Cervical cancer

Q 1. What is cervix cancer? 

Cervical cancer develops in a woman’s cervix. 

The cervix is the narrow bottom portion of a woman’s uterus (womb). Cervix connects the uterus to the vagina.

Cervix cancer mainly affects women aged between 35 and 55

Q 2 What causes cervix cancer?

  • Persistent infections with high-risk types of human papillomavirus (HPV)
  • Two strains, HPV 16 and HPV 18 are responsible for most of the cases of cervical cancer. HPV virus is transmitted via the sexual route. Having sex with multiple partners increases the chances of exposure to HPV.
  • Generally HPV virus infection does not have any symptoms, so women will not realize they have it. But these infections are very common and most women who have them do not develop cervical cancer
  • Multiple (3 or more) full-term pregnancies
  • Long-term oral contraceptive (birth control pill) use
  • Cigarette smoking
  • Having a weakened immune system (for example, after an organ transplant or with HIV infection)

Prevention: 

  • The HPV vaccine has been routinely offered to girls aged 12 and 13 
  • Cervical Cancer Screening: Pap smears starting from the age of 21

Q 3 What are the types of cervix cancer?

There are two primary types of cervical cancer:

  • Squamous cell carcinomas: It is the most common type.  
  • Adenocarcinomas 

Q 4 what are the symptoms of cervix cancer? 

Symptoms of cervical cancer are not always obvious, and it may not cause any at all until it’s reached an advanced stage.

  • Unusual bleeding from the vagina.  This includes bleeding:
  • during or after sex
  • between your periods
  • after menopause
  • Pain and discomfort during sex 
  • Unusual vaginal discharge, which can be foul-smelling, pus-like or blood-tinged
  • Pain in your lower back or pelvis
  • The buildup of fluid in the abdomen (called ascites) or in the legs (called lymphedema)

Advanced cervical cancer

If cancer spreads out of your cervix it may result in:

  1. Pain in your lower back or pelvis
  2. Constipation
  3. Losing control of your bladder (urinary incontinence) or losing control of your bowels (bowel incontinence)
  4. Blood in urine
  5. Swelling of one or both legs

A word of caution 

All of these symptoms can also be caused by conditions that are not cancer. Kindly consult your doctor first. 

Q 5 How cervical cancer is diagnosed?  

Investigation:

Colposcopy

The doctor uses a device called a speculum to open the vagina. A small microscope with a light at the end (a colposcope) will be used to look at the cervix. 

If there is any suspicious area or mass visible then the doctor may remove a small tissue sample (biopsy) so it can be checked for cancerous cells. 

A word of caution 

  • There is a common myth that taking biopsy leads to the spread of cancer cells in the body. This is not true. Taking a biopsy does not lead to the spread of cancer cells in the body.
  • Biopsy confirms that it is cancer and not infection and also helps in knowing the type of cancer so that further treatment can be planned accordingly. 

Further testing

If the results of the colposcopy or biopsy confirm cervical cancer, then the doctor may advise having additional tests to assess how widespread the cancer is. These tests may include:

  • Blood tests – to assess the state of liver, kidneys and bone marrow
  • CT/MRI scan – To find out the local spread of disease 
  • Chest X-ray – to check if cancer has spread to the lungs or not. 
  • Sometimes a PET scan – To know distant spread of disease 

Q 6 What is cervix cancer staging

Staging is a measurement of how far cancer has spread.

After all the tests have been completed and the results are known, it should be possible to predict what stage the cancer is. The higher the stage, further cancer has spread.

The staging for cervical cancer is:

  • stage 0 – no cancerous cells in the cervix, but there are abnormal cells that could develop into cancer in the future – this is called pre-cancer or carcinoma in situ
  • stage 1 – the cancer is only inside the cervix
  • stage 2 – cancer has spread outside the cervix into the surrounding tissue but hasn’t reached the tissues lining the pelvis (pelvic wall) or the lower part of the vagina
  • stage 3 – cancer has spread into the lower section of the vagina or pelvic wall
  • stage 4 – the cancer has spread into the bowel, bladder or other organs, such as the lungs

A word of caution 

Above staging is a simplified version for your basic understanding. Reader is advised to follow the TNM staging system developed by the American Joint Committee on Cancer (AJCC) in which 

  • T stands for the size and location of primary tumor
  • N stands for nodes. It tells whether the cancer has spread to the nearby lymph nodes
  • M stands for metastasis. It tells whether the cancer has spread to distant parts of the body

Q 7 How cervix cancer is treated?  

Cervical cancer is often curable if it’s diagnosed at an early stage.

When deciding treatment options for a particular patient, doctor will consider following factors and will decide individual treatment plan:

  • The size of the cancer
  • The stage of the cancer
  • The location of the cancer
  • Your overall health and ability to recover from surgery, radiation therapy or chemotherapy
  • Your personal preferences

Following are the general guidelines but treatment may vary from patient to patient:  

  • For early cervical cancer – Surgery ( Radical hysterectomy ) to remove cervix, uterus, surrounding tissue, lymph nodes, fallopian tubes and, sometimes, ovaries are all removed or radiotherapy or a combination of both
  • For locally advanced cervical cancer – radiotherapy with or without chemotherapy
  • When cervical cancer is not curable, then only chemotherapy can be given to slow its progression and relieve symptoms. This is known as palliative chemotherapy.