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Understanding Cervical Cancer. An informative Guide for Risk Factors and Symptoms.

Discover essential information about cervical cancer, including causes, and symptoms.

While we all know that the most common cancer is breast cancer in women, it is not the only one that affects them on massive levels. Another cancer, known as cervical cancer, is the fourth most common globally among women. And in 2022, an estimated 660,000 new cases and 350,000 deaths were registered. So knowing about how it can develop and how to reduce the chances of having one is important.

The goal of the article is to give an extensive understanding of cervical cancer, including what causes it, how to avoid getting it, and the different types of treatment that are available.

What is Cervical Cancer?

cervical cancer

It is a cancer that begins at the level of the cervix. The cervix is a narrow tube that lets the lower part of a woman’s uterus connect to her vagina. It begins with abnormal cellular growth in that area. To understand it better, let’s learn about the cervix structure first. The cervix has two main parts,

The region where these two meet is called a squamocolumnar junction or a transformation zone. Because changes in cells are more likely to occur in this zone, it is also the origin of most cervical cancers, and both types of cells can give rise to cancer.

In most cases, cervical cancer develops in stages, beginning with an HPV infection and progressing through precancerous changes and, if left untreated, invasive malignancy.

Precancerous changes called dysplasia occur in the first stage. Adenocarcinoma in situ or cervical intraepithelial neoplasia (CIN) are the terms used to describe these changes. Failure to treat these precancerous lesions may result in the development of an invasive form of cancer.

The second stage may occur very slowly. According to research, 30% to 70% of people with untreated in situ cervical cancer (a very early stage of disease) might develop invasive cancer within 10 to 12 years. However, in around 10% of cases, the illness can advance from in situ to aggressive malignancy in less than a year.

But as the cancer reaches to invasive stages, it can break a thin barrier known as the basement membrane. They may have very prominent symptoms, such as,

  • Ulcerations and open sores in the cervix.
  • Exophytic tumors that may protrude outside the cervix.
  • The cancer spreads to surrounding tissues, such as the rectum and bladder.

Types of Cervical Cancer

There are two main types of cancer in the cervical region, according to the area affected. Knowing the type is important for the proper treatment. The types include,

  1. Squamous cell carcinoma: Approximately 70-90% of cervical cancers are of this kind, as reported by the American Cancer Society (ACS). These cancers typically start in cells close to the transformation zone, which is the junction of the exocervix and the endocervix.
  2. Adenocarcinomas: The rest of the cancers are of this type but are far less than the squamous type. The majority of these cases start as adenocarcinoma in situ, a form of cancer that does not spread. While they are rare but have grown in frequency during the past 20–30 years. They are also rare to detect because they develop high in the cervix.

Some other rare types of cancer include the following

  • Mixed Carcinoma or Adenosquamous Carcinoma: The rare (5 to 6%)  cervical cancer known as adenosquamous carcinoma combines elements of squamous cell carcinoma and adenocarcinoma. Because of its two sources of growth, this kind of cervical cancer is more aggressive and complicated than the others.
  • Small Cell Neuroendocrine Carcinoma: This is very uncommon only (1%) and fatal cervical cancer develops in the cervix’s neuroendocrine cells. It is fast development and bad prognosis.

Causes and Risk Factors of Cervical Cancer

The main cause of cervical cancer is an infection caused by certain types of human papillomavirus (HPV) in 99.7% of cases.

As per the recent data, 14 kinds of HPV are considered high risk for cervical cancer. However, the strains HPV 16 and HPV 18 account for approximately 70% of all cervical cancer cases. Most HPV infections are harmless and will go away on their own. But high-risk HPV infections can result in the creation of tumors, which may, in rare situations, evolve into cancer.

Having an HPV infection doesn’t always mean you will have cervical cancer. 

Apart from HPV, there are many other risk factors that can increase the risk of having cervical cancer, such as,

  • High Parity: Women who have gone through multiple full-time pregnancies are susceptible to having HPV infections, which increases the risk of having cervical cancer. It can be attributed to the hormonal changes that pregnancy may bring.
  • Having First Sexual Encounter at a Young Age: Engaging in sexual activity at a young age increases the likelihood of HPV infection. This is because the cervical cells are particularly vulnerable to HPV’s impacts when they are still developing throughout adolescence.
  • Prolonged Oral Contraceptive Use: The use of oral contraceptive methods for more than five years has been associated with an increased risk of cervical cancer. The hormones in these contraceptives might make cervical cells more susceptible to HPV infection and its consequences.
  • Smoking: It is already established that smoking can lower the body’s immunological response, making it difficult to fight HPV infection. And according to the American Cancer Society, the risk of having cervical cancer is greater in women who smoke than those who don’t. As per another study, tobacco by-products are found in the cervical mucus of women with cervical cancer.
  • Immunosuppression: Conditions that impair the immune system, such as HIV/AIDS or the use of immunosuppressive medicines (for example, organ transplant patients), might raise the risk of cervical cancer. A weaker immune system is less capable of combating HPV infections and preventing the formation of abnormal cells.
  • Low Socio-economic Status: Regions with low income seem to have greater rates.
  • Multiple Sexual Partners: The more partners a person has, the higher their chances of catching the HPV virus, which can cause cervical cancer.

What other infections can be caused by having multiple sexual partners? Let’s get a full understanding of these STIs in this article here.

Symptoms

As there are no initial symptoms seen with this type of cancer, it cannot be detected in its early stages. But as the disease progresses, symptoms may appear similar to those of UTIs, such as,

In early stages, it can have symptoms,

  • Pain during intercourse.
  • Pain in the pelvic area
  • Bleeding between the menstrual cycles after sexual contact
  • Unusual vaginal discharge. It can be watery, heavy in its flow, and may also contain blood.

But there are certain signs that can indicate the spread of such asImage of symptoms of cervical cancer

  • Painful urination
  • Extreme pelvic pain
  • Backache
  • Frequent urgency for urination
  • Swelling on legs
  • Bleeding in menstruation that is longer or heavier than usual.
  • Vaginal bleeding even after menopause.

These signs and symptoms can take years to develop, which is why it is hard to diagnose cervical cancer early.

Screening and Diagnosis

The Pap smear and the HPV test are the methods used to identify cervical cancer. These tests of cervical cancer screenings have led to a dramatic decline in the disease’s incidence and mortality rate in the USA. They are carried out at

Pap Smear test

This test is part of a woman’s screening exam. It is the most common and utilized way which look for abnormal or unusual changes in the cervical cells.

In this test, a healthcare provider will collect some cells from the cervix with a brush or spatula and then they are observed under the microscope. If the doctor finds anything out of the ordinary, a biopsy will be performed on a small sample of cervical tissue.

HPV Testing

This test identifies HPV strains that pose a higher risk of cervical cancer. It is carried out like a Pap test and then studied for the high-risk strains of cancer. This test can be carried out at the same time as that of a Pap smear or after if the Pap results are abnormal.

The most effective method for preventing cervical cancer is to detect abnormal cells during cervical screening. 

If any screening tests turn out abnormal and recommend that there are chances of having cancer, the following tests may also be carried out by the healthcare provider:

Screenshot 2024 05 30 234839

Coloscopy

This test is carried out to examine the areas where the abnormal cells are located. It’s just like a pelvic exam, but in this case, a solution such as acetic acid is used to make the abnormal cells more visible. Then a special instrument known as a colposcope is used to view the walls of the cervix. When a doctor notices anything out of the ordinary, they will often extract a tissue sample (biopsy) from the cervix’s surface to send to a pathologist for further analysis.

Biopsy

It is also known as Endocervical curettage (ECC). Cone biopsies, and loop electrosurgical excision procedures (LEEP) are among the many types of biopsies that can be done. 

1. Cone biopsy

The procedure involves the removal of a cone-shaped portion of cervix tissue. The base of this cone is formed by the exocervix area and the cone is by the endocervical canal and includes the transformation zone area. Many pre-malignancies and some very early cancers can be entirely removed using a cone biopsy as a treatment.

Loop electrosurgical excision technique (LEEP), also known as the long loop excision of the transformation zone (LLETZ), and cold knife cone biopsy are the two most frequent approaches to cone biopsies.

-Loop electrosurgical procedure (LEEP, LLETZ)

In this approach, the tissue is removed with a fine wire loop heated by electricity and used as a little knife.  This process, which only requires a local anesthetic, may be performed in the comfort of your own doctor’s office. LLETZ is the procedure of choice for removing cervical tissue to examine and treat precancerous cervix alterations. 

Instead of using a heated wire, a surgical scalpel or laser is utilized to remove the tissue. Depending on the procedure, the patient receives general anesthesia or spinal or epidural anesthesia. 

– Cold Knife Biopsy

In this type of biopsy, instead of using a heated wire, a surgical scalpel or laser is utilized to remove the tissue. Depending on the procedure, the patient receives general anesthesia or spinal or epidural anesthesia. 

Endocervical curettage (endocervical scraping)

If colposcopy fails to detect any abnormalities or if the area is not visible with the colposcope, another method is required to examine the transformation zone (the region susceptible to HPV infection and pre-cancer) for cancer.

A small device is inserted into a cervical canal and after scraping the interior of the canal with a brush or curette, some tissue is removed and submitted to the lab for analysis. Light bleeding and cramps are common side effects of this procedure. 

If the sample gets rid of all the abnormal tissue, that may be all that is needed for treatment. But make sure to discuss the potential risks of a biopsy with your doctor. Although they are uncommon, they can happen and can have long-lasting effects, such as uncomfortable periods or changes to the cervix’s structure. Make sure to notify your healthcare physician right away if you have any symptoms, such as discomfort or vaginal bleeding, that last more than a few days following the surgery.

Imaging Tests

The imaging test can display the cancer’s location and extent and are must in advanced stages. These include

  • Chest X-Ray: To detect if the cancer has progressed to the lungs.
  • CT Scans: Detailed pictures of the inside of the body may be obtained using CT scans. They are useful for detecting if the tumor is large or the spread of cancer is concerned. 
  • MRI: For examining soft tissue of the body and is preferred in this case. 
  • PET Scans: In this scan, a radioactive substance is injected which usually accumulates inside the abnormal tissues. PET scans, when coupled with CT scans (PET/CT), aid in the detection of lymph node metastasis, in particular.
  • Intravenous pyelogram (IVP) or intravenous urography (IVU) is a diagnostic procedure that uses X-rays taken of the urinary tract following the injection of a specific dye into a vein. It can identify ureteral obstructions and other abnormalities brought on by cervical cancer metastasis. Nowadays, CT and MRI scans are more successful in identifying urinary tract anomalies; hence, this method is rarely utilized.

Staging Cervical Cancer

Finding out the stage of cervical cancer is the next step once a diagnosis is established. Cervical cancer staging is based on the International Federation of Gynecology and Obstetrics’ approach, each of which indicates the extent of the disease’s propagation.

The carcinoma in situ, a noninvasive biopsy result, is often referred to as stage 0 although it is generally not counted as a stage.

Stage 1

During stage I, cervical cancer has developed and is primarily located in the cervix. While a microscope is usually required to view a tumor in its early stages, cancer in its advanced stages can sometimes be spotted without one. It is further divided into parts,

Stage IA: Cancer is only detectable under a microscope and cannot be seen with the human eye. This step is further subdivided according to size, into:

  • Stage IA1: Invasion depths of less than 3 mm.
  • Stage IA2: Invasion depths between 3 and 5 millimeters.

Stage IB: Invasion depths over 5 mm but still limited to the cervix characterize stage IB. Like IA, it is also divided as per size,

  • Stage IB1: Cancer that is deeper than 5 mm but less than 2 cm is considered stage IB1.
  • Stage IB2: Cancer that is 2 centimeters or less but no more than 4 centimeters is considered stage IB2.
  • Stage IB3:Cancer that has spread outside the cervix and is more than 4 centimeters is considered stage IB3.
Stage 2

When cervical cancer has progressed to stage II, it has metastasized to either the uterine tissue or the upper two-thirds of the vagina.

  • IIA: Spread to the upper two-thirds of the vagina.
    • IIA1: Tumor 4 cm or less.
    • IIA2: Tumor more than 4 cm.
  • IIB: Spread to the parametrial tissue but not to the pelvic wall.
Stage 3

When cervical cancer reaches stage III, it has progressed past the uterus and is now located in the lower vaginal region or even the pelvic wall. Nearby lymph nodes may or may not be involved, and the cancer may be obstructing the ureters ( urine transporting tubes)

  • Stage IIIA cancer has progressed to the vaginal base but has not yet reached the pelvis.
  • Stage IIIB: The pelvic wall has been affected by cancer, and the tumor has grown to the point where it blocks one or both ureters. Additionally, the tumor has caused one or both kidneys to enlarge or stop functioning.
  • Stage IIIC: Regardless of the size or extent of the tumor, the malignancy spreads to the pelvic and/or para-aortic lymph nodes (those around the abdominal aorta), as well as micrometastases.
Stage 4

When cervical cancer reaches stage IV, it has metastasized, or spread, to other parts of the body.

  • Stage IVA: The cancer has progressed to the point that it has invaded the rectum, the bladder, or both.
  • Stage IVB: These malignancies have progressed to other parts of the body, such as distant lymph nodes, the liver, the lungs, or the bones.

Cancer in Stage IV is also known as metastatic cancer. When malignant cells metastasize, they spread to different regions of the body via the blood and lymphatic systems.

 

There are a lot of potential strategies to fight this condition, such as the HPV vaccine, lifestyle changes, and early intervention, but prevention remains the best method. All of this will be discussed in the next article.

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Dr Aimen

Being a Doctor by profession, Aimen is passionate about helping people get better health in their lives. Aimen enjoys her research on Prime With Time subjects and strives to create better awareness of the problems and changes related to women's health.
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