Cervical Cancer

What is Cervical Cancer?

Cervical cancer is the third most commonly diagnosed cancer worldwide and the fourth leading cause of cancer death in women. It is also the second most common cancer in women living in less developed regions with an estimated 84% of the new cases worldwide. Cervical cancer causes around 270,000 deaths worldwide.

What Causes Cervical Cancer?

The normal cells of the cervix first gradually develop pre-cancerous changes that turn into cancer. Doctors use several terms to describe these pre-cancerous changes, including cervical intraepithelial neoplasia (CIN), squamous intraepithelial lesion (SIL), and dysplasia. These changes can be detected by the Pap test and treated to prevent cancer from developing. Although cervical cancers start from cells with pre-cancerous changes (pre-cancers), only some of the women with pre-cancers of the cervix will develop cancer. It usually takes several years for cervical pre-cancer to change to cervical cancer, but it also can happen in less than a year. For most women, pre-cancerous cells will go away without any treatment; if treatment is needed to excise abnormal cells or lesions, cryotherapy (destroying abnormal tissue on the cervix by freezing it) is recommended. Still, in some women pre-cancers turn into true (invasive) cancers. In developing countries, limited access to effective screening means that the disease is often not identified until it is further advanced and symptoms develop. In addition, prospects for treatment of such late-stage disease may be poor, resulting in a higher rate of death from cervical cancer in these countries. Treating all cervical pre-cancers can prevent almost all cervical cancers.

Risk Factors

Persistence of HPV infection is the most important factor in developing cervical cancer; HPV is detected in 99% of cervical tumours. There are around 80 types of HPV that are related to cervical cancer. The high-risk types - HPV 16 and 18 - are highly involved in 70% of cervical cancer. Other risk factors include:

  • Early first sexual intercourse.
  • Heterosexual women.
  • Women with multiple sexual partners, or partners of promiscuous males.
  • Smoking.
  • Lower social class.
  • Immunosuppression - eg, HIV and post-transplant.
  • There is a slight increase in risk with use of a combined oral contraceptive.
  • Non-attendance at the cervical screening programme.

Symptoms of Cervical Cancer

Many cases are detected by screening. Abnormal vaginal bleeding is the most common symptom of cervical cancer. The first symptoms of established cervical cancer are:

  • Vaginal discharge: this varies greatly in amount and can be intermittent or continuous and often foul smelling.
  • Bleeding: this can be spontaneous but may occur after sex, urination or defecation, in the early stages. Patients may ignore this if it is scanty and ascribe it to normal menstrual dysfunction. Occasionally, severe vaginal bleeding may necessitate emergency hospital admission.
  • Vaginal discomfort.

Late symptoms

  • Painless Bloody urine
  • Frequent Urination
  • Bleeding from the rectum (Back Side)
  • Ankle and Leg swelling
  • Back/leg or pelvic pain

Diagnosis and Treatment

The extent of disease is referred to as the stage. Information about the size of the cancer or how far it has spread is often used to determine the stage. Doctors use this information to plan treatment and to monitor progress.

Types of Treatment

Cervical cancer is treated in several ways. It depends on the kind of cervical cancer and how far it has spread. Treatments include surgery, chemotherapy, and radiation therapy.

  • Surgery: Doctors remove cancer tissue in an operation.
  • Chemotherapy: Using special medicines to shrink or kill the cancer. The drugs can be pills you take or medicines given in your veins, or sometimes both.
  • Radiation: Using high-energy rays (similar to X-rays) to kill the cancer.

How is Cervical Cancer prevented?

WHO recommends a comprehensive approach to cervical cancer prevention and control. Two tests can help prevent cervical cancer—

  1. The Pap test (or Pap smear) looks for precancers, cell changes on the cervix that may become cervical cancer if they are not treated appropriately. You should start getting Pap tests at age 21.
  2. The human papillomavirus (HPV) test looks for the virus that can cause these cell changes. If the any of high risk types of HPV are identified, you will be referred to a gynecologist for more detailed testing.

The most important thing you can do to help prevent cervical cancer is to have regular screening tests starting at age 21.

If your Pap test results are normal, your chance of getting cervical cancer in the next few years is very low. For that reason, your doctor may tell you that you will not need another Pap test for as long as three years. If you are 30 years old or older, you may choose to have an HPV test along with the Pap smear.

If your test results show cells that are not normal and may become cancer, your doctor will let you know if you need to be treated. In most cases, treatment prevents cervical cancer from developing. It is important to follow up with your doctor right away to learn more about your test results and receive any treatment that may be needed.

If both test results are normal, your doctor may tell you that you can wait five years to have your next Pap test. But you should still go to the doctor regularly for a checkup.

For women aged 21 to 65, it is important to continue getting a Pap test as directed by your doctor—even if you think you are too old to have a child or are not having sex anymore. However, if you are older than 65 and have had normal Pap test results for several years, or if you have had your cervix removed as part of a total hysterectomy for a non-cancerous condition, like fibroids, your doctor may tell you that you do not need to have a Pap test anymore.

Getting the HPV Vaccine

The HPV vaccine protects against the types of HPV that most often cause cervical, vaginal, vulvar and other anogenital cancers. It is recommended for preteens (both boys and girls) aged 11 to 12 years, but can be given as early as age 9 and until age 26. The vaccine is given in a series of either two or three shots, depending on age. It is important to note that even women who are vaccinated against HPV need to have regular Pap tests to screen for cervical cancer.

More Steps to Help Prevent Cervical Cancer

  • Education about safe sexual practices, including delayed start of sexual activity
  • Promotion and provision of condoms for those already engaged in sexual activity
  • Warnings about tobacco use, which often starts during adolescence, and which is an important risk factor for cervical and other cancers; and
  • Women who are sexually active should undergo a PAP Smear to identify abnormal cervical cells and pre-cancerous lesions.

You can contact us today about screening!