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During a menstrual period, blood flows from the uterus through the cervix into the vagina. The mucus produced in cervix under hormonal influence. It helps sperms to move from the vagina through the cervix into the uterus.
Normal cervical cells are in constant process of division and growth. When normal cells become old or get damaged, they die, and new cells take their place.
Due to favorable cancerous conditions and risk factors, certain cervical cells grow and multiply in uncontrolled manner. The cell structure and function distinctly varies from normal cell. An enlarged mass of such cancerous cells is known as tumor.
This is known as cervical cancer. It is slow, gradual in onset with minimal symptoms but visible signs and symptoms occur in later stages. Cervical cancer begins in cells on the surface of the cervix. Over time, the cervical cancer can invade more deeply into the cervix and nearby tissues.
Cervical cancer cells can spread by breaking away from the cervical tumor. They can travel through lymph vessels to nearby lymph nodes. Also, cancer cells can spread through the blood vessels to the lungs, liver, or bones. After spreading, cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues.
It is ranked as third most common cancer in women all over the world.
Cervical cancer is highly preventable in developed countries because screening tests and a vaccine to prevent HPV infections are available. Sooner the cervical cancer is detected and treated; more chances of long survival are present.
Stages of cervical cancer:
The stage is based on where cancer is found. These are the stages of invasive cervical cancer:
Stage I: Cancer cells are found only in the cervix.
Stage II: The tumor has grown through the cervix and spread to the upper part of the vagina. It may have reached other nearby tissues but not the pelvic wall (the lining of the part of the body between the hips) or the lower part of the vagina.
Stage III: The tumor has affected the pelvic wall or the lower part of the vagina.
Stage IV: The tumor has spread into the bladder or rectum. Or, the cancer has spread to other parts of the body, such as the lungs.
All women that are sexually active or above age of 25-30 years are at risk for cervical cancer
The human papilloma virus is the main cause of cervical cancer. HPV is a common virus that is passed from one person to another during sex. At least half of sexually active people will have HPV at some point in their lives, but few women will get cervical cancer.
Sexual habits and patterns of women increase her chances of cervical cancer. Sexual activities which are highly risky for women include having sex at an early age, multiple partners or indulging in sex with those who participate in high-risk sexual acts.
Other risk factors, such as smoking, can act to increase the risk of cervical cancer among women infected with HPV.
Cervical cancers start in the superficial layer cells which are of two types- squamous and columnar. Most types of cervical cancers arise from squamous cells.
Cervical cancer develops gradually and starts as a precancerous condition called dysplasia. Pap smear test can be used for detecting it. Cervical dysplasia is completely treatable. It is a slow process to develop into cancer from dysplasia which can take years.
Nearly all cervical cancers are caused by HPV (human papilloma virus) that is transmitted through sexual intercourse. There are certain strains of HPV which lead to cervical cancer.
Early cervical cancer usually has no symptoms. If cervical cell changes progress to cancer, symptoms may include:
Abnormal vaginal bleeding or discharge that may have mucus and blood.
Unexplained change in menstrual cycle.
Abnormal cervical bleeding during sex.
Pain during sex.
Constant vaginal discharge, which can be either pale, watery, pink, brown, bloody, or foul-smelling
Symptoms of advanced cervical cancer due to local and other distant tissue spread include:
Anemia because of abnormal vaginal bleeding.
Urinary problems because of blockage of a kidney or ureter.
Leakage of urine or stool into the vagina (Due to an abnormal opening -fistula developed between the vagina and the bladder or rectum.)
Loss of appetite
Bone pain or fractures
Pain in legs
Pap smear: It is a screening test for cervical cancer. Any abnormal cells that can become cancerous later are detected.
Cervical examination/ colposcopy: the cervix is usually examined under magnification.
Biopsy: Pieces of tissue are removed surgically during this procedure and sent for examination in labs.
Punch biopsy: small samples of cervical tissue are taken off by pinching with a surgical tool.
Cone biopsy: in this cone-shaped sample of tissue is removed. A cone biopsy detects abnormal cells beneath cervix. It is done in the hospital under general anesthesia.
Endocervical curettage: in this a curette (a small, spoon-shaped instrument) is used to scrape a small sample of tissue from the cervical canal.
After being diagnosed with cervical cancer, the physician will need further investigations to determine staging/ spread of disease. Tests may include:
CT scan of the pelvis
MRI of the pelvis
It depends upon the following:
The type of cancer
The stage of the disease
The woman's age and general physical condition
Reactivation of cancer after treatment in remnant cancer cells
Pre-cancerous conditions are completely curable proper follow up and treatment is done. The chance of survival for 5 years in cancer that has spread to only internal parts of cervix is 92%. This drops down as the cancer spreads to other parts.
Some types of cervical cancer are unresponsive to treatment.
It may reactivate after treatment.
Surgery and radiation can cause difficulty in sexual, bowel, and bladder functions.
It depends on:
The stage of the cancer
The size and shape of the tumor
The woman's age and general health
Woman's desire to have children in the future
Early cervical cancer:
In this stage the precancerous or cancerous tissue is either removed or destroyed. Types of surgery at this stage include:
Loop electrosurgical excision procedure (LEEP) - to remove abnormal tissue with the help of electricity
Cryotherapy - freezing of abnormal cells
Laser therapy - uses light to burn abnormal tissue
Treatment for advanced cervical cancer may include:
Radical hysterectomy- in this surgery the uterus and surrounding tissues- lymph nodes, the upper region of the vagina are removed.
Pelvic exenteration- a rare type of surgery by which all pelvic organs- even the bladder and rectum, are removed.
Radiation can be helpful to treat cancer which has spread beyond the pelvis, or that has recurred.
Chemotherapy includes several drugs to kill cancer cells. Both radiation and chemotherapy can be used together before or after surgery.
Preventive vaccines for cervical cancer - Gardasil and Cervarix are now available. Gardasil prevents infection against the both types of HPV that causes most cervical cancers. It can be given to females aging between 9 to 26 years.
Regular Pap smears can help detect precancerous changes, which are treatable before they progress into cervical cancer. Pelvic examinations at every year, including a pap smear, should be done in sexually active, or since the age of 20 in a sexually inactive woman.
Practicing safe sex (using condoms) also reduces risk of HPV and other sexually transmitted diseases. Avoid all intimate sexual contact with anyone who has symptoms of STD's or who may have been exposed to an STD's.
Women should restrict their number of sexual partners as minimum as possible and avoid partners who engage in high-risk sexual activities.
Quit smoking as it has been found to increase risk of cervical cancer. Both active and passive smoking by women is dangerous.