Overview

Cervical cancer is a type of gynaecological cancer affecting women of all ages. According to the World Health Organization, in 2020, cervical cancer affected thousands of women worldwide, making it the fourth most common cancer. Sadly, this disease caused approximately 604,000 new cases and resulted in the loss of 342,000 lives. Nonetheless, timely diagnosis and medical intervention can improve the chances of survival for those affected. Most of these cases (90%) and deaths occurred in low- and middle-income countries with elevated cervical cancer rates.

What is Cervical Cancer?

Cervical cancer is a serious condition that impacts the cervix, the lower portion of the uterus that links to the vagina. It happens when unusual cells in the cervix grow uncontrollably and can invade nearby tissues and other parts of the body. One of the primary reasons for the development of cervical cancer is the human papillomavirus (HPV), which is a common sexually transmitted infection. In addition, there are other risk factors for cervical cancer, such as smoking, having a weak immune system, and having a family history of the disease. 

Causes of Cervical Cancer

HPV Infection - HPV infection is the most common cause of cervical cancer. HPV is a group of over 200 related viruses, and some types of HPV can cause changes in the cells of the cervix that can lead to cancer. The Human Papillomavirus (HPV) is typically spread through contact between the skin of two individuals, usually during sexual behaviour.

Other Risk Factors

Other risk factors for cervical cancer include:

- Smoking: Females smoking are more likely to develop cervical cancer than those who do not smoke.
- Weak immune system: Women with a weak immune system, such as those with HIV, are more likely to develop cervical cancer.
- Age: Cervical cancer is most commonly diagnosed in women over 30.
- Family history: Females with a family history of cervical cancer are at increased risk of developing the disease.

 Symptoms of Cervical Cancer

In its early stages, cervical cancer may not cause any symptoms. However, as the tumour grows and spreads, women may experience the following:

- Abnormal vaginal bleeding, such as bleeding between periods or after sex
- Pain during sex
- Unusual vaginal discharge
- Pelvic pain

It's crucial to remember that these indications might stem from medical conditions other than cervical cancer. If you encounter any of these symptoms, you must seek an evaluation from your healthcare professional.

Diagnosis of Cervical Cancer

Cervical cancer is usually diagnosed through a combination of tests, including:

- Pap test: A Pap test is a screening test that detects abnormal cells on the cervix before they become cancerous.
- HPV test: An HPV test can detect the presence of high-risk types of HPV on the cervix.
- Biopsy: A biopsy may be performed to confirm a cervical cancer diagnosis if abnormal cells are found on the cervix.

Stages of Cervical Cancer

There are four stages of cervical cancer, which are determined based on the size and location of the cancerous cells:

- Stage 0 is the earliest stage of cervical cancer, also known as carcinoma in situ. It means that the abnormal cells are only present on the surface of the cervix and have not spread to deeper tissues.
- Stage I: This stage indicates that cancer has grown beyond the surface of the cervix and into the underlying tissue. Depending on the tumour size, it is divided into two sub-stages, IA and IB.
- Stage II: Cancer has spread beyond the cervix and into nearby areas, such as the upper part of the vagina or the tissue around the uterus. It is also divided into sub-stages IIA and IIB.
- Stage III: Cancer has now spread to the lower part of the vagina, the pelvic wall, or the ureters (the tubes that connect the kidneys to the bladder). This stage is further divided into IIIA, IIIB, and IIIC, depending on the extent of the spread.
- Stage IV: In this stage, cervical cancer has progressed extensively and has metastasised to other organs such as the bladder, rectum, liver, or lungs. It is also divided into two sub-stages, IVA and IVB.

Treatment Options for Cervical Cancer

The treatment for cervical cancer depends on the stage and extent of the tumour and the patient's overall health and preferences. Some common treatment options include:

- Surgery: Surgery may be recommended for early-stage cervical cancer, where the cancer is confined to the cervix. Surgery aims to remove the cancerous cells and preserve as much of the reproductive system as possible. Depending on the stage of cancer, different types of surgery may be performed, such as a hysterectomy (removal of the uterus) or a trachelectomy (removal of the cervix).
- Radiation Therapy: Radiation therapy employs radiation, such as high-energy X-rays, to eliminate cancer cells. It can be utilised alone or with chemotherapy or surgery to combat cancer. Radiation therapy may be delivered externally (external beam radiation) or internally (brachytherapy), depending on the stage and location of cancer.
- Chemotherapy: Chemotherapy is a treatment method that involves administering drugs to eliminate cancer cells throughout the body. This approach can be applied as a standalone therapy or in conjunction with surgery or radiation therapy. Chemotherapy is usually given intravenously, but it can also be given orally or topically, depending on the type and stage of cancer.

Prevention and Screening for Cervical Cancer:

Prevention and early detection are key to managing cervical cancer. Some effective ways to prevent cervical cancer include

- HPV Vaccination: The human papillomavirus (HPV) vaccine can protect against the types of HPV that are most likely to cause cervical cancer. The vaccine is recommended for males and females, starting at 11 or 12. The actual indication is to give between 9-13 years of age, but the vaccine can be given up to 26 yrs.
- Pap Test: The Pap test, also known as a Pap smear, is a screening test that detects abnormal cells in the cervix before they become cancer. It is recommended for women starting at age 21 and should be done every three years for women aged 21-65.
- HPV Test: Besides the Pap test and HPV vaccination, an HPV test can also be used to screen for cervical cancer. This test looks for high-risk HPV strains that can cause abnormal cell growth in the cervix. The HPV test is often combined with the Pap test for women over 30.

When to Consult a Doctor

You can also get in touch with the expert Oncology doctors at Narayana Healthcare based in your city to get immediate attention and medical support during injuries, health disorders or any other health concern.

Conclusion

Cervical cancer is a common gynaecological cancer that can often be prevented through regular screening and vaccination. Knowledge about the factors that lead to cervical cancer, its indications, and available medical interventions can assist individuals in making informed choices regarding their health and minimise their chances of acquiring the condition. For those who do receive a diagnosis, it is important to work closely with healthcare providers and to seek support from loved ones and counselling services to manage the physical and emotional challenges of the disease. With early detection and proper treatment, many individuals with cervical cancer can live long and healthy lives.

FAQS

Q. What are the five warning signs of cervical cancer? 

A. Here are the five warning signs of cervical cancer:

- Abnormal vaginal bleeding: includes bleeding between periods, after sex, or after menopause.
- Unusual vaginal discharge: may include a watery, bloody discharge or foul odour.
- Pelvic pain: may occur in the lower abdomen or pelvis and may be constant or come and go.
- Pain during sex: may be a sign of cervical cancer, particularly if it is a new or persistent symptom.
- Changes in urination or bowel movements: This may include pain during urination or bowel movements or a change in the frequency or consistency of bowel movements.

Q. Is cervical cancer very serious?

A. If cervical cancer is not identified and addressed during its initial stages, it can become a severe and potentially fatal illness. However, with regular screenings and prompt treatment, the prognosis for cervical cancer can be excellent. According to Dr. Rohit Raghunath Ranade (Gynaecologic Oncosurgeon Consultant at  Narayana Superspeciality Hospital, Howrah), the 5-year relative survival rate for all stages of cervical cancer is approximately 68%. This means that, on average, people with cervical cancer are about 68% as likely as those without it to live for at least five years after their diagnosis. However, the survival rate can vary depending on factors such as the cancer stage at diagnosis and the individual's overall health.