Cervical Cancer

Introduction

In India, cervical cancer contributes to approximately 6 - 29% of all cancers in women. Cervical cancer occurs in approximately 1 in 53 Indian women during their lifetime compared with 1 in 100 women in more developed regions of the world. Cervical cancer is a condition in which cancer cells appear in the cervix, which connects the uterus to the vagina. Cervical cancer usually takes a long time to develop. During this time, the cells in the cervix convert and grow rapidly. Cervical cancer generally develops very slowly, starting as a pre-cancerous condition called dysplasia. Dysplasia can be detected by a Pap smear. This is why it is so important for women to get regular Pap smears. Undetected, pre-cancerous changes can develop into cervical cancer and spread to the lungs, liver, bladder, and intestines. It can take a long time for pre-cancerous changes into cervical cancer.

TYPES OF CERVICAL CANCER

Cervical cancer is categorized based on the type of cell where it occurs. The most common types of cervical cancer are:

Squamous cell carcinoma : This is the most common type of cervical cancer and is found in 80% to 90% of cases. It develops in the lining of the cervix.
Adenocarcinoma : This type of cervical cancer occurs in gland cells that produce cervical mucus. About 10% to 20% of cervical cancers are adenocarcinomas.
Mixed carcinoma : Generally, cervical cancer has features of squamous cell carcinoma and adenocarcinoma.

RISK FACTOR

The risk of developing cervical cancer is directly associated with the risk of contracting HPV.

Having multiple sexual partners or having sex with a promiscuous partner.
History of sexually transmitted disease (STD).
Sexual intercourse at a young age – hormonal shifts that occur in adolescence appear to make the cervical cells more susceptible to infection with HPV.
Smoking decreases the ability of the immune system and women who smoke have a higher incidence of cervical cancer

Types

Epithelial ovarian cancer is the most common type of ovarian cancer. Primary peritoneal cancer and fallopian tube cancer are analogous to epithelial ovarian cancer and are treated in the same way. Rare types of ovarian cancer include germ cell tumours, stromal tumours and sarcomas.

Symptoms

In its initial stages, cervical cancer normally does not have symptoms. That is why regular Pap tests are so important, particularly for sexually active women.

Signs and symptoms of cervical cancer include:

Vaginal discharge tinged with blood
Vaginal bleeding after sexual intercourse
Abnormal vaginal bleeding: after menopause, between menstrual periods or excessively heavy periods
Urinating more often
Pain during sexual intercourse
Swollen leg
Persistent pelvic and/or back pain
Pain during urination
Weight loss
Vaginal discharge that may be heavy and have a foul odor

Diagnosis

Cervical cancer is one of the most successfully treatable forms of cancer, as long as it is detected early and managed effectively. If cervical cancer is diagnosed inlater stages, it can be controlled with appropriate treatment and palliative care.

The best method to diagnose cervical cancer is screening tests. The HPV test and the Pap test are screening tests that are used primarily for early detection of this type of cancer.

This test is performed by scraping cells from the cervix. The cells are then sent to a lab where they are examined to detect any abnormalities.
If a Pap smear shows any cervical abnormalities, a colposcopy may be advised.
A colonoscopy test is used to examine the cervix, vagina, and vulva through a colposcope.
During the colposcopy, the expert may perform a cervical biopsy depending on what is found during the exam.
Endocervical curettage (ECC) is the second type of cervical biopsy that may be done during a colposcopy exam. During an ECC, the experts use a small brush to remove tissue from the endocervical canal, the narrow passageway through the cervix.
Imaging like body CT scan, body MRI, chest x-ray, and PET scan is often useful to determine if cancer has spread.

Management

Management of cervical cancer depends on the stage, patient co-morbidities, lymph node involvement, and risk factors for recurrence. Treatment may include surgery, Cone biopsy, Trachelectomy, chemotherapy, radiation therapy.

Surgery : Some of the cervical cancer treatments mayuse alone or in combination, and that depends on the stage of cervical cancer and other factors. Surgery can be the only treatment required if cervical cancer has not spread.
Cone biopsy : For the starting stage of cervical cancer, a cone biopsy with wide margins can be done. This is a fertility-preserving surgery. This surgery takes out the extocervix and endocervical canal using a scalpel. It is not an appropriate treatment if the tumor is large or deeply invasive or is found in the small blood vessels or lymphatic spaces (lymphovascular space invasion). Cone biopsy is preferred over a loop electrosurgical excision procedure.

Trachelectomy : This is a surgery that preserves fertility. It removes the cervix, upper vagina, and surrounding tissue. It is an appropriate treatment for an early-stage disease that cannot be treated with a cone biopsy. It is generally appropriate for early-stage cancer. A sampling of the regional lymph nodes (pelvic and/or paraaortic lymph nodes) can be performed at the same time.
Chemotherapy: is often prescribed before radiation therapy treatments as a way to shrink the tumor, which can make radiation therapy more effective. It is also prescribed for the treatment of cervical cancer when it has spread to other organs.
Radiation therapy : it uses high-energy rays to damage cancer cells and stop their growth. As with surgery, the radiation affects cancer cells only in the treated area.

Follow-Up

In patients with higher-risk cervical cancers, clinical follow-up may be performed every 3 months for the first 2 years, every 6 months for years 3 through 5, and then annually.

For patients with low-risk cervical cancer, clinical assessment is less frequent and may be performed every 6 months for the first 2 years, and then annually.

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