Cervical cancer: Causes, symptoms and treatment

Cervical cancer occurs when there is abnormal growth of the cells of the cervix, that invade other tissues and organs of the body. When it invasive, it affects the deeper tissues of the cervix and may have spread to other parts of the body (metastasis), for instance the lungs, liver, bladder, vagina and rectum. Though cervical cancer is slow-growing, if not detected and treated early, it can be life-threatening.

Cervical cancer occurs in the cells of the cervix (the neck of the womb), the lowest part of the uterus (womb) that connect the uterus with the vagina. In a nutshell, it affects the entrance to the womb. When cells in the cervix become abnormal and multiply rapidly, cervical cancer is born. The cancer in its early stages, produces no symptoms at all. Therefore, women should have regular cervical smear tests, or pap tests.

Cancer arises as a result of uncontrolled division and growth of abnormal cells, when normal healthy cells get a genetic change (mutation) that causes them to turn into abnormal cells. Unlike normal cells (grow and multiply at a set rate) in our bodies that have a set lifespan and when they die, the body generates new cells to replace them, abnormal cells (grow and multiply out of control) do not die and they continue dividing.

The cumulating abnormal cells result in an excessive build-up of cells, which eventually forms a lump, or tumor. Cancer cells invade nearby tissues and can break off from a tumor to spread (metastasize) elsewhere in the body. Human Papilloma Virus (HPV), a type of virus that is sexually transmitted, is the cause almost all of the cases of cervical cancer. When exposed to HPV, the immune system is weakened and therefore unable to fight the virus.

The virus can survive for several years in the body, that will late facilitate the process that cause the cells of the cervix to become cancer cells. Regular screening tests and receiving a vaccine can help protect against HPV infection. In most cases precancerous changes in the cervix are detected in women at 20s and 30s, but cervical cancer can be diagnosed when a woman is even in her mid-50s. This highlights the slow progressive nature of the disease, and thus can be suppressed completely if adequate steps are taken towards its treatment.

Types of cervical cancer

There two main common types of cervical cancer. It’s important to know which one someone is ailing from in order to determine the prognosis and treatment.

• Adenocarcinoma: This type of cervical cancer begins in the column-shaped glandular cells that line the cervical canal.
• Squamous cell carcinoma: This type of cervical cancer begins in the thin, flat cells (squamous cells) lining the outer part of the cervix, which projects into the vagina. Most cervical cancers are squamous cell carcinomas.

Sometimes  both the glandular and squamous cells may be involved in the cancer. But its very rare for cervical cancer to occur in the other cells in the cervix.

Causes of cervical cancer

1. Cigarette smoking: The risk of getting cervical cancer in women smokers is 2 to 5 times compared with the general population of women. This is because the chemicals found in the cigarette smoke interact with the cells of the cervix, causing precancerous changes that may over time progress to cancer. Smoking often leads to squamous cell cervical cancer.
2. Oral contraceptives (Birth control pills): If taken in the long-term, especially longer than five years, may increase the risk for cervical cancer.
3. Sexually Transmitted Diseases (STDs): Like Chlamydia, gonorrhea and syphilis, increase the risk of developing cervical cancer.
4. Weak immune system: Women who have weakened immune system are at risk of developing cervical cancer. For instance, those with HIV & AIDS, another health condition, have HPV or those who have undergone a transplant, leading to the use of immunosuppressive medications.
5. HPV: HPV is a sexually transmitted virus. HPV causes a majority of cervical cancers. 13 out of the 100 different types of HPV that occur, may cause cervical cancer. Certain strains of this virus cause normal cells to become abnormal, which in turn over years become cancerous.
6. Many sexual partners: Having many sexual partners puts one on a higher risk of acquiring HPV, which in turn increases their risk of developing cervical cancer.
7. Early sexual activity: Having sex at an early age increases one’s risk of HPV.
8. Diethylstilbestrol (DES): Women who used this drug, in the 1970s when it was in the market, while pregnant as a way of preventing miscarriage, exposed their newly born daughters to risk of developing cervical cancer as they grow. DES has been linked with causing abnormal cells in the cervix and vagina.

Symptoms (signs) of cervical cancer

The early stages of cervical cancer don’t normally produce any symptoms or signs. Until in its advanced stages is when most symptoms start to show off. They may include:

1. Pain during urination.
2. Pelvic pain.
3. Pain during sexual intercourse.
4. Urinating more frequently.
5. Bloody, watery vaginal discharge in unusual amount that may be heavy and have a foul odor.
6. Kidney failure due to a urinary tract or bowel obstruction, in the advanced stages of the cancer.
7. Abnormal bleeding:
   • Between menstrual periods.
   • After sexual intercourse.
   • After a pelvic exam.
   • After menopause.

Stages of cervical cancer

Understanding the stages of cervical cancer is very important, in order to know the kind of treatment one needs. Staging helps assess the effect of the cancer to the victim, for instance how far it has spread, the kind of damage it has done to the nearby body structures and if it has destroyed vital organs regardless of how far they are from the cervix.

Cervical cancer occurs in four stages:

• Stage 0: The precancerous cells are present.
• Stage 1: At this stage, the cancer cells have grown from the surface into deeper tissues of the cervix. And in some instances, they have grown into the uterus and to nearby lymph nodes. In early stage 1, the chance of surviving at least 5 years is 93%, and in late stage 1, it is 80%.
• Stage 2: At this stage, the cancer has spread beyond the cervix and uterus, but not as far as the walls of the pelvis or the lower part of the vagina. It may or may not affect nearby lymph nodes. In early stage 2, the chance of surviving at least 5 years is 63%, and in late stage 2, it is 58%.
• Stage 3: At this stage, cancer cells are now present in the lower part of the vagina or the walls of the pelvis. The cancer may also be blocking the ureters. It may or may not affect nearby lymph nodes. In early stage 3, the chance of surviving at least 5 years is 35%, and in late stage 3, it is 32%.
• Stage 4: At this stage, the cancer affects the bladder or rectum and is growing out of the pelvis. It may or may not affect the lymph nodes. As the cancer gets severe, later in stage 4, it will spread to distant organs, including; the liver, bones, lungs, and lymph nodes. During this stage, the chance of surviving at least 5 years stand between 15% to 16%.

Prevention of cervical cancer

To reduce the risk of developing cervical cancer, one should take the following measures:

1. Get vaccinated against HPV: The vaccine is more effective if administered to girls and women between ages 9 to 26 before they become sexually active.
2. Avoid smoking: Mostly cigarette smoking.
3. Practice safe sex: If you must have sex with a partner whose health condition you don’t know, then use a condom. Also try to have having fewer sexual partners.
4. Delay first sexual intercourse: A young girl who engages in early sexual intercourse for the first time is at a very high risk of contracting HPV. The longer the delay, the lower the risk.
5. Have routine Pap tests: A Pap test is preventive. It aims not to detect cancer but to reveal any cell changes that indicate the possible development of cancer so that a person can take early action to treat it. It’s advisable that women should have regular cervical smear tests or pap tests.
6. Cervical screening: Having regular cervical screening can help one identify the signs of cervical cancer (by indicating the changes to the cells of the cervix) and deal with it before it advances.

Diagnosis of cervical cancer

Diagnosis is normally done to determine if one has abnormal cells in her cervix that can lead to cervical cancer. This process is important in identifying if one has already be affected by the cancer and if so, what stage she is in. This will in turn help in deciding the appropriate treatment for the patient. Diagnosis of cervical cancer can be done using the following methods:

1. A pap test: It is used to diagnose the presence of abnormal and potentially cancerous cells. This involves swabbing the cervix with a device that’s similar to a cotton swab. The swab is then sent to a laboratory to be examined for precancerous or cancerous cells. It’s recommended to be done more frequently by women with HIV, long-term steroid use or those who have undergone an organ transplant.
2. Cervical smear test: It’s done to identify abnormal changes in the cells of the cervix.
3. The HPV DNA test: It’s very similar to a Pap test. The doctor collects cells from the cervix through swabbing. The swab is sent to a laboratory to test the cells for the presence of genetic material associated with HPV. This includes DNA or RNA of known HPV strands. The test can detect high-risk HPV strains in cell DNA before any anomalies become clear in the cervical cells. If there are signs and symptoms of cervical cancer, or if the Pap test reveals abnormal cells, additional tests may be recommended. Such as:
   • Colposcopy: Visual examination of the vagina using a speculum and a colposcope, a lighted magnifying instrument.
   • CT scan: Using a barium liquid to show up any cellular abnormalities.
   • MRI: Special types of MRI to help identify cervical cancer in its early stages.
   • Biopsy: Extracting a small section of tissue under general anesthesia.
   • Cone biopsy: Extracting a small, cone-shaped section of abnormal tissue (deeper layers of cervical cells) from the cervix for examination. A special magnifying instrument (colposcope) is used to check for abnormal cells. A sample of cervical cells (biopsy) is obtained for laboratory testing. It can be done through; punch biopsy, which involves using a sharp tool to pinch off small samples of cervical tissue, or endocervical curettage, which uses a small, spoon-shaped instrument (curet) or a thin brush to scrape a tissue sample from the cervix.
   • LLETZ (Electrical wire loop): Diathermy using a wire loop (a thin, low-voltage electrical wire) with an electric current to help remove abnormal tissue. The tissue then sent to the lab for checking.
   • Pelvic ultrasound: High-frequency sound waves to create an image of the target area on a monitor.
   • Examination under anesthesia (EUA): Examination of the vagina and cervix more thoroughly.
   • Blood tests: A blood cell count to help identify liver or kidney problems.
4. Staging: If one is found to have cervical cancer, further tests will be done to determine the extent (stage). This is important so as to aid in deciding the appropriate form of treatment. Staging exams include:
   • Imaging tests: Tests such as X-rays, CT scans, magnetic resonance imaging (MRI) and positron emission tomography (PET) help determine whether the cancer has spread beyond the cervix.
   • Visual examination of the bladder and rectum: Done using special scopes to see inside the bladder and rectum.

Treatment of cervical cancer

When cervical cancer is detected in its earliest stages, when it’s still confined in the cervix, it’s considered one of the most treatable cancer types. The further the cancer spreads from its original area, the lower the treatment success rate. In treating cervical cancer different factors are taken into consideration, such as age, stage of cancer, overall state of health and the preferences of the patient. The following methods can be used in treatment.

1. Surgery

The early stages of the cancer can be treated with surgery to remove the uterus (hysterectomy). This can help cure the cancer in its early stages and prevent recurrence. But the major issue is that, removing the uterus makes it impossible someone to become pregnant. It can be done in two ways:

• Simple hysterectomy: This is option only applies in the very early stage of cervical cancer, where the cervix and uterus are removed along with the cancer.
• Radical hysterectomy: The cervix, part of the vagina, uterus and lymph nodes in the area are removed with the cancer.

A minimal invasive surgery or surgery that preserves the possibility of becoming pregnant without lymph node involvement, may be options too in the very early stage of cervical cancer.

2. Radiation therapy

Radiation therapy (radiation oncology or XRT) is often used if cancer cells are present inside the body. It reduced the risk of recurrence. Radiation therapy can be used alone or even combined with chemotherapy, either before surgery to shrink a tumor or after surgery to destroy any remaining cancer cells. Radiation therapy uses high-powered energy beams, such as X-rays or protons, to kill cancer cells. Radiation therapy can be administered:

• Internally, by placing a device filled with radioactive material inside your vagina, usually for only a few minutes (brachytherapy).
• Externally, by directing a radiation beam at the affected area of the body (external beam radiation therapy).
• Both internally and externally.

Radiation therapy may result in the following side effects:

• Diarrhea
• Nausea
• Upset stomach
• Bladder irritation
• Narrowing of the vagina
• Interrupted menstrual cycle
• Early menopause

3. Chemotherapy

Chemotherapy utilizes medications, normally injected into a vein, to kill cancer cells. Higher doses of chemotherapy can be used to control advanced cervical cancer if it cannot be cured. Low doses of chemotherapy can be combined with radiation therapy, to enhance the effects of radiation. Chemotherapy is also used to target cancer cells that surgery cannot or did not remove, or to help the symptoms of people with advanced cancer. Chemotherapy can result in the following side effects:

• Diarrhea
• Nausea
• Hair loss
• Fatigue
• Infertility
• Early menopause

4. Supportive (palliative) care

Palliative care is a form of specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. When used with all of the other appropriate treatments, people with cervical cancer may feel better and live longer. It’s provided by a team of doctors, nurses and other specially trained professionals, who work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. It’s often offered alongside curative or other treatments the patient is currently receiving, to improve the quality of life for the cancer patient and their families.

5. Cervical cancer clinical trials

In some cases, clinical trials might be the best treatment option for some patients. In the cancer research process, clinical trials play an integral part. They are carried to determine the safety and effectiveness of new treatments, and if they can supplement or be better than the existing ones.