What is cervical cancer?
Cervical cancer is a type of malignancy affecting the cervix, which is the lower most part of the uterus opening into the vagina. The most common symptom is abnormal vaginal bleeding although in rare cases there are no symptoms until the disease has reached an advanced stage. The human papilloma virus (HPV) infection is known to be associated with more than 90% of cervical cancer cases. Death due to cervical cancer is declining as there is early diagnosis by regular examination with a Pap smear. Vaccines against HPV are currently approved to reduce the risk of infection as well as consequent development of cervical cancer. However, the mass immunization of teen girls against HPV infection in some countries has sparked controversy.
Cervical Cancer Symptoms
Usually in the early stages, there are no symptoms and most women are unaware of the cancer if they do not undergo routine Pap smears. With progression of the disease, the following symptoms appear :
- Vaginal bleeding occurring in between menstrual periods, immediately after intercourse (contact bleeding).
- Prolonged menstrual bleeding and heavy periods (menorrhagia)
- Vaginal discharge
- Pain during intercourse
Symptoms of advanced cervical cancer depend upon the organ involved. Other symptoms that may be seen includes :
- Lower back pain, bone fracture with trivial injury (due to spread to the bone)
- Leakage of urine or fecal matter through vagina (due to spread to the bladder or bowel)
- Leg pain and swelling of leg (single)
- Fatigue and weakness
- Weight loss
- Loss of appetite
Causes of Cervical Cancer
All cellsl of the body have a fixed life span beyond which they undergo apoptosis (programmed cell death) and are replaced by new cells. These new cels are produced from strictly controlled cell division process. In cancer patients the balance between cell death (apoptosis) and new cell generation (cell division) is disrupted. There is unregulated cell division with no cell death leading to development of “immortal” cells with the capability of spreading to other organs (metastasis) via the blood stream or lymphatic system.
Usually sudden genetic change (mutation) is responsible for the imbalance between cell division and apoptosis. There are two types of cells lining the cervix, namely, squamous and columnar. Cervical cancer usually affects the squamous cells of the lining (squamous cell cancer). Initially there is a precancerous condition known as dysplasia, affecting the cervical cells. This condition is easily diagnosed with a Pap smear and dysplasia is curable. Untreated dysplasia takes years to become frank cervical cancer.
The most common cause of cervical cancer is HPV infection. HPV infection spreads via sexual contact (a condom use does not completely protect from HPV infection) and even with skin-to-skin contact.
Some women are at a significantly greater risk of developing cervical cancer. These risk factors include :
- HPV infection
- Cigarette smoking
- Early sexual activity (before 18 years)
- Many sexual partners or a single partner who has many sexual partners
- Co-existent infections like other sexually transmitted diseases such as syphilis, gonorrhea, HIV and chlamydia
The treatment approach depends on several factors include :
- Stage of the cancer
- General health of the patient
- Desire to have children in the future
For the early stages, laser therapy (by burning the abnormal cells with laser), cryotherapy (by freezing the cells) and LEEP (using electricity) are used. For advanced cases, simple or radical hysterectomy (removal of uterus, cervix vagina along with surrounding lymph nodes) are recommended.
Radiation therapy may be considered in advanced stages. The radiation may be delivered in two ways :
- Internally (brachytherapy)
Cytotoxic drugs are used to eradicate cancerous cells and is useful once the malignancy spreads beyond the initial site.