Health Tips

All about cervical cancer. 

Cervical cancer is the fourth most common cancer in women. Prevention, early diagnosis, effective screening and treatment programmes can reduce the mortality rate of cervical cancer. Moreover, getting vaccinated can protect women against it.  

What is cervical cancer?

Cervical cancer as the name suggests is the cancer of the cells in the cervix (the lower part of the uterus). Cancer starts when cells in the body grow out of control and abnormally. These changes are caused by certain factors listed below.  

Stages of cervical cancer

Cervical cancer has four stages:

• Stage 1: The cancer is small. It may have spread to the lymph nodes. It hasn’t spread to other parts of your body.

• Stage 2: The cancer is larger. It may have spread outside of the uterus and cervix or to the lymph nodes. It still hasn’t reached other parts of your body.

• Stage 3: The cancer has spread to the lower part of the vagina or to the pelvis. It may be blocking the ureters, the tubes that carry urine from the kidneys to the bladder. It hasn’t spread to other parts of your body.

• Stage 4: The cancer may have spread outside of the pelvis to organs like your lungs, bones, or liver.

What are the risk factors?

Human Papillomavirus (HPV) infection

• • Human papillomavirus (HPV) is the most common viral infection of the reproductive tract. Most sexually active women and men will be infected at some point in their lives and some may be repeatedly infected.

  • The peak time for acquiring infection for both women and men is shortly after becoming sexually active. HPV is sexually transmitted, but penetrative sex is not required for transmission. Skin-to-skin genital contact is a well-recognized mode of transmission.

  • Although most HPV infections clear up on their own and most pre-cancerous lesions resolve spontaneously, there is a risk for all women that HPV infection may become chronic and pre-cancerous lesions progress to invasive cervical cancer.

  • It takes 15 to 20 years for cervical cancer to develop in women with normal immune systems. It can take only 5 to 10 years in women with weakened immune systems, such as those with untreated HIV infection.

  •  

• Having HIV (the virus that causes AIDS) or another condition that makes it hard for your body to fight off health problems.

• Smoking

• Using birth control pills for a long time (five or more years).

• Having given birth to three or more children.

• Having several sexual partners.

Symptoms 

In the early stages, cervical cancer may be asymptomatic (without signs and symptoms). Symptoms of advanced cervical cancer may cause bleeding or discharge from the vagina that is not normal, such as bleeding after sex. If you have any of these signs, see your doctor. They may be caused by something other than cancer, but the only way to know is to see your doctor.

Prevention

Primary prevention 

HPV vaccine can protect against the most common types of HPV that cause cervical, vaginal and vulvar cancers. 

• HPV vaccination is recommended for preteens aged 11 to 12 years, but can be given starting at age 9.

• HPV vaccine also is recommended for everyone through age 26 years, if they are not vaccinated already.

• HPV vaccination is not recommended for everyone older than age 26 years. However, some adults age 27 through 45 years who are not already vaccinated may decide to get the HPV vaccine after speaking with their doctor about their risk for new HPV infections and the possible benefits of vaccination. HPV vaccination in this age range provides less benefit, as more people have already been exposed to HPV.

If vaccination is started before age 15, a two-dose schedule is recommended, with the doses given 6 to 12 months apart. For people who start the series after their 15th birthday, the vaccine is given in a series of three shots.

HPV vaccination can prevent new HPV infections, but does not treat existing infections or diseases. This is why the HPV vaccine works best when given before any exposure to HPV. You should get screened for cervical cancer regularly, even if you received an HPV vaccine.

Secondary prevention 

Screening 

2 screening tests can help prevent or detect these cancers early on : 

• The Pap test (or Pap smear) looks for precancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately.

• The HPV test looks for the virus that can cause these cell changes.

Treatment 

When diagnosed, cervical cancer is one of the most successfully treatable forms of cancer, as long as it is detected early and managed effectively. Cancers diagnosed in late stages can also be controlled with appropriate treatment and palliative care.

Early treatment prevents up to 80% of cervical cancers. 

Treatment options:

Surgery 

• Cryosurgery - the killing of abnormal cells by freezing them. Used to treat Cervical Intraepithelial Neoplasia (CIN).

• Laser ablation - focused laser beam to vaporised/burn off the abnormal cells. 

• Conization - removal of abnormal cells at the transformation zone of the cervix where cancer cells usually start to form.

• Hysterectomy - simple (removal of the uterus alone) or radical (total removal)

• Trachelectomy  - removal of the cervix and the upper part of the vagina, this helps to preserve the ability to have children

Radiotherapy

Radiation kills cancer cells using high-energy X-ray beams delivered outside or inside of the body (through a metal tube placed in the targeted organ). 

Chemotherapy

Chemotherapy uses drugs to kill cancer cells throughout the body. Doctors give this treatment in cycles. There’s a period of treatment and a period to rest after it. 

Targeted therapy

Targeted therapy blocks the growth of new blood vessels that help the cancer grow and survive. This drug targets certain process in the cancer cell cycle and is often given together with chemotherapy.

Immunotherapy 

Immunotherapy is a biological therapy that helps your body to fight cancer by stimulating one’s own immune system to recognise and destroy cancer cells effectively. It can be used to treat cancer cells that have spread or a recurrent case.  

Cervical cancer is preventable through HPV vaccination and it has a high rate of recovery if treated early. 

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Reference :

1. https://www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer/en/

2. https://www.cdc.gov/cancer/cervical/basic_info/risk_factors.htm

3. https://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer

4. Cancer.org 

Picture credit:

1. https://news.llu.edu/patient-care/cervical-cancer-basics-of-what-you-need-know

2. https://www.healthline.com/health/cervical-cancer#stages

3. https://www.who.int/reproductivehealth/publications/cancers/cervical-cancer-infographics/en/

4. https://www.mayoclinic.org/diseases-conditions/cervical-cancer/symptoms-causes/syc-20352501

5. WHO

Written By

Dr. Jessamine Chong Sze Lynn

Reviewed By

Doc2us Medical Board