Cervical Cancer

Overview of cervical cancer

Cervix is an essential organ of a woman’s reproductive system which helps in vaginal lubrication during sexual intercourse.Abnormalities in the normal functioning of the cervix can be a strong indicator of diseases of the organ which in due course of time can even lead to “Cervical Cancer”, a disease affecting millions of women all over the world.

According to statistics produced by the American Cancer Society, each year, more than 2,70,000 women die from cervical cancer and more than 85% of these deaths occur in low and middle-income countries.Clearly, the current global scenario of cervical cancer is alarming.

Definition of cervical cancer

Cervical cancer is defined as the abnormal cell growth and proliferation in the cervix that leads to the formation of solidified mass called tumors.

It is mainly catalyzed by the Human Papilloma Virus (HPV), which is also responsible for several other infections of the reproductive tract.

Under healthy conditions, the normal cells of the cervix grow and divide and are replaced by new cells after their death.

But under certain abnormal conditions, old cells do not die even after a certain time and new cells are formed even though the body does not need them.

Thus these extra cells form solidified mass of tissues (malignant tumors) on the outer surface of the cervix.  After a certain stage, these tumors break loose from their site of formation (cervix) and are carried via the bloodstream to the lymph nodes, lungs, liver, and bones. Till date, cervical cancer is considered as the second most common cancer in women worldwide.

Causes of cervical cancer

Cervical cancer is typically a sexually transmitted disease, mediated by the HPV virus. The commonly studied causes of cervical cancer are described below-

• Smoking: Thorough research has revealed tobacco by-products in the cervical mucus of women who are habitual smokers. These products have an adverse effect on the DNA of the cervix cells and may lead to cervical cancer.
• Immunity: Immunocompromised people such as the ones suffering from HIV infection or women undergoing treatment for autoimmune diseases have high risks of HPV infection and cervical cancer.
• Chlamydia infection: Women evincing history of Chlamydia infection (sexually transmitted bacterial infection) are more susceptible to HPV infection as well.
• Diet: Regular diet deficient in fruits and vegetables can predispose the body to HPV infections.
• Obesity: Adenocarcinoma of the cervix may develop in women who are overweight.
• Medications: Taking oral contraceptive pills for a prolonged period (5 years or more) can increase chances of cervical cancer. Also, few fertility drugs such as Diethylstilbestrol (DES) can increase chances of cervical cancer. These chances are reduced once the medications are stopped.
• Heredity: Having a family history of cervical cancer increases chances of the disease in the future generations.
• Sexual interaction: Unprotected sexual intercourse with multiple sexual partners or having sexual activities at a very young age increases risks of HPV infection.
• Pregnancies: Giving birth to three or more children can increase risks of cervical cancer.

Symptoms of cervical cancer

Cervical cancer is manifested through the following symptoms-

• Abnormal and excessive vaginal bleeding after sexual intercourse, menopause, pelvic examination or douching
• Bleeding between consecutive menstrual cycles
• Prolonged menstrual periods with heavy flow
• Abnormal vaginal discharge (other than blood) with a foul smell
• Painful intercourse
• Post-coital spotting
• Pain in the lower abdomen and pelvic region which gradually radiates to the back causing lower back pain
• Nausea, vomiting, and lethargy
• Swelling and pain in legs

Types of cervical cancer

Cervical cancers are broadly classified into three categories depending on the type of cell affected. These are as follows –

• Squamous cell carcinoma: They constitute about 9-10% of cervical cancer cases. These kinds of malignancies usually originate from cells present in the outer surface of the exocervix. They exhibit features of squamous cells when examined under a microscope. The site of origin of squamous cell carcinoma is usually the junction of the exocervix and endocervix.
• Adenocarcinoma: These types of cervical cancers originate from the gland cells of endocervix that secrete mucus.
• Adenosquamous carcinoma: It exhibits characteristics of both squamous cell carcinoma and adenocarcinoma. It is also called mixed carcinoma.

Another classification of cervical cancer is done based on the nature of malignancy. This is described below-

• Microinvasive cervical cancer: In this case, the cancerous cells only break through the bottom layer of the cervical lining.
• Invasive cervical cancer: In this condition, the cancerous cells are transmitted from the outer layer of the cervix to the inner layer of tissues. Gradually it spreads to the vagina, lymph nodes and adjoining tissues as well.

Stages of cervical cancer

Cervical cancer normally starts from the cells forming the inner linings of the cervix, more correctly, from the lower portion of the uterus. Hence it is also called uterine cancer and it usually progresses through the following stages-

• Stage I: In this stage, the malignant cells are present only within the cervix.
• Stage II: Tumour growth occurs and it breaks through the skin of the cervix and penetrates the upper portion of the vagina. It may also invade other adjoining tissues or the lower portion of the vagina.
• Stage III: The tumor penetrates through the lower portion of the vagina and the pelvic wall. Bigger tumors may obstruct the urinary tubes and lead to kidney dysfunctions.
• Stage IV: The tumor invades the urinary bladder and rectum. Cancer cells also spread to other parts of the body such as liver, lungs, and bones.

Diagnosis

The following diagnostic tests are recommended for cervical cancers-

• Pap test: It detects precancerous or cancerous cells in the cervix.
• Colposcopy: Examination of vulva, vagina, and cervix is done.
• Cervical biopsy: It reveals the presence of abnormal tissues.

Treatment & Prevention

While there are no definitive ways to prevent cervical cancer, many cases of this type of cancer can be prevented by regular Pap Tests or Pap smear, which is a screening procedure for the HPV or Humanpapilloma virus.

This can help detect the invasion of the virus before it turns cancerous in nature.

Other effective preventive measures include vaccination, practicing healthy lifestyle habits such as no smoking, and following safe sexual practice.

Treatment of a case of cervical cancer depends on the degree of the spread of the cancer. The treatment methodologies include surgery, radiation therapies, chemotherapy, and targeted therapy. Patients and their families are advised to take a second opinion on the diagnosis of cancer in order to decide on the treatment course.

Cervical cancers detected at an advanced stage may call for surgical intervention. Protected sexual activities and healthy dietary habits can curb the spread of the disease to a considerable extent.

References