Cervical Cancer Symptoms and Causes

Did you know that January is the month of Cervical Cancer Awareness, when experts all across the globe join hands to raise awareness about the diagnosis, treatment, and prevention of cervical cancer, breaking all myths and taboos, to educate the masses and empowering them to fight the malignancy in the best possible way. Despite being one of the most common cancers affecting women worldwide, Cervical cancer is often misunderstood, owing to the lack of knowledge and facts. This blog, by the experts from the leading hospital in India, will help you understand all that you need to know about cervical cancer. Continue reading to learn more. 

What is Cervical Cancer?

Cervical cancer is a term that many women may have heard before and it is quite obvious that it is a cancer that develops in the cervix. But we are here to help you understand what exactly it means. Well, cancer is a progressive disease that is marked by the gradual replacement of healthy cells or tissues in any part of the body with malignant cells that are incapable of supporting life function. When this happens inside the cervix, the condition is referred to as cervical cancer.

The cervix is a part of the female reproductive tract that connects the uterus with the vagina. It is basically the lower part of the uterus, a tiny canal that is no longer than 2.5 to 3.5 cm in length. 

How common is Cervical Cancer?

As per the report published by the World Health Organisation, Savita cancer is the fourth most common cancer in women globally. In the year 2020 around 604,000 new cases of cancer were diagnosed and it contributed to 342,000 cancer-related deaths. It is very commonly diagnosed in women lying in the age group of 35 to 44 years and the median age of diagnosis is 5 years. 

What are the symptoms you need to watch out for?

Many women tend to develop the symptoms late and are asymptomatic during the early stage of cervical cancer. In fact, it may take a couple of years for the signs to show up, which gives the cancer enough time to progress without being caught. 

Some of the most common symptoms that have been associated with Cervical cancer include:

• Vaginal bleeds, especially after having intercourse
• Bleeding in between periods 
• Having periods that last longer than usual
• Unusually heavy flow during periods
• Watery discharge from the vagina
• Pelvic pain or discomfort that aggravates during intercourse 

Symptoms that suggest that the cancer has spread

In case the cancer has spread, one is likely to experience more severe symptoms which are not just limited to the pelvic cavity. The most common of these include:

• Experiencing pain while urination
• Traces of blood in urine or stools
• Rectal bleeds 
• Persistent diarrhea 
• Fatigue and weakness 
• Pain in legs and back
• Severe cramps 
• Abdominal discomfort

When is the right time to see a doctor?

You should consider seeing a doctor as soon as you start noticing any of the symptoms related to cervical cancer. Experts suggest that catching the early signs of cervical cancer can help to facilitate timely treatment making it possible to fight cancer more efficiently. It is also important to understand that all the symptoms do not necessarily indicate the prevalence of cervical cancer and the diagnosis can be made only after undergoing proper assessment. So, it is advisable to not reach any conclusion without consulting a specialist. 

Types you should know about

Cervical cancer can be of many types which are classified based on the type of cells that are involved. Two of the most common types of cervical cancers are squamous cell carcinoma, which originates from the flat cells lining the outer part of the cervix and adenocarcinoma, which originates from the cells found within the cervical canal. 

Various stages through which cervical progresses 

Cervical cancer progresses through 4 different stages. These are categorized on the basis of the severity of the cancer and how far it has spread. 

• Stage 1 is the initial stage when the cancer is limited to a small area within the cervix. If diagnosed at this stage, the cancer can be easily treated by removing the cancerous tissue surgically. In some cases, the patients may also need chemotherapy or radiotherapy to get rid of the cancer completely. 
• Stage 2 is when the cancer has spread out but has not gone beyond the pelvic region. If the cancer is diagnosed during this stage doctors generally recommend chemotherapy or radiotherapy followed by surgery. The therapies help to shrink the cancerous mass making it easier to remove it surgically. 
• Stage 3 is when the cancer has spread to the vagina and gone beyond the pelvic walls. It may even involve the ureters and the surrounding lymph nodes. If the cancer is diagnosed during the stage surgery is rarely recommended as the cancer is widespread. Doctors generally recommend a combination of Chemo and Radiation therapy
• Stage 4 is when the cancer has metastasized and spread to distant areas of the body such as the bones and the lungs. If the cancer is diagnosed during this stage the patient needs extensive treatment, which may include chemotherapy, radiation therapy, targeted drug therapy and, immunotherapy. The treatments may be altered from time to time depending on the prognosis of the patient. 

Understanding the cause

Cervical cancer originates as a result of abnormal mutations in the DNA of the cells lining the cervix. As it is the DNA, that regulates cell multiplication and growth, these abnormal changes compel the cervical cells to grow at an abnormal pace. The unhealthy cells gradually overcrowd the healthier ones and since these tend to have a longer life span they continue to pile up, resulting in the formation of a malignant lump called a tumor. 

The majority of the cases of cervical cancer, more than 90 per cent, are linked to HPV (Human Papillomavirus) infection. There are over 100 different types of HPV and most of these are linked with increased risk of cervical cancer.

Are you at a risk?

Wondering if you are at risk of developing cervical cancer? Well, being a woman in itself is a major risk factor however there are other factors that can increase the likelihood of developing cervical cancer. The most significant of these is HPV infection, as mentioned earlier. Other factors that have been linked with cervical cancer include:

• Having sexual intercourse at a young age (below 18 years) 
• Having multiple partners
• Excessive smoking
• Having HIV
• Long-term use of birth control pills
• Having more than 3 full-term pregnancy
• Having a compromised immune system
• Having a family history of cervical cancer

Apart from all these, there is one more risk factor that needs to be considered. It is DES or Diethylstilbestrol, a type of hormone, that was used between 1938 and 1971 to lower the risks of miscarriage. If your mother has taken the same during her pregnancy, your risks of developing cervical cancer are slightly higher.

Screening Tests Available for Cervical Cancer

The aim of screening is to detect any abnormal cells or unusual changes that could point toward the possibility of cervical cancer. There are two different tests available for the screening of cervical cancer. These are:

• Pap test: the test is done by collecting and analyzing cervical cells by scraping them off gently from the cervix and carefully observing these under a microscope to look out for any signs of abnormality. 
• HPV test: The test is done to detect HPV and assess its type to determine if one has a high-risk type of infection. 

How can screening help?

Fortunately, cervical cancer is one of the few cancers for which screening is available. This means that it is possible to catch the early signs of any cancer-related changes in the cervix. This makes it possible to start early treatment and ward off the risks of life-threatening complications by curbing the disease in the early stage. 

How to get screened for cervical cancer?

Regular screenings for breast cancer are important for every woman after the age of 21, irrespective of your sex life. 

• If you lie in the age group of 21 to 29 years you should get a Pap test done after every 3 years. HPV test is not required. 
• If you are above 30 years of age, you should go for both a Pap smear and an HPV test every 5 years. If you wish to go for a Pap smear only, repeat it after every 3 years. 
• If you have undergone a hysterectomy for any medical reason, that does not involve an underlying malignancy or history of cervical intraepithelial neoplasia, you can stop getting your routine Pap test. 
• You can stop going for the screening once you cross 65 years of age, with no history of any abnormal Pap test results in the past 10 years. 

How is the diagnosis made?

There are a wide range of tests and procedures available for diagnosing cervical cancer and these are recommended by Doctors based on the symptoms that one is experiencing. It is important to understand that one may not need all these days and only if you have them are required to make the diagnosis. 

• Examination and assessment of medical records: The initial and most crucial step is pelvic examination. Doctors use a special device known as a speculum to open the vagina and examine the internal structures. Doctors may insert 2 fingers to feel any structural abnormality or unusual mass. This is followed by an assessment of the patient's medical history. Doctors may also ask questions related to the symptoms. 
• Pap test: This involves the collection of a small sample of tissues from the cervical cavity for thorough analysis. The sample is collected during pelvic examination by carefully scrapping off the tissue.
• HPV test; The procedure is somewhat similar to the Pap test, however, in this case, the sample is used to detect HPV and assess its type and strain. Testing positive for HPV does not necessarily mean that you have cervical cancer and some other tests may be needed to confirm the diagnosis.
• Colposcopy: it is an imaging technique that involves the use of a special device known as a colposcope for visualizing the cervix. The device helps to generate magnified images of the interior making it possible for the doctors to examine the area. 
• Biopsy: It is one of the most trusted techniques for making a cancer diagnosis as it not only helps to detect the traces of cancer but also helps to assess its type & grade and provides other authentic information. Different techniques that may be used for collecting the tissue sample for a biopsy include Endocervical Curettage (ECC), Loop Electrosurgical Excision Procedure (LEEP), and Conization.
• Imaging techniques like X-ray, computed tomography (CT scan), magnetic resonance imaging (MRI), and positron emission tomography (PET scan), which help to thoroughly analyze the internal structures and detect the presence of any unusual mass or lesions. 

What treatments are available for cervical cancer?

Treatment for cervical cancer primarily varies depending on various factors, the most significant of which is the stage of the cancer. Earlier, in this blog we discussed the different stages of cervical cancer and what treatments are recommended for each stage. Now let us try to understand how these treatments work

• Radiation therapy: The technique involves the use of a focused beam of powerful radiation to target the cancer cells in the cervix and destroy them. These radiations may be given externally using a special machine or internally with the help of a radioactive material. The former is known as External Beam Radiation Therapy (EBRT) and the latter is known as brachytherapy. 
• Chemotherapy: The technique involves the use of a special combination of drugs for targeting cancer cells in different areas of the body as it has a widespread impact. The chemicals can be given orally or administered into the body with the help of injections or by using an IV drip. 
• Surgery: This is usually recommended in the initial stages of cervical cancer when it is not spread far and wide. Surgery can help to target and treat localized cancer using different approaches. Common surgical procedures that are used to treat Cervical cancer are laser surgery, cryosurgery, conventional hysterectomy, radical hysterectomy with node dissection, pelvic exenteration and trachelectomy. 
• Targeted therapy: The technique works by targeting the DNA mutations that are responsible for abnormal multiplication of the cells. This helps to destroy the abnormal cells while leaving the healthier ones intact. 
• Immunotherapy: The technique works by boosting the immune response of a patient, making it strong enough to fight the cancer cells on its own. 

Is it possible to prevent cervical cancer?

If you are wondering whether cervical cancer is preventable or not, we have good news for you. In many cases the cancer is preventable and this can be done by taking necessary preventive measures to control and curve the risk factors. 

• First of all, you need to get vaccinated against HPV which is the leading risk factor for cervical cancer. If you have not received the vaccine yet, connect with your doctor to know if it is an option for you. 
• Go for routine screening as these can help to catch any signs of Precancerous changes at the earliest making it possible for you to seek early treatment. 
• Practice safe sex. It is advisable to use protection and limit your partners. 
• Avoid smoking and if you find it difficult to get rid of the habit, seek professional help.