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Cervical Cancer

Cervical Cancer Definition: Cervical cancer, as the name suggests, refers to cancer occurring in the cells lining the part of the uterus i.e., cervix. Cervix connects the uterus (the site where fetal growth takes place) to the vagina (birth canal). The cervix is made up of two parts (inner and outer) that are covered with two different types of cells. • Endocervix: This refers to the cervical opening that leads into the uterus. Glandular cells are the cells that cover them. • Ectocervix: It is the outer part that can be usually seen by the doctor when doing a routine examination. Squamous cells are the cells that cover them. These two types of cells meet in a region called the transformation zone. As one gets older or if they have given birth, the location of this transformation zone changes. This transformation zone is the place where most cervical cancers start. Such cancers usually affect the deep tissues of the cervix and from there, they may get spread to other parts of the body like the liver, bladder, lungs, vagina, etc.

Most cervical cancers are caused due to an infection. This infection is mostly caused by a virus known as the Human Papilloma Virus (HPV). Usually, when the body is exposed to this virus, the immune system of the body can prevent this virus from causing/bringing any kind of harm to the body but, in a small group of people, this cancer can survive for years and hence, making such cells more cancerous. Women in the age groups between 35 to 45 years are most prone to getting cervical cancer. However, more than 15 % of the cases are seen in women older than 65 years of age. Cervical cancers are mostly seen in people who don’t get regular check-ups and screening tests. One should, hence, have regular screening tests to be on the safe side of firstly, being safe from the condition and even if it is detected, it will be detected early that is also not bad. Cervical cancer is preventable with a vaccine. Cervical cancer is staged as follows:

  • Stage I: In this stage, the cancer is only in the cervix region and has not yet spread to the nearby tissues or organs.
  • Stage II: In this second stage of cervical cancer, cancer has grown to the upper two-third part of the vaginal region but still has not spread to other regions surrounding the uterus.
  • Stage III: Here, cancer has grown into the nearby structures of the pelvic region Here, in this stage, cancer may or may not spread to the pelvic lymph nodes. There are chances that cancer may have grown into the lower vaginal region.
  • Stage IV: This stage means the cancer is now spread up to the bladder/ rectum or even further.

Cervical Cancer Types: In order for us to have a great diagnosis and treatment, you need to know the exact type of cervical cancer that you are suffering from. The main three types of cervical cancers that are commonly seen include:

  1. Squamous cell carcinoma: This type of cervical cancer usually starts from the thin squamous cells which line the outer cervix and project into the vagina. Squamous cell carcinomas are the most common among cervical cancer patients. In fact, 9 out of 10 cervical cancer cases fall under this category.
  2. Adenocarcinoma: This type of cervical cancer begins in the glandular cells (cells responsible for producing mucus). These cells usually line the cervical canal i.e., in the endocervix part of the cervix.  
  3. There are also times when both of the above-mentioned cells can be involved. As a result, these are said to be mixed carcinomas.

Cervical Cancer Causes/ Cervical Cancer Etiology:

In these years, a lot of progress has been made in understanding the happenings that take place in the cervical cells when cancer starts developing in an individual. Various risk factors have also been identified that are responsible for increasing the odds of cervical cancer being developed in a woman.  Some genes have also been identified that control when the cells are in a growing phase (phase in which the cells grow), dividing phase (phase in which the cells divide), and the senescent phase (phase in which the cells die). These genes are:

  • Oncogenes: These are the genes responsible for helping the cells grow, divide, and stay alive.
  • Tumor suppressing genes: These genes are responsible for keeping the growth of the cell under control or making the cells die at the appropriate time. As the name suggests, these are the ones stopping the cells from being cancerous.

Any mutations in the DNA can lead to turning the oncogenes on and turning off the tumor-suppressing genes and therefore, can lead to the onset of cancer. The human Papilloma Virus contains two different proteins i.e., the E6 and E7 proteins that can turn off the tumor suppressor genes. As a result of this, the cervical cells can grow too much, and hence, additional changes can be developed in the genes ultimately leading to cancer development. However, one should not think that HPV is the only cause of cervical cancers as not all women who have HPV get cervical cancers. There are other risk factors like smoking that have been found to cause cervical cancers.

Cervical Cancer Risk Factors: There are various risk factors that have been found to play major roles in causing cervical cancers. These risk factors include the following:

  1. Having multiple sexual partners: With the increase in the number of sexual partners you have, the chances of you getting the HPV also increases.
  2. Smoking: Smoking has been found to play a major role in the development of cervical cancer in squamous cells.
  3. Early sex: If you have had sex before the age of 16 then also, the risk of HPV increases, and hence, the risk of cervical cancer also increases with it.
  4. Weak immune system: There is an increased probability of you developing cervical cancer if your immune system has weakened due to any other health condition. This weakened system is not able to protect you against HPV (if you get infected with HPV) and hence, the chances of you having cervical cancer increase.
  5. Other STD infections: The risk of developing cervical cancer increases if someone has other sexually transmitted infections like HIV, gonorrhea, Syphilis, etc.

Cervical Cancer Symptoms:

There are usually no symptoms in the early and pre-cancer stages. Most of the time, the symptoms start appearing when cancer has become larger and grown into the nearby tissues. Some of the common symptoms are:

  1. Abnormal vaginal bleeding: There can be witnessing of abnormal bleeding like bleeding after sex (vaginal), postmenopausal bleeding, spotting, and bleeding in between the periods. The menstrual periods can also become heavier and longer.
  2. Unusual vaginal discharge: An unusual discharge may also be seen from the vagina that can occur between the menstrual periods or after menopause. Blood can also be found in this discharge.
  3. Pelvic pain: Pain in the pelvic region may also be an early indicator of cervical cancer.
  4. Painful sex: If you have pain during sex, there are chances you may be experiencing pain as a pre-cancerous symptom.

As the disease advances, the symptoms also get serious. Some of these symptoms of advanced cervical cancer are:

  1. Swelling of the legs
  2. Facing problems while urinating and/or having irregular bowel movements
  3. Finding Blood in the urine.
  4. Weight loss or loss of appetite.

The signs and symptoms mentioned above can also be caused due to other conditions. And hence, these are not sure-shot or specific symptoms of cervical cancer only. You should, however, see a doctor or a healthcare professional if you have any or more of the above symptoms. Ignoring such symptoms can cause cancer getting advanced or any condition or disease (if it’s not cervical cancer) and hence, your chances of successful treatment also get decreased with the delay. You should, therefore, have regular screening tests in order to be on the safe side as early detection is also no less than a cure when we talk of cancers.

Prevention of Cervical Cancer:

Almost all cervical cancers start with pre-cancerous changes and hence, one has the scope to note the changes in order to detect and hence, stop cancer from developing. Although, cervical cancer early detection is not that easy it is really good if cancer gets detected before it becomes cancerous.

Discovering cervical pre-cancers

The most efficient and convenient way to prevent oneself cervical cancer is to get regular screening tests done. Screening can detect pre-cancers before they become invasive/ metastatic and therefore, stop cancer from spreading in other areas. The two most common tests are the Pap smear test and the HPV test that can be used for screening. Both of these tests are done in a similar way. Gentle scraping or brushing is done by your doctor/ healthcare professional in order to get a few cells of the cervical region for testing. These cells are then observed under the microscopes by a lab technician for the presence of pre-cancers. If any pre-cancer favoring condition is found, then the doctors try to stop it from becoming cervical cancer.

Results of the Pap Smear test and the HPV test help the doctor in determining the scope of the pre-cancer i.e., whether cervical cancer is going to develop or not. If the test comes out to be positive then you will probably have to come for more follow-up appointments, tests in order to look for a pre-cancer/ cancer. You should be actively involved in matters of your health. You should talk and discuss your results with your doctor so that you completely understand your risk of acquiring cervical cancer and the steps that will be taken next in order to fight against cancer.

You can do the following things so as to prevent yourself from getting a cervical cancer

  1. Getting HPV vaccine: Nowadays, there are vaccines available that can protect children against HPV infections. These vaccines can also prevent other conditions like warts of the genital or anal area even. One important thing to keep in mind regarding this vaccine is that it only works if you don’t already have the infection. These should be administered to a person before she gets exposed to HPV infections.

Medical experts recommend vaccinating a child between the ages of 9-12 years. Young adults and children in the age groups from 13 to 26 should be vaccinated as these vaccines are not recommended to someone older than 26 years of age because most of the HPV infections infest in teenage and early adulthood.  

  1. Limiting HPV exposure: HPV can be transmitted from one part of the body to another in an individual. Also, it is not compulsory that the infection will be spread through only sex as this can also spread through skin-to-skin contact also (including vaginal, oral, anal sex, etc.). It can also be spread if there was no sexual intercourse, but the other person has touched your genital or anal area. You can, hence, prevent an HPV infection by not letting others touch your genital or anal area.  There are other unclear ways also for the infection to get infested in you.  You can prevent yourself against cervical cancers generally if you limit the number of sexual partners and don’t have sexual intercourse with a lot of people.  
  2. Using condoms: Although condoms can protect you against some infections, it is not sure that you will not get infected with HPV if you use a condom. The reason for condoms not being able to protect you from HPV infections is the fact that they cannot cover each and every area of the body that can be HPV-infected like the genital or anal skin. But condoms are good tools in order to protect you from HIV and other various STD infections.
  3. Not smoking: Yes, like many other cancers, cervical cancer can also be caused by smoking. So, if you don’t smoke then there are lesser chances of you having cervical cancer.

Cervical Cancer Diagnosis:

As has been already discussed, the Pap test and HPV test are the two main tests used for the screening done in cervical cancer detection. Your healthcare professional will also collect cells in order to observe under the microscope. If there are any unusual findings, then your doctor may do a biopsy (taking out a little of your cervical tissue) to study.

There are other tools that can be helpful in finding the changes in the cervical region. These are:

Colonoscopy: This can be followed by a Pap test with unusual findings. Here, your cervix is stained with a dye and then a microscope known as the colonoscope is used to observe your cervix, which magnifies by 8-15 times making it easier to look.

LEEP: This refers to the procedure where an electrified loop of wire is used to take cervical tissue as a sample.

Conization: This involves the removal of cervical tissue of a person in the operating room under the effect of general anesthesia. The doctor may make use of a scalpel, LEEP, or even a laser to do so.  This is done to provide your doctor with a better for a better diagnosis.

For invasive cancers: Your doctor may need to perform the following tests if the cancer is spreading:

  • Chest X-ray to observe your lungs
  • Blood tests to see if cancer has spread to the lungs
  • CT scan for the urinary tract

Cervical Cancer Treatment:

In cases the cancer is on the surface, then your doctor can perform removal or destruction of the cells with LEEP or the cold knife conization procedures. If cancer has gone deeper then only surgery can treat cancer. The main treatments for cervical cancer are:

Radiation therapy: This refers to the use of high-energy rays in order to damage the cancer cells.

The treatments can be external, internal, or both.

  • The external radiation involves a large machine aiming a beam of radiation at the pelvis. These treatments take only a few minutes, 5 days a week for 5-6 weeks. Then, you finally receive the final dose of the radiation known as the “boost”  
  • Internal radiation is also known as implant radiation, is the one in which capsules are used which contain radioactive material which is put into the cervix. This implant puts cancer-killing rays close to the tumor while leaving the healthy tissues harmless.

Chemotherapy: This involves using chemical drugs to kill the cancerous cells. It is used by doctors for advanced cancer treatment that has spread to other body parts.

Targeted Therapy: This refers to the treatment using drugs that focus on specific weaknesses present within the cancer cells. These weaknesses are then blocked and hence, these cancer cells then die as a result. This targeted drug therapy is mostly used in combination with chemotherapy in treating cervical cancer. It is used for cases with advanced cervical cancer.

Biological therapy: Also known as immunotherapy, this involves targeting checkpoints in the immune cells that are turned on or off in order to set off an immune response. This is used by the doctors in case the chemotherapy is not proving to be helpful.

Palliative care: This is specialized medical care that is mainly focused on pain relief and helping with other symptoms. Palliative care Specialists provide additional support by working with you, your family, and your doctors with a purpose to complement the ongoing care and treatment that you are receiving.

Conclusion:

One should always practice safe sex and have required vaccines to keep themselves at bay from STD infections. There are, however, times when even while one is being alert and cautious then also, they can get some infections like the HPV infection. In such cases, you need to have a well-experienced and competent doctor by your side. You need someone who explains all the things going on in your case so that you feel comfortable and confident with the treatment.

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