Cervical cancer – symptoms, diagnosis, prevention and treatment

Cervical cancer is quite frequent, occupying the second place among all gynecological oncological diseases after cancer of the uterine body.

Cervix is located at the bottom of the uterus and connects it with vagina. It usually becomes susceptible to various benign and malignant changes starting from 20 years of age. Fortunately, cervical cancer is a slowly-developing type of usually found in women aged 45-50 years.

Short information about cervical cancer

From 10 diagnosed cases, 9 are Squamous, i.e. the disease develops from surface cells in the bottom part of the cervix nearest to the vulva. Another type, a rare one, is adenocarcinoma affecting the glandular cells closest to the uterus.

You should know that cervical cancer is preceded by benign and precancerous processes.

Benign changes include:

- Simple ectopia;
- Endocervicosis;
- Leukoplakia;
- Endometriosis;
- Cicatricial deformity of the cervix, etc.

Precancerous conditions, i.e. conditions raising the risk of cancer, are cervical dysplasia of varying severity.

Statistics

According to statistics, this cancer type becomes rarer with every passing year but the percentage of diagnosis at the late stages grows.
In developed economies, due to early detection and use of papillomavirus vaccine, the frequency is minimal - about 3.8%. In the U.S., it has dropped by 45% since 1980.

The risk group is all females over the age of 30 who should undergo yearly gynecological examination to catch negative changes early.
The forecast for the disease is highly contingent on the timeliness of the visit to the gynecologist and start of the therapy.

Risk factors

In the majority of cases, the causative agent is the human papillomavirus (HPV) that is unidentified timely and not managed properly. HPV is quite frequent and it doesn’t mean that every woman having it will develop cancer. Only a few kinds of the virus are proven to be inducing factors for the disease. This is why it is crucial to exclude their presence in a woman’s body. And if it is detected, prescribe comprehensive treatment.

Other risk factors include:

- Cigarettes smoking;
- Many sexual partners (even with condoms because they ensure only 70% protection from HPV);
- Weakening of the immune system (HIV-positive, organ transplantation, etc.);
- Cured or present chlamydial infection,  (and other STIs to the lower extent);
- Overweight;
- Three or more full-term pregnancies;
- Long-term use (more than five consecutive years) of hormonal birth control pills;
- First pregnancy before the age of 17;
- Early sex life;
- Rare visits to gynecologist;
- Familial predisposition to cancer and, in particular, to cervical cancer.

Symptoms

Cervical cancer doesn’t cause any noticeable symptoms in the begining. Symptoms usually show up when malignant cells start to grow through the top layer of the cervix into adjacent tissues below it.

Go to a gynecologist right away in case of:

- Vaginal bleeding or dark-spotting between periods;
- Longer or heavier periods than usual;
- Painful urination;
- Vaginal bleeding after reaching menopause;
- Painful sensations during sex;
- Vaginal bleeding after sex;
- Pain in the lower stomach;
- Any vaginal discomfort;
- Other abnormal vaginal discharge that is unusual in quantity, color, consistency, or odor.

The disease can be accompanied by rapid weight loss, fatigue, frequency of urination, a feeling of hard-to-define discomfort, weakness, anemia, lack of appetite, a small long-term temperature in the range of 37.0 - 37.5 C (98.6 F – 99.5 F), edema of one or both legs, and other symptoms.

The above manifestations do not indicate cervical cancer with certainty. They can be indicating other gynecological diseases or even diseases of other systems of the body. Nevertheless, these are alarming signs that require gynecological examination and conduction of all tests that your doctor considers necessary.

Diagnosis

One of the most important methods of early detection of any gynecological disease is the regular gynecological examination. Since the clinical manifestations of precancerous and underlying diseases are not pronounced, differential diagnosis is made to identify such changes as:

- Cytological screening;
- Visual examination of the genitals;
- Colposcopy;
- Bacterioscopic/bacteriological tests;
- Cervical biopsy or of suspicious areas of the cervix;
- Cervical swab test.

Cytological screening is a swab test that helps to identify an incipient pathological process.

Colposcopy is the main diagnostic method. If necessary, it is supplemented with manipulations (biopsy, cytology of smears, application of acetic acid to detect flat warts, curettage of the cervical canal, etc.).

Conditions preceding cancer can be cured with cryosurgery, laser surgery, and other methods. If a gynecologist suspects oncology during the listed manipulations, a biopsy, i.e. collection of small amount of cells for the test, is made to identify the severity of organ damage and the stage of cancer.

This method of tissue harvesting is usually used after a gynecologist detects an abnormality during a routine examination.  When monitoring the epithelium of the cervix, diagnostic methods are also used, such as:

- Optical coherence tomography;
- Ultrasound;
- Fluorescence spectroscopy;
- Irrigoscopy;
- Lung radiography;
- Rectoscopy;
- MRI;
- Urography;
- Cystoscopy;
- PET CT;
- Use of tumor marker;
- CT scan.

Cervical cancer treatment

Choice of therapy is contingent on many factors. The optimal method could be surgery, radiotherapy, chemotherapy (for instance, with Hydrea) or several methods a once.

The disease is difficult to treat. 50% of women diagnosed with cervical cancer die within the first 5 years.  But do not be scared –in most cases the number is so high because of late stage diagnosis which can be avoided by yearly or every 6 months routine gynecological examinations. Treatment includes different regimens using hormonal, targeted, radiation therapy, surgery and chemotherapy.

Stage 1

At this stage, the tumor is limited to the cervical tissue, reaching a maximum of four centimeters. Rhys, the treatment is the least traumatic. Surgeries are carried out with the removal of only the affected tissues of the uterus until the moment when healthy cells remain on the cut. This is especially important if a woman wants to have children. Resection is performed using different methods:

If the disease is caught very early and the formation is limited to the mucous layer, then cryodestruction or laser cauterization is possible.

If the tumor penetrates into the tissues by more than 3 mm, after the surgery, radiotherapy is used: distance or brachytherapy. These therapies are utilized only if the woman is not planning to have children.

90% of women can be saved at this stage.

Stage 2

From the second stage, the formation extends to the tissues of the uterus above, and the vagina.  In this case, the neck itself, partly the vagina, parametrium, and lymph nodes are removed. The surgery is possible if cancer has not extended to the body of the uterus above.

If the process is more extended, then a panhysterectomy is performed. Then, the uterus with appendages is excised. Intervention is performed by the laparoscopic method to examine the surrounding organs for capture by the tumor process.

Further irradiation is necessary.  It is made in the case of finding atypical cells in the section and in the adjacent tissues. And if there are metastases in the lymph nodes, then chemotherapy is appointed. For very large formations, chemotherapy and radiotherapy are prescribed before resection.

Treatment is successful for 75% of women.

Stage 3

At the third stage, the formation becomes so voluminous that it begins to squeeze the adjacent structures. Cancerous cells leave the genitals and grow into the parametrium. Lymph nodes are affected.

At this stage, a radical hysterectomy is performed. Almost all reproductive organs are removed, including part of the vagina, uterus, and ovaries. The affected fatty tissue and lymph nodes are also excised. Surgery is reasonable if the tumor hadn’t spread to other organs.

If cancer has extended far, radio or chemotherapy are used to shrink the tumor and allow having surgery.

When resection is not possible, radiation is the leading method. Remote exposure and intracavitary contact methods are used. Radiotherapy is combined with chemotherapy. Chemotherapy at the third stage is a complex of several cytostatics. They are administered regionally intra-arterially. Platinum-based substances (Cisplatin, Carboplatin) give good results. The combination of Paclitaxel, Topotecan, and Bevacizumab is also common.

Despite intensive treatment, recovery ends in only 30% of women.

Stage 4

At the final stage, all structures of the pelvis are captured by the oncological process. The surrounding organs are affected. Metastases spread through the blood. Only palliative care is possible. It includes operations to remove the colostomy, the installation of a urine collection bag for the normal outflow of secretions. Chemotherapy and radiation are given to slow tumor growth and reduce the size of metastases.

Recovery at this stage is rare. Only 10% of women live longer than 5 years.

Prevention

You can reduce your chances of contracting cervical cancer by taking steps to reduce your chances of contracting HPV and herpes viruses. To do this, they are vaccinated against HPV, increase immunity, and use barrier contraceptives.

It is recommended that girls begin their sex life no earlier than 16 years old. Give preference to stable long-term relationships. It is important to use contraception correctly and avoid abortion.

Once every two to three years, it is recommended to do the cervix swab test to check for oncology. Do not neglect preventive gynecological examinations every six months.

Post by: John Avery, General Practitioner, Manchester, United Kingdom