CERVICAL CANCER

​​​​​CERVICAL CANCER FACTS

The cervix is in the bottom part of the uterus (or womb, where a baby grows). It joins the uterus to the vagina (birth canal).

Most women who develop cervical cancer are between 20 and 50 years old. It used to be one of the main causes of death from cancer, but the widespread use of the Pap test has helped doctors find cervical cancer in the early stages. Cervical cancer often can be treated successfully when it is caught and treated early.

Before cervical cancer appears, the cells of the cervix go through precancerous changes, known as dysplasia. Usually this is a slow process that develops over many years.

An annual Pap test looks for these changes. If precancerous cells are found, they often can be removed.


Most cases of cervical cancer are caused by infection with human papillomavirus (HPV), which usually is passed from person to person by sexual contact.

In most people, the immune system clears the virus before it is detected or causes cells to change. However, in a small percentage of people the virus will remain and cause cell changes that may develop into cancer.

Cervical Cancer Types

Cervical cancer is usually one of the following types, which are named for the type of cell where they develop. The most common types of cervical cancer are:

Squamous cell carcinoma (cancer): This is the main type of cervical cancer and is found in 80% to 90% of cases. It develops in the lining of the cervix.

Adenocarcinoma develops in gland cells that produce cervical mucus. About 10% to 20% of cervical cancers are adenocarcinomas.

Mixed carcinoma (cancer): Occasionally, cervical cancer has features of squamous cell carcinoma and adenocarcinoma.

In rare instances, other types of cancer, such as neuroendocrine (small and large cell cervical cancer), melanoma, sarcoma and lymphoma, are found in the cervix.


Cervical Cancer Risk Factors

Anything that increases your chance of getting cervical cancer is a risk factor.

HPV is spread by sexual contact and is the cause of almost all cases of cervical cancer, as well as many vaginal and vulvar cancers. HPV may cause the cells in the cervix to change. If abnormal cells are not found and treated, they may become cancer.

As many as 75% of men and women who have had sex have HPV. Usually the body’s immune system handles the virus, and most people never know they have it. While most women with HPV will not get cervical cancer, you should be aware of the risk and have regular Pap tests.

Cervical cancer risk factors include:

  • Age: The risk of cervical cancer increases with age. It is found most often in women over the age of 40. However, younger      women often have precancerous lesions that require treatment to prevent cancer.
  • Smoking: Cigarette smoke contains chemicals that damage the body's cells. It increases the risk of precancerous changes     in the cervix, especially in women with HPV. 
  • Sexual behavior: Certain types of sexual activity may increase the risk of getting HPV infection. These include: 1) Multiple      sexual partners, 2) high-risk male partners, 3) first intercourse at an early age and 4) not using condoms during sex.


Other cervical cancer risk factors include:

  • Lack of regular Pap tests
  • Having a sexually transmitted disease (STD), including chlamydia
  • Diethylstilbestrol (DES) exposure before birth: This drug was used between 1940 and 1971 to help women not have                miscarriages. Women whose mothers took DES during pregnancy have a high risk of vaginal and cervical cancers.
  • HIV infection
  • Weakened immune system: Having an organ transplant or taking steroids raise your risk
  • Being overweight or not eating a healthy diet


Not everyone with risk factors get cervical cancer. However, if you have risk factors it’s a good idea to discuss them with your health care provider.

Some people have an elevated risk of developing cervical cancer. 

Behavioral and lifestyle changes can help prevent cervical cancer. 

In rare cases, cervical cancer can be passed down from one generation to the next. Genetic counseling may be right for you. 



CERVICAL CANCER SYMPTOMS


In its earliest stages, cervical cancer usually does not have symptoms. This is why regular Pap tests are so important, particularly if you are sexually active.

When cervical cancer does have symptoms, they vary from person to person. Tell your doctor if you have any of the following:

  • Vaginal discharge tinged with blood
  • Vaginal bleeding after sexual intercourse
  • Abnormal vaginal bleeding: after menopause, between menstrual periods or excessively heavy periods
  • Urinating more often
  • Pain during sex
  • Swollen leg
  • History of untreated dysplasia (precancerous cell changes) of the cervix


These symptoms do not always mean you have cervical cancer. However, it is important to discuss any symptoms with your doctor, since they may signal other health problems.


CERVICAL CANCER DIAGNOSIS​


​It’s important to diagnose cervical cancer early and accurately and find out if it has spread. This helps your doctors choose the best treatment for you. At NGHL, specialized experts use the most modern and accurate equipment to diagnose cervical cancer. With pinpoint attention to detail, our pathologists, diagnostic radiologists and specially trained technicians find out the exact extent of disease. This helps increase the likelihood your treatment will be successful.

Cervical Cancer Diagnostic Tests

If you have symptoms or Pap test results that suggest precancerous cells or cervical cancer, your doctor will examine you and ask you questions about your health; your lifestyle, including smoking and drinking habits; and your family medical history.

One or more of the following tests may be used to find out if you have cervical cancer and if it has spread. These tests also may be used to find out if treatment is working.

Colposcopy: This test uses an instrument called a colposcope to look more closely at an area of abnormal tissue on the cervix, vagina or vulva. A colposcope is a microscope designed to examine the cervix. It looks like a pair of binoculars on a stand.

Biopsy: In a biopsy to look for cervical cancer, the doctor removes a small amount of tissue from the cervix to look at under a microscope. Types of cervical biopsies include:

Punch biopsy: The tissue sample is removed from the cervix using biopsy forceps, an instrument used to grasp tissue firmly and remove it.

Endocervical curettage (ECC): A tissue sample is scraped from an area just past the opening of the cervix using a curette (small, spoon-shaped instrument) or a thin, soft brush.

LEEP (Loop electro-surgical excision procedure): This test uses a small wire that is heated with low-voltage, high-frequency radio waves to remove cells from the cervix.

Cone biopsy: A cone-shaped sample of tissue is removed so the pathologist can see if abnormal cells are in the tissue beneath the surface of the cervix. The amount of tissue removed is larger than that removed with other types of biopsy. This type of biopsy can be done by one of the following methods:

  • LEEP cone biopsy: The LEEP device is used, and the biopsy can be done in the doctor's office under local anesthesia.
  • Knife cone biopsy: A scalpel (small sharp knife) is used in an operating room with local or general anesthesia.
  • Laser: A carbon dioxide laser is used to remove tissue.


Cystoscopy or proctoscopy: If you are diagnosed with cervical cancer and your doctor thinks it may have spread, you may have a cytoscopy or proctoscopy or both. These tests use lighted tubes to view the inside of the bladder (cystoscopy) or the anus, rectum and lower colon (proctoscopy).

Imaging tests, which may include:

  • CT or CAT (computed axial tomography) scans
  • MRI (magnetic resonance imaging) scans
  • PET (positron emission tomography) scans
  • Chest X-ray


Laparoscopic retroperitoneal lymph node dissection: In this minimally invasive surgical procedure, lymph nodes are removed to help find if cancer has spread.


TREATMENT


The treatment of cervical cancer generally depends on various factors – cancer stage, size and shape of the tumor, woman's age and general health. In earlier days, cervical cancer was being cured by the removal of cancerous tissues. However, nowadays surgeries have undergone heavy advancements. Different types of treatment options are:

  • Loop electrosurgical excision procedure (LEEP) – This procedure employs electricity to remove abnormal tissue.
  • Cryotherapy – The procedure involves freezing abnormal cells.
  • Laser therapy – This therapy uses light to destroy cancerous tissue.
  • Radical hysterectomy – It involves removal of the uterus and much of the surrounding tissues, including lymph nodes and     the upper part of the vagina.
  • Pelvic exenteration – A rare type of surgery in which all of the organs of the pelvis, including the bladder and rectum, are      removed.
  • Radiation therapy – Internal or external radiation may be used to treat cancer that has spread beyond the pelvis, or cancer    that has returned.
  • Chemotherapy – It involves the use of certain drugs that kill cancer tissues.