What is cervical cancer? The cervix is the bottom part, or neck, of the uterus. Cervical cancer happens when normal cells in the cervix change into abnormal cells, and grow out of control. Most women whose cervical cancer is found and treated early.
Incidence rate (how many people affected) The mean age at diagnosis of cervical cancer in the United States is 48 years old. It is the fourth leading cause of cancer-related deaths in females worldwide and the third most common cancer diagnosis and cause of death among gynecologic cancers in the United States. Each year, 530,000 new cases of cervical cancer are diagnosed worldwide, accounting for approximately 9% of new cases of cancer diagnosed in women each year. The incidence of cervical cancer in low- and middle-income countries (LMICs) is five times higher than that observed in high-income countries
What are the symptoms of cervical cancer? Early cervical cancer is frequently asymptomatic, emphasizing the importance of screening. The most common symptoms at presentation are: Abnormal vaginal bleeding (including post-coital bleeding), vaginal discharge, and vaginal bleeding after menopause. A lesion may or may not be visible or palpable on physical examination. These symptoms can also be caused by conditions that are not cancer.
Is there a test for cervical cancer? The diagnosis of cervical cancer is made based upon histologic evaluation of a cervical biopsy. Visualization of the cervix upon speculum examination may reveal a normal appearance or a visible cervical lesion; large tumors may appear to replace the cervix entirely. Any lesion that is raised, friable, or has the appearance of condyloma should be biopsied, regardless of previous benign cervical cytology results. Symptomatic women without a visible lesion and those who have only abnormal cervical cytology should undergo colposcopy with directed biopsy and, if necessary, diagnostic conization.
Nearly all cervical cancers are caused by specific types of human papillomavirus (HPV). The use of the Pap test and HPV test provides the most effective means of screening for cervical cancer. -The Papanikolau test (Pap test or Pap smear) looks for precancers, which are cell changes on the cervix that might become cervical cancer if they are not treated appropriately. The HPV test looks for the virus that can cause these cell changes
Other Risk Factor for Cervical Cancer Risk factors for cervical cancer are mostly associated with an increased risk of acquiring or having a compromised immune response to HPV infection and included: Early onset of sexual activity, multiple sexual partners, a high-risk sexual partner, history of sexually transmitted infections History of vulvar or vaginal squamous intraepithelial neoplasia or cancer, and immunosuppression Oral contraceptive use Cigarette smoking(increased risk of squamous cell cancer, but not adenocarcinoma)
The Pap test (pap smear) is recommended for women between ages 21 and 65.
There are two main types of cervical cancer: Squamous cell cervical cancer is the most common. This develops from a skin-like cell (a squamous cell) that covers the neck of the womb (cervix), which becomes cancerous. Adenocarcinoma cervical cancer is less common. This develops from a glandular cell (a cell that makes mucus) within the cervical canal, which becomes cancerous. Both types are diagnosed and usually treated in a similar way.
Stages of Cervical Cancer Stage 0 describes cancer cells found only on the surface of the cervix. Stage I - the cancer has grown beyond the cervix and uterus, but hasn't spread to the walls of the pelvis or the lower part of the vagina. Stage II -the cancer has spread to the lower part of the vagina or the walls of the pelvis. Stage III- tumor extends to the lower part of the vagina and may block urine flow. It hasn't spread to lymph nodes. Stage IV - this is the most advanced stage of cervical cancer. The cancer has spread to nearby organs or other parts of the body.
Some doctors may also use the following terms when discussing cervical cancer: -Early stage -Locally advanced -Advanced stage
How is cervical cancer treated? Surgery : Removing the cervix, uterus, and upper part of the vagina This is called a "radical hysterectomy, or removing all or part of the cervix but leaving the uterus in place This type of surgery is done only in special situations ( total hysterectomy). cervical conization: A cone biopsy removes a cone-shaped piece of tissue from the cervix. The cone is formed by removing the outer part of the cervix closest to the vagina and part of the endocervical canal (the pathway from the uterus to the vagina).
Cont d Radiation therapy: Radiation kills cancer cells. Chemotherapy: Chemotherapy is the medical term for medicines that kill cancer cells or stop them from growing. Women with cervical cancer usually receive chemotherapy at the same time as radiation therapy.
What happens after treatment? If cervical cancer is detected during the early stages, the chance of successfully treatment are higher. After treatment, patients will be checked every so often to see if the cancer comes back. Follow-up tests can include exams, Pap tests, and X- rays. If the cancer comes back or spreads, patients might have more surgery, radiation, or chemotherapy. The overall five-year survival rate associated with all stages of cervical cancer is 68%. However, the five-year survival rate in patients with distal metastases is only 16%. In Canada, the 5-year net survival for cervical cancer is 73%. This means that, on average, about 73% of women diagnosed with cervical cancer will survive for at least 5 years.
Can Cervical Cancer Be Prevented? Almost all cervical cancer is caused by a virus called HPV (human papillomavirus) that is spread through skin-to-skin contact and sex. Prophylactic vaccination for HPV provides the most effective method of primary prevention against HPV-related diseases. HPV vaccination is available for men and women, and works best if a person receives it before he or she starts having sex. treating precancerous cells can keep them from turning into cervical cancer. The preventive examination of vagina and cervix smear, Pap test, and the HPV DNA test are remarkable diagnostic tools according to the American Cancer Association guidelines, in the investigation of asymptomatic women and in the follow up of women after the treatment of pre-invasive cervical cancer.
References: -Kessler, T. A. (2017). Cervical Cancer: Prevention and Early Detection. Semin Oncol Nurs. doi: 10.1016/j.soncn.2017.02.005 -Mezei, A. K., Armstrong, H. L., Pedersen, H. N., Campos, N. G., Mitchell, S. M., Sekikubo, M., Ogilvie, G. S. (2017). Cost-effectiveness of cervical cancer screening methods in low- and middle-income countries: a systematic review. doi: 10.1002/ijc.30695 -Siegel, R. L., Miller, K. D., & Jemal, A. (2015). Cancer statistics, 2015. CA Cancer J Clin, 65(1), 5-29. doi: 10.3322/caac.21254 -Torre, L. A., Bray, F., Siegel, R. L., Ferlay, J., Lortet-Tieulent, J., & Jemal, A. (2015). Global cancer statistics, 2012. CA Cancer J Clin, 65(2), 87-108. doi: 10.3322/caac.21262 -Tsikouras, P., Zervoudis, S., Manav, B., Tomara, E., Iatrakis, G., Romanidis, C., Galazios, G. (2016). Cervical cancer: screening, diagnosis and staging. J buon, 21(2), 320-325.