Cervical Cancer
: What to Know
Cervical cancer is one of the more common cancers among women. It begins in the woman’s cervix, which is where the upper portion of the uterus connects to the vagina.
The CDC describes cancer as a disease where cells in the body grow out of control. This article includes an overview of what you need to know about cervical cancer.
How is HPV involved?
Malignant tumors growing in the cervical area are primarily caused by human papillomavirus (HPV). There are approximately 200 variants of HPV, with 40 of them spreading through direct sexual contact with someone who has the infection. Intimate, skin-to-skin contact can also cause the virus to spread. At least 14 strains of HPV are responsible for developing into cervical cancer.
The WHO Facts Sheet explains that two specific types of HPV (HPV Types 16 and 18) cause approximately 70% of cervical cancers and pre-cancerous lesions. This is why a great deal of cervical cancer prevention measures involve defense against HPV. Vaccinations against HPV 16 and 18 are recommended by the WHO and approved in numerous countries.
Development into Cervical Cancer
HPV can develop into cervical cancer. At first, there may not be any symptoms, but it can progress to pelvic pain and vaginal bleeding, often outside of the normal menstrual cycle.
It can take several years before the cervix’s cells transform into malignant cells. The cervix has two parts and has two different types of cells: glandular cells and squamous cells. Glandular cells are located around the cervix’s opening leading to the uterus, also known as the endocervix. On the other hand, squamous cells are found in the exocervix (also known as the ectocervix), and this is the outer part which a doctor inspects during a speculum exam.
These two cell types meet in the transformation zone, which is an area that changes as a woman grows up or gives birth. Most incidences of cervical cancer begin here. The transformation, however, is not immediate. The normal cells first go through a set of abnormal pre-cancerous changes. They have different names (dysplasia, cervical intraepithelial neoplasia, and squamous intraepithelial lesion are just some of them), but they are all checked in a lab. These are graded on a scale of 1-3, based on the level of abnormality of the tissue.
It’s important to remember that not all women who have pre-cancerous cells in their cervix will develop cancer. Some of these pre-cancerous cells may resolve themselves without medical intervention. However, there is still a substantial risk of these pre-cancerous cells turning into invasive cancers. With the right procedures, most cervical cancers are preventable and treatable.
A Brief History
By no means is cervical cancer a new disease. The very first mention of it dates back to 400 BCE. Pericles Hippocrates, a Greek physician, described the condition, and it had no known cure at the time.
But it wouldn’t be until 2000 years later that the disease's pathogenic mechanism would be identified by Dr. Rigoni Stern, an Italian surgeon in the mid-19th century. He documented numerous pieces of evidence of cervical cancer and noted that it was exceedingly rare among nuns, but quite common among sex workers. Women who had husbands who hired prostitutes regularly led to the theory that cervical cancer had to do with sexual intercourse and could be a transmissible disease.
In 1976, Zur Hausen, a German scientist, finally identified human papillomavirus as the culprit in cervical cancer. His work paved the way towards the discovery of the HPV vaccine.
Types of Cervical Cancer
Both cervical cancers and pre-cancers are categorized according to their appearance during lab tests. The major types are:
- Squamous Cell Carcinomas
This is the most common type of cervical cancer. Approximately nine out of ten cervical cancers are classified as squamous cell carcinomas, developing at the exocervix. They begin in the transformation zone.
- Adenocarcinomas
Other cervical cancers are often adenocarcinomas. These develop from the glandular cells, which are the mucus-producing glands in the endocervix.
- Adenosquamous or mixed carcinomas
This least common type of cervical cancer includes both squamous cell carcinomas and adenocarcinomas.
There are other subtypes of cervical cancer that can develop within the cervix, such as melanomas, sarcomas, and lymphomas. However, these types of carcinomas are not exclusively found in the cervix; they can be found more often in other parts of the body.
A sexually active person has a 50% chance of getting HPV at one point or another. However, only a small number of women will get cervical cancer. This is why doctors and experts recommend regular screening through pap smears and scheduling the HPV vaccine to prevent it. If found early, it’s an incredibly treatable disease with an excellent prognosis. Women can go on to survive for an extended period with a good quality of life.
Cervical cancer is diagnosed most often between the ages of 35-44. It’s rare to develop in women younger than 20-years-old. However, many women on the older side of the spectrum may be unaware that cervical cancer is a disease that progresses slowly. Most of the symptoms won’t manifest in a patient until the latter stages of the disease. Many women may also consider the first symptoms related to something else; they might believe that the symptom is related to a yeast infection, their menstrual cycle, or even a urinary tract infection. While there may be no noticeable signs in the early stages, the symptoms become more apparent as cancer grows and spreads to nearby tissue.
And as with all cancers, speed of detection is critical. Early detection vastly improves the chances of survival, reduces the risk of complications, and makes treatment more likely to be effective. Through preventative methods and keeping a sharp eye on the early warning signs, women can detect cervical cancer earlier.
Earliest Symptoms
Here are the most common symptoms associated with the onset of the disease:
- Abnormal vaginal bleeding – This symptom could become apparent after vaginal sex and between period cycles in women. Bleeding may become heavier than usual during periods themselves. Women who are already in menopause could also experience bleeding. Women who douche may also notice abnormal bleeds.
- Unusual vaginal discharge – While vaginal discharge is normal, there is cause for concern when the discharge has an unusual smell or signs of blood and occurs between periods and after menopause. The discharge may also be watery.
- Pain during vaginal sex – Another often-overlooked symptom is pain during sex for women. Some women may dismiss it as usual discomfort with sex, but significant pain (or if accompanied by blood) during sexual contact is a symptom.
- Frequent and painful urination – Often mistaken for a urinary tract infection, this symptom is another early indicator of cervical cancer, especially if accompanied by pain during urination.
These early symptoms may turn out to be nothing, but it is crucial to see a doctor and have an exam to rule out any possibility of cervical cancer or to detect it as early as possible. Other vital symptoms to look out for often appear in the cancer’s more advanced stages.
These include:
- Swelling in the legs
- Difficulty in urination or during bowel movement
- Bloody urine
- Persistent pain in the back, leg, or pelvic region
- Unusual weight loss, fatigue, and a loss of appetite
- Unpleasant-smelling discharge and vaginal discomfort
Again, these symptoms could indicate another condition other than cervical cancer, but it’s essential to have them checked immediately. As always, experts recommend regular screening tests instead, as the best chances of a successful treatment happen when the patient does not wait for symptoms to appear in the first place.
HPV is a significant cause of cervical cancer. Recent years have revealed a substantial amount of information that gives doctors a better understanding of cervical cancer and its development.
Cervical cancer is considered the second most common cancer in women living in underdeveloped regions. There are an estimated 570,000 new cases in 2018 in these areas, 84% of all worldwide cases. Approximately 311,000 women died in 2018 from cervical cancer, with the ratio skewed toward low- and middle-income countries. Around the world, cervical cancer is the fourth most frequently diagnosed cancer in women.
Several risk factors could lead to a woman developing cervical cancer.
HPV infection
This is the most critical risk factor in developing cervical cancer, responsible for many cases around the world. HPV can affect numerous areas of the body, not just the cervix. It can infect the skin, genital lining, mouth, throat, and even the anus. However, it does not affect the blood or other internal organs. HPV spreads during skin-to-skin contact between people, primarily through sexual activity. It’s a significant risk during vaginal, anal, and even oral sex. Chronic HPV infections can lead to severe cancers and not just cervical cancer.
Sexual history
People who have become sexually active at a young age, especially before the age of 18, have a higher risk of getting infected with HPV and are more at risk of developing cancer. Having a more significant number of sexual partners also increases that risk. People who have a partner who is considered high risk are, in turn, making themselves high risk for cancer.
Smoking
Smoking exposes an individual to numerous cancer-causing factors, thus heightening the likelihood of developing cervical cancer. Women who smoke are twice as likely to develop cervical cancer than those who do not. Tobacco byproducts have been found in the cervical mucous of women who regularly smoke. Researchers believe that the substances the body absorbs through smoking travels through the lungs and is carried by the bloodstream through the body. They finally end up damaging the DNA of cervix cells.
Weak immune system
Women who have weaker immune systems are more susceptible to HPV infections. HIV (human immunodeficiency virus), which causes AIDS, is one such cause of weaker immune systems, leading to a higher HPV risk. A job of the immune system is to slow pre-cancer and cancer cells' growth and prevent them from spreading. But for a woman with weaker immunity, the pre-cancer cells might develop into invasive cancer faster than average.
Other Sexually Transmitted Agents
Exposure to other infections like chlamydia, herpes simplex, syphilis, and gonorrhea cause issues like inflammation or weakens the body’s defense against other similar infections. It puts the patient at additional risk of getting HPV, which can also be sexually transmitted.
Long-term contraceptive use
Some studies also show evidence that long-term use of OCPs or oral contraceptives can increase the likelihood of cervical cancer. However, the risk goes down as she stops taking them, eventually returning to normal risk levels years later.
Multiple pregnancies
Women with three or more pregnancies carried to full term also have an increased risk of cervical cancer. Some studies indicate that this could be due to the hormonal changes that could make women more susceptible to HPV infections or cancer growth in the area. Another theory suggests that pregnant women’s immune systems might be weaker.
Economic status
Numerous low-income women do not have as much access to healthcare or may not be able to afford regular cervical cancer screening or vaccination against HPV. This puts them at greater risk of contracting the virus and having it develop into invasive cancer without realizing it was there until the cancer advanced to later stages.
Diethylstilbestrol
This is one risk factor for cervical cancer that has no real solution. DES is a hormonal drug that had been prescribed to women between 1938 to 1971. At the time, its purpose was to prevent miscarriages. Women with mothers who took the drug during pregnancy developed clear-cell adenocarcinoma in the vagina or their cervix more frequently than expected. These cancers are extremely rare otherwise. Their daughters, in turn, have an increased risk of developing squamous cell cancers and pre-cancers.
Cervical cancer is diagnosed through a combination of screening and diagnostic tests. Screening for any pre-cancerous cells or indications of cervical cancer should ideally begin at age 21.
Screening Tests
- Pap Test - The doctor scrapes and brushes cells from the cervix, and the cells are then examined for any abnormalities.
- HPV DNA Test – Cells collected from the cervix are tested for the presence of an HPV infection that could lead to cervical cancer.
Diagnostic Tests
- Punch Biopsy – Using a sharp tool to excise small samples of cervical tissue, doctors can biopsy the samples for the presence of cancer or pre-cancerous cells.
- Endocervical Curettage – Doctors use an instrument called a curet, a spoon-shaped tool, to scrape a tissue sample for biopsy.
- Electrical Wire Loop – A thin electrical wire is used to emit a low-voltage that then picks up a tissue sample. This is done under local anesthesia.
- Cone Biopsy or Conization – Doctors may use this test to collect cervical cells from deeper layers for more comprehensive laboratory testing. This procedure is done under general anesthesia.
Staging tests are performed when a doctor confirms a diagnosis of cervical cancer. These tests can indicate how far along the disease has advanced and allows doctors to make better treatment decisions.
These include:
- Imaging tests – Doctors use X-rays, CT, and MRI to check cancer's spread through or beyond the cervix.
Visual bladder and rectum examination – Through select scopes, doctors visually check the condition of these areas.
Medications:
The FDA has approved several drugs to prevent and treat cervical cancer. Vaccines like Cervarix, Gardasil, and Gardasil 9 are used to prevent and protect against HPV infection. Drugs used to treat cervical cancer include Avastin, Bevacizumab, Bleomycin Sulfate, Hycamtin, Keytruda, Mvasi, Pembrolizumab, and Topotecan Hydrochloride.
Diet & Lifestyle:
The first and most widely-recommended lifestyle change to prevent cervical cancer is to schedule vaccinations for both girls and boys. Furthermore, avoiding multiple sexual partners can significantly reduce the risk of contracting HPV. Doctors also recommend a diet rich in fruits and vegetables, focusing on carotenoids and folate foods. These include legumes, whole grains, fruits, and vegetables.
Therapy and Procedures:
Surgery is one of the primary procedures performed to treat cervical cancer, especially in the early stages. The type of surgery needed will depend on the cancer’s size and stage.
- Cone biopsy – Surgery to cut away malignant cells can be performed for small cancers. It may be possible to remove cancer through a cone biopsy altogether as well.
- Trachelectomy – This procedure is performed for early-stage cervical cancer. It removes the cervix along with the surrounding tissue. For women who still want to get pregnant, the uterus remains intact.
- Hysterectomy – Through a radical hysterectomy operation, the cervix, uterus, part of the vagina, and lymph nodes may be removed, curing early-stage cancer and preventing recurrence. However, this also makes it impossible to become pregnant.
Radiation and chemotherapy are other procedures performed to treat cervical cancer, directing radiation and targeted drug treatments to kill the cancer cells growing in the cervix.
Today, research into cervical cancer continues. In recent years, having accurate data on the course and treatment of cervical cancer has become critical to research on cervical cancer. And because HPV is an infectious disease, the careful study of infection, patient history, family, and regular screening has become extremely valuable to understanding the underlying causes of cervical cancer. Collecting data through medical records is one of the most powerful tools doctors and scientists have to better understand HPV and cervical cancer.
By digitizing medical and patient records, doctors can get a more accurate view of patients’ family and treatment histories. Knowing if their mothers also developed cervical cancer, their sexual partners' health, and how often they were screened can make a world of difference in patient care. Doctors can request the right tests, make the right diagnoses, and prescribe better treatments.
Is there a preventative surgery for cervical cancer?
There is no recommended prophylactic surgical procedure for cervical cancer. Doctors recommend that women continue to follow medical guidelines and maintain a schedule of pap smears every three years, starting at age 21. They should also get HPV testing starting at age 30 and receive the HPV vaccine. If they’re in high-risk groups, testing and screening should be done more often.
Are there side-effects to treatments?
Side-effects of treatments will vary between patients. Some common chemotherapy side-effects include fatigue, nausea, or vomiting. Hair loss, lack of appetite, and mouth sores are also common side-effects. In the longer term, narrowing of the vagina, weaker bones, sensitivity in the vulva, and low blood counts may also occur. In targeted therapy, side-effects may include fatigue, high blood pressure, blood clots, and other bleeding problems.
If I have a hysterectomy, will I still need cervical cancer screening?
Yes. You might still need screening, depending on whether your cervix was removed or not. If you have a history of moderate or severe cervical cell changes, there may still be cells present at the top of vagina. Screening should continue up to 20 years following the time of surgery.
Do I need a more intensive routine and screening guidelines?
Some women may need more frequent screening and testing. If you have a family history of cervical cancer or have already had it yourself, if you’re infected with HIV, and if you have a weakened immune system, or if your mother was exposed to diethylstilbestrol, you should be tested more often.
The screening test said I have an abnormal result. What does it mean?
Many women have abnormal results. It doesn’t always mean you have cancer. It’s possible that the abnormal cells can revert on their own. And it often takes several years before these changes become cancerous. Instead, you need to have additional testing to determine whether high-grade changes are present if these abnormalities are actual cancer cells. Sometimes, only repeat testing is needed.
A diagnosis of cervical cancer can be disheartening, but with the right treatment and correct understanding of the disease with your physician, there is every opportunity to live a long, productive life. Visit PicnicHealth.com to learn more about how you can get access to your health records and help with cervical cancer research.