Cervical cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs is the growth of abnormal cellsthe basic structural and functional unit of all living things in the lining of the cervix. The cervix is a part of the female reproductive system that connects the uterus to the vagina. It has many important functions, including fluid production for vaginal health, mucus production to assist sperm in the fertilisation process, and it acts as a barrier to hold the baby in the uterus until birth.
The most common type of cervical cancer is squamous cell carcinomacancer arising from tissues that line organs (cancer arising from the squamous cells that line organs). These cells are found on the outer surface of the cervix, called the ectocervix. A less common subtype of cervical cancer is adenocarcinomacancer arising from mucus-producing glands in organs. These cells line the inner surface of the cervix, which is known as the cervical canal or the endocervix. Most cervical cancers start in-between the ectocervix and endocervix in an area called the transformation zone.
Cervical cancers are most commonly diagnosed in women over 30, however, it can affect anyone with a cervix – including women, teenagers, transgender men, and intersex people – at any age.
Treatment
If cervical cancer is detected, it will be staged and graded based on size, metastasiswhen the cancer has spread to other parts of the body, also known as mets, and how the cancer cells look under the microscope. Stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas and grading helps your doctors determine the best treatment for you.
Cervical cancers can be staged using the Federation of Gynecology and Obstetrics (FIGO) system from stage I to IV:
- Stage I: cancer cells are confined to cervix tissuea group of cells that work together to perform a function only. This stage is also known as early-stage cancer.
- Stage II: cancer cells have spread to the upper two-thirds of the vagina and/or other nearby tissue. This is also known as localisedaffecting only one area of body cancer.
- Stage III: the cancer has become larger and has spread to lower third of the vagina and/or the side of the pelvic wall. Lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid and kidneys may be affected. This is also known as advancedat a late stage, far along or metastatic cancer.
- Stage IV: the cancer has spread to the bladdera hollow, muscular sac in the pelvis that stores urine or rectumthe last section of the large intestine/bowel that holds waste until it is ready to be removed from the body, or to more distant organs, such as the lungs or the liver. This is also known as advanced or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumoura tissue mass that forms from groups of unhealthy cells.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including fertility, type, stage of disease and overall health.
Treatment options for cervical cancers may include:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence, potentially including:
- Complete or partial trachelectomycomplete or partial removal of the cervix.
- Complete or partial hysterectomycomplete or partial removal of the uterus.
- Unilateralaffecting one side or bilateralaffecting both sides salpingectomyremoval of one (unilateral) or both (bilateral) fallopian tubes.
- Bilateral salpingo-oophorectomyremoval of both ovaries and fallopian tubes.
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells.
- Chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells.
- Targeted therapymedication that targets specific molecular features of cancer cells, potentially including bevacizumab.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Cervical Cancer Treatment and Fertility
Treatment for cervical cancer may make it difficult to become pregnant. If fertility is important to you, discuss your options with your doctor prior to the commencement of treatment.
Risk factors
Most cases of cervical cancer are caused by an infectiona condition where harmful pathogens, such as bacteria, viruses or parasites, have entered the body with a human papillomavirus (HPV), which is a sexually transmitted disease (STD). HPV is a group of viruses that can affect various areas of the body, such as the cervix, vagina, and skin. It is often asymptomatic. Most people with HPV will not develop cervical cancer.
Other riskthe possibility that something bad will happen factors for cervical cancer may include:
- Smoking or passive smoking.
- Prolonged oral contraceptive use.
- Having a weakened immune system.
- Exposure to diethylstilbestrol (DES).
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Diethylstilbestrol (DES) exposure
Diethylstilbestrol (DES) is a synthetic form of the female hormonea chemical substance produced by glands in the endocrine system that regulates various functions in the body estrogen. It was prescribed to pregnant women between 1940 and 1971 to prevent miscarriage, premature labour, and related complications of pregnancy. The use of DES declined after studies in the 1950s showed that it was not effective in preventing these problems.
In 1971, researchers linked prenatal (before birth) DES exposure to a type of cancer of the cervix and vagina called clear cell adenocarcinoma in a small group of women. Soon after, the Food and Drug Administration (FDA) notified physicians throughout the country that DES should not be prescribed to pregnant women. The drug continued to be prescribed to pregnant women in Europe until 1978.
Women who have taken DES, and women whose mothers took DES whilst pregnant, may be at higher risk of cervical cancer, as well as other conditions.
Symptoms
Early changes in cervical cells rarely cause symptoms. If early cell changes develop into cervical cancer, the most common signs include:
- Vaginal bleeding between periods.
- Menstrual bleeding that is longer or heavier than usual.
- Bleeding after intercourse.
- Pain during intercourse.
- Unusual vaginal discharge.
- Vaginal bleeding after menopause.
While uncommon, advanced cervical cancer may cause the following symptoms:
- Excessive tiredness.
- Leg pain or swelling.
- Lower back pain.
Not everyone with the symptoms above will have cancer, but see your GP if you are concerned.
Diagnosis
If your doctor suspects you have cervical cancer, they may order the following tests to confirm the diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results and refer you to a specialist for treatment:
- Cervical screening testa screening test that looks for signs of human papillomavirus (HPV) and abnormal cells in the cervix (CST).
- Colposcopyan examination of the cervix and vagina using a small, flexible instrument known as a colposcope.
- Biopsyremoval of a section of tissue to analyse for cancer cells, potentially including a cone biopsythe surgical removal of a cone-shaped piece of tissue from the cervix to test for cancer cells.
