Cervical Cancer - Stages, Treatment, Symptoms and Causes

Cervical Cancer is fourth on the list of cancer in women. It is the type of cancer that occurs in the cervix cells. Around 5,70,000 women were diagnosed with this condition in 2018, while there was a death of 3,11,000 women.

Disease Name	Cervical Cancer
Alternative Name	Cervix Cancer
Symptoms	Blood and Pungent odour in vaginal discharge, Bleeding after intercourse, Sharp pain in the back of the pelvis, Blood in urine, Sudden loss of weight, Swelling in legs.
Causes	Human papillomavirus (HPV), Weakened immune system, Birth control pills like oral contraceptives, Socioeconomic factors
Diagnosis	Screening, Punch Biopsy, Endocervical curettage, Imaging tests
Treated by	Oncologist
Treatment options	Surgery, Radiation therapy, Chemotherapy.

Cervical Cancer develops in the cervix, the lower part of the uterus. Cervical cancer can be effectively managed if detected at an early stage. It is preventable through HPV vaccination and screening.

Following are the most common signs and symptoms of Cervical Cancer:

1. Blood and pungent odour in vaginal discharge
2. Bleeding after intercourse
3. Sharp pain in the back of the pelvis
4. Blood in urine and pain during urination
5. Sudden loss of weight
6. Swelling in legs

Some of the causes of Cervical Cancer are:

1. Mainly, cervical cancer is caused by the Human Papillomavirus (HPV), a sexually transmitted virus. However, it is to be noted that not all types of Human papillomavirus cause cervical cancer.
2. Low immunity or  weakened immune system.
3. Birth control pills like oral contraceptives may also cause cervical cancer.
4. Socioeconomic factors also play a vital role in causing cervical cancer. Economically backward women are at a high risk of getting cervical cancer. These women have no access to modern medical facilities.

Some of the significant risk factors of cervical cancer are:

1. Women smokers are more likely to have cervical cancer. Tobacco has been found in the cervical mucus of women with smoking habits.
2. As almost 99% of cervical cancers are caused by human papillomavirus (HPV), the infection of human papillomavirus (HPV) is the significant risk factor for cervical cancer.
3. Women with a weakened immune system are at a high risk of getting cervical cancer.
4. Multiple sexual partners
5. Starting sexual activity at an early age
6. Sexually transmitted diseases such as AIDS, gonorrhoea, chlamydia, or syphilis
7. If the mother is exposed to diethylstilbestrol while pregnant, she is at risk of developing cervical cancer.

1. Screening: Screening tests like the Pap test and the HPV DNA test help to detect cancer in its early phase.
2. Pap test: The doctor scrapes the cervix cells and then sends them to the lab for examination.
3. HPV DNA Test: Collected cells are examined with the help of the strain of DNA. Some strains of HPV may cause cancer.
4. Punch Biopsy: The doctor removes the cervical tissue through a sharp tool and then examines it.
5. Endocervical Curettage: It involves using a spoon-shaped instrument called a curette to scrape the tissue sample.

If the woman is uncomfortable with the endocervical curettage or punch biopsy, one of the following tests can be performed.

1. Electrical wire loop: This process uses a thin electrical wire to get the cell sample.
2. Cone biopsy: A cone is used to get the deeper tissue samples.
3. Imaging tests: These tests help determine the presence and stage of cervical cancer. Some imaging techniques include MRI, CT scan, PET, and X-ray.
4. Visual examination: The doctor may also inspect the rectum and bladder to determine the spread of cervical cancer.

Disease Progression of Cervical Cancer

1. Stage I: Cancer has spread to deeper tissue.
   1. Stage IA: The area covered by the cancerous cell is about 3mm to 5mm.
   2. Stage IB: The area covered by cancerous cells is about 5 mm to 4cm.
2. Stage II: Cancerous cells spread from the cervix to the other parts like the vagina but are still in the pelvic area. 
   1. Stage IIA: Area is limited to the upper two-thirds part of the vagina. The area of cancerous cells is about 4 cm or more.
   2. Stage IIB: Tumour has spread to the tissues near the cervix.
3. Stage III: The pelvic walls and the lower third part of the vagina are affected.
4. Stage IV: It is divided into two sub-stages. 
   1. Stage IVA: Cancer spreads to the rectum and bladder but not to the distant organs of the body.
   2. Stage IVB: Cancer has spread to distant body organs, such as the lungs.

How to prepare for the doctor's consultation?

The patient can book an appointment to consult the doctor in the following ways: 

1. Book an appointment to avoid any waiting time. Reach the hospital at the scheduled time and get registration done at the reception. 
2. The doctor will ask about the symptoms, past medical history, and the reports of tests done, if any. Make sure to explain the signs in detail. It will help the doctor to diagnose the problem more accurately.
3. If there is already a diagnosis, make a list of questions you need to ask the doctor in your next appointment. It may include questions regarding treatment options, disease progression, and recovery. 
4. If you are concerned about your signs and cannot visit the hospital, you can also book a virtual/video consultation with a suitable doctor using an online platform.

The treatment of cervical cancer depends on the stage at which the disease is diagnosed.

Surgery

If cervical cancer is diagnosed early, it is typically treated by surgery. The doctor decides the type of surgery based on the stage of cervical cancer.

1. Surgery to remove the cancer cells only: In this process, the cone is used and the deeper tissue is extracted. The remaining cervix is kept intact in this process.
2. Surgery to remove the cervix: Radical trachelectomy is the surgical procedure of removing the affected cervix and other surrounding tissues. The uterus remains intact in this process, and it is still possible to get pregnant after this surgery.
3. Surgery to remove the cervix and uterus: The method is known as hysterectomy in which the cervix, lymph nodes, part of the vagina and the uterus is removed by cutting out. It is very effective in the early stages of cervical cancer. However, as this process involves the removal of the uterus, the woman cannot get pregnant.

Radiation Therapy

1. High energy radiations, such as protons, are used to kill cancer cells. It is often combined with chemotherapy.
2. The doctor may consider both internal and external radiation therapy methods depending on the patient's condition.
3. In some cases, both methods are used. Radiation therapy may cause menopause in premenopausal women.
4. Further, as radiation therapy may affect the reproductive system, women should consult the doctor if they are planning for pregnancy after radiation therapy. 

Chemotherapy

1. Chemotherapy is the method of treating cancer by administering drugs that kill cancerous cells.
2. In early-stage or locally advanced cervical cancer, the doctor may add low-dose chemotherapeutic drugs with radiation therapy. Maximum doses of these drugs are prescribed for advanced cervical cancer.

Immunotherapy

1. In this treatment, the drugs are given to the patient to enhance the body's immune system to help it fight cancer.
2. Cancer cells hide from the immune system's attack through several mechanisms, such as immuno-suppressive effects.
3. Immunotherapy works by interfering with these processes. The doctor recommends immunotherapy in patients with advanced cervical cancer or when the other conventional treatments are ineffective.

If not diagnosed and managed early, cervical cancer progresses to cause various complications. These complications are:

1. Fistula between vagina and rectum
2. Persistent discharge of fluid from the vagina
3. Bleeding in the vagina or during urination
4. Blood clotting
5. Failure of the kidney

When to consult a Doctor?

1. Any signs of cervical cancer should never be ignored.
2. If one finds any signs and symptoms of cervical cancer like pain during urination, blood in vaginal discharge, blood in urine, pain during urination, swelling in legs, and bone fractures, consult with the doctor immediately.