Cervical Cancer – Symptoms, Causes & Treatment

Cervical cancer is a disease in which malignant (cancer) cells form in the cervix, the lower part of the uterus. The cervix is the passageway that connects the vagina, uterus, and fallopian tubes. The uterus is where a baby grows before birth. Cervical cancer can lead to death if not treated, but it’s most often treatable when found early.

What Causes Cervical Cancer?

Cervical cancer is a disease that develops when cells become abnormal and multiply uncontrollably. These abnormal cells begin to crowd out healthy cells in the cervix responsible for protecting the uterus and fallopian tubes. Cervical cancer is most often caused by human papillomavirus (HPV), although other factors can also cause it.

What are the Symptoms of Cervical Cancer?

Cervical cancer symptoms include,

  • Bleeding after sexual intercourse or between menstrual periods
  • Difficulty urinating or pain in the lower abdomen or pelvis
  • Pain during sex, especially deep penetration
  • Prolonged menstrual bleeding or bleeding between periods
  • A lump or mass in the vagina

What are the Stages of Cervical Cancer?

There are three stages of cervical cancer: stage 0, stage 1, and stage 2.

Stage 1: In this stage, the cancer is confined to the cervix, the lower part of the uterus. Stage 1 is further divided into two sub-stages:

  • Stage 1A: The cancer is microscopic and can only be detected with a microscope.
  • Stage 1B: The cancer is visible to the naked eye or can be detected through imaging tests but remains confined to the cervix.

Stage 2: At this stage, the cancer begins to spread beyond the cervix but still remains within the pelvic area. Stage 2 is further divided into two sub-stages:

  • Stage 2A: The cancer has spread to nearby tissues, such as the upper part of the vagina.
  • Stage 2B: The cancer has reached the tissues next to the cervix, such as the parametrium (connective tissue surrounding the cervix) or the lower part of the vagina.

Stage 3: In this stage, the cancer extends further beyond the pelvis. Stage 3 is divided into three sub-stages:

  • Stage 3A: The cancer has reached the lower part of the vagina.
  • Stage 3B: The cancer has invaded the pelvic wall or caused hydronephrosis (buildup of urine in the kidney due to a blocked ureter).
  • Stage 3C: The cancer has spread to nearby lymph nodes.

Stage 4: This is the most advanced stage of cervical cancer, indicating that the cancer has spread to distant organs or tissues. Stage 4 is further divided into two sub-stages:

  • Stage 4A: The cancer has spread to nearby organs, such as the bladder or rectum.
  • Stage 4B: The cancer has metastasized to distant sites, such as the lungs, liver, or bones.

How is Cervical Cancer Diagnosed?

Cervical cancer is diagnosed through physical exams, tests, and procedures. The first step in the process is a pelvic exam. During this exam, your doctor will perform an internal examination to look for abnormalities in your cervix. If abnormalities occur, your doctor may order additional tests such as a pap smear or HPV test. If you have symptoms of cervical cancer, your doctor may recommend other tests such as an endocervical swab for cytology (a sample of cells) or imaging tests like an MRI or CT scan. It may also be diagnosed with colposcopy and biopsy. This procedure involves inserting a small magnifying instrument called a colposcope into the vagina to examine the cervical area. The doctor will then use a tiny tool to scrape cells from your cervix for testing.

What is Colposcopy?

A colposcopy is an examination of your cervix using a magnifying instrument called a colposcope. A biopsy removes tissue samples from your cervix to be examined under a microscope.

What are the First Steps in Treating Cervical Cancer?

You should first make an appointment with your primary care physician or gynecologist to discuss your diagnosis and treatment options.

Your doctor will likely order blood tests and a Pap smear to evaluate the stage of your cancer and determine if chemotherapy or radiation therapy is needed.

He or she may also recommend an MRI scan of your pelvis to check for any tumor spread into nearby lymph nodes. Once you have more information about the extent of your cancer, you may choose one of three treatment options: surgery, radiation therapy, or chemotherapy.

Surgery involves removing the tumor and some surrounding tissue; radiation therapy uses high-energy beams to destroy cancer cells; chemotherapy uses drugs that kill cancer cells by stopping them from dividing or growing.

Importance of Serial Cervical Smears for Early Detection of Cancer Cervix 

Cervical cancer is the second leading cause of death in women. Most women diagnosed with advanced stages of cancer have either not done screening or have not followed up on their abnormal smears. 

Here are some interesting facts about cancer cervix: 

  1. Unlike most other cancers, the cervix is slow-growing, and it has a pre-malignant/pre-invasive stage where it can be captured through smears and treated completely. The diagnoses of these pre-malignant lesions are made through serial pap smears in short paps smears.  
  2. Majority of these cancers, the etiological factor is found to be a virus called the Human Papillomavirus ( HPV). The high-risk HPV strains, predominantly 16 and 18, and a few other strains are responsible for causing the disease. One has to understand that the mere presence of HPV does not mean that the woman will develop cancer; subsequently, in the majority of cases, the virus dies a natural death and disappears when tested in a couple of years. Only in a small percentage do they persist and cause the disease.
  3. Vaccines are developed that protect against HPV 16, 18, and a few other high-risk HPV strains. Vaccination is ideally given before the girls get sexually active and young women up to 26 years of age.

 According to the UAE National Guidelines

  • All women should begin screening with cervical smears  at 21 years of age 
  • Women aged 21-30 should have pap smears every 3 years.  
  • After 30 years, the frequency of screening is again once in 3 years, but if HPV testing is also combined, the frequency could be once every 5 years. 

Since Abu Dhabi has a rapid population turnover, we, as general gynecologists, perform opportunistic testing; we take cervical smears when women present to us with unrelated complaints.  Few precautions, however, need to be exercised to get satisfactory reports with opportunistic testing. Avoid taking smears when women present with symptoms of vulvovaginitis. It is a good practice to schedule the women for smears after the infection is treated. Performed during an ongoing infection can result in the finding of abnormal cells, which will confuse the patient and the physician. It is important to understand that the presence of abnormal cells does not mean the presence of cancer but needs to be evaluated by an expert who has experience treating abnormal cervical smears and correctly interpreting them in the context in question.   

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