

If cancer has spread from the cervix to other regions of the uterus, your doctor will remove it. There are different surgeries to remove the uterus.

Simple hysterectomy- You will have this if cancer has not spread beyond the uterus. The doctor will remove only the uterus and will not touch areas close to it.

Radical hysterectomy- You will have this for cancers that have spread to the vagina. Your doctor will remove the uterus along with a part of the vagina.

Cervical cancer treatment In India
Cervical cancer treatment In India

References / Additional Reading
This article has been reviewed by Dr Niti Raizada for authenticity and medical correctness on 24 Jul 2020
Dr Niti Raizada
Dr Niti Raizada
MBBS, MD, DM-Medical Oncology, MRCP
Dr. Niti Raizada is a senior Medical Oncologist with over fifteen years of experience in the field. Dr Niti has special interests in the areas of Thoracic, Gastrointestinal, Breast, Gynaecological Oncology, and Bone Marrow Transplants. She did her MBBS at Gandhi Medical College, Bhopal; MD-General Medicine at G R Medical College, Gwalior, DNB-General Medicine from National Board Of Examination,DM from Adyar Cancer Institute Chennai and Fellowship in Hematology from Hammersmith Hospital and Imperial College,London. She is a member of American Society of Clinical Oncology,USA; Royal College of Physicians,Edinburgh,UK; Member of Pharmacy Committee,Member of DNB teaching program in Medical Oncology and European Society of Medical Oncology (ESMO).
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