Before answering what is cervical cancer, the cervix must be explained. The cervix is found in a woman’s reproductive system. It is a narrow part under the uterus (womb). The cervix bridges the uterus and the vagina. The cervix has a passageway called the cervical canal where blood flows from the uterus into the vagina during menstruation. It produces mucus that helps the sperm move from the vagina into the uterus. The cervix is tightly closes during pregnancy to keep the baby inside the uterus and opens or dilates during childbirth.
Cervical cancer happens when there is malignant neoplasm of the cervical area or cervix uteri. Vaginal bleeding usually presents the cancer but symptoms do not usually appear during the early stages.
Cancer starts in cells that make up tissues which in turn make up the organs of the body. Normally cells grow, form new cells, and die when they grow old. When this process goes wrong, new cells are reproduced when they are not needed and old cells do not die when they should. This then leads to tumors. Tumors may be benign or malignant. Benign tumors are rarely life threatening and do not reappear when removed. Malignant tumors are cancer and pose life threats during the advanced stages.
The most relevant risk factor in the development of cervical cancer is having a human papillomavirus (HPV) infection. HPV is a group of viruses that may infect the cervix. They are very common and are passed through sexual contact. Most adults have been infected with the virus at some time in life. Because such viruses can cause changes to cells in the cervix, genital warts, cancer and other problems may develop. HPV may be detected even without warts or other symptoms. By triggering alterations in the cells of the cervix, cervical intraepithelial neoplasia may be developed and may cause cancer.
Although the HPV is accountable for most cervical cancer cases, risk factors associated with cervical cancer include: sexual history, lack of regular pap tests, weakened immune system, age, smoking cigarettes, using birth control pills for a long time, having many children, chlamydia infection, exposure to the hormonal drug diethylstilbestrol (DES), and a family history of cervical cancer. Women who have or had multiple sexual partners have a greater risk. Pap tests help doctors discover precancerous cells which when treated prevents cancer. HIV that is responsible for weakening the immune system presents greater risk to those infected with it. Cervical cancer occurs mostly in women over age 40. Women with HPV infections who smoke cigarettes are at greater risk than those who don’t. Using birth control pills for 5 years or more may increase the risk of cervical cancer in women with an HPV infection. Giving birth to many children and multiple pregnancies in women with an HPV infection increases their risk of having cervical cancer.
Screening before symptoms appear is very important. It helps doctors check cervical changes and discover abnormal cells before cancer develops. When abnormal cells are found and treated at an early stage, cervical cancer is prevented. Where cancer is present and found in an early stage, treatment is more likely to be successful and effective. Because of screening, lesser number of women are diagnosed with cancer for the past decades.
Doctors recommend regular Pap tests to help reduce risk of cervical cancer. A Pap test or Pap smear is a simple examination of cervical cells and is usually painless. This process is done by having a doctor or nurse scrape a sample of the cells from the cervix and smear the cells on a glass slide. A new Pap test method (liquid-based Pap test) is done by rinsing cells into a small container of liquid and a special machine puts the cells onto slides. For both types, the cells are examined under a microscope to check abnormalities.
While the Pap smear is an effective screening test, diagnosis of cervical cancer or pre-cancer must be done through a biopsy of the cervix. This is performed through colposcopy which is a magnified visual inspection of the cervix with the use of a dilute acetic acid solution to emphasize abnormal cells on the surface of the cervix. Loop electrical excision procedure and conization are further diagnostic procedures removing the inner lining of the cervix to be submitted for examination to a pathologist. These are performed when biopsies confirm severe cervical intraepithelial neoplasia.
If the biopsy shows cancer, a thorough pelvic exam is performed removing additional tissue from the cervix to learn the extent or stage of the disease. The stage will determine invasion and metastases. Stage 0 or carcinoma in situ is the earliest stage of cervical cancer where the cancer is found only in the top layer of cells in the tissues lining the cervix. Stage I is when cancer is found only in the cervix where the cancer has invaded the parts beneath the top layer of cells. Stage II is when the cancer has invaded nearby tissues beyond the cervix and has extended to the upper part of the vagina. Stage III is when the cancer has extended to the lower part of the vagina and may have also spread to the pelvic wall close to lymph nodes. Stage IV is when the cancer has metastasized to the bladder, rectum, or other parts of the body. Recurrent cancer, from the name itself is the return of cancer after a period of time after treatment and may show up again in the cervix or other body parts.
Before starting a treatment, a patient might want a second opinion about the diagnosis and treatment plan. Where a delay in treatment does not affect the effectiveness, it is best to seek second opinions. But there are patients who require immediate medical attention. The treatment choice depends on the tumor size and metastases. Fertility issues for women also influence treatment options. The doctor describes treatment choices and expected results and side effects of each. The choice is based on the patient’s medical needs and values.
What is cervical cancer treatment? Treatment options available for women with cervical cancer are surgery, radiation therapy, chemotherapy, or a combination of methods. At any stage, there may be treatment given to control pain and other symptoms, to relieve side effects, and to lessen emotional problems. Such treatments are referred to as supportive care, symptom management, or palliative care.
