The basic building blocks that makeup body tissues are cells. The cells constantly grow, wear out, and get replaced after they wear out or get injured through cell multiplication. Cancer is a disease that attacks body cells. It happens during cell multiplication when abnormal cells grow, forming a lump or a mass called a tumor. Every cell is not cancerous; a malignant tumor is cancerous and can spread, unlike benign tumors that are not cancerous and do not metastasize. Cervical cancer starts when abnormal cells along the cervix lining start growing uncontrollably. It commonly begins in the transformation zone and spreads to the other tissues around the cervix lymph nodes and the vagina. Most times, cancer can metastasize to other parts such as the liver. It is among the cancers that can be successfully treated if discovered early.
Types of Cervical Cancer
Cervical cancers are mainly classified after the cells they start growing at. The cervix has the inner and outer surfaces. The outer one opens into the vagina, and the inner one lines the cervical canal. The outer surface is known as the ectocervix and is covered by the squamous cells. Cervical cancer that starts in these cells is called squamous cell carcinoma; it is responsible for approximately 70% of the total cervical cancer cases. The endocervix that forms the inner surface of the cervix is covered by the glandular cells, and cancer that develops in these cells is known as adenocarcinoma. It is less common and accounts for about 25% of cervical cancer cases. It is usually challenging to diagnose as it occurs higher up in the cervix.
Causes and Risk Factors
Human papillomavirus (HPV) accounts for almost all cervical cancer cases. The group of viruses can attack the surface of different body parts such as the cervix and the vagina. More than a hundred different types of human papillomaviruses, with more than fourteen affecting the genitals; about fifteen of the genital HPVs cause cervical cancer. Although HPV infections are common, not all people with HPV infections develop cervical cancer. Various factors increase the risk of developing cervical cancer. Among them include passive smoking and smoking. Tobacco use damages cervix cells and increases the chances of women with HPV developing cancer. Studies have also shown that women in long-term use of oral contraceptives are also at a higher risk, although the reason is not apparent. Women with weak immune systems are also at a higher risk of developing this cancer, for instance, HIV-positive women and other women who take medications that can weaken their immune system. Although the disease might run in the family where a woman whose sister or mother had cancer has high chances of developing it, there is no known genetic cause of cervical cancer.
Symptoms and Staging
People with cervical cancer might not produce any signs or symptoms specifically during the early stages. However, when cervical cancer starts to invade other areas such as the vagina, symptoms may develop. Some women will experience longer and heavier menstrual periods, while others might have abnormal vaginal discharge. Others will spot or bleed in between their periods, and others might have vaginal bleeding after sex. Some women will find sexual intercourse painful, while others will bleed even when they have reached their menopause stage. Although these symptoms might result from certain medications or conditions, it is essential to rule out cervical cancer. It is crucial that people with a cervix go for regular screening whether they are transgender, gays, lesbians, straight or bisexual.
Staging cancers is vital in determining the best treatment plan. There are four stages of cervical cancer. A stage refers to the extent to which cancer has spread in the body by the time it is diagnosed. Cervical cancer at stage I is localized and found in the cervix tissue only. At stage II, cervical cancer is locally advanced and has spread to other tissues next to the cervix, such as the upper two-thirds of the vagina. Cervical cancer at stage III has reached other vaginal parts and to the pelvic lining; the possibility of metastasizing to the lymph nodes exits and might even stop the kidney from functioning. Finally, cervical cancer at stage IV has metastasized to the rectum and beyond to other areas such as the lungs, the bones, and the liver. Most cervical cancers diagnosed at early stages have a good prognosis and higher survival rates.
Detecting cervical cancer usually starts with an abnormal pap test result during the cancer screening stage. This calls for more testing to confirm the presence of cervical cancer. Sometimes the test might be proposed if a patient experiences suspected symptoms such as abnormal vaginal bleeding. A doctor, usually a gynecologist, conducts a physical examination and medical history, including a pelvic exam and feeling the lymph nodes. The doctor performs the colposcopy test to closely look at the cervix to see the changed or abnormal cells locate where exactly they are and how they look like. If a doctor sees suspicious areas, a biopsy is conducted and the tissue examined in the laboratory by a pathologist. If the results from the biopsy confirm the presence of cervical cancer, other imaging scans such as the MRI scan, CT scan, or PET scan are done to the areas the cancerous cells have spread to.
Management and Treatment
The cervical cancer treatment chosen depends on the patients’ preferences and recommendations from the medical team. The treatment chosen depends on the test results, the location of cancer, the areas it has spread to, patients’ general state of health, age, and whether they would like to have children in the future. Treatment is achieved by utilizing combination therapy of surgery, radiation, and chemotherapy. However, the surgical procedure remains the only option for most patients, for instance, if the cancer is in the cervix only. Surgical procedures depend on the extent of metastasis; early cervical cancers are treated using the cone biopsy to remove the tissue around the tumor and other surrounding healthy tissue. Trachelectomy can be done to remove all or part of the cervix alongside the upper part of the vagina. The ovaries and the fallopian tubes are usually left in place, especially if a woman would like to give birth in the future. Total hysterectomy is generally done to remove the cervix and the uterus. The fallopian tubes might also be removed.
Radiation therapy where doctors use x-rays to kill cancer cells might be used to damage or kill cervical cancer cells. A patient might have it as the primary treatment or have it after surgery to kill the remaining cancer cells. The radiation usually targets the affected parts and is done carefully to minimize harm to healthy cells. This method of treatment is safe, although it has various side effects. It can cause an increase in vaginal discharge cause loss of hair around the pelvic area, and bowel and bladder issues. Radiation can also result in early menopause as it can stop ovaries from producing hormones or cause narrowing of the vagina. In rare cases, radiation therapy can weaken bones and cause a pelvic fracture. The radiation can be conducted internally or externally, and the process is not painful.
In addition, chemotherapy can be used where drugs are used to slow the growth or kill cancer cells. Chemotherapy is usually used when the cancer is at its advanced stage and may be combined with radiotherapy. The number of chemotherapy sessions usually depends on the type of cancer a patient has and whether they are going through any other treatment. The drugs are generally administered intravenously. Treatment with chemotherapy has various side effects depending on a person’s fitness and general health, how often they have the treatment or whether they are having any other treatments such as radiotherapy. Some patients might feel tired, experience nausea and vomiting, lose some hair from the body, including the hair in the head. Temporary or permanent menopause has also been reported. In addition, chemotherapy may weaken the body’s immunity, and patients become prone to infections.
Cervical cancer affects patients emotionally and physically. Palliative care is essential, regardless of the stage of cancer, to help improve the patients’ quality of life. It can be done by a team of healthcare professionals in collaboration with family members and other caregivers. Non-medical and medical methods can be used to control pain in patients, relieve stress, and ensure that patients are peaceful during treatment. Palliative surgery can also be done to correct fistula and bowel obstruction problems.
Overall, cervical cancer is among the most preventable cancers. Anybody with a cervix must go for regular screening to catch the pre-cancers early enough and treat them before they become cancers. In addition, girls below the age of fifteen and who have not engaged in sexual behavior should get the HPV vaccine to prevent them from getting infected with the virus. Women can minimize the risk of getting this cancer by quitting smoking and limiting numerous sexual partners.