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| Cervical Cancer |
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What is cervical cancer?
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Cancer is not just a single
disease, but is a group of diseases. All forms of cancer cause cells in the body to change
and grow out of control. Cervical cancer begins at the lining of the cervix. The cervix is
the lower part of the womb (uterus). The uterus has two parts. The upper part, called the
body of the uterus, is where the baby grows. The cervix is the lower part and it connects
the body of the uterus to the vagina, or the birth canal.
Cancer of the cervix does not form suddenly. At first, some cells begin to change from
normal to pre-cancer, which then convert to cancer. This can take a number of years,
although sometimes it happens more quickly. For some women, pre-cancerous changes may go
away without any treatment. But more often, they need to be treated, to keep them from
changing into true cancers.
There are two main types of cervical cancer. About 85%-90% of these cancers are squamous
cell carcinomas. The other 10%-15% are adenocarcinomas.
Apart from these two, there is also a very small percentage of cervical cancers that are very rare.
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How
common is cervical cancer? |
Cervical cancer is the second
most common cancer (after breast cancer) in women. If we look at the worldwide data, it
can be seen that the increased number of such cases has been drastic. Also the cases in
the developing countries are roughly four times more than in developed countries. The
following table can show the data.
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| Incidence in the developed world |
102 |
| Incidence in the developing world |
421 |
| Mortality worldwide |
247 |
| 5 years prevalence worldwide |
1558 |
(all
Figures in thousands) |
The survey also
indicates that Colombia (Cali) showed the maximum number of cases, 48 cases per 1,00,000
of female population, whereas China (Shanghai) showed the least number of cases, 8.5 per
1,00,000. India (Bombay) show that 20.6 women out of 1,00,000 have been affected. |
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What
causes cervical cancer? |
| Cervical cancer can appear due to a number of
reasons. But, the most important risk factor is infection with HPV (human
papillomavirus). This disease can be passed from one person to another
during sex. Having unprotected sex, especially at a young age, makes HPV infection more
likely. Also, women who have many sexual partners (or who have sex with men who have had
many partners) have a greater chance of getting HPV. HIV infection(the
virus that causes AIDS) is also a risk factor for cancer of the cervix. Being HIV positive
makes a woman's immune system less able to fight both the human papillomavirus mentioned
above and early cancers.
Smoking is another risk factor for cervical cancer. Smoking can
produce chemicals that may damage the DNA in cells of the cervix and make cancer more
likely to develop. Thus women who smoke are at a great risk for cancer of the cervix.
Poor economic and social conditions have also shown to be in correlation
with this cancer. This may be because such women cannot afford to get regular Pap tests;
or may be that the genital hygiene in not taken care of. Eating more fruits and vegetables
may be linked to a lower risk of cervical and other cancers.
Past and/or present occurrence of clinical genital warts
has been found to be an important risk factor. Also early marriage, early coitus, early
child bearing and repeated childbirth have been associated with increasing risk.
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Can it be prevented?
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Most cervical cancer can be prevented. There are two
ways to prevent this disease. The first way is to prevent pre-cancers (primary
prevention), which can be done by avoiding the risk factors.
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- Young women can delay having sex until they are older.
- Women of all ages can protect against disease by having their partner use condoms.
- Women of all ages (like everyone else) should not smoke.
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| The second way to prevent cancer of the cervix is to
have regular Pap tests. The Pap test can detect HPV infection and pre-cancers. Treatment
of these problems can stop cervical cancer before it develops fully. |
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- All women should have yearly Pap smears starting at age 18 or when they begin having
sex.
- Women who have had their uterus removed and those past menopause (change of life) still
need to have regular Pap tests.
- The doctor may decide to do the test less often if a woman has had three normal tests in
a row.
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Even though the Pap test is the best method of
preventing cancer or finding it early, it is not perfect. This is because even good labs
can miss some cell changes. Women who are no longer having children still need to have
pelvic exams and Pap tests
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What are signs and
symptoms of cervical cancer? |
| Early cervical pre-cancers or cancers often have no
signs or symptoms. A woman usually develop symptoms when the cancer has become invasive.
That's why it's important for women to have regular Pap tests. Symptoms usually appear
when the cancer is in its developed stages. You should report any of the following to your doctor
right away: |
- Any unusual discharge from the vagina
- Blood spots or light bleeding other than your normal period
- Bleeding or pain during sex
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| These symptoms do not mean that a woman has cancer
of cervix. They can also be caused by something else. For example, an infection can cause
pain or bleeding. But, if you have any of these signs or other suspicious symptoms, it is
important that you see your doctor right away. Ignoring symptoms may allow the cancer to
progress to a more advanced stage and hence lower the chances for an effective treatment. back
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How can cervical cancer be
tested? |
Pap Smear: As we have already
talked about the pap smears in the earlier articles, the tests are a must for
all women. It should be done at least once in three years. But the time duration
should be decided by doctor, depending upon the results of the test.
If the results of your Pap test raises questions, your doctor will want to do some more
tests, such as:
Colposcopy: In this test the doctor looks at the cervix through an
instrument called a colposcope. The exam is not painful and has no side effects. It can be
done even if you are pregnant. If there are abnormal cells on the cervix, the doctor will
order a biopsy.
Biopsy: A biopsy is the removal of a sample of tissue to see whether cancer cells
are present. This is the only way to tell for certain if you have pre-cancer, true cancer,
or neither. There are several kinds of biopsies. Ask your doctor which kind you will have
and what kind of anaesthetic you will need. You should also ask what side effects you might
have after the biopsy. Sometimes the biopsy itself can be used to treat a pre-cancer or a
very early cancer.
If the biopsy shows that you have cancer, doctor may suggest that you consult a
doctor who specializes in treating this type of cancer. Also, there are more tests you may
need to have. Some of these are described below. A woman should never feel hesitant in
asking about the tests and what will the test tell about the cancer.
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- Cystoscopy: This test is done to see if the cancer has spread to the
bladder. The doctor exams the inside of the bladder using a lighted tube.
- Proctoscopy: This is a similar test to the one above to see if the
cancer has spread to the rectum.
- Examination of the pelvis under anaesthesia is done for further check.
- Chest x-ray is done to see if the cancer has spread to the lungs.
- Imaging tests such as CT (computed tomography) scans, MRI (magnetic
resonance imaging) or IVP (intravenous pyelogram) are done to see where the cancer
has spread.
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After the
tests: Staging |
| How a cervical cancer is treated depends largely on
the stage of the disease. Staging is the process of finding out how far the cancer has
spread. This is very important because the treatment and the outlook for recovery depend
on the stage of the cancer. The system most often used to stage cervical cancer is the
FIGO (International Federation of Gynecologists and Obstetricians) system. Roman numerals
from 0 to IV are used. The smaller the number, the less the cancer has spread. A higher
number, for example, stage IV, means a more serious stage of the disease. By knowing the
stage a woman can make out how serious her cancer is. The stage can be known by just
asking the doctor. |
| Following is a brief description of the stages of
cervical cancer: |
| Stage 0 |
The tumor is carcinoma in situ, which means the
cancer, is found only in the layer of cells lining the cervix. It has not spread deeper
into the tissues of the cervix. |
| Stage I |
The cancer has spread from the lining of the cervix
into the deeper connective tissue of the cervix. But it is still confined to the uterus. |
| Stage II |
The cancer has spread beyond the cervix to nearby
areas, but it is still inside the pelvic area. |
| Stage III |
Cancer has spread to the lower part of the vagina or
the pelvic wall. The cancer may be blocking the tubes (ureters) that carry urine from the
kidneys to the bladder. |
| Stage IV |
This is the most advanced stage of cervical cancer.
The cancer has spread to other parts of the body. |
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| (Stages I-IV each have sub-stages that describe more
precisely how far the cancer has grown.) |
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How can the cancer of the cervix be
treated? |
| Deciding upon the best way to treat this cancer is
never an easy choice. Often there are more than one treatments to choose from. There is a
need to make a quick decision. But give yourself time to absorb the information you have
learned. Talk to your doctor at length about it. You may also want to get a second
opinion. Your doctor should not mind your doing so. You may not need to have tests done
again since the results can often be sent to the second doctor. |
| The three main types of treatments for cervical
cancer are surgery, radiation, and, less often, chemotherapy. |
| Surgery |
| There are several kinds of surgery for cervical
cancer. Some involve removing the uterus (hysterectomy), whereas others do not.
If the cancer has spread beyond the uterus, it may be necessary to remove other organs
such as the colon or rectum as well. The list below covers the most common types of
surgery for cancer of the cervix. |
- Laser surgery - A laser beam is used to burn off cells or to remove a
small piece of tissue for study. Laser surgery is used as a treatment for pre-invasive
cervical cancer only.
- Cone biopsy - A cone-shaped piece of tissue is removed from the cervix. A
cone biopsy is seldom used as the only treatment, except for women with early cancer who
might want to have children.
- Simple hysterectomy - In this case the uterus is removed, but the tissue
next to the uterus is not touched. After this operation, a woman cannot become pregnant.
- Radical hysterectomy and pelvic lymph node dissection - In this case the
uterus, the tissues next to the uterus, the upper part of the vagina and lymph nodes from
the pelvis are all removed. After this surgery a woman cannot become pregnant.
- Pelvic exenteration - Besides removing all the organs and tissues, as
mentioned above, in this operation the bladder, vagina, rectum and parts of the colon, may
also be removed. This operation is used when the cancer has come back after earlier
treatment.
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| Ask your doctor to explain the details of the
surgery he or she recommends. You'll want to know how long you will be in the hospital,
how long it could take you to recover, and what side effects you can expect to have. |
| Radiation |
| Radiation therapy uses high energy x-rays to kill or
shrink cancer cells. External beam radiation focuses radiation from outside the body on
the cancer. Local radiation treatment uses a small pellet of radioactive material placed
directly into the cancer. There can be a number of side effects from radiation. Most of
these will go away after a short while. The skin in the area treated may look sunburned
and then tan, though it returns to normal within 6-12 months. You may also feel tired.
Treatment to the pelvic area may cause the vagina to become narrower because of scar
tissue. This can make it painful to have sex. Early menopause (change of life) and
problems with urination can also occur. Be sure to talk with your doctor about any side
effects. Often there are medicines or other methods that will help. |
| Chemotherapy |
| Chemotherapy refers to the use of anticancer drugs
to kill cancer cells. The drugs are given in the form of shots or pills. They enter the
bloodstream and reach all areas of the body. If this treatment is chosen, you may receive
several drugs at one time. Chemotherapy can have some side effects. These side effects
will depend on the type of drugs, the quantity you intake, and for how long you take them. Side
effects might include the following: |
- Upset stomach and vomiting (drugs given at the same time can prevent or reduce nausea
and vomiting)
- Change in appetite
- Temporary loss of hair
- Mouth or vaginal sores
- Increased chance of infection
- Tiredness
- Changes in the menstrual cycle
- Menopause
- Infertility (not being able to get pregnant)
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| Most of the side effects (except for menopause and
infertility) go away when treatment is over. Anyone having the above mentioned side effects (or any other for that matter)
should talk to their doctor or nurse. back to top |
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