Cervical Cancer

Cervical Cancer

Cervical Cancer occurs at the cervix which locate in the lower part of the uterus, connecting to the vagina. Human Papillomavirus (HPV); a sexually-transmitted infection, does influence the development of most cervical cancer.

At the first exposure of HPV, the immune system will generally prevent the virus from attacking your body. However, when normal cervical cells begin to mutate, it will lead to the development of cervical cancer. Fortunately, cervical cancer is a preventable disease. HPV vaccination and cervical screening tests including Pap smear and HPV DNA test can help lower the risk of developing cervical cancer.

Cervical cancer in the early stage usually does not show any symptoms. However, as the disease progresses, abnormal vaginal bleeding or abnormal vaginal discharge may occur.

Symptoms

You should make an appointment with your doctor if any of the following symptoms occur.

• Abnormal vaginal bleeding (light bleeding between periods / bleeding from vagina after sexual intercourse/ abnormal menstrual bleeding such as longer or heavier than usual / bleeding after menopause)
• Abnormal vaginal discharge (increased amount of vaginal discharge / foul odor discharge/ brown or bloody discharge)
• Unexplained lower abdominal pain (pelvic pain) or pain during sexual intercourse.

However, if your cervical screening test is abnormal without any symptoms, you should see a doctor and then the further management should be discussed.

What are the causes of cervical cancer and its risk factors?

Human papillomavirus (HPV) certainly plays a major role in cervical cancer. After HPV infection, healthy cervical cells can be mutated and they will develop to be precancerous or cancer cells at the cervix.  Nevertheless, most people with the HPV infection will not develop cancer at the first exposure. Lifestyle and environmental factors also impact the disease.

There are several risk factors that could lead to cervical cancer.

• You will have a higher chance of developing HPV if you have many sexual partners and if your partner also has a great number of sexual partners.
• If you have sexual intercourse at an early age, it could increase the risk of HPV.
• If you have been diagnosed with other sexually-transmitted infections (STIs) such as chlamydia, gonorrhea, syphilis, and HIV/AIDS, you have a higher chance of getting HPV.
• Cervical cancer will be more likely to develop if you have a weakened immune system due to other health conditions.
• There is an association between smoking and cervical cancer.

How to prevent cervical cancer

Cervical cancer is one of the most highly preventable cancer. Preventing any risk factors including avoidance of many sexual partners, and smoking cessation are advised. More important, HPV vaccination are highly effective in preventing cervical cancer. The HPV vaccine targets the high-risk HPV types that most commonly cause cervical cancer and also cancers of the vulva, vagina, anus, and oropharynx. HPV vaccine is recommended at age 11 or 12 years through age 26 and it works well when given before any HPV exposure. However, the HPV vaccination cannot substitute for regular pelvic exam and routine screening tests.

Screening tests are including Pap smear and HPV DNA test. In order to perform a Pap smear or Liquid-base cytology (LBC), your doctor will scrape or brush cells at the cervix to further examine the abnormalities. These tests will be able to detect both cancer cells and cells that may be developed to cervical cancer. To be more accurate, doctors will also test for the high-risk HPV types by looking for their DNA in cervical cells. 

You should discuss different options to perform screening tests with your doctor. The screening tests are recommended in women age 21 years and over.

How do doctors diagnose cervical cancer?

For the diagnosis, your doctor will most likely start with a thorough cervix examination and pelvic exam.

If cervical cancer is suspected, a cervical biopsy procedure will be performed to further examine the malignancy. Your doctor will use a punch biopsy method which is the use of a sharp tool to gently pinch cervical tissue samples.

However, if no suspicious lesion seen on a cervix while abnormal Pap smear or HPV DNA was detected, your doctor will perform a colposcopic examination with the use of a colposcope to check any cells’ abnormalities. The punch biopsy may be performed and sometimes doctors will use a curette (a small instrument) to scrape samples of cervical tissues in the endocervical curettage method. You may sometimes undergo one of these additional tests other than the punch biopsy or the endocervical curettage.

In case of precancerous cell is suspected, conization (cone biopsy) will be performed to obtain some tissue samples for further diagnosis and treatment for abnormal or precancerous conditions. Loop electrosurgical excision procedure (LEEP) is one of the conization method that use a small wired loop charged with a low voyage electrical current.

For staging of cervical cancer, the pelvic exam and rectal examination will be performed initially to determine the stage. You will undergo further imaging tests including chest x-ray, CT, MRI, or PET scan that will evaluate if cancer has spread to other areas. Occasionally, your doctor may evaluate inside the bladder and rectum as well.

What are the treatments of cervical cancer?

Different treatment options range from surgery, radiation, chemotherapy, or a combined treatment.

• Surgery

Those that are diagnosed with early-stage cervical cancer will be advised to undergo surgery. There are different surgical options. Most patients with early-stage cervical cancers are advised to undergo a radical hysterectomy operational treatment. Your doctor will perform surgery to remove the cervix, uterus, part of the vagina, and lymph nodes in the surrounding area. For those whose cervical cancer remain very early-stage, they can undergo surgery that removes only the cervix and uterus which is called a simple hysterectomy. However, if you still prefer to get pregnant in the future, you should discuss with your doctor about the risks and benefits of the optional treatment procedure that removes only the cervix (trachelectomy).

• Radiation therapy

According to the pathological results from the surgery, if there is a higher risk for the cancer recurrence, your doctor may advise you to treat with radiotherapy as an adjuvant treatment.

Most patients with locally advanced cervical cancers, surgery may not be appropriated. A high-doses radiation therapy often combined with chemotherapy will be a mainstay for primary treatment in this circumstance.

There are different types of radiation therapy. External beam radiation therapy can perform externally by pointing the energy beam to the abnormal area. Brachytherapy is a type of radiation therapy that is performed internally. It is when your doctor places a radioactive device inside your vagina for a very short time.

Radiation therapy may trigger menopause. You should consult with your doctor about how to preserve your eggs before you start with any treatment procedure if you are still young or wish to have a baby after the radiotherapy. 

• Chemotherapy

Your doctor may use chemotherapy to destroy cancer cells. Low doses of chemotherapy are most likely being combined with radiation therapy for patients with locally advanced cervical cancer. Chemotherapy has an ability to enhance the radiation effects. However, for those with late stages of cancer, high doses of chemotherapy alone as a primary treatment will be recommended.

Other optional treatment for advanced cervical cancer is the targeted-drug therapy. The doctor often combines this type of treatment with chemotherapy.

Immunotherapy

Immunotherapy can also be used to treat advanced cervical cancer or when other treatments failed. This drug treatment helps your immune system fight against cancer cells. However, the data about immunotherapy in cervical cancer is still unclear.