Cervical Cancer Symptoms Risk Factors and Treatment

Description

What is cervical cancer?

Cervical cancer is a cancerous tumor of the uterine cervix (cervix uteri). The cervix is a 1 inch long cylindrical neck that connects the uterus and vagina.

The cervix is the lower part of the uterus.

Explanation

Invasive cervical cancer makes up about 2. 5 % of all cancers affecting women in the Unites States, where about 13, 500 cases of invasive cervical carcinoma are diagnosed every year, while there are at least 50, 000 new cases of pre-invasive cancer in situ diagnosed yearly in which abnormal cells are present only in the squamous epithelium or the surface layer of the cervix.[1][2][3]

Since 1940, there have been a steady decrease in the incidence rates of cervical cancer because most women even those who are asymptomatic are being screened for cervical cancer annually. Screening tests include the papanicolaou smear (Pap test) and testing for human papillomavirus (HPV). However, in low-risk population, most pap test results are normal.[4][8]

The incidence of cervical cancer in post gravida white women decreased from 1. 1 % in 75 to 0. 7 % in 85. Similarly, the incidence of cervical cancer in post gravida black women dropped from 2.3% in 1975  to 1. 6 % in 1985.[5]

Overall, fatality dropped 45% in the period between 1992 and 1994 as well, simply because of the increased effectiveness of screening procedures, which contributes to the all time developing healthcare system.

Over 90 % of all cervical cancer cases are squamous cell carcinomas that arise from the epithelium or the surface cell layer that lines the surface and the underlying glands, whereas 5 to 9 % begin in glandular tissue and are known as adenocarcinomas.

Adenocarcinomas are identified more easily, but they are managed in the same way as squamous cellular carcinomas, and the success rate, phase to phase therapeutic prognosis, is similar.

There are many types of adenocarcinomas, about 60% of all adenocarcinomas are endocervical adenocarcinomas, 10 % are endometrioid and clear cellular carcinomas, and the remaining 20% are adenosquamous carcinomas.

There are 2 rare types of cervical cancer, known as small cell cervical cancer and cervical sarcoma, both of which do have a bad prognosis.

Most researchers agree that cervical cancer and pre-invasive cervical cancers are progressive diseases that develop over time, in a period of years (commonly 3-10 years) following a human papilloma virus infection (HPV infection).

Early arising tumors, known as mild dysplasia or cervical intraepithelial neoplasia (CIN-1) or type 1 dysplasia, can progress to moderate dysplasia (CIN-2), which, in turn, may progress to severe dysplasia and carcinoma in situ (CIN-3) that may eventually become an invasive cancer and spread to nearby tissue or to other parts of the body if left untreated.[11]

Most doctors believe that two-thirds of all cases associated with severe dysplasia will progress to invasive cancer if case left untreated. This malignant transformation of cells takes from 3 to 30 years; However, in most cases, this progression usually takes about 10 years to occur.[1]

Once the cervical tumor becomes invasive, it may spread locally to the upper vaginal area and into the tissues encircling the upper vagina and the cervix (the parametrium). Eventually, the tumor grows toward the pelvic sidewall, obstructing the ureters, which may interrupt the urinary stream by blocking urine from reaching the bladder throughout the renal tubules (interrupted voiding). Moreover, cervical cancers commonly spread to the bladder and anal area (rectum).[1]

Cervical tumor cells may invade the lymphatic system and spread towards the lymph nodes of the pelvic wall. Eventually they might spread to the iliac lymph nodes within the pelvis; However, tumor growth may reach the aortic lymph nodes, and the groin lymph nodes as well.

Metastases can spread through blood, in the vessels feeding the vagina, vulva, lungs, liver and brain. Invasion of the pelvic nerve fibers is common in superior instances. There the disease will spread inside the stomach, especially when the tumor fully penetrates the cervix.

Symptoms

What are the symptoms of cervical cancer and how to detect early signs of cervical cancer?

Common signs or symptoms of cervical dysplasia or cancer include:

1. Abnormal Vaginal Bleeding or spotting between periods, light vaginal bleeding or blood spots are common in females with cervical dysplasia
2. Menorrhagia or menstrual bleeding that is longer and heavier than usual
3. Abnormal vaginal discharge, a watery, pink or foul smelling vaginal discharge is common
4. Postcoital Bleeding or bleeding after intercourse [12]
5. Abnormal bleeding during a pelvic examination
6. Dyspareunia or pain during sexual intercourse
7. Postmenopausal Bleeding or bleeding after menopause
8. Increased vaginal discharge (Leukorrhea)

Causes

What is the cause of cervical cancer?

In general, these factors are the major risks contributing for the growth of cervical cancer:

1. Premature sexualisation of children (sexual activity of children)
2. Having several sexual partners (Promiscuity, or if your sexual partner is having casual sex frequently with different partners).
3. Human Papilloma Virus Infection.[9]
4. Sixteen, and smoking cigarettes

Most experts agree that squamous cell carcinomas (approximately 90% of cervical cancer cases) are sexually transmitted. Generally there is much proof that cervical carcinoma relates in order to sexually transmitted infections. The majority of researches believe that human papilloma virus (HPV) is a powerful cofactor in the development of pre-invasive and invasive cervical carcinomas, as well as pre-invasive / invasive squamous cell cancers of the vagina and vulva respectively.[6][7][9]

Over 90% of cervical squamous cell carcinomas are associated with human papilloma virus. However, other infections, such as genital herpes zoster can also increase the risk of cervical cancer. Herpes zoster is a sexually transmitted disease.[7]

There are more than 50 types of human papilloma virus (HPV). Over 90% of hpv lesions or genital warts cases are caused by HPV types 6 and 11 (low-risk types), whereas most cases of severe cervical dysplasia (CIN-2 and CIN-3) and cervical carcinomas are caused by HPV types 16, 18, 31 and 33 (high risk types).[7]

The virus infects the tissues of the vaginal tract and might produce apparent or moderate genital hpv lesions, moderate or severe dysplasia and cancer in situ.

Genital hpv lesions are related to cervical, genital and vulvar dysplasia as well as to invasive cancer (in 25% of all cases).[10]

What are the risk factors for cervical cancer?

HPV infection increases your risk of developing cervical cancer; However, the vast majority of women infected with HPV do not develop cervical cancer because only some HPV types (high-risk HPV) can lead to cervical cancer over time.

About 90% of HPV infections do not cause cervical cancer as they are caused by low-risk HPV types.

Co-factors include

1. Immunodeficiency Disorders and immune system malfunctions
2. Unhealthy or bad eating and lifestyle habits, such as poor nutrition, poor hygiene, etc.
3. Hormone Imbalance
4. Cigarette smoking
5. Other sexually transmitted Diseases (STDs), such as HIV, herpes zoster, etc.[9]

Other cases are currently examined by researchers as possible causes.

Several aspects can reduce the danger of cervical cancer in woman within the high risk group. In general, any taken steps to prevent sexually transmitted infections will certainly reduce the risk of cervical cancer.

Lower than typical risks include

1. Nulliparity, mature virginity and delay of first sexual intercourse, females who didn’t lose their virginity until they turned 18 – 20 or even older
2. Having sex with only one partner of the opposite sex in their lifetime
3. Usage of condoms
4. Use of spermicide
5. Circumcision and Jewish ethnicity

Aspects associated with higher compared to average risks include:

1. Previous CIN (cervical intraepithelial neoplasia, also known as dysplasia)
2. Vaginal HPV infection (some strains)
3. Earlier vulvar or even vaginal cancer/tumor
4. Exposure to a male whose earlier partner(s) had cervical cancer, tumor or CIN
5. Contact with a sexual partner who has had penile cancer or tumor
6. Having more than one sexual partner increases the risk of cervical cancer because the more sexual partners you have in your lifetime, the more likely you are to have HPV infection. Having two or three sex partners during one’s lifetime increases your chance of developing cervical cancer 25%, whereas, having six or more sex partners during one’s lifetime increases your chance of developing cervical cancer 600%
7. Cigarette smoking
8. In utero exposure to DES (diethylstilbestrol)
9. Long term use of birth control pills for more than four years
10. Earlier herpes, gonorrhea, syphilis or other STDs
11. First sexual intercourse before age 18-20
12. Adolescent pregnancy or becoming pregnant before before the age of 18-20

How to detect cervical cancer?

Pap smear tests are recommended for the early detection of irregular and abnormal cervical tissue

The American cancer Society (ACS) recommends a yearly Pap smear test along with pelvic exam to all sexually active females and for all women older than eighteen (ACS guidelines suggest that after three or more consecutive yearly exams with normal results, the Pap smear test might be performed less frequently, in accordance with the physician).

Your doctor may recommend colposcopy if you have an abnormal Pap smear. An abnormal Pap test may not mean that you have cervical cancer; however, an abnormal Pap test result is often the first step in finding cervical cancer. There are many causes for abnormal Pap test results, such as HPV infection, chlamydia, bacterial vaginosis or yeast infections.

A colposcopy is a minimally invasive diagnostic procedure used to find out whether there are abnormal cervical cells if your Pap test result is positive. During colposcopy, your doctor uses a colposcope to examine the cervix, vagina, and vulva.

 

The accuracy, sensitivity, specificity, and efficacy of colposcopy in identifying precancerous cells is higher than those of the Pap smear (Papanicolaou smear test).

Treatment

What are the treatment options for cervical cancer?

Therapy for early diagnosed cervical cancers depends on the woman’s age, the choices of the patient and the physician’s treatment decisions

Treatment may include

1. Cryosurgery
2. Cauterization
3. Conization
4. Laser skin treatment
5. Hysterectomy

Conization may be the usual therapy for ladies who want to have children. Nearly all women who do not wish having children/extra kids are treated with complete hysterectomy (removal of the cervix and uterus).

How to treat invasive cervical cancer?

Treatment of invasive cervical cancer is dependent on the stage of the disease. Patients whose cancer has invaded only the cervix and those in whom cancer has spread locally to nearby tissues or lymph nodes only can be efficiently treated with surgery and radiation therapy. Surgical therapeutic options include a total hysterectomy or a radical hysterectomy in which the cervix, uterus, both ovaries, both fallopian tubes, ligaments supporting the uterus, the upper part of the vagina and the pelvic lymph nodes are all removed. Both internal (brachytherapy) and external radiotherapy are often used to treat invasive cervical cancer.

Your physician may suggest radiation therapy as a treatment to control the disease and to relieve the symptoms caused by cancer that has spread into the pelvis, the dorsal part of the vaginal area or the ureters.

Patients with cervical cancer that has spread to the bladder, rectum or other distal parts of the body, may receive radiation therapy (radiotherapy) in combination with surgery, chemotherapy, or both. Additionally, Chemotherapy is used as first line therapy for patients whose disease recurs after initial treatment.

 

 

 

References

 

 

 

Verified by: Dr.Diab (September 16, 2018)

Citation: Dr.Diab. (September 16, 2018). Cervical Cancer Symptoms Risk Factors and Treatment. Medcoi Journal of Medicine, 34(2). urn:medcoi:article1087.