Cervical cancer begins in the cervix, the lower part of the uterus that connects to the vagina. It primarily affects women over 30, and long-lasting infection with certain types of human papillomavirus (HPV) is the leading cause. Screening tests and the HPV vaccine, recommended for girls and women aged 9 to 45, can help prevent cervical cancer. Early detection of cervical cancer significantly improves treatment outcomes and quality of life.
Early-stage cervical cancer often does not present symptoms. In advanced stages, symptoms may include:
• Vaginal bleeding after intercourse
• Heavy, malodorous vaginal discharge
• Bleeding post-menopause
• Pain during intercourse
• Pelvic pain
Cervical cancer begins when mutations occur in the DNA of cervical cells. Normally, cells grow, divide, and die in a controlled manner. Mutations disrupt this process, causing cells to grow uncontrollably and form a tumor. Cancer cells can invade nearby tissues and spread to other body parts. HPV is a key factor in cervical cancer, though environmental and lifestyle factors also contribute.
Types of Cervical Cancer
1. Squamous Cell Carcinoma: Originates in the squamous cells lining the cervix and accounts for nearly 90% of cases.
2. Adenocarcinoma: Develops in the glandular cells of the cervical canal.
In some cases, both cell types may be involved, and rarely, cancer can arise from other cervical cells.
• HPV infection
• Multiple sexual partners
• Smoking
• Long-term use of oral contraceptives
• Having three or more children
• Early sexual activity
• Early Menopause: Occurs when the ovaries stop producing estrogen and progesterone.
• Narrowing of the Vagina: Radiotherapy can cause the vagina to narrow, leading to painful or difficult intercourse.
• Lymphoedema: Removal of pelvic lymph nodes can disrupt lymphatic system function, causing swelling.
Cervical cancer is less common in women under 30 and often has a lower mortality rate in those who undergo regular screenings, including the Pap test. This test helps identify cancer and precancerous changes. The risk of cervical cancer-related death increases with age, and recent data shows higher mortality rates among Black women compared to White women, particularly in those under 50 and over 60 years old.
Screening tests include:
• Bimanual Pelvic Examination: A doctor examines the cervix, uterus, vagina, ovaries, and surrounding organs for abnormalities.
• Pap Test: A sample of cells is gently scraped from the cervix and vagina to test for abnormalities.
• HPV Typing Test: This test analyzes cells from the cervix for the presence of HPV, similar to the Pap test.
• Pap and HPV Testing: A positive Pap test may lead to an HPV test. HPV testing can also be performed alone or in conjunction with a Pap test. Self-collected HPV samples are being explored in clinical trials.
• Stage 1: Cancer is confined to the cervix and has not invaded deeper tissues or spread.
• Stage 2: Cancer has spread beyond the cervix and uterus but has not reached the pelvic walls or lower vagina and has not spread to lymph nodes or distant sites.
• Stage 3: Cancer extends to the lower vagina or pelvic walls and may obstruct the ureters. It may have spread to nearby lymph nodes.
• Stage 4: Cancer has spread to the bladder, rectum, or distant organs such as the lungs or bones and possibly to lymph nodes outside the pelvic area.
• Stage 1: Surgery is the primary treatment, sometimes combined with chemoradiotherapy.
• Stage 2: Treatment generally involves chemotherapy and radiation therapy, with a radical hysterectomy and radiation therapy considered for severe cases.
• Stage 3: Chemotherapy and radiation therapy are used, with surgery to remove pelvic lymph nodes and internal radiation therapy as needed.
• Stage 4: Treatment typically includes chemotherapy and radiation therapy, with external radiotherapy given five days a week for about five weeks, potentially followed by brachytherapy.
Regular screenings can detect and treat precancerous changes, helping to prevent cervical cancer. The HPV vaccine, recommended for individuals aged 9 to 45, protects against cancer-causing HPV types.
Additional preventive measures include:
• Delaying sexual activity until later in life
• Limiting the number of sexual partners
• Practicing safe sex with condoms and dental dams
• Avoiding sexual partners with a high number of partners or symptoms of genital warts
• Quitting smoking
• Early-Stage Cervical Cancer: If detected early, treatment can be delayed until after delivery. Options like hysterectomy or cone biopsy will be considered based on cancer progression.
• Advanced Cervical Cancer: For advanced stages, treatment options are critical and may involve terminating the pregnancy, depending on the severity of the cancer.
• Stage 1: 80-99%
• Stage 2: 60-90%
• Stage 3: 30-50%
• Stage 4: 20%
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