Cervical Cancer Symptoms, Risk Factors, Diagnosis and Treatment | Narayana Health

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Cervical Cancer:

Symptoms, Causes, Risk Factors, Diagnosis & Treatment



What is Cervical Cancer?

Cancer is a disease pertaining to the uncontrolled growth of abnormal cells in the body. The type of cancer is named after the region from where these cells start to proliferate. Cervical cancer occurs in females when the cells of the cervix grow at an abnormal rate and affect the surrounding tissues and organs. Cervical cancer generally grows very slowly which means that there is enough opportunity for affected women to undergo proper diagnosis and treatments to eliminate the disease. But deeply invasive cases of cervix cancer can lead to metastasis, which means that cancer can spread and affect other parts of the body like lungs, liver, urinary bladder, vagina and rectum.

What is Cervix?

The cervix is a part of the reproductive system of a female and is located at the lowermost part of the uterus.

Where is Cervix located?

The cervix location marks the connecting point of the uterus and the vagina. The opening of the cervical canal is usually very narrow and the main cervix function is to allow the flow of menstrual blood from the uterus to the vagina and direct the passage of sperms during intercourse.



Types of Cervical Cancer

  • Squamous cell carcinoma - This occurs in the thin, flat cells at the bottom of the cervix. Squamous cell carcinoma cervix makes up for 80% of cervical cancers.
  • Adenocarcinoma of cervix - Cervical adenocarcinoma occurs when cancer cells develop in the glandular cells that line up the upper portion of the cervix. Such Adenocarcinoma cells cause 20% of cervical cancers.



Symptoms of Cervical Cancer

Most women that face cervical cancer symptoms are aged 20 to 30 years but they are diagnosed with the disease only after their 50s. This shows how slowly the cancer of cervix spreads. If adequate treatment can be done in this precancerous stage, then cervical cancer can be prevented.

Early symptoms of cervical cancer can go unnoticed. At this stage, they tend to cause no pain or show any abnormal symptoms. Hence, it is important for women to undergo regular pelvic exams and Pap tests to detect the presence of cancer at the stage when it is curable. Warning signs of cervical cancer are seen only at the later stages. Such symptoms of cervical cancer are:

  • Abnormal Vaginal Bleeding - Cervical cancer symptoms may show heavy bleeding during menstruation, abnormal bleeding after intercourse, post menopause or between two consecutive menstrual cycles.
  • Excessive Vaginal Discharge - Bloody and abnormal vaginal discharge that feels heavier and has a foul odor.
  • Cervical cancer symptoms and signs entail severe pain during intercourse with abnormal pelvic discomfort.

Early signs of cervical cancer, when undetected, spreads to other parts of the body like the liver, urinary bladder, and vagina.

The most common symptoms of cervical cancer include:

  • Urination problems - pain during urination and blood discharge through urine
  • Diarrhea, severe pain and bleeding from the rectum
  • Swollen abdomen causing nausea, vomiting, and constipation
  • Backache and weakness
  • Swelling of the legs
  • Excessive fatigue and loss of appetite

Vaginal bleeding and discharge after menopause are the most common signs and symptoms of cervical cancer. Even though it may happen due to a normal case of vaginal dryness, it is important to get a pelvic examination done in order to avoid risks of cervical cancer.



What causes cervical cancer?

Causes of cervical cancer can be attributed to the genetic mutations that occur in the healthy cells of the cervical tissue. Normal cells multiply, grow and die at a certain rate. Mutations in the DNA changes the fundamental life cycle of the cervical cells that accumulate over time to form a mass, known as the cancerous tumor. Cervical cancer causes this tumor to spread and metastasize in some other tissue or organ of the body.

The initial risk of developing this abnormal growth of cells or the factors that form the main reasons for cervical cancer is the infection caused due to Human Papillomavirus (HPV). Causes for cervical cancer that ultimately occur due to this viral infection are related to sexual contact at an early age, consuming oral contraceptives or birth control pills too often, having multiple sexual partners and the lack of knowledge about using external contraceptives. All of these factors increase the risk of exposing oneself to infection by Human Papillomavirus (HPV).

Human Papillomavirus (HPV) is a common virus that is transmitted through sexual contact. A notorious microbe, several types of Human Papillomavirus is known to cause abnormal skin disorders like genital warts and skin warts. In most cases, the infection of HPV is easily subdued by the immune system of the human body, hence preventing it from doing any harm. But the virus may remain in the system of people with weak immunity, ultimately contributing to being the leading reasons of cervical cancer in the patient. This means that cervical cancer reasons are not just limited to sexual contact but it also depends on the environment and lifestyle conditions of the patient. On testing the cervical tissues that show cancerous and precancerous signs and symptoms, genetic material from the various high-risk subtypes or malicious strains of the Human Papillomavirus (HPV) has been found.



Risk Factors for Cervical Cancer

Exposure to certain notorious strains of Human Papillomavirus (HPV) is the most standard risk factor of cervical cancer. This is the most common virus transmitted through intercourse but certain strains can cause genetic mutations in the DNA that can pose severe cervical cancer risk factors. Some other strains of HPV can cause genital warts are other skin disorders while in most people, the virus is eliminated from the body without any effect. Risk factors of cervical cancer that increase the chances of HPV infection are:

  • Infection of Human Immunodeficiency Virus (HIV) that causes AIDS ultimately leads to the weakening of the immune system which makes way for HPV infection.
  • Smoking
  • Consumption of birth control pills for five or more years
  • Given birth to three or more children
  • Multiple sexual partners and unprotected intercourse
  • Sexual contact from an early age
  • Infection of other Sexually Transmitted Infections like chlamydia, gonorrhea, and syphilis
  • Exposure to miscarriage-prevention drug



How to Prevent Cervical Cancer

Regular Screening

Mainly occurring due to an infection, cervical cancer is preventable. Proper hygiene and regular screening from the age of 21 can help prevent Cervical Cancer.

There are two types of screening tests that can be done to detect signs of cervical cancer. They include:

  • The Pap test or pap smear test - This type of test looks for signs and symptoms of cervical cancer that occur at the pre-cancer stage. The main aim of the test is to look for abnormalities near the cervix region of the female reproductive system that might turn out to be cancerous over a period of time. Most doctors suggest undergoing routine pap smear tests to reduce the risk of cervical cancer signs going undetected.
  • HPV Tests - Human Papillomavirus (HPV) tests are specifically designed to look for the virus that can cause changes at the genetic level of the cervical cells.

Administration of HPV Vaccine

The HPV vaccine can help prevent infection from the types of HPV strains that lead to vagina cancer, pelvic cancer, and cervical cancer. The most common doses of the HPV vaccine are mentioned below:

  • Recently, the HPV vaccine has been recommended for children just before they step into puberty. This means pre-teens of the age group 9-12 years can be administered the HPV vaccine to help prevent any symptom of cervical cancer in the future.
  • The HPV vaccine is strongly recommended for individuals of the age-group 21-26 years if they have not been vaccinated already.
  • If persons above the age of 26 want to get administered with the HPV vaccine then it is recommended that they talk to their doctor first to understand the possibility and risk factors of doing so. This is because most people have already been exposed to HPV infection by the age of 26 i.e they have reached the cervical cancer age.

HPV vaccinations prevent any new infections but do not act against existing HPV in the body. Symptoms for cervical cancer should be checked regularly even if the individuals have been vaccinated against Human Papillomavirus.

Lifestyle Changes

  • Quit smoking - Smoking is highly associated with squamous cell carcinoma of cervix.
  • Adopt safe sex practices - This involves limiting the number of sexual partners and using external contraceptives to prevent the transmission of HPV infection.



Diagnosis of Cervical Cancer

Depending on the results of the screening tests, if the doctor suspects any cervical cancer symptom then the patient’s diagnosis starts with a thorough examination of the cervix. Diagnosis is generally performed by a trained gynecologic oncologist who uses a special instrument called the colposcope to check for the presence of abnormally growing cells at the cervix.

During the cervical cancer diagnosis examination using a colposcope, the doctor needs to take samples from the overgrowth of cells to study it in the laboratory. To obtain such tissue samples, the following methods are put to use:

  • Punch Biopsy - To accurately diagnose cervical carcinoma, the doctors perform a punch biopsy. This process involves the pinching off of a small amount of abnormal cervical tissue using a sharp tool.
  • Endocervical Curettage - For this procedure, the doctor uses a small spoon-shaped instrument called a curet or a thin brush to scrape off a tiny sample of the affected tissues from the endocervical canal.

If the results obtained from the punch biopsy and endocervical curettage show positive outcomes for the presence of carcinoma of cervix and the patients show severe cervix cancer symptoms, then the doctor may perform some further tests to confirm the onset of the disease. These tests include:

  • Electrical wire loop test - During the electrical wire loop test, a very thin electrified wire of low-voltage is used to obtain a tiny amount of affected tissue. This procedure is performed under anesthesia but can be done at the clinic itself.
  • Conization or Cone Biopsy - This procedure requires hospitalization of the patient showing symptoms of pelvic cancer. Cone biopsy allows the doctor to extract abnormal and diseased cervical cells from the deeper layers of the female cervix for laboratory testing.



Cervical Cancer Stages

Cervical Cancer Stages

The extent or spread of cervical cancer is referred to as the stage of the disease. Doctors perform cancer investigation of the various cervical cancer stages symptoms and if they are positive that the patient has cervical cancer, then the following tests are done to determine the stage. Cervical carcinoma staging is necessary for figuring out the course of cervical cancer treatment. The tests involve:

  • Imaging Tests: X-Ray, MRI, CT Scan and Positron Emission Tomography (PET) are performed to obtain a detailed and accurate image of the internal organs of the body. This helps doctors to identify if cancer has spread to other parts of the body apart from the cervix.
  • Visual examination of the bladder and rectum is done to look for the presence of abnormal growth of cells in the area.

The stages of cervical cancer

Stage I

This is the stage of cervical cancer when cancer cells have formed but only at the cervix. Stage I of cervical cancer is divided into stages IA and IB with further subtypes based on the size of the cervical tumor formed and the depth of tumor invasion in the body. The final point of stage I is reached when the size of the cervical tumor has crossed 4 centimeters.

Stage II

Stage II of cervical cancer occurs when the abnormal cell growth has spread to the tissues around the uterus and cervix and has also infected the upper two-thirds of the vagina. Stage II is divided into stages IIA and IIB depending on how far cancer has spread.

  • Stage IIA - cancer has spread to a larger area of the upper part of the vagina and the tumor has grown to a size more than 4 centimeters.
  • Stage IIB - cancerous cells have metastasized on the tissues surrounding the uterus.

Stage 2 cervical cancer life expectancy - Patients suffering from stage II of cervical cancer are expected to live for 5 years after proper diagnosis and presence of cervical cancer symptoms and treatment.

Stage III

The extensive spread of cancer in the uterine cervix region is diagnosed as cervical cancer stage 3. Stage III is divided into three sub-stages based on how far and in which regions cancer has metastasized. The sub-stages are:

  • Stage IIIA: In this stage, cervical cancer has spread to the lower third part of the vagina but has not yet affected the pelvic wall. This means that the patient has not yet started to show any pelvic cancer symptoms.
  • Stage IIIB: This is the stage when the carcinoma cells have grown from the cervix and the ureters are starting to get affected by the abnormal proliferation of cells. One or more ureters have been blocked in this case which has caused one or more kidneys to malfunction or completely stop working. Stage IIIB marks the stage where cancer has successfully metastasized on the pelvic wall.
  • Stage IIIC: This stage is further subdivided based on the spread of cancer to the lymph nodes.
    • Stage IIIC1: Cervical cancer, in this case, has spread to the lymph nodes in the pelvis
    • Stage IIIC2: Cancer has affected the lymph nodes near the aorta, hence making its way into the abdomen

Stage IV

Cervical cancer at its last and final stage denotes that cancer has largely spread to several vital organs of the body, hence making the treatment process even more complicated. Stage 4 cervical cancer symptoms like swelling of the leg and excessive body pain start to become more recurrent. This stage is subdivided into:

  • Stage IVA: Cancer has spread extensively to the surrounding areas like urinary bladder and rectum
  • Stage IVB: In this last stage, cancer has affected vital parts of the body like liver, lungs, bones and very distant and deeper lymph nodes



Treatment and Management

Treatment for cervical cancer is of many different types with newer types of treatments being tested globally in clinical trials. Cervical cancer cure can be obtained with these five routine and standard types of treatment of cervical cancer are as follows:

  • Surgery - Early-stage cervical cancer treatments generally involve surgical procedures. These procedures are:

1.  Cone Biopsy - Patients who show symptoms of cervical cancer but have only a small tumor can undergo cone biopsy. In this case, the entire cone-shaped cervical tissue is removed from the cervix.

2.  Trachelectomy - Involves the removal of the entire cervix and some surrounding tissue but the uterus remains intact.

3.  Hysterectomy - A radical procedure in early-stage cervical cancer which involves the removal of the cervix and uterus followed by parts of the vagina and some lymph nodes. This can cure cancer and also prevent its recurrence. But the removal of uterus means that the patient cannot be pregnant anymore.

  • Radiation Therapy - This procedure uses high-powered energy beams or protons to kill cancer cells. It can also be used after surgery if there is a risk of recurrence.

1.  External Radiation Therapy - This involves directing a radiation beam at the area of the body affected with cervical cancer.

2.  Brachytherapy - Internal radiation therapy process, this involves placing a device loaded with radioactive material inside the vagina for a few minutes.

The limitation of radiation therapy is that it can cause menopause in women.

  • Chemotherapy - This involves the administration of chemicals by injection or pills for carcinoma cervix treatment. Sometimes, radiation therapy and chemotherapy are done together as the chemicals are known to boost the effects of radiation.
  • Targeted Therapy - Drug treatments aimed towards targeted weak regions of the cancer cells. This is often clubbed with chemotherapy for cervix cancer treatment of the later stages.
  • Immunotherapy - Cancer cells release certain proteins that make the immune cells incapable of identifying the potential threat. Immunotherapy makes the immune cells of the body detect cancer cells and fight them off.

Cervical cancer treatment success rate - If detected and treated early, the 5-year survival rate for cervical cancer in women is 66%.



Road to Recovery and Aftercare

Post-treatment recovery is important to prevent any sign of cervical cancer showing up again. This involves the following:

  • Regular doctor visits: Doctors may recommend follow-up care and visits to the oncologist every 3-6 weeks for the first couple of months after treatment. Doctors also advise such patients to keep getting Pap tests every few months. Patients should also ask for a detailed follow-up plan from the doctor to mention dietary supplements or lifestyle changes that they have to adopt in the future.
  • Imaging tests: These should be done if doctors suspect the risk of cancer coming back



Cervical cancer FAQs: All your concerns addressed

Q.  What are the early signs of cervical cancer?

  1. Most women do not experience the early signs that come with cancer. However, when it comes to cervical cancer, early signs and symptoms can be noticed. Women who are suffering from metastatic cancer or advanced-stage cancer, the symptoms will be more severe; the signs also depend on the tissues and organs that are infected by the disease. Here are some of the signs of cervical cancer that you will have to look out for in the earlier stages:
  • Blood spots or light bleeding between periods
  • Menstrual bleeding that is heavier and longer than normal
  • Bleeding after intercourse or a pelvic examination
  • Increase in vaginal discharge
  • Experiencing pain during sexual intercourse
  • Bleeding after menopause
  • Constant back pain

If you experience any of these symptoms, visit your doctor immediately.

Q.  How serious is cervical cancer?

  1. If cervical cancer is not diagnosed and treated in time, it can be quite serious. This cancer can take a long time to develop. During this period the cells in the cervix will take a long time to grow and change, so if any mutation is found during the change cancer can be treated and prevented.

Q.  Who is at risk of developing cervical cancer?

  1. One of the major risk factors of cervical cancer is having a severe type of HPV. There is no definite cause behind people developing prolonged HPV infections, cell changes, or cancer. Besides HPV, other factors that put a patient at cervical cancer risk are:
  • A history of vagina, vulva, or cervix dysplasia
  • Genetic history of cervical cancer
  • Smoking
  • Infections like chlamydia
  • Immune disease like AIDS make it harder to fight off cervical cancer
  • The patient above the age of forty

Q.  Can cervical cancer affect your fertility?

  1. If your cancer is found in the early stages and treated as soon as possible, then your fertility is not affected and you can recover fully. However, some cervical cancer treatments can affect your fertility, the risks and side effects will affect your ability to get pregnant in the future.

Q.  How can you prevent cervical cancer?

  1. Here are four points you can follow to keep your cervix healthy-
  • Go for regular checkups- Pap tests and HPV tests are quite important. They help the doctor detect any abnormal changes in your body, this way you can treat any cancer mutations before they get worse. Generally, you should get your first pap test done when you’re 21 and then get it done every three to five years.
  • Get the HPV vaccine- The HPV vaccine is important because it protects you against HPV 16 and 18, which are the two types that can cause cervical cancer. The vaccines are provided in a three-shot series, over six months.
  • If you are indulging in smoking, then stop immediately, especially if you have high-risk HPV.

Q.  How long can cervical cancer go undetected?

  1. Women who have HPV won’t necessarily get cervical cancer because the virus will get resolved on its own in two years or less, depending on the treatments. However, cancer can go undetected for a year or so, if the infection persists for a long time.

Q.  What is the meaning of Cervix?

  1. Cervix definition - A narrow passage that forms the lower end of the uterus, connecting it to the vagina.

Q.  Can you die from cervical cancer?

  1. If treatments start only at Stage IV, then cervical cancer can be fatal. Early diagnosis and treatment have the potential to cure cervical cancer in women.

Q.  What is the cervical cancer survival rate?

  1. As per estimates, the 5-year survival rate for cervical cancer in women is 66%.

Q.  What are the symptoms of cervical cancer?

  1. Symptoms of cervical cancer in females range from abnormal vaginal bleeding, urination problems, and excessive fatigue. Cervical cancer symptoms like leg pain are also widely seen among affected people.

Q.  What is the cause of cervical cancer?

  1. Cervix cancer causes can be attributed to the genetic mutations that occur in the healthy cells of the cervix mostly due to Human papillomavirus infection.

Q.  What is cervical cancer meaning?

  1. The meaning of cervical cancer is the growth of cancer at the cervix of the female reproductive system.

Q.  What is meant by cancer?

  1. Cancer is a disease concerning the uncontrolled growth of abnormal cells in the body.



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