CervicalCancer

CervicalCancer

CervicalCancer

What is Cervical Cancer

Cervix

Cervix is the narrow part of the lower uterus that opens into the vagina. It is often referred to as the neck of the womb.
Functions

  • The cervix allows the flow of menstrual blood from the uterus into the vagina
  • It also directs the sperms into the uterus during intercourse.

Cancer

Cancer is the uncontrolled growth of abnormal or mutated cells in any part of the body.

Cervical Cancer

When the cells in the cervix become malicious and start growing in an uncontrolled way, resulting in a lump or tumour then this condition is termed as Cervical Cancer.

Types:

Cervical Cancer is categorized into two main types based on the cells that get mutated. They are:

  • Squamous cell carcinoma: Cancer that begins in the thin, flat cells that line the bottom of the cervix is termed as Squamous cell carcinoma. This is the most common type of Cervical Cancer accounting to 80-90%.
  • Adenocarcinoma: Cancer that occurs in the glandular cells lining the upper portion of the cervix is called adenocarcinoma. 10 to 20 % of Cervical Cancers are under this group.
Anatomy of Cervical

cervical-cancer

What are the general symptoms of Cervical Cancer?

In most cases, Cervical cell abnormality rarely causes any notable early symptoms. But with the passage of time as the Cancer spreads and grows following symptoms can be spotted:

  • Unusual bleeding from the vagina.
  • Bleeding after sex or after menopause.
  • Pain in the lower belly or pelvis.
  • Pain during sexual intercourse.
  • Unusual Vaginal discharge.
What are the general causes of Cervical Cancer?
  • Most Cervical Cancer is caused by a virus called human papillomavirus, or HPV. One may get infected by HPV by
    • Having sexual contact with someone who has it.
    • Unsafe sexual practices with multiple people.
  • Giving birth to many children
  • Having first sexual intercourse at a young age
  • Smoking cigarettes.
  • Using oral contraceptives.

There are many types of the HPV virus. Not all types of HPV cause Cervical Cancer. Some of them cause genital warts, but other types may not cause any symptoms.

Can Cervical Cancer be prevented?

Some of the causes of Cervical Cancer are known while some causes are yet under the veil. So we have a few precautionary measures that might help in avoiding the disease.

  • As the most prevalent cause of Cervical Cancer is HPV virus, getting HPV vaccination before the age of 26 comes as a precautionary measure.
  • Going through a Pap test is the best way to find Cervical cell changes that can lead to Cervical Cancer. Most women are advised to get a Pap test starting at age 21.
  • Regular Pap tests almost always show these cell changes before they turn into Cancer. This may help prevent Cervical Cancer.
  •  Practicing safe sex using condoms/protection; limiting the number of sex partners.
What is a Pap Smear Test?

Pap Smear Test:

A Pap smear test is a microscopic examination of cells taken from the uterine cervix. It tests for the presence of preCancerous or Cancerous cells on the cervix. Having regular Pap tests is the best way for women to protect themselves against Cervical Cancer. A Pap test looks for changes to the cells of the cervix that, if left untreated for a number of years, could develop into Cancer.

A Pap test is conducted to detect certain viral infections or abnormal cells, which is known to cause Cervical Cancer. Early treatment of preCancerous changes detected on the Pap smear helps in stopping Cervical Cancer before it fully develops.  Pap tests are very accurate, and regular Pap screenings reduce Cervical Cancer rates and mortality by 80 percent.

The incidence of Cancer and deaths from Cervical Cancer has significantly declined over the years because of prevention, screening, and early detection by the Pap smear. Most abnormal Pap smear results indicate the early stages of the disease.

Preparing for Pap test

On the day of the Pap test, it is highly suggested to stay as relaxed as possible as this will help ensure any physical discomfort is kept to a minimum. For most accurate results of the Pap test one must ensure that:

  • She is not menstruating as Pap test conducted during menstruation might be less accurate.
  • Avoid intercourse/vaginal medicines/vaginal contraceptives the day before the test.
  • Pap Test can be done in the first 24 weeks of pregnancy.

Procedure for Pap Smear Test

  • The patient is laid flat on the back on an examination table with legs spread, knees bent and feet resting in supports called stirrups.

  • A device called a speculum is slowly inserted into your vagina to keep the vaginal walls open and get access to the cervix.

  • Then a small sample of mucus and cells is scraped from the cervix using either a spatula, or a spatula and a brush, or a cytobrush.
  • The sample is then preserved properly and is sent to the lab for tests.
  • This procedure takes about 10 - 15 minutes to be completed.
  • It may cause a slight discomfort due to the scrapping in most of the women. However, it should not be painful, if any pain is experienced it is advised to discuss it with the doctor.

Result of Pap Smear Test

The result of the test is either normal i.e. negative or abnormal i.e. positive.

Normal Pap smear: It means that no abnormal cells were identified and there is no need of a Pap smear for another three years.

Abnormal Pap smear: Abnormal doesn’t necessarily signify the presence of Cancer. Rather, it might indicate the presence of abnormal cells or inflammation of cells on the cervix, some of which could be preCancerous. There are several levels of abnormal cells:

  • atypia
  • mild
  • moderate
  • severe dysplasia
  • carcinoma in situ

Pap Test is highly recommended for:

  • Those diagnosed with HIV-positive
  • People having Multiple sexual partners
  • Having been exposed to diethylstilbestrol (DES) before birth
  • Those who have a weakened immune system from chemotherapy or an organ transplant

How often the Pap Smear Test needs to be done?

PapScreen Victoria recommends all women aged 18 to 70 who have ever been sexually active have a Pap test every two years. Sexual activity includes genital-skin to genital-skin contact, not just intercourse. This is why even if you are a virgin you may still need to have Pap tests.

Age Sexual Status Frequency
<21 Inactive Not needed
<21 Active every 3 years
21-29 Active/Inactive every 3 years
30-65 Active/Inactive 3-5 years
>65 Active/Inactive Not needed
What are the stages of Cervical Cancer?

Cervical Cancer is staged using the TNM system of staging.

  • T(Tumour):  It describes the size of the tumour
  • N(Node): indicates if the lymph nodes are affected
  • M (Metastasis): denotes the spread of Cancer to distant part.
  • Stage 0 : Cancer cells are confined to the surface of the cervix.
  • Stage I: Cancer cells have grown deeper into the cervix. Stage I is categorized as:
    • Stage IA (T1a, N0, M0): The area of Cancer spread is less than 3 mm deep and 7 mm wide.
    • Stage IB (T1b, N0, M0): The area of Cancer cells spread is between 3 mm to 5 mm and less than 7mm wide.
  • Stage II : The Cancer has grown beyond the cervix and uterus, but has not reached the walls of the pelvis or the lower part of the vagina. This type is further sub typed as
    • Stage IIA (T2a, N0, M0): The Cancer has not spread into the tissues next to the cervix, but it may have grown into the upper part of the vagina. It’s size is not larger than 4 cm.
    • Stage IIB (T2b, N0, M0): The Cancer has spread into the tissues next to the cervix and its size is usually larger than 4cm.
  • Stage III: The Cancer has spread to the lower part of the vagina or the walls of the pelvis, but not to nearby lymph nodes or other parts of the body. At this stage, the Cancer might start blocking the uterus. Stage III is further sub typed as
    • Stage IIIA (T3, N0, M0): The Cancer has spread to lower part vagina but not to the walls of the pelvis.
    • Stage IIIB (T3b, any N, M0): The Cancer has grown into the walls of the pelvis and/or has blocked one or both ureters. This gives rise to several kidney problems.
  • Stage IV : This is the last or final stage of Cervical Cancer stage, the disease has spread to nearby organs or other parts of the body. It is classified into two subcategories:
    • Stage IVA (T4, any N, M0): The Cancer has spread to the bladder or rectum, but not to distant sites.
    • Stage IVB (any T, any N, M1): The Cancer has spread to other parts of the body.
  • Stage IVA (T4, any N, M0): The Cancer has spread to the bladder or rectum, but not to distant sites.
  • Stage IVB (any T, any N, M1): The Cancer has spread to other parts of the body.
Survival rates of Cervical Cancer?

Survival rate speaks about the general statistics based on the outcome of large groups of patients. However, these survival rates can’t precisely predict the outcome or prognosis of any individual case. A number of factors like age, health and family record etc., play a vital role in determining an individual’s survival rate.

Cervical Cancer is highly curable when detected at an early stage and the chances gradually decline with each passing stage and may prove to be fatal if waited till the last stage. However, it might bring some relief to know that most cases of Cervical Cancer are detected at an early stage through Pap test.

The statistics for 5 year survival rate are as follows:

Stage of Cancer 5 year Survival Rate
Stage I 95%
Stage II 50%
Stage III 40%
Stage IV 5%
Can Cervical Cancer be detected early?

The good thing is that Cervical Cancer can be found at a very early stage through a Pap test.

  • Pap test : In a pap test, a small sample of cells is scraped from the surface of the cervix to look for cell changes.
  • Pelvic examination : In this examination, the patient’s uterus, vagina, ovaries, fallopian tubes, cervix, bladder, and rectum are checked thoroughly for any unusual changes.
  • Biopsy: Sometimes a pap test is followed by a biopsy to confirm the presence of Cervical Cancer.
    Some other tests to detect Cancer are:
    • X Ray
    • CT scan
    • MRI
    • PET scan
    • Cystoscopy
    • Proctoscopy 
    • Laparoscopy
What are the Treatments available?

Cervical Cancer can often be successfully treated when it's found early. Treatment options depend on several factors including:

  • The stage of the Cancer.
  • The type of Cervical Cancer.
  • The patient's desire to have children.
  • The patient’s age.

The treatment for most stages of Cervical Cancer includes:

  • Surgery: Surgery is the procedure of removal of the tumour and some surrounding healthy tissue during an operation. For treating Cervical Cancer, following procedures can be opted:
    • Conization is the procedure of removing all of the abnormal tissue. It can be used to remove micro invasive Cervical Cancer.
    • LEEP is the use of an electrical current passed through a thin wire hook. The hook removes the tissue. It can be used to remove micro invasive Cervical Cancer.
    • Hysterectomy is the removal of the uterus and cervix. Hysterectomy can be either a simple hysterectomy or a radical hysterectomy. A simple hysterectomy is the removal of the uterus and cervix. A radical hysterectomy is the removal of the uterus, cervix, upper vagina, and the tissue around the cervix.
    • Bilateral salpingo-oophorectomy is the removal of both fallopian tubes and both ovaries. It is done at the same time as the hysterectomy. This is usually not performed if not utmost necessary as this leads to infertility.
    • Radical trachelectomy is surgery to remove the cervix that leaves the uterus intact with pelvic lymph node dissection. It may be used for young patients who want to preserve their fertility. This procedure has gained acceptance as an alternative to a hysterectomy for some patients.
    • Exenteration: This involves the removal of the uterus, vagina, lower colon, rectum, or bladder. This is rarely required and is usually used in case of recurrence of Cancer.
  • Chemotherapy: Chemotherapy is the use of drugs to destroy Cancer cells or inhibit their growth.  For treating Cervical Cancer, chemotherapy is given with radiation therapy to increase the effectiveness of radiation therapy.
  • Radiation therapy: Radiation therapy is the use of high-energy x-rays to destroy Cancer cells. Radiation therapy imparted externally through a machine is called external radiation therapy and if it is given using implants then it is called internal radiation therapy.
  • Targeted Therapy : Targeted therapies are drugs that interfere with one specific property or function of a Cancer cell, rather than acting to kill all rapidly growing cells indiscriminately. This means there is less damage to normal cells with targeted therapy than with chemotherapy. One common targeted therapy drug used to treat Cervical Cancers is bevacizumab a monoclonal antibody and angiogenesis inhibitor that may be used in combination with cisplatin a chemotherapy treatment.
How frequently should one visit doctor for early diagnosis?

It is highly recommended to visit the doctor and take a Pap test before the age of 21. If one is detected with Cervical Cancer then the regular sessions as recommended by the doctor should not be skipped!

How can I as a patient know it early?

As mentioned time and again, go for the Pap test and don’t let this health hazard skip your notice.

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