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Cervical Cancer

Cervical cancer implies an abnormal appearance of certain cells that multiply uncontrollably in the cervix (which is the first part of the uterus that opens into the vagina). Fortunately, when discovered early enough, cervical cancer is fully curable in most cases. The best way to prevent cervical cancer from developing until is no longer treatable would be conducting regular Pap smear tests, which can detect atypical cells before the appearance of the actual tumor cells, at which stage treatment would be the most effective. There are two main types of cervical cancer: the epidermoid one and the cervical adenocarcinoma.

 

Cervical Cancer Overview & Facts

The evolution of cervical cancer

In the absence of a proper treatment, cervical cancer can spread to the vagina and the neighboring tissues next to the uterus. When the cervical cancer progresses, the lymphatic ganglia and the rest of the pelvic organs will be affected. When referring to an advanced stage of this disease, with remote metastases included, kidney, intestinal, liver and even lung damage can occur. Cervical cancer is classified according to the size of it and the extent area (metastases to other tissues and organs in the body). A specialist oncologist will perform tumor staging by conduction further investigations such as blood tests, bone radiographs to make sure no bone metastases appeared etc. Staging cervical cancer is important for choosing the appropriate treatment, depending on the prognosis of the disease.

Risk factors

The existent cellular changes before the tumor cells appear can be influenced by a woman’s sexual life. A disorganized sexual behavior increases the risk of contracting sexually transmitted infections and diseases. The most common cause of cervical cancer would be the consequence of the infection with HPV (Human Papilloma Virus), which can cause major, irreversible cellular changes in the cervix at a specific interval from infection (up to several years). The HPV infection is usually asymptomatic, so it can take years to diagnose it, enough time for the growth of cells to cause damage. This is the reason why a precautious sexual life is recommended. What is there to avoid:

• Starting the sexual life before the age of 18
• Unprotected intercourse (medical studies have shown that not using a condom during sex can easily lead to cellular metaplasia if a partner is infected with HPV)
• More than three different sexual partners throughout one’s life
• Sexual contact with a person who had numerous previous partners
• A compromised immune system (where HIV-AIDS infection has a tremendous impact)
• Using birth control pills for more than five years in a row
• The body exposure to diethylstilbestrol (DES)
• A history of abusive smoking

Both pregnant and non-pregnant women can develop cervical cancer.

 

 

Cervical Cancer Symptoms & Diagnosis

Cervical Cancer Symptoms

The cellular changes in the cervix are usually asymptomatic, at this early stage diagnosis being entirely based on the Pap smear test results. With the development of the entire cancerous process, symptoms can occur, including:

• Abnormal vaginal bleeding or significant changes in the menstrual cycle (menometrorrhagias)
• Bleeding during sexual intercourse
• Pain during sexual intercourse (dyspareunia)
• Abnormal vaginal discharge, present in large quantities and sometimes mixed with fine traces of blood

The advanced symptoms of cervical cancer include:

• Anemia due to abnormal blood loss
• Pelvic pain (the lower part of the abdomen)
• Lower limb pain and back pain
• Vaginal fistula (an affection which permits the communication between the vagina and the rectum or bladder, resulting in the elimination of urine or feces through the vagina). This occurs only in severe cases of cervical cancer when the cancerous process spreads to the neighboring tissues.
• Visible weight loss

Cervical Cancer Diagnosis

The diagnosis of cervical cancer requires detailed consults of a gynecologist or oncologist. Whenever new symptoms start to develop or if the existent symptoms worsen, medical advice is highly required. Women that experience an increased risk of developing cervical cancer or women who encounter the following symptoms should make an appointment with their doctor as soon as possible:

• Intermenstrual bleeding
• Abnormal menstrual periods
• Abnormal vaginal discharge

The Pap cytology test is the safest method of early identification of incipient cell changes and their proper treatment. When the cervical cancer is detected early enough, the moment when incipient cell changes occur, a proper treatment can be set. Precancerous lesions should be carefully kept under control by regularly seeing a doctor. Specialists who can evaluate the symptoms and the risk factors will be able to diagnose cervical cancer. Someone who is possibly suffering from cervical cancer should see a gynecologist, a general practitioner, an oncologist or a radiotherapist.

Cervical Cancer Investigations

A cervical cancer screening can be done by annual Pap smear tests, which are able to highlight all the precancerous or malignant cell changes in the cervix. If cervical cancer is suspected, more investigations should follow to confirm the diagnosis. These can include:

• Colposcopy / cervical biopsy (determining the exact location of the malignant cells on the cervix surface)
• Endocervical biopsy (which can determine whether malignant cells are present in the cervical canal)
• Microscopic analysis of the cervical tissue

All the investigations mentioned above can be performed on pregnant women as well.

Staging Cervical Cancer

These investigations are necessary to properly determine the stages of cervical cancer:

• Blood tests which should indicate the presence or absence of anemia or other blood changes
• Evaluating the liver and kidney functions
• Observing if there is any extent of malignant lesions in neighboring tissues
• Hysteroscopy (a better visualization of cervical and uterine canal)
• Cystoscopy (metastases in the urinary system)
• Proctoscopy (metastases at the level of intestines)
• Urography (kidney blockages)
• Chest radioscopy (lung metastases)

There are special investigations for determining the right kind of cervical cancer treatment:

• Computed Tomography (CT) which can identify the abdominal and pelvic metastases presence
• Nuclear Magnetic Resonance (MRI) which can identify the stage of cancer present
• Positron Emission Tomography (for accurately assessing the spread of tumor cells to other organs)
• Lymphatic angiogram to determine the eventual tumor invasion in the body

 

 

Cervical Cancer Treatment & Care

Cervical cancer which is diagnosed in an early stage can be treated entirely. The types of treatment used for this affection are:

• Surgical therapy that removes the tumor entirely
• Radiotherapy used for treating other organs affected by the tumor as well
• Chemotherapy used to treat metastases

Choosing the right type of treatment has a major impact on the patient’s quality of life. It is highly important to discuss with a specialist about all the possible therapeutic options a person suffering from cancer may have. The prognosis of cervical cancer depends on its type and its stage. The appropriate treatment choice also considers age, the main health status of the patient and the desire to have children in the future. Treatment can be either combined or individual:

• Total hysterectomy (the removal of the entire uterus and every tissue related to it)
• Radiotherapy (high-intensity x-rays which can destroy the malignant cells)
• Chemotherapy and chemoradiation

All anticancer drugs involved in the treatment have high toxicity, affecting the blood, skin, hair and other organs of a patient. The larger the administered dose, the greater the chance of destroying a larger number of cancer cells. The downside would be that chemo can destroy healthy cells as well. When there is no other possibility, large doses of chemo are the solution. Such treatment should be done in cures with alternating breaks. The pace of the treatment depends on the recovery time of each patient.

Micro invasive squamous cell carcinoma which is a stage one cancer with minimal invasion at the level of deep cervical layers is the type of tumor with the highest success rate in treating. At this stage, the survival rate is 100%. Most treatments for cervical cancer do have serious side effects. These vary from one patient to another, depending on the type of treatment chosen and the other factors that influence their general health status. The most frequently occurred side effects are:

• Extreme fatigue
• Skin lesions
• Mood disorders
• Lack of appetite, nausea, vomiting, diarrhea
• Hair loss

Most women will experience denial when being told they are suffering from cancer. These emotions should be controlled, or they can influence the patient’s decision-making capacity. If the patient is affected by contradictory feelings, it is recommended to seek professional help or groups of people who are suffering from the same disease to help coping with the whole situation.

In the most cases, pregnant women have the same treatments as non-pregnant ones. The treatment for the incipient stage of cancer can be postponed until after birth, if diagnosed in the third trimester of pregnancy.

The initial treatment

In the initial phase of cervical cancer, radiotherapy combined with chemo are associated with surgical therapy. This kind of combination is called adjuvant therapy. Women who do not desire to undergo the standard treatment enroll in medical programs for testing other types of treatment. Women with cervical cancer that also suffer from HIV encounter a rapid unfavorable evolution of the affection.

The maintenance treatment

Maintenance treatment is extremely important for preventing relapses. The emotional status of the patient during treatment differs from woman to woman, depending on the type of treatment chosen. The doctor will establish a program that includes regular medical checkups, as follows:

• a complete gynecological examination and a cytology exam (Pap smear) every 3 months for 2-3 years after diagnosis
• a gynecological examination and a Pap smear every 6 months after 4-6 years of diagnosis

If there is a suspicion that the tumor cells spread to other organs, the oncologist will recommend further complementary investigations such as a CT scan of the abdomen and pelvis.

If respiratory symptoms (chest pain, coughing) are present, pulmonary radioscopy is required to determine if the tumor process has spread to the lungs.

The rescuing treatment

In some cases, patients confront a difficult situation: cervical cancer relapses. Approximately 35% of women diagnosed with cervical cancer will experience a recurrent disease. Less than 5% of the women that suffer from recurrent cancer and leave it untreated survive up to 5 years. Women who have had a total hysterectomy and suffer from recurrent cancer have a survival rate of 30% to 40% if treated with chemo. Patients who develop localized recurrences that do not exceed the pelvis area can be surgically treated by removing all the tissues and organs affected by the respective tumor, thus reducing the risk of new recurrences. The purpose of palliative treatment in advanced cases of cervical cancer, where the disease has completely metastasized outside the pelvis, is to control the symptoms and reduce the complications, thus increasing the overall comfort for the patient. Curative treatment is no longer possible when cancer reached this stage. Palliative treatment includes radiotherapy, chemotherapy and symptomatic medication.

Complementary treatment

The conventional treatment for cervical cancer should be accompanied by a complementary one that can include one of the following:

• acupuncture
• bio-feedback
• meditation
• yoga
• nutritional supplements
• vitamins

Complementary treatment is never used as a substitute for standard therapy for any type of cancer. Before initiating the complementary treatment chose, a patient needs to discuss with the doctor related to both the side effects and benefits of such methods. Some women who experience cervical cancer at an advanced stage choose not to receive any treatment due to their side effects, costs and reduced benefits. The decision to entirely stop the treatment that could or could not prolong the life of a patient is difficult to make so a patient needs to know all the possibilities and options he has.

 

 

 

Cervical Cancer Causes

Cervical cancer is caused by different cellular abnormalities found in the cervix. Most precancerous cells appear in the cervix, this being an area that constantly undergoes types of cyclical changes depending on the menstrual cycle of a woman. During this physiological process, cervical cells can suffer mutations, favoring the appearance of atypical cells, especially in the case of Human Papilloma Virus infection (a sexually-transmitted virus that can cause cervical lesions and increase the risk of cervical cancer apparition).

Other risk factors that may influence developing cervical cancer would be:

• Smoking
• A compromised immune system
• Birth control pills