Cervical Cancer: All you need to know

Last Updated on October 17, 2023 by Shabnam Sengupta

The cervix is the lower part or neck of the uterus which connects the uterus to the vagina. The cancer development in the cells lining the cervix refers to cervical cancer, which is one of the most common types of cancer among females worldwide. 

The development of cervical cancer may happen due to Human Papilloma Virus (HPV) infection. It transmits through sexual contact and causes mutations in cervical cells when infected.

Though very common in the reproductive age group in females, cancer development can be easily prevented if vaccination and early screening of the disease are done. In this article, we will discuss symptoms, causes, risk factors and other aspects of cervical cancer.

Symptoms of cervical cancer

In its early stages, there may not be any signs and symptoms. However, as it progresses, some symptoms of cervical cancer are:

• Pain during intercourse
• White discharge
• Heavy and foul-smelling vaginal discharge
• Vaginal bleeding in between the menstrual cycles
• Pain in the lower abdomen

Causes and risk factors

In most cases, the cause of cervical cancers is Human Papilloma Virus infection which brings about cancer-causing mutations within the cells of the cervix. Not everyone who is infected with HPV develops cancer, in around 95% of cases HPV will cause genital warts which will heal by themselves. However, in the other 5% of cases, there is cell transformation and cancer development.

The following are risk factors for HPV infection: 

• Multiple sexual partners

• Sexual exposure before the age of 16
• Birth control pills for more than 5 years 
• Weak immunity 
• Smoking history 
• Multiple pregnancies or early pregnancies 
• Not using condoms during intercourse 
• Positive family history of cervical cancer 

Types

There are three types of cervical cancer on the basis of the type of cell affected:

• Squamous cell carcinoma: this is the cancer development in the flat-lining cells of the cervix
• Adenocarcinoma: This is the cancer development in the mucus-secreting cells of the cervix 
• Mixed carcinoma: When both the types of cells are involved 

Diagnosis

Before even diagnosing cancer, screening tests such as a pap smear are done to help detect early cases of cervical cancer in the population before any symptoms develop.

For this test, the doctor collects some of the cells from the cervical canal and examines them in a microscope to see the changes in the appearance of the cervical cells that may suggest a possible impending development of cervical cancer and signs of HPV infection.

The different changes seen are:

• Normal cell appearance: The cervical cells appear normal under the microscope 
• Precancerous stage: The cells have undergone some changes but haven’t progressed to complete cancer development, if this stage remains ignored the cells can turn into cancerous cells after a few years. The patient should get frequent check-ups or treatment on the basis of their requirements.
• Cancerous stage: The cells at this stage turn malignant. They should be treated to prevent further growth or spread to any distant organ.

Colposcopy: It is done along with the PAP smear to visualise the lower part of the womb for the presence of any visible abnormal growth. 

HPV testing: This checks for the presence of the HPV virus and also detects the strain of the virus causing the infection. If the infection is due to strains 6 and 11, there is a low risk of cancer development and only genital warts can develop which regress on their own.

But if the strain is 16 or 18, then the risk of malignancy increases and the patient has to be closely followed up.

If there is extensive involvement of the cervix, then the following scans help to see the spread of cancer cells:

• CT scan 
• MRI scan 
• PET-CT scan 
• Chest X-ray 

Treatment

The protocol of treatment varies with respect to the stage of cancer development, its spread, size of the portion of cervix involved and the general health of the patient.

• In pre-cancerous stages: Only the affected portion of the cervix is removed usually by laser or diathermy and the rest of the cervix is left as it is.

The commonly used procedures are LLETZ (Laser Loop Excision of the transformation zone ) where a heated wire loop is used to remove all the abnormal cells.

The second method used is cone biopsy, where a cone-shaped tissue having abnormal cells is removed.

• In case of invasive cancer, partial removal of the cervix or complete removal of the cervix along with the uterus can be done (hysterectomy).
• In case of systemic metastasis, chemotherapy and radiotherapy are given to kill the distant metastasised cells.
• Lymph nodes may be removed along with the infiltrated organs
• Targeted therapy: Medicines like Avastin (Bevacizumab), which are specially targeted against cervical cancer cells can be given 

Prevention

Some factors are thought to lower the chances of cancer development like:

• HPV vaccine (Bivalent, Quadrivalent, and multivalent vaccines against various subtypes of HPV are known to significantly reduce the risk of cancer development)
• Healthy diet maintenance
• Avoid smoking 
• Practice safe sex with the use of condoms 
• Screening with routine PAP smear checkups for early diagnosis

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