Cervical Cancer – Cancer of the Cervix

Cervix is a part of the reproductive system in women that resides as a bridge between the vagina and the uterus. When cancerous /abnormal cells start growing in the cervix region, it is termed as cervical cancer. If ignored or left untreated, cancer can spread (metastasize) to other organs of the body such as lungs, liver, vagina, rectum etc. HPV – Human Papillomavirus is the major cause of cervical cancer. HPV is a Sexually Transmitted Disease and can be prevented with vaccine.

Types of Cervical Cancer

There are 3 types of cervical cancer depending on where the cancer causing cells are found.

1. Squamous Cell Carcinoma – In 90% of the patients, this is the type of cancer found. The abnormal growth of cancer cells is found in the lining of the cervix.
2. Adenocarcinoma – The cancer causing cells are found in the mucus present in the cervix.
3. Mixed Carcinoma – In patients suffering from this condition, cancer cells are found in both the lining of the cervix and in the mucus.

What causes Cervical Cancer?

Typically any cancer is caused by abnormal growth of cancerous cells. In case of Cervical cancer, HPV (Human Papillomavirus) has been recognized as the cause in majority of the cases. There are over 100 different strains of HPV, some of them cause genital warts, warts near mouth, on palms etc. Other strains of HPV cause cancer of Cervix, Vagina, Anus, Tongue, Vulva etc.

Risk factors of cervical cancer (factors that increase the odds of getting cervical cancer):

1. Having sex before the age of 16 or just within a year after first menstruation
2. Having multiple sex partners – this increases the chances of contracting HPV
3. Taking birth control pills for more than 5 years.
4. Weakened Immune system
5. Smoking Cigarettes
6. Having other sexually transmitted Infections / Diseases.

Symptoms of Cervical Cancer

The main problem with cervical cancer is the delay it causes to identify the disease. During the initial stages, cervical cancer does not show any symptoms. Symptoms start showing only when it is too late.

Symptoms of cervical cancer include:

1. Unusual Vaginal Discharge
2. Pain during sex
3. Vaginal bleeding after sex, between periods or after reaching menopause. Chances of contracting cervical cancer reduce after menopause, but women are still at risk.

Once the cancer is spread beyond cervix region, it can cause other symptoms such as:

1. Pelvic Pain
2. Pain during urination
3. Swollen legs
4. Kidney failure
5. Bone pain
6. Fatigue, weight loss, lack of appetite.

When you should not ignore the symptoms or signs?

1. Bleeding after sex. Rough sex can sometimes cause vaginal bleeding but it should subside very shortly. If it bleeds every time you have sex with moderate intensity to rough, you must see a gynaecologist immediately.
2. If you are having unusually heavy period of spotting/bleeding in between periods.
3. If you faint or have weakness along with vaginal bleeding, you must get immediately admitted to the intensive care unit.

Diagnosing Cervical Cancer

1. HPV testing – Due to it’s ability to put you at higher risk of developing cervical cancer
2. Pap Smear test – Papanicolaou Test – Cells from the cervix are taken and observed under a microscope for the presence of cancer causing cells. If any such abnormality is found, a little bit of cervix tissue will be taken for biopsy.
3. Pelvic Exam with a colonoscopy – Before going for a biopsy, colonoscope may be used to look for abnormal cells. Cervix will be stained with a dye or acetic acid before inserting the colonoscope. This is done for having a better view at the cells inside the cervix. The colonoscope shows a magnified picture of the interiors of the cervix. If the gynaecologist finds any abnormalities, biopsy may be suggested.
4. LEEP – Loop Electrosurgical Excision Procedure – In this procedure, an electrified loop of wire is used by the gynaecologist to collect a sample of tissue from the cervix.
5. Conization – A part of cervix is removed in this procedure using LEEP or Laser or a scalpel for biopsy.

Further testing for Cervical Cancer

If the biopsy confirms the presence of cancer cells, the next step will be to understand the stage of the cancer, i.e, to know till where the cancer has spread from the cervix.

1. Chest X-ray to check for cancer cells in the lungs
2. Blood test and CT scan to check the liver
3. Intravenous Pyelogram (IVP) or CT scan to check Urinary Tract
4. Barium Enema or proctosigmoidoscopy to check the rectum
5. CT, MRI or PET scans to check lymph nodes.

Treatment for Cervical Cancer

If the cancer cells are present only on the surface of cervix, simpler procedures such as LEEP or Cold Knife Conization can be adopted to destroy the cells.  If the cancer cells have passed through the basement membrane, the division between the surface of the cervix and the underlying tissues surgery and/or radiation therapy may have to be used. Chemo and biological therapies are also options in some cases or a combination of these therapies may be employed in treating cervical cancer.

1. Radiation therapy – high energy beams produced from external devices will be focused on the areas where cancer cells are present and they will be destroyed leaving the healthy tissues unaffected. Radiation therapy can be either internal or external. In external radiation therapy, an external device will be used to generate the high energy beams. External radiation therapy may have to be done 5 times a week for 5 to 6 weeks.

In internal radiation therapy, radioactive substances will be deployed in the affected areas. These substances emit radioactive energy that destroys the cancer cells.

2. Chemotherapy – Chemotherapy involves powerful drugs that target and kill cancer cells. This method will be employed when the cancer has spread beyond cervix region.
3. Biological therapy or Immunotherapy – The medicines administered in this therapy signals the immune system to attack and destroy the cancer cells. Other medicines that shrink the cancer cells may also be given. This approach may be taken when Chemotherapy doesn’t seem to be effective in containing and destroying the spread of cancer cells.

What to do at home during Cervical Cancer treatment

1. You may not feel hungry like before, but you have to eat nutritious diet, multiple times in smaller proportions. This helps your body cope up with the medications being given.
2. Have good night sleeps and you can also take naps during the day if you feel like.
3. Quit smoking and alcohol

Follow up with your gynaecologist after Cervical Cancer treatment

You will need to keep in regular touch with your gynaecologist after treatment of cervical cancer.  You may have to see your doctor occasionally as advised by him/her for some tests to check if the cancer is recurring or has cured completely.