• Category: Women's Health
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Cervical Cancer at a Glance

Cervical Cancer is the fourth most common cancer in the world.

Cervical cancer occurs when the abnormal cells in the lining of the cervix (the entrance from the womb to the vagina) begin to grow in an uncontrolled way. The cells continue to grow and begin to form a growth also known as a tumor. If the tumor is not detected early, the cancer cells continue to grow into the surrounding tissues and eventually spread to other areas of the body. Cervical cancer usually affects sexually active women between the ages of 30-45.

Cervical cancer is often confused with ovarian cancer. Although these are both cancers that occur in the reproductive system, they occur in different parts of the reproductive system. Ovarian cancer originates in the fallopian tubes and occurs in the ovaries. In contrast, cervical cancers occur in the cervix the lower part of the uterus where it connects to the upper end of the vagina.

Pre-Cervical Cancer

Precancerous Cervical cancer grows very slowly and develops from abnormal cells, these cells are called pre-cancerous cervical cells. These cells are not yet cancer but if left untreated may develop into cancer.

Types of Cervical Cancer

There are two main types of cervical cancer Squamous cell carcinoma and adenocarcinoma.

  • Squamous Cell Starts in the cells that cover the outside of the cervix (exocervix)
  • Adeno Carcinoma Starts in the cells found in the cervical canal (the endocervix)

Other rarer types of cervical cancer include adenosquamous carcinoma, clear cell carcinoma neuroendocrine or smaller cell carcinoma of the cervix, lymphoma, and sarcoma. These types of cancers are less common and may be treated differently.

Risks and Causes

Several risk factors can increase your chance of developing cervical cancer.

  • Human Papilloma Virus (HPV): Almost 99% of cervical cancers are linked to HPV infection. Many types of HPV can infect the cervix, however, only some of them can cause abnormal cell changes which turn into cervical cancer.
  • A weak immune system: Having a weakened immune system and viruses such as human immunodeficiency disease (HIV) which causes AIDS, put these women at a greater risk for HPV infections. Women who also take drugs to suppress the immune system, such as drugs for autoimmune diseases or following an organ donation are also at increased risk
  • Contraceptive pill: Taking the contraceptive pill for more than 5 years increases your risk of developing cervical cancer. Although research has found that the risk reduces and returns to normal years after the administration of the contraceptive pill is stopped.
  • Smoking: Women who smoke are twice as likely to develop cervical cancer than those women who do not or have never smoked.  This is because tobacco by-products have been found in the cervical mucus of women who smoke.
  • Family history: If your mother or sister had cervical cancer, you are at higher risk of developing cervical cancer than if no one in the family had it.
  • Multiple pregnancies or first pregnancy at a young age: women with more than three children or who were younger than 20 years of age are at increased risk of cervical cancer than women who had their first pregnancy over the age of 25 years and less than 3 children.
  • Sexually transmitted diseases: Women who have a sexually transmitted infection (STI) alongside HPV may be at an increased risk of developing cervical cancer. Some studies show that Chlamydia bacteria may help HPV grow and live on the cervix which may increase the risk of cervical cancer. This has been shown in women with past and current Chlamydia infection.

Symptoms

Precancerous cells and early cervical cancers don’t usually present with symptoms. Therefore it is always recommended to attend regular cervical screening. Symptoms that may be experienced include:

  • Pain, discomfort, or bleeding during sex.
  • Vaginal discharge that smells unpleasant or offensive
  • Unusual vaginal bleeding.
  • Pain, discomfort in the pelvis (e.g hip bones)

It is important to remember that these symptoms can also be experienced with other medical conditions and may not indicate cervical cancer.

Prevention of Cervical Cancer

Most cervical cancers start with changes in pre-cancerous cells. There are effective ways to stop these cells from developing. This includes preventing the pre-cancerous cells and finding and treating the precancerous cells. This can be done by either regular screening, taking the Human Papilloma Vaccine, or reducing risk factors.

Human Papilloma Virus (HPV) Vaccine

The HPV vaccine is for young children and young adults and aims to protect against certain types of  HPV infection. The vaccine protects against the most commonly associated HPV infections linked to cancer and in some cases can protect against genital and anal warts.  The vaccine is not effective against those who have already been exposed to the HPV virus. The vaccine is commonly given to children aged between 9-13 years. The vaccination does not provide complete protection and therefore regular screening is also recommended.

Limiting Exposure to HPV

Another effective method of preventing cervical cancer is to limit your exposure to the HPV infection. As the HPV infection is passed through close contact with infected individuals using protection during sexual intercourse can help reduce the potential exposure. Although sexual contact does not have to occur to contract the HPV infection, it is still advised to utilize condoms during sexual intercourse. Condoms do provide some protection against HPV infections and other sexually transmitted infections and also human immunodeficiency disease (HIV) which are also risk factors for cervical cancer.

Cervical Screening

The most effective way to prevent cervical cancer and a proven method to save lives is through regular screening. Precancerous cell changes often do not have symptoms, and therefore cervical screening programs aim to detect abnormal changes in cells and prevent cervical cancer from developing. Cervical screening tests include an HPV test and a SMEAR test also known as a Papanicolaou (PAP) test. Both of these types of screening tests can be undertaken at the same time as each other.

  • HPV TEST: Tests to see if the HPV infection is present.
  • SMEAR/ PAP TEST: This test checks for any abnormal cell changes in the cervix.

These tests involve collecting a sample of cells from your cervix. Both of these tests can be taken at the same time using the same swab or a separate swap. The cervical screening exam should take around 10 mins. It can be slightly uncomfortable and you may experience light bleeding on spotting following your examination.

Screening Results

Normal Results

  • Approximately 7/8 Screening tests are normal.
  • Screening will be repeated every 3-5 years following a normal result.

Abnormal Results

Changes to the cells of the cervix are called dyskaryosis. If you get abnormal results, this does not mean you have cancer. It means these cells might develop into cancer if they are not treated. Abnormal results mean one of the following:

  • You have HPV, but your cells look normal: If you have HPV, but your cells look normal you will be invited back for another screening evaluation in 1 year to check if the HPV is still present.
  • You have HPV and borderline or mild changes to your cells: If you have HPV and mild changes to your cells you will be invited for further testing to examine your cervix more closely. This is called a colposcopy and is usually undertaken within 6 weeks of an abnormal result. These mild changes very rarely develop into cancer. If treatment is required, it is usually undertaken at the same time as your colposcopy.
  • You have HPV and moderate-severe changes to your cervical cells: If you have HPV and Moderate-severe changes to your cervical cells, you will be invited for a colposcopy to examine your cervix and remove any precancerous cells if required. The colposcopy is usually undertaken within 6 weeks of your abnormal result. It is still unlikely you will have cancer with severe cell changes; however, these cells are unlikely to return to normal without treatment.

Further Screening and Treatment of Pre-Cancerous Cells

Colposcopy

Following an abnormal result, you may be referred for a colposcopy. This procedure involves examining the cervix with a colposcope and removing a biopsy sample of tissue from the transformation zone. The tissue is sent to the lab to examine the cells for cancer. This procedure can be used to treat precancerous cells and very early cancers. Several techniques can be used to take the biopsy and remove abnormal cells.

Large Loop Excision of the Transformation Zone (LLETZ)

Also known as a loop biopsy, loop electrosurgical excision, or loop diathermy. This treatment uses a thin wire with an electric current running through it to remove the tissue from the transformation zone (the area around the opening of the cervix). This procedure usually takes around 10 minutes and is performed under local anesthetic. This is the most common treatment for abnormal cervical cells,

Needle Excision of the Transformation Zone (NETZ)

This is a similar procedure to the loop biopsy, but the thin wire is shaped in a straight line rather than a loop. This treatment may be recommended if there are abnormal cells present in the cervical canal.

Cold Knife Cone Biopsy

This treatment involves removing a cone-shaped piece of tissue from the transformation zone using a surgical scalpel. This treatment is usually undertaken under a general anesthetic and may require an overnight stay in the hospital.

Other Treatment Types

Instead of removing the precancerous cells, other methods of treatment include destroying the abnormal cells:

  • Laser treatment – A laser is used to destroy the abnormal cells on your cervix.
    • Cryotherapy- Using a cold probe the abnormal cells are frozen and destroyed.
    • Cold coagulation- Despite the name, this treatment involves using a heated probe to burn and destroy abnormal cells.

Hysterectomy

In some cases, this treatment method may be considered if abnormal cells on your cervix have been found more than once if you’re past the child-bearing age and do not want more children, and or if you have several abnormal cells.

After Your Treatment

Although you will not be able to feel these treatments at the time, after your treatment you may experience cramping and bleeding. These can be managed with the use of over-the-counter pain relief and a menstrual pad.  Unless you have had a hysterectomy, treatment should not affect your chances of being pregnant in the future. Some of the treatments may slightly increase the risk of pregnancy complications such as premature birth (birth before 37 weeks) This is usually following multiple treatments.

If the results come back normal following your colposcopy, you will be invited for a follow-up at 6 months. This is increased to 1 year if your results are normal at a 6-month follow-up. Approximately 4/5 of women will have a normal result following treatment. If the results are abnormal again at 6 months, you will be invited for another colposcopy.

Diagnosis of Cervical Cancer Following an Abnormal Biopsy Result.

If your biopsy following your colposcopy shows you have cervical cancer, you will be referred for further diagnostic testing to see if cancer has spread further than the cervix and to determine the best treatment. Diagnostic testing includes:

  • Blood Test—A blood test may be undertaken to check your blood count (how many blood cells are in your blood), how well your kidneys are working, and your overall general health.
  • Chest X-Ray – A chest x-ray uses a small dose of radiation to check for signs of cancer in your chest.
  • MRI – Using magnetism and radio waves an MRI creates a picture and can show abnormal areas in the lymph nodes and other areas of the body.
  • CT Scan- A CT scan uses x-rays and a computer to create a detailed picture of the inside of your body.
  • PET-CT scan -This is an imaging test that uses radiotracers to assess organ and tissue functions and is combined with a CT scan to give detailed information about your cancer.
  • Pelvic examination under a general anesthetic: an internal examination that checks your cervix, vagina, womb, bladder, and rectum (back passage).

Stages and Treatment of Cervical Cancer

Following a diagnosis, your doctor needs to evaluate if cancer has spread and if it has how far cancer has spread this is called staging.  Cancer staging ranges from 1-4. The general rule of staging is that the lower the number, the less cancer has spread, and the higher the number, the more advanced the cancer is. Each stage has a sub-division represented by a letter which refers to the size of the cancer.

STAGES

  • Stage One: The cancer is in the cervix only.                                    

Treatment: The main treatment is surgery. Some people need chemotherapy too.

  • Stage Two: The cancer has spread beyond the cervix and into the surrounding tissues.

Treatment: The main treatment is a combination of Surgery, Chemotherapy, and Radiotherapy

  • Stage Three: The cancer has spread beyond the cervix and into the tissues surrounding the cervix or into the lymph nodes, abdomen, or pelvis.

Treatment: The main treatment is a combination of Surgery, Chemotherapy, and Radiotherapy

  • Stage Four: The cancer has spread to the bladder, bowel, or beyond the pelvis.

Treatment: The main treatment is a combination of Surgery, Chemotherapy, Radiotherapy, and targeted drug therapy or symptom control.

Treatment of Cervical Cancer

Surgery

The main treatment for cervical cancer is surgery. In some cases, you may also have chemotherapy, radiotherapy, targeted drug therapy, or a combination.

There are three main types of surgery used to treat cervical cancer.  These include:

  • Radical Trachelectomy: Surgery to remove the cervix and the upper part of the vagina. This surgical procedure leaves the womb in place, and therefore it is possible to have a baby afterward. This type of surgery is often only indicated for stage one cervical cancer and for those who wish to get pregnant in the future.
  • Hysterectomy Surgery

There are two types of hysterectomy surgeries. Both surgeries result in you being unable to have children in the future.

  • Simple Hysterectomy– The cervix and womb are removed and, in some cases, also the ovaries and fallopian tubes. This is only appropriate for early-stage cervical cancers.
  • Radical Hysterectomy- The cervix, womb, top of the vagina, surrounding tissue, lymph nodes, fallopian tubes, and sometimes ovaries are all removed.
  • Pelvic Exenteration- This is a major operation that involves the removal of the cervix, vagina, womb, ovaries, fallopian tubes, bladder, and rectum.

Possible side effects of surgery are bleeding, your vagina narrowing causing painful sex, urinary incontinence, swelling of the arms and legs and your bowel being blocked, requiring further surgery.

Chemotherapy

Depending on the stage of your cancer, you might have chemotherapy before or after your surgery and, in some cases, both. Chemotherapy can also be combined with radiotherapy for the treatment of cervical cancer. Chemotherapy uses anticancer drugs that circulate throughout the body in the bloodstream to destroy cancer cells.

Typical side effects of chemotherapy include:

  • Loss of appetite
  • Nausea and or diarrhea
  • Feeling tired all of the time
  • Mouth ulcers
  • Hair loss- Cisplatin (a type of anticancer drug) does not cause hair loss but other chemotherapy drugs may.
  • Reduced production of blood cells, causing an increased risk of infection and breathlessness.

Radiotherapy

Radiotherapy uses radiation to kill cancer cells. Radiotherapy can be given externally to your pelvis to destroy cancer cells. Or externally also known as brachytherapy, which uses a radioactive implant placed next to the tumor inside your body to destroy the cancer cells. This type of radiotherapy targets the affected area only reducing the damage to healthy tissues. 

Some of the typical side effects of chemotherapy include:

  • Pain during urination.
  • Nausea and vomiting and or diarrhea.
  • Feeling tired all of the time.
  • Sore skin like sunburn.
  • Damage to the ovaries (triggering early menopause), bladder, and bowel (leading to incontinence).
  • Reduced production of blood cells, causing an increased risk of infection and breathlessness.
  • Bleeding from the rectum or vagina.

Targeted Cancer Drugs

Targeted cancer drugs change the way that cells work and help the body control the growth of cancer and are often used in combination with chemotherapy. Targeted therapy will not cure cancer.

Possible side effects include:

  • High blood pressure.
  • Headaches.
  • Feeling sick.
  • A sore mouth.
  • Tiredness.
  • Diarrhea.

Disclaimer

** The information presented here is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. All content, and information, contained on or available through this website is for general information purposes only.

Sources

1. Targeted therapy for cervical cancer – Macmillan Cancer Support. Macmillan.org.uk. https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/targeted-therapy-for-cervical-cancer. Published 2021. Accessed February 4, 2021.

2. Cervical screening (smear testing) | Health Information | Bupa UK. Bupa.co.uk. https://www.bupa.co.uk/health-information/womens-health/cervical-screening. Published 2021. Accessed February 4, 2021.

3. Cervical cancer. Who.int. https://www.who.int/health-topics/cervical-cancer#tab=tab_1. Published 2021. Accessed February 4, 2021.

4. Cervical Cancer Surgery | How to Remove Cervical Cancer. Cancer.org. https://www.cancer.org/cancer/cervical-cancer/treating/surgery.html. Published 2021. Accessed February 4, 2021.

5. Chemotherapy | Cervical cancer | Cancer Research UK. Cancerresearchuk.org. https://www.cancerresearchuk.org/about-cancer/cervical-cancer/treatment/chemotherapy. Published 2021. Accessed February 4, 2021.

6. Cervical cancer – Treatment. nhs.uk. https://www.nhs.uk/conditions/cervical-cancer/treatment/. Published 2021. Accessed February 4, 2021.

7. BREAST CANCER – GENERAL. https://www.cancer.be/. https://www.cancer.be/les-cancers-types-de-cancers-liste-z/cancer-du-seinhttps://www.cancer.be/les-cancers-types-de-cancers-liste-z/cancer-du-sein. Published 2021. Accessed February 4, 2021.

8. Human papillomavirus (HPV) – Public Health – European Commission. Public Health – European Commission. https://ec.europa.eu/health/vaccination/hpv_en. Published 2021. Accessed February 4, 2021.