Cervical Cancer – Types, Symptoms, Stages, Diagnosis & Treatment
Overview and Statistical Facts
Uterus is a part of the female reproductive organ that responds to the female sex hormones. The lower end of the uterus is called cervix and it opens into the vagina. Cervix is 2-3 cm long passage that is nearly cylindrical in shape. The cervix can become infected with human papillomavirus (HPV) which is transmitted sexually. This infection is the major cause of cervical cancer in females. The disease shows no symptoms in the early stages.
One of the most commonly observed symptoms of cervical cancer includes unusual vaginal bleeding, especially after vaginal intercourse, in between periods and after menopause.
Women should remember that all abnormal vagina bleedings do not point towards cervical cancer and these can be due to some other causes also. However, if you observe any of these symptoms you should get yourself examined by a doctor as soon as possible. If cervical cancer is suspected, treatment is started within 2 weeks.
Cervical cancer develops when the cells of cervix grow abnormally and start invading other tissues and organs. When the cancer becomes invasive, it starts affecting deeper cervical tissues and can even spread to other parts of the body like liver, lungs, vagina, bladder and rectum.
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There are a number of strains of human papillomavirus (HPV) that are responsible for causing cervical cancer. After getting exposed to HPV, the body’s immune system tries to protect itself from the attack. In some women, the virus survives for a number of years and causes some of the cells of cervix to become cancerous.
Cervical cancer is a slowly progressing disease which gives a lot of time for prevention, early detection and treatment. Due to advancements in the diagnostic procedures, there has been a rapid decline in the number of cervical cancer cases in the U.S.A.
Most of the women diagnosed with cervical cancer belong to the age group of twenty and thirty, however the average age of women with cervical cancer is mid-fifty. This difference in ages is due to the difference of ages in which precancerous cells start developing and the age in which cancer is diagnosed. This fact highlights the slow progression of the disease and is the reason that it can be prevented, if diagnosed early.
As per the American Cancer Society, there were nearly 13,240 new cases of cervical cancer is being diagnosed in the American women in2018, out of which 4,170 will result in death. The disease was the number one reason for female mortality in the U.S.A. a few years back. With an increase in the pap tests, the number of cases of cervical cancer have decreased significantly. The disease is most commonly found in women in the age group of 35 to 44 years. It is rarely seen in women below the age of 20 years. In the States, the disease is more common among Hispanic women, followed by African-Americans, Asians and Pacific Islanders and Whites. The lowest risk of cervical cancer was found in American Indians and Alaskans. [1]
Types and Symptoms of Cervical Cancer
There are mainly two types of cervical cancer:
- Squamous cell carcinoma:
It begins in the flat, fine cells that line the bottom of cervix and is responsible for 80-90% cervical cancer cases.
- Adenocarcinoma:
This type of cervical cancer develops in the glandular cells lining the upper portion of cervix and make up only 10-20% of the cancer cases.
Grading of Cervical Cancer
Grading of the tumor cells of cervical cancer is done from 1 to 3 in order to determine how much the cancer cells look different from the normal cells.
Grade 1 is assigned to cancer cells which do not look as abnormal as the cancer cells of higher grade 3. Cancer cells of grade 1 are slow growing and have less chances of spreading to other parts of the body.
High-grade cancer cells are undifferentiated or poorly differentiated. They look more abnormal than normal cells. They have a tendency to grow more quickly and spread to different parts of body.
By determining the grade of cervical cancer, doctors determine the rate of growth and the spread of cancer cells. This helps in outlining the course of treatment of cancer. It also proves to be an important tool in determining the prognosis and what are the chances the patient will respond to treatment.
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Symptoms of Cervical Cancer
Precancerous cervical cell changes and early signs of cervical cancer do not show any symptoms. Therefore, regular screening of cervical cancer with the help of PAP and HPV test is very important. Abnormal vaginal bleeding, pain during intercourse or vaginal discharge are some of the most important symptoms of cervical cancer.
Commonly observed symptoms of cervical cancer include:
1. Abnormal bleeding like
- Bleeding between regular menstrual periods
- Bleeding after intercourse
- Bleeding after douching
- Bleeding after pelvic exam
- Bleeding after menopause
2. Pelvic pain not related to menstrual cycle
3. Heavy or unusual discharge that is watery, thick and probably has foul odor
4. Increased urinary frequency
5. Pain during urination
Stages of Cervical Cancer
Stage of cervical cancer conveys the information about its severity and how far it has spread. This information is used for determining what course of treatment should be adopted. The International Federation of Gynecology and Obstetrics (FIGO) have defined the following 4 types stages of cervical cancer
1. Stage 1:
When the cancer is in stage 1, cancerous cells are present only in the neck of the womb. It is often divided into following subtype:
a. Stage 1A
In this stage, the growth of cancer cells is very less and can only be observed with the help of a colposcope or a microscope. It can be further divided into 2 smaller groups:
- Stage 1A1
When the cancer is in this stage, the cancer cells have grown less than 3 mm into the cervical tissue and is less than 7 mm wide. - Stage 1A2
In this stage, the cancer cells have grown and are between 3 to 5 mm into the tissue of cervix but is still less than 7 mm in width.
b. Stage 1 B
By the time cancer is in this stage, the cancerous area has widened but it is still present only in the cervix area. It can now be observed without a microscope but not in all cases. It can be divided into following subtypes:
- Stage 1B1
In this stage, the width of cancerous mass is not more than 4 cm. - Stage 1B2
In this stage the cancer is more than 4 cm wide.
2. Stage 2:
When cancer reaches this stage, it begins spreading outside of cervix into the surrounding tissues. However, it has still not spread to the ligaments or muscles lining the pelvis or to the lower part of vagina. It is also divided into sub-stages:
a. Stage 2A
In this stage, the cancer has already spread to the top of vagina. It can be divided into following subtype:
- Stage 2A1
In this stage, the cancer is 4 cm or less in width. - Stage 2A2
In this stage, the width of the cancerous mass is more than 4cm.
b. Stage 2B
In this stage, the cancer has spread to the tissues surrounding the cervix.
3. Stage 3:
By the time cancer reaches this stage, it has already spread to the structures surrounding the cervix like the pelvis. There is a possibility that that it might have spread to the lower parts of vagina, even to the muscles and ligaments lining the pelvis. It might even spread to the kidney tubes and block them.
a. Stage 3A
This stage is reached when the cancer spreads to the lower third of the vagina but has not spread to the pelvic wall.
b. Stage 3B
In this stage, cancer has spread to the pelvic wall and starts blocking at least one or both of the kidney tubes.
4. Stage 4:
In this stage, cancer has spread to the rectum, bladder and even further.
a. Stage 4A
At this stage, the cancer has spread to the organs near cervix like rectum and bladder.
b. Stage 4B
At this stage, cancer has metastasized to organs as far as lungs.
Risk Factors of Cervical Cancer
Some of the factors that increase the chances of developing cervical cancer are given as follows:
Human Papilloma Virus (HPV) Infection
HPV infection is the most important risk factor for cervical cancer. It is spread from one person to other through unprotected sex. There are a number of strains of HPV infection but only HPV 16, HPV 18, HPV 31, HPV 33, HPV 45 are related to cervical cancer.
Many Sexual Partners
If a woman has multiple sexual partners who again have a number of sexual partners, the chances of getting exposed to HPV increases manifold.
Early Sexual Activity
A woman’s chances of developing cervical cancer increases if she starts indulging in sexual activity from a relatively younger age.
Other Sexually Transmitted Infections (STIs)
Being infected with sexually transmitted infections like gonorrhea, syphilis, chlamydia and HIV/AIDS, other than HPV, can also increase the risk of developing cervical cancer.
Weak Immune System
The chances of developing cervical cancer increases when a woman has a compromised immune system due to other ailments along with HPV infection.
Smoking
The probability of squamous cell cervical cancer increases due to smoking.
Obesity
Overweight or women with obesity are more prone to developing cervical cancer than those who have normal weight. [2]
Having a Full-Term Pregnancy Before the Age of 17 Years
Early pregnancies are known to increase the chances of developing cervical cancer in women.
Family History
Women who have close family members with cervical cancer were most likely to develop the condition as well. It is thought that the disease runs in the family.[3]
Poverty
Poverty is also considered a risk factor for cervical cancer. Many women belonging to low income group do not have an access to health care facilities and therefore may not receive an early screening for cervical cancer when it is in the pre-cancerous state.
Long Term Use of Contraceptives
Long term use of contraceptives increase risk of developing cervical cancer. However, when the pills are stopped, the risk becomes negligible. If a woman takes contraceptive pills for 5 or more than 5 years consecutively, the chances of developing cervical cancer becomes double. But after a decade of stopping the pills, the risk returned to that of non-users.
Having More Than 3 Full Term Pregnancies
The exact reason behind the relationship between multiple pregnancies and cervical cancer is not understood but it is thought that unprotected sex increases the chances of contracting HPV infection which can lead to cervical cancer.
Do I Have Cervical Cancer?
Cervical cancer is very difficult to diagnose in the early stages and there are no symptoms. This is the reason both CDC and American Cancer Society recommend getting a pap test from the age of 21 years. If you get an abnormal pap smear test, it indicates that you might have early stage cervical cancer, sometimes called the ‘pre-cancerous’ stage.
However, if you are observing certain symptoms like abnormal bleeding, pelvic pain, heavy periods, persistent nausea, sudden weight loss, strange vaginal discharge, fatigue and changes in bowel movements, it is time to pay a visit to your doctor to get yourself checked. These symptoms are also seen in other diseases like ovarian cysts, endometriosis, adenomyosis and pelvic inflammatory disease (PID).
Causes and Prevention of Cervical Cancer
Cervical cancer develops when the normal cells of cervix become abnormal due to genetic changes. Healthy and normal cells divide at a normal rate and eventually die. But, cancer cells multiply at an uncontrolled rate and do not die. This causes the cells to accumulate and form a tumor. Cancer cells have a feature of invading neighboring cells and when the tumor breaks, some of the cells travel through the bloodstream and reach other organs and start multiplying.
The exact reason of cervical cancer is not known, but it is sure that HPV has an important role to play in the development of cervical cancer. HPV is an extremely common infection and most women with the infection do not develop cervical cancer. Lifestyle and environmental factors are also thought to play a crucial role in the development of cervical cancer.
Also, women who have been exposed to a drug diethylstilbestrol (DES) when they were in the womb are at a greater risk of developing cervical cancer. It is a medicine that was thought to prevent miscarriage.
Prevention of Cervical Cancer
In order to prevent cervical cancer, following steps can be taken:
1. Get vaccinated Against HPV Women and girls in the age group of 9 to 26 years must get vaccinated with HPV vaccine. It is thought that the vaccine is most effective when it is given to girls before they become sexually active.
2. Have Regular Pap Tests Pap tests can be extremely useful in detecting cervical cancer in the precancerous stages. Most of the medical organizations recommend that young women should start getting themselves tested for cervical cancer by the time they reach 21 years of age.
3. Practice Safe Sex Safe sex practices such as use of condom, delayed intercourse and limiting the number of sexual partners should be adopted.
4. Stop Smoking Smoking should be stopped in order to prevent cervical cancer. Women who are regular smokers are unable to fight HPV infection which can develop into cancer.
Diagnosis and Tests of Cervical Cancer
Abnormal observations of the cervical tissue don’t mean the woman has cervical cancer. However, if the cervical screening test is abnormal, the doctor will suggest following tests in order to diagnose cervical cancer:
Tests for Sexually Transmitted Infections (STIs)
First and foremost, the woman is screened for sexually transmitted infections, especially chlamydia. It is one of the most common reasons for abnormal vaginal discharge and growth. If chlamydia test comes out to be positive, it implies that the abnormal vaginal discharge is due to chlamydia.
- Colposcopy
Colposcopy is carried out when an abnormal cervical screening test is observed. During this test, a small microscope having a light source at the end is used to examine the cervix. A small tissue sample is also extracted while examining for biopsy.
- Cone Biopsy
This is a minor operative procedure in which a cone shaped section s removed from the cervix and observed under the microscope for the presence of cancerous cells. Patient might observe vaginal bleeding for up to 4 weeks after the procedure. Abdominal pain similar to period pain can also be observed after the procedure.
- Pelvic Examination
Under general anesthesia, a pelvic examination can be performed in order to check for signs of cancer in the womb, rectum, vagina and bladder.
- Blood Tests
Blood tests are performed to access the condition of liver, bone marrow and kidneys.
- CT Scan
These scans are performed in order to identify cancerous cells and to check whether such cells have spread to other parts of the body.
- MRI Scan
In this test, strong magnetic field and radio frequencies are used for producing detained picture of the internal organs of the body for testing the presence of cancerous cells in the body.
- PET Scan
This is a special test in which a slightly radioactive substance is injected into the body in order to see the cancerous cells more clearly. It is often coupled with a CT scan for checking whether the cells have spread or to judge how well the person is responding to the treatment.
Treatment and Care of Cervical Cancer
The treatment of the cervical cancer is done as per the stage of the disease. Since the treatment is extremely complex, the hospitals adopt multidisciplinary teams (MDTs) in order to treat the disease and to custom make the treatment process. The cancer team will suggest the treatment options as per the stage of the disease but the final decision is that of the patient. In most of the cases, following recommendations will be made:
- Early cervical cancer: In this case, some or all of the womb is removed surgically, Radiotherapy or a combination of the two is also performed depending on the case.
- Advanced cervical cancer: When the disease is in the advanced stage, chemotherapy and/or radiotherapy is suggested along with surgery.
It is possible to completely cure the disease when it is detected in its early stages. However, it is not possible to cure the disease when it has spread to other parts of the body. In such cases, the progression of cancer can be slowed down, lifespan can be increased and associated symptoms like vaginal bleeding and pain. This comes under palliative care.
Following are the various methods that can be used for the treatment of cervical cancer:
Removing Abnormal Cells
If the screening test shows abnormal cell growths but it has not developed into cancer, then the abnormal cells can be removed before they become cancerous in future. The methods by which abnormal cells can be removed include:
- Large Loop Excision of the Transformation Zone (LLETZ)
In this technique, a fine wire and electrical current are used for cutting away the abnormal cells.
- Cone Biopsy
Here, the area harnessing abnormal tissue is removed during surgery.
- Laser Therapy
In this method, the abnormal cells are burnt away with the help of laser.
- Surgery
Surgical treatment is effective when treating cervical cancer in its initial stage. However, the treatment is ineffective in the later stages of cancer, when the cancer cells have spread to other parts of the body. There are mainly 3 types of surgeries for managing cervical cancer:
Radical Trachelectomy
This surgical procedure is only effective when the cancer is in its early stages and the woman wants to preserve her child bearing capacity.
During the procedure, a number of small incisions are made in the abdomen and special instruments are introduced through it for removing the cervix and upper parts of vagina and sometimes the lymph nodes of the pelvis. The womb is then attached to the lower section of vagina. The womb is intact but the doctors cannot guarantee that the patient will be able to conceive after the surgery.
Hysterectomy
It is recommended when the cancer is in its early stages. This procedure might also be followed by radiotherapy in order to prevent the cancer from coming back. There are two types of hysterectomies:
- Simple Hysterectomy
In this procedure the womb and cervix are removed and sometimes even the fallopian tubes and ovaries are taken out.
- Radical Hysterectomy
The cervix, womb, lymph nodes and surrounding tissue, fallopian tubes and ovaries are all removed in this procedure. This is recommended when the cancer is in the advanced stage 1 or early stage 2.
Pelvic Exenteration
This is a major surgery which is generally recommended when the cancer has returned after a previously presumed successful treatment procedure. The disease should be localized in the pelvis but has not spread to other parts of the body.
This procedure involves two steps:
1. Cancer cells along with rectum, bladder , vagina and lower section of the bowel are removed from the body.
2. In the abdomen, two holes are created in order to assist the patient in passing urine and feces. There are collection bags called colostomy in which the excretory products get collected.
After the procedure, the vagina is reconstructed with the help of tissues and skin harvested from other parts of the body so that the patient can have a normal sexual life after the surgery.
- Radiotherapy
Radiotherapy is used along with chemotherapy and surgery for managing the symptoms of cervical cancer like bleeding and pain. There are two ways in which the radiotherapy can be delivered:
- Externally
High energy wave beams are illuminated over the affected area in order to kill cancerous cells.
- Internally
In this procedure, a radioactive implant is fitted inside the vagina and cervix for delivering radiotherapy.
- Chemotherapy
It involves the use of medications and drugs for the treatment of cervical cancer. Common drugs that are used for the treatment of cervical cancer include cisplatin, paclitaxel, topotecan, carboplatin and gemcitabine. These drugs are sometimes used in combination for treating cervical cancer.
- Targeted Therapy
This treatment involves the use of certain drugs that are targeted for inhibiting the growth of cancerous cells by interrupting the cellular cycles that promote growth of cancerous cells. Bevacizumab is one such drug that inhibits the formation of blood vessels in cancerous cells. This treatment is used for managing advanced cancer cases.
If a woman is diagnosed with cervical cancer while she is pregnant, the treatment is delayed till the baby is born, if the disease is in the early stages. This is because the treatment can be very dangerous for the fetus and can even result in miscarriage.
Care for Cervical Cancer Patients
Women who are diagnosed with cervical cancer undergo a huge amount of trauma, physically, mentally and emotionally. They require a lot of support from their families and friends. After undergoing treatment for cervical cancer which involves hysterectomy and pelvic exenteration, she might feel that she is less of a woman because she no longer has a uterus or has underwent vaginal reconstruction. Pelvic exenteration changes the way she urinates or defecates, which makes the woman self-conscious and takes a heavy toll on her self-confidence. Low self-esteem leads to self-induced isolation that hampers the emotional healing of the person and gradually the patient moves towards depression. Therefore, it becomes extremely important for the patient’s family and friends to take care of the patient. Some of the ways by which the family’s family and friends can support and care for the person are as follows:
- Help the patient in coping with the changes happening to her body due to the treatment
- Be there for the patient when she undergoes chemotherapy and radiotherapy treatments
- Motivate the patient to stay positive
- Make sure she eats well and goes to the doctor for regular checkups
- If the cancer becomes incurable, try to keep her as comfortable as possible
OTC and Self-Management Methods Available for Cervical Cancer
There are no over the counter medicines available for treating cervical cancer because the disease is very severe. No medicine should be taken without consulting a doctor.
Getting diagnosed with cervical cancer can be extremely difficult to process. But with positivity and confidence, it is possible to win over the disease. Following ways can be adopted to manage the disease:
- Eat healthy food and indulge in regular exercise.
- Mediate and practice yoga regularly to keep away stress.
- Join self-help groups where you can meet other people struggling with the disease.
- Do not lose self-confidence.
- Try to accept your body after the surgery and do not lose self-esteem.
- Take help from friends and family
- Go for regular checkups.
Even after treatment, the patient will require a lot of help from her friends and family. Regular checkups should be done. Most of the women lose themselves completely after the treatment as the body completely changes. Cancer patients require a lot of work to reestablish themselves and restore their integrity. [4]
Natural Ways to Cure Cervical Cancer
Cervical cancer requires an extensive medical treatment for managing the disease. However, there are some natural herbs that support the treatment process and can also help in coping up with the symptoms.
Some of the common herbs, minerals, and nutrients that can help in fighting cervical cancer are as follows:
Vitamin A
Foods rich in vitamin A like apple, broccoli, tomatoes, spinach and apricots help in boosting the immune system and protects cervix from developing cancer. The vitamin can help in slowing down the multiplication of cancer cells and prevent the symptoms from getting worse.
Vitamin B-2
Vitamin B2 containing foods like eggs, milk, almonds and mushrooms are very effective in preventing development of cervical cancer. It also helps in repairing tissues damaged by cancer. It decreases inflammation of the affected area.
Turmeric
Curcuma longa or turmeric is a natural herb that help in reducing the symptoms of cervical cancer like pelvic pain and excessive vaginal bleeding. It brings down inflammation as well due to its anti-inflammatory properties.
Cat’s Claw
Uncaria tomentosa or Cat’s claw is known for boosting immune system and protecting the body from viral and bacterial infections, and other diseases that can cause cervical cancer. It is taken in the form of tea, capsules and liquid extracts.
Health Tip by Experts
Cervical cancer is not the end of life. It might change the course of how you live it but is definitely not the end. With positivity and strength, you can still live the life of your dreams.
