What is Cervical Cancer?
Cervical cancer is a cancer that develops due to an abnormal growth of cells in the cervix. The cervix is the lower part of the womb or uterus and connects the womb to the birth canal. This type of cancer has the ability to spread to other parts of the body.
Thankfully, instances of death from cervical cancer are on the decrease. This is largely due to our awareness of this disease and women having regular tests for precancerous cells. (1)
Screening tests are essential for this disease because very often there are no warning signs in its early stages and the earlier this type of cancer is detected the better the prognosis for treatment. (2)
Symptoms
There are very few symptoms of this cancer, especially in the early stages. Chances are you will not experience any symptoms until the cancer has spread to nearby tissues. When it does you can notice:
Vaginal Bleeding
Abnormal bleeding from the vagina may be one of the first signs of this cancer. Irregularities such as: bleeding after sex, in between your menstrual periods or post menopause are all warning signs.
It is also possible to bleed heavier than what you would class as normal for you during your monthly period. Heavy abnormal vaginal bleeding may indicate the cancer has reached an advanced stage and can be life threatening. (3)
Vaginal Discharge
Unusual discharge from the vagina, especially if tinged with blood, is a cause for concern.
Most women have some vaginal discharge, it’s what helps keep the vagina moist, clean and protects against infection. However, noticeable changes may be seen in the smell, texture and color which could indicate an infection or cancer. (4)
Pain
Pain or discomfort during sex is another symptom of cervical cancer. If the disease has progressed you can feel pain in other areas like your back, pelvis or bones. (5)
Other Symptoms
Advancement of cervical cancer into surrounding tissue and areas can cause symptoms such as: changes in bowel or bladder habits, blood in the urine or swelling in the legs.
You could also feel overly tired and lethargic and not feel like eating or you may experience unexplained weight loss. (6)
Stages
Following diagnosis doctors will try and ascertain if the cancer has spread and if so how far. This important procedure helps determine the type of treatment and likelihood of successful outcome. The stages for cervical cancer are: (7)
Stage 0
This is referred to as carcinoma in situ which means there are abnormal cells present which could become cancerous and spread.
Stage l
Cancer cells have spread from the surface of the cervix into deeper tissues. The cancer may also be spreading into the the uterus, but it’s still contained. It may have spread to nearby lymph nodes but not to elsewhere in the body.
Stage lA
Cancer cells are small in number and can only be seen with the aid of a microscope. It may have spread to nearby lymph nodes but not to elsewhere in the body.
Stage lA1
The cancer covers an area less than 3 mm deep and 7 mm wide. It may have spread to nearby lymph nodes but not to elsewhere in the body.
Stage lB
This stage applies to cancers that can be seen with or without a microscope and have spread at least 5 mm deep and 7 mm wide. It may have spread to nearby lymph nodes but not to elsewhere in the body.
Stage lB1
The cancer is visible but size is 4 cm or less. It may have spread to nearby lymph nodes but not to elsewhere in the body.
Stage lB2
The cancer is visible and larger than 4 cm. It may have spread to nearby lymph nodes but not to elsewhere in the body.
Stage ll
The cancer has spread beyond the cervix and uterus, but not to the walls of the pelvis or the lower area of the vagina. It may have spread to nearby lymph nodes but not to elsewhere in the body.
Stage llA
The cancer has spread beyond the cervix and uterus, but not to the walls of the pelvis or the lower area of the vagina. It has also not grown into tissues next to the cervix. However, it may have spread to nearby lymph nodes but not to elsewhere in the body.
Stage llA1
At this stage the cancer has spread beyond the cervix and uterus, but not to the walls of the pelvis or the lower area of the vagina. It is visible but not larger than 4 cm. It may have spread to nearby lymph nodes but not to elsewhere in the body.
Stage llA2
The cancer has now spread beyond the cervix and uterus, but not to the walls of the pelvis or the lower area of the vagina. It is visible and is larger than 4 cm and may have spread to nearby lymph nodes but not to elsewhere in the body.
Stage llB
The cancer has spread beyond the cervix and uterus, but not to the walls of the pelvis or the lower area of the vagina. It is now in the tissue next to the cervix (parametria). It may have spread to nearby lymph nodes but not to elsewhere in the body.
Stage lll
By this point the cancer can be found in the lower part of the vagina or the walls of the pelvis. It may be blocking the tubes that carry urine to the bladder (ureters). It may have spread to nearby lymph nodes but not to elsewhere in the body.
Stage lllA
The cancer can be found in the lower third of vagina but not the pelvic wall. It may be blocking the tubes that carry urine to the bladder (ureters). It may have spread to nearby lymph nodes but not to elsewhere in the body.
Stage lllB
The cancer has spread into the walls of the pelvis and is blocking one or both tubes that carry urine causing kidney problems (hydronephrosis). It may have spread to nearby lymph nodes but not to elsewhere in the body.
Stage lVA
Cancer has spread to the rectum or bladder. It may have spread to nearby lymph nodes but not to elsewhere in the body.
Stage lVB
The final stage is where the cancer has spread to other areas of the body like the liver, lungs, bones or lymph nodes. (8)
Treatment
Following diagnosis your doctors will speak to you about the best treatment options dependent on the stage your cancer has reached. These treatments include surgery, radiation therapy, chemotherapy and targeted therapy.
Surgery
There are several surgery options to treat cervical cancer. Some of them are used to detect the cancer and ascertain how far it has spread.
Cryosurgery
This involves a very cold metal probe being placed directly on the cervix to freeze abnormal cells and kill them. Following this procedure, which can be done in a doctors surgery, you may have brown watery discharge for several weeks. (9)
Laser Surgery
A laser beam is directed at the cervix through the vagina which burns away abnormal tissue. It can also be used to remove some tissue for analysis. This procedure can be done in your doctors office under local anesthesia. (10)
Conization
A cone shaped section of the cervix is removed using a laser or a thin wire loop heated with electricity. The tissue which has been removed is examined for precancer or cancer cells to see if further treatment is required. (11)
Simple (Total) Hysterectomy
Surgery that removes the uterus and cervix but leaves the other areas around them intact is classed as a simple hysterectomy. The ovaries and fallopian tubes remain intact unless there is any other reason to remove them.
There are several ways this surgery can be carried out.
Abdominally involves an incision at the front of the abdomen to allow removal, whereas vaginal hysterectomy utilises the vagina for removal.
Laparoscopic hysterectomies can be done abdominally or vaginally where a doctor makes smaller incisions. This procedure involves using a camera attached to a thin tube, when it’s inserted it enables removal of tissue.
A doctor can also use robotic assisted surgery with special instruments attached to robotic arms which they control. (12,13)
These surgeries are all done under anesthesia and have recovery times varying from two to six weeks.
Radical Hysterectomy
This type of hysterectomy can be performed in the same way as a simple hysterectomy. The difference is the removal of tissues next to the cervix and possibly some lymph nodes. (14)
Trachelectomy
For women of childbearing age cervical cancer is a major concern in relation to fertility. This procedure removes the cervix, upper part of the vagina and lymph nodes but keeps the uterus intact. A band or “purse string” stitch is placed at the opening of the uterus to replace the cervix.
Women who have undergone this procedure have still carried a child to full term, although delivery may be via cesarean section. (15)
Pelvic Exenteration
This extensive surgery is performed to treat cervical cancers that recur. It may remove the bladder, vagina, rectum, and part of the colon depending on the spread of cancer.
The impact of this surgery can mean having a colostomy or urostomy to remove waste from the body. This usually means the faeces or urine drain into a bag outside the body. Wherever possible a surgeon will try all alternatives first and reconstruction of the bladder or bowel is possible.
Removal of the vagina is another possibility but this can also be reconstructed. In time your sex life can be as full and productive as it was before surgery. (16)
Lymph Nodes
When performing surgery for hysterectomy the lymph nodes will also be looked at. They may be tested to see if abnormal cells have spread and if so removed. These include lymph nodes in the pelvis and large artery in the abdomen. (17)
Radiation Therapy
There are two types of radiation therapy used for cervical cancer. Both can be done to treat cancer cells or as a follow up after surgery.
The first type is external beam radiation which uses a high radiation dose delivered via x-ray. The second is brachytherapy where a radiation source is placed inside the vagina to deliver low or high dose radiation. (18)
Chemotherapy
Chemotherapy uses drugs to stop the growth of cancer cells. When treating cervical cancer these drugs may be administered as a stand alone or in conjunction with radiation therapy. (19)
Targeted Therapy
As new research is discovered drugs are being developed all the time to deal with cancer. Tumors need to create new blood vessels which enable them to grow. Some drugs are also able to block this process and therefore reduce or stop tumor growth. (20)
FAQ
What is cervical cancer? Cervical cancer is a cancer that develops due to an abnormal growth of cells in the cervix.
What are the signs of cervical cancer? There are very few symptoms associated with this type of cancer, particularly in the early stages. Abnormal vaginal bleeding, vaginal discharge and painful sex are indications to be noted.
How do you develop cervical cancer? Risk factors like smoking and HIV can contribute towards this cancer but the main cause is a virus called the human papillomavirus (HPV). It is a common sexually transmitted disease that affects millions of people. (21)
How are you diagnosed for cervical cancer? Following a physical examination and determining your medical history the first diagnostic test is a pap or smear test. This detects any abnormal cells in the cervix. Follow up tests include a colposcopy, a visual examination of the cervix, or biopsy where cell samples are taken.
What is the best treatment for cervical cancer? There are treatment options available including surgery, radiation therapy, chemotherapy and targeted therapy. Your doctor will discuss your options with you to decide the best course of action.
What are the long term complications of cervical cancer? Long term implications of this type of cancer will depend on stage and treatment. A hysterectomy means that you will not be able to have children. Extensive surgery could leave you with a colostomy or urostomy bag.
Is cervical cancer considered a disability? Cervical cancer is not considered a disability per se but you may be able to claim social security benefits. (22)
Is there a cure for cervical cancer? There are many treatments for cervical cancer which do have a good success rate. The key however is prevention and regular screening via pap test to detect this disease in its early stages.
Is cervical cancer life threatening? Prognosis if caught in the early stages is good for this type of cancer. However if undetected it can spread through the body and be terminal.
Summary
Cervical cancer is a cancer that develops due to an abnormal growth of cells in the cervix. It can be caused by a common sexually transmitted disease called human papillomavirus (HPV).
Symptoms of this cancer are few and not always obvious.
Whilst there are many effective treatments there are also steps which can be taken for prevention.Vaccines are available for HPV, as are screening tests. Not smoking and practising safe sex using a condom can also help. (23)
The important thing is to make sure you go a get yourself screened on a regular basis.