Cervical cancer

Cervical cancer arises in the cervix, the lower part of the uterus that connects to the vagina. It’s a significant health issue worldwide but can be detected early and effectively treated if regular screenings are conducted. The introduction of the Pap smear test and the human papillomavirus (HPV) vaccine has significantly decreased the incidence of cervical cancer in areas where they are widely available. Despite these advances, cervical cancer remains a major cause of cancer-related deaths among women in many parts of the world, particularly where access to routine screening is limited.

Causes

The primary cause of cervical cancer is a persistent infection with certain strains of human papillomavirus (HPV), a common virus transmitted through sexual contact. While most HPV infections clear up on their own and don’t cause cancer, infections that don’t go away can cause certain types of HPV to transform cervical cells into cancer cells over time. Other factors that can increase the risk of developing cervical cancer include:

1. Multiple Sexual Partners: Increases the likelihood of HPV infection.
2. Early Sexual Activity: Engaging in sexual activity at a young age can increase the risk of HPV infection.
3. Other Sexually Transmitted Infections (STIs): Having other STIs, such as chlamydia, gonorrhea, syphilis, and HIV/AIDS, can increase the risk.
4. Weakened Immune System: The body’s ability to fight off HPV might be reduced in those with weakened immune systems.
5. Smoking: Tobacco use is associated with an increased risk of cervical and other cancers.
6. Long-term use of oral contraceptives: Research suggests that long-term use of birth control pills may slightly increase the risk.

Symptoms

symptoms may include:

1. Abnormal Vaginal Bleeding: Including bleeding after sexual intercourse, between menstrual periods, or after menopause.
2. Unusual Vaginal Discharge: Discharge that may be watery, bloody, and have a foul odor.
3. Pelvic Pain: Pain during intercourse or at other times.
4. Painful Urination: Signaling that the cancer has spread to nearby tissue.
5. Increased Urinary Frequency: Or other urinary changes.

It’s important for women to be aware of these symptoms and to seek medical advice if they experience any of them. Early detection through regular Pap smears and HPV testing is key to successfully treating cervical cancer and preventing its progression.

Diagnostics

Accurate diagnosis of cervical cancer involves a series of tests and procedures to confirm the presence of cancer cells and determine the extent (stage) of the disease. The diagnostic process typically includes:

1. Pap Smear Test: Screens for precancerous or cancerous cells on the cervix. Abnormal results may necessitate further testing.
2. HPV DNA Test: Identifies the presence of high-risk HPV strains that are more likely to lead to cervical cancer.
3. Colposcopy: A procedure using a special microscope (colposcope) to closely examine the cervix for abnormal areas, often following abnormal Pap smear results.
4. Biopsy: During a colposcopy, a biopsy may be performed to remove a small sample of tissue for laboratory analysis. Types of biopsies include punch biopsy, endocervical curettage, and cone biopsy.
5. Imaging Tests: Such as X-rays, CT scans, MRI, and PET scans, may be used to determine whether the cancer has spread beyond the cervix.
6. Staging Procedures: Include examinations under anesthesia to check the bladder and rectum, which help in determining the cancer stage.

Treatment

Treatment for cervical cancer depends on several factors, including the stage of cancer, overall health, age, and personal treatment preferences. Options may include:

1. Surgery:
   • Cryosurgery or Laser Surgery: Used for early-stage cancer or precancerous lesions, to freeze or vaporize abnormal cells.
   • LEEP (Loop Electrosurgical Excision Procedure): Removes abnormal tissue using a wire loop heated by electric current.
   • Conization: Removes a cone-shaped piece of tissue from the cervix.
   • Hysterectomy: Surgical removal of the uterus; may be partial or total, and sometimes includes removal of nearby lymph nodes and tissues.
   • Trachelectomy: Removal of the cervix but preserving the uterus, an option for women who wish to preserve fertility.
2. Radiation Therapy: Uses high-energy rays to kill cancer cells. It can be external beam radiation or brachytherapy (internal radiation). Often used for more advanced stages or to reduce tumor size before surgery.
3. Chemotherapy: Involves the use of drugs to kill cancer cells, typically used for advanced cervical cancer or when cancer has spread. It can be used in combination with radiation therapy (chemoradiation).
4. Targeted Therapy: Focuses on specific molecules involved in cancer growth, like bevacizumab (Avastin), which targets the blood vessels that supply oxygen and nutrients to the tumor.
5. Immunotherapy: Uses the body’s immune system to fight cancer. For example, pembrolizumab (Keytruda) is approved for advanced cervical cancer with specific genetic markers.
6. Palliative Care: Aimed at relieving symptoms and improving quality of life, palliative care can be integrated at any stage of cancer treatment.

The choice of treatment is carefully considered based on the individual’s specific circumstances. Early-stage cervical cancer may be effectively treated with surgery or localized therapies, preserving fertility in some cases. Advanced stages often require a combination of surgery, radiation, and chemotherapy. Regular follow-ups post-treatment are crucial for monitoring recovery and detecting any recurrence early.

Prevention

Preventative measures can significantly reduce the risk of developing cervical cancer. Key strategies include:

1. HPV Vaccination: Vaccines protect against the high-risk HPV strains most commonly associated with cervical cancer. It’s recommended for preteens of all genders, but can be given up to age 26, and sometimes older for certain individuals.
2. Regular Pap Smears: Screening can detect precancerous conditions of the cervix, allowing for early intervention before cancer develops. Guidelines suggest starting screening at age 21 and continuing at regular intervals.
3. HPV Testing: Combined with Pap smears or alone, HPV testing is recommended starting at age 30 and can be a part of routine cervical cancer screening to identify high-risk HPV infections.
4. Practice Safe Sex: Using condoms and limiting the number of sexual partners can reduce the risk of HPV infection.
5. Avoid Smoking: Smoking increases the risk of cervical and other cancers. Quitting smoking can reduce this risk.

Complications

If not detected and treated early, cervical cancer can lead to several serious complications, including:

1. Metastasis: Cancer can spread beyond the cervix to other parts of the body, such as the lungs, liver, bladder, or rectum, complicating treatment and reducing survival rates.
2. Fertility Issues: Certain treatments for cervical cancer, particularly those involving the removal of the uterus and/or radiation therapy, can affect a woman’s ability to conceive and carry a pregnancy.
3. Lymphedema: Swelling in one or both legs can occur if lymph nodes are removed or damaged during treatment, affecting mobility and quality of life.
4. Emotional and Psychological Impact: The diagnosis and treatment of cervical cancer can have significant emotional and psychological effects, including issues related to sexual health, self-image, and the stress of managing a chronic condition.

Conclusion

Cervical cancer represents a significant health challenge, but it is one of the most preventable types of cancer thanks to effective screening methods and the availability of the HPV vaccine. Early detection through regular screenings is crucial for successful treatment and can often prevent cervical cancer from developing. For those diagnosed, advancements in treatment offer hope for effective management and cure, especially when detected at an early stage. Public health efforts continue to emphasize the importance of vaccination, screening, and education to reduce the incidence and impact of cervical cancer worldwide. Adopting preventive health measures and seeking regular medical care can empower individuals to protect their health and improve outcomes for those affected by cervical cancer.