Cervical Cancer

Overview

The uterine cervix is the lowest part of a woman’s uterus that connects the uterus to the vagina. Cervical cancer takes place when there is abnormal growth of the cells of the cervix to the extent that they invade other tissues and body organs.

Cervical cancer affects the entrance to the womb. One of the key causes of cervical cancer is strains of the human papillomavirus (HPV), which is a sexually transmitted infection.

When exposed to HPV, the immune system of the woman normally prevents the virus from cause damage. However, the virus has the ability to survive for years if not realized and/or treated.

When the virus stays for years, it contributes to the process that leads certain cells on the cervix to become cancerous.

World Health Organization reports that cervical cancer is the fourth most common cancer among women in the world with an estimate of 570,000 new cases reported in 2018, which signified 6.6% of all female cancers.

About 90% of deaths from cervical cancer reported in 2018 occurred in low-and-middle- income countries. In Kenya, cervical cancer is the second leading cancer in women after breast cancer, with 25 women in every 100,000 affected.

Early diagnosis, effective screening, treatment programs, and embracing preventive measures are key to the reduction of high mortality rates. 

Symptoms

In the early stages of cervical cancer, a person may experience no symptoms at all because in most cases, HPV does not have symptoms. For this reason, women need to have frequent cervical smear tests or pap tests.

The most common symptoms of cervical cancer include:

  • Bleeding after sexual intercourse
  • Bleeding between periods
  • Bleeding in post-menopausal women
  • Vaginal discharge with a strong smell
  • Pelvic pain
  • Vaginal discharge tinged with blood
  • Pain during sexual activity
  • When cervical cancer is at an advanced stage, you may experience kidney failure

These symptoms may not necessarily mean you have cervical cancer as they may suggest the presence of HPV or other infections.

If you experience these symptoms, see a doctor immediately or use the Uzima Health App to find a doctor and a medical facility near you as soon as possible.

Causes

Cervical cancer starts with abnormal changes in the cervical tissue. The risk of developing abnormal cells in the cervix is linked to infection with human papillomavirus (HPV).

According to America’s National Cervical Cancer Coalition (NCCC), HPV is found in approximately 99% of cervical cancers. It means that up to 99% of cervical cancer is caused by HPV.

Other minor causes of cervical cancer that are equally associated with HPV include:

  • Early sexual contact – below 16 years or 1 year before the menstrual cycles
  • Multiple sexual partners
  • Taking oral contraceptives (birth control pills)

All these factors lead to greater exposure to human papillomavirus (HPV).

Risk Factors

Other than the above-mentioned risk factors associated with HPV, other risk factors include:

  • Other sexually transmitted infections (STIs): Having gonorrhea, chlamydia, syphilis, and HIV/AIDS increase the risk of HPV.
  • Smoking: Smoking is linked to squamous cell cervical cancer
  • Weak immune system: Weak immune system exposes you to several infections including HPV

Diagnosis

 If cervical cancer is suspected, the doctor will initiate a thorough examination of the cervix. He or she will use a colposcope (special magnifying instrument) to check for abnormal cells.

During the colposcopic examination, the doctor may take a sample of cervical cells for the lab test. To obtain cervical tissue, the doctor may use: 

  • Punch biopsy: Involves the use of a sharp tool to pinch off small samples of cervical tissue
  • Endocervical curettage: It uses a tiny, spoon-shaped instrument (curet) to scrape a tissue sample from the cervix.

If the above procedures are not possible or may lead to harm, the doctor may undertake one or both of these tests:

  • Cone biopsy: It allows the doctor to access deeper layers of cervical cells and obtain them for a lab test. It is often done in the hospital under general anesthesia.
  • Electrical wire loop: Used to obtain a small sample of the tissue and mostly done under local anesthesia in the office. 

Further tests to determine the severity/cervical cancer stage (Staging) include:

Imaging tests: They include CT scans, X-rays, magnetic resonance imaging (MRI), and positron emission tomography (PET). They are vital in determining whether cancer has spread beyond the cervix or not.

Visual examination of your rectum and bladder: The doctor will likely use special scopes to see inside the rectum and bladder.

As mentioned, the cancer stage is an important determinant of the treatment to be undertaken. Stages of cervical cancer include:

  • Stage I: Cancer confined to the cervix
  • Stage II: Cancer is present in the cervix and upper part of the vagina
  • Stage III: Cancer has moved to the lower part of the vagina or internally to the pelvic walls
  • Stage IV: Cancer has spread to surrounding body organs such as the rectum or bladder or to other parts such as the liver, lungs, or bones.

Screening

It is advisable for women aged 21 and above to go through cervical cancer screening because once it is detected early, there is a high chance of being treated successfully.

In fact, screening is the difference between high mortality rates from cervical cancer experienced in developing countries compared to the western countries.

Extreme awareness and understanding the importance of screening makes most westerners perform frequent screening than people in developing countries.

Screening tests include:

  • Pap test: It is the scraping and brushing of cells from the cervix for examination in the lab for abnormalities. It detects both cancer cells and cells that show changes likely to cause cervical cancer.
  • HPV DNA test: Involves detecting any type of HPV infection in the cervix that may likely lead to cervical cancer. This is the best option for women aged 30 and older or younger women with an abnormal pap test.

Treatment

Cervical cancer treatment employs options such as surgery, chemotherapy, radiotherapy, or combinations of these treatments.

Settling on the treatment approach largely depends on the stage of cancer, age, and the overall health of the patient.

Surgery is the common treatment method for stage one cancer and has a high success rate since cancer has not spread from the cervix. Radiation therapy may be used thereafter to reduce the chance of recurrence.

Radiation therapy may also be used if the doctor believes the cancer cells might have spread to other parts of the body.

Advanced cervical cancer is often treated using radiation therapy or a combination of radiation and chemotherapy. In this case, surgery is not an option.

Radiation therapy is associated with side effects such as nausea, diarrhea, upset stomach, early menopause, narrowing of the vagina, bladder irritation, and interrupted menstrual cycle.

Chemotherapy may equally be associated with side effects such as fatigue, diarrhea, nausea, infertility, early menopause, and hair loss.

Prevention

To reduce the risk of cervical cancer:

  • Have routine Pap tests at least once a year or once in every two years (women aged 21 or older)
  • Get vaccinated against HPV
  • Do not smoke
  • Practice safe sex: use a condom and have one sexual partner

For more information on treatment, speak to a doctor, or get access to a hospital near you through the Uzima Health App.

Sources

https://www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer/en/

https://www.mayoclinic.org/diseases-conditions/cervical-cancer/symptoms-causes/syc-20352501

https://www.mayoclinic.org/diseases-conditions/cervical-cancer/diagnosis-treatment/drc-20352506

https://www.medicalnewstoday.com/articles/159821.php