Women play an essential part in evolution; their bodies have been engineered to ensure that the human race keeps progressing. A small but vital organ that plays a part in our reproduction is the cervix - a cylindrical portion of the uterus located within the pelvic cavity. It plays a crucial role in fertility, menstruation and pregnancy.
Cervical cancer is one type of cancer that happens when abnormal cells generate in the lining of the cervix. It is highly prevalent; in fact, it is the fourth most common cancer in women worldwide.
Cervical cancer is the second most common cancer among women in India. It's also the second most common cancer among women ages 15–44. In 2022, India had 127,356 new cases of cervical cancer.
Cervical cancer usually develops slowly and over many years. Before turning into cancer, the cells in your cervix go through a lot of changes. The once normal cells in your cervix start to appear irregular or abnormal. These abnormal cells may disappear, stay the same or become cancer cells.
Regular cervical cancer screenings with a Pap test can detect most cases of cervical cancer. The goal of cervical cancer screening is to detect cell changes on your cervix before they become cancer. A Pap test, or Pap smear, involves looking at cells from your cervix under a microscope. These cells are examined for signs of precancers or other irregularities.
The importance of cervical cancer screening lies in the fact that if there are no symptoms, then you haven’t been affected. If the screenings come back as abnormal, your healthcare provider will want to run more tests to confirm the presence of cervical cancer.
They might suggest a colposcopy. A colposcope magnifies the cells in the cervix so the doctor can catch irregular cells. If the cells appear suspicious or strange, they will remove a sample of cervical cells and send them to a lab.
Any of the following methods are used to get a tissue sample from the cervix.
Punch biopsy - Your doctor uses a cutting tool with a round top to cut out precancerous cells.
Endocervical curettage - The provider scraps the lining of your cervix using a spoon-shaped tool called the curette.
Loop electrosurgical excision procedure (LEEP) - The doctor uses a loop of electrical wire to remove the abnormal cervical tissue.
Cone biopsy - Your provider picks out a slightly larger, cone-shaped piece of tissue from your cervix.
If the tests above confirm cervical cancer, further tests are done to find out whether the cancer has metastasised.
These are -
Liver and kidney function tests.
Blood and urine tests.
X-rays of the bladder, bowels, rectum and lungs.
MRI
CT scans
Your doctor can judge the progress of the cancer using these tests. Cervical cancer might range from Stage I (least severe) to Stage IV (most severe). Staging helps doctors come up with a treatment plan. But how do you diagnose this cancer?
No matter what the cause, once cervical cancer affects you, you tend to exhibit several symptoms. During its early stages, cervical cancer does not showcase any symptoms, and any signs that you see are hard to detect. The first signs of cervical cancer might take a long time to develop. Signs and symptoms of stage I cervical cancer include -
Watery or bloody vaginal discharge
If you have a watery or bloody vaginal discharge, it could be a sign of cervical cancer, especially if it is heavy, persistent, or has a strange odour. Cervical tumours can result in abnormal discharge because the tumour interrupts the normal flow and function of vaginal secretions. The discharge might smell foul because of the infection associated with the cancer.
Vaginal bleeding after sex, between menstrual periods or after menopause
Out-of-the-blue vaginal bleeding is one of the most common signs of cervical cancer. It might be postcoital bleeding, between menstrual cycles, or post-menopause when bleeding should have stopped.
Pain during sex (dyspareunia)
If you are unable to have intercourse without pain, then that is a sign of cervical cancer. This might be a sharp, dull or aching pain because the tumour invades nearby tissues, resulting in irritation and sensitivity.
Difficult or painful urination, sometimes with blood in urine
When cervical cancer spreads to proximity organs like the bladder, it can result in urinary symptoms, like difficulty or pain while urinating (dysuria). Sometimes, the tumour might cause the bladder to bleed, resulting in blood in the urine (hematuria).
Diarrhoea, or pain or bleeding from your rectum when pooping
As the cancer spreads, it can impact nearby structures like the colon and rectum, resulting in symptoms like painful bowel movements, bleeding from the rectum or diarrhoea. These symptoms happen when the cancer spreads to adjoining tissues.
Fatigue, Loss of Weight and Appetite
Feeling fatigued, inexplicable weight loss and a drop in appetite can be a sign of advanced cervical cancer. As the tumour grows and spreads, it results in systemic effects on the body, resulting in a person feeling ill or tired.
A general feeling of illness
If you are in the later stages of cervical cancer, it is common to feel a general feeling of illness or malaise. The body’s immune system has gone into overdrive, fighting cancer, which is why you might feel unwell.
Dull backache or swelling in your legs
Swelling of the leg or dull backaches can be a result of cervical cancer that has spread or compressed nearby tissues, lymph nodes or nerves. Back pain, especially in the lower back, happens when the cancer spreads to the pelvic bone or spine.
Pelvic/abdominal pain
Pelvic and abdominal pain is a common symptom of advanced cervical cancer. This pain might be intermittent or persistent, dull or sharp, and differs in its intensity. As the tumour grows, it puts pressure on adjacent areas like the bladder, uterus or rectum.
Cervical cancer occurs when healthy cells in the cervix exhibit DNA changes. A cell's DNA has instructions that will dictate what it must do to the cell. The changes direct the cells to multiply quickly.
The cells carry on living when healthy cells would perish as their natural life cycle dictates. This results in too many cells that might come together and form a mass called a tumour. Once this happens, the cells can destroy healthy body tissue. The cells can break away and spread to other body parts with time.
At the root of most cervical cancer is the HPV. Human Papillomavirus is a common virus that spreads through sexual contact. This virus does not pose a problem for most people and usually disappears independently. For an unlucky few, though, the virus can cause alterations in the cells, which might eventually lead to cancer.
HPV spreads through sexual contact (anal, oral or vaginal) and can result in cancer. A lot of people, including some you know, might get HPV at some point in their lives without realising it because their bodies battle the infection. If the body does not fight the infection, the cells of the cervix change to cancerous cells.
There are more than 100 varieties of HPV, with about a dozen of them having been shown to result in cancer. Detecting these HPV strains is key to preventing cervical cancer. There’s a vaccine called the HPV vaccine that can help prevent HPV infection by protecting you against the virus that is responsible for 90% of all cervical cancers.
If you have been afflicted with cervical cancer, you need to visit a gynaecologic oncologist. Treatment is based on several factors, like the stage the cancer is in, your age, general health and whether you want children in the future.
Treatments for cervical cancer include radiation, surgery, targeted therapy and immunotherapy.
Some folks might depend on alternative treatments like diets, herbs, acupuncture and more to supplement their cancer treatment. Speak to your doctor about this before you take anything.
Radiation
This therapy uses energy beans to eliminate the cancer cells in the cervix. There are two kinds of radiation therapy, namely external beam radiation therapy (EBRT) or brachytherapy -
Under EBRT, a machine outside your body aims a high-powered radiation beam at the cancer.
Brachytherapy - This puts the radiation in or right near the cancer.
Chemotherapy
Under this treatment method, drugs are injected into the veins or taken orally to kill cancer cells. It is effective for eliminating cancer cells anywhere in the body. There are many drugs used in chemotherapy, and they might be combined.
This therapy is often given in cycles. The chemotherapy rug used and the location of the cancer in your body dictate the length of the chemotherapy cycle and the schedule or frequency of the treatment.
Surgery
Various kinds of surgery are implemented for treating cervical cancer. Your doctor can eliminate cancerous tissues if the cancer is in its early stages. Some of the most common kinds of surgery for cervical cancer are -
Laser surgery - A laser beam burns off just the cancer cells under this method.
Cryosurgery - This surgery freezes cancer cells, eliminating them.
Hysterectomy - This is a procedure to remove the uterus and cervix.
Trachelectomy - This operation removes the cervix and the top part of the vagina but not the uterus.
Pelvic Exenteration - This is like a hysterectomy but also takes into account your bladder, rectum, vagina, and some section of the colon, depending on where the cancer might have spread.
Targeted Therapy
This drug treatment targets specific cancer cells and avoids damaging the healthy cells. It targets proteins that dictate how cancer cells grow and spread.
Immunotherapy
Under this method, doctors use medicines to stimulate the immune system to recognise and destroy cancer cells, which pretend to be healthy to hide from the immune system. Immunotherapy targets such signals so the cancer cells don't fool your body into thinking it is a healthy cell.
In conclusion, cervical cancer can be treated if it is detected early. Early detection is vital for nipping the cancer in the bud and ensuring survival. While this cancer remains a global health concern, however, advancements in prevention, detection and treatment have improved the outlook considerably.
Public awareness, education, and access to healthcare play an important role in empowering individuals so they can take active steps to safeguard their health. Through research, we can work towards reducing the incidence and mortality rates of this deadly disease.
I am a 50-year-old female. Am I at risk of getting cervical cancer?
Cervical cancer can affect anyone. Getting a test done would tell you whether you are at risk of developing this cancer or not.
How can cervical cancer be prevented?
Cervical cancer can often be prevented through vaccination against HPV, regular screenings such as Pap smears, and HPV testing to detect early signs of abnormal cell changes.
What are the symptoms of cervical cancer?
In its early stages, cervical cancer may not show noticeable symptoms. As it progresses, symptoms can include abnormal bleeding, pelvic pain, or pain during intercourse.
Who is at risk for cervical cancer?
Women who have had multiple sexual partners, do not get regular screenings, or have a history of HPV infections are at higher risk.
What are the treatment options for cervical cancer?
Treatment options for cervical cancer include surgery, radiation therapy, chemotherapy, and targeted therapies.
