• Cancer of the uterine cervix, which is the lower part of the uterus, extending slightly into the top of the vagina, is one of the most common cancers in women.
• Abnormal vaginal bleeding is the most commonly seen early symptom.
• In most cases, cervical cancer develops in women in their 30s or 40s. While in some cases it may develop in older women, but is rare in women under 25 years.
• There is a good chance of cure if cervical cancer is diagnosed at an early stage.
• Regular cervical screening tests can detect ‘pre-cancer’.

You should report any abnormal vaginal bleeding (bleeding in between periods, heavy periods, bleeding after intercourse) or vaginal discharge promptly to a doctor.

Types of Cervical Cancer

• Squamous cell cervical cancer is the most common type of cervical cancer which develops from a skin-like cell (squamous cell) that covers the cervix causing cancerous.
• Adenocarcinoma cervical cancer is the least common type which develops from a glandular cell (a cell that makes mucus) within the cervical canal.

Something for Cervical Cancer

• Women should be aware of cervical cancer and should be offered regular cervical screening tests.
• The test involves scraping some cells from the surface of the cervix, which is sent to the laboratory for examination.
• Dyskaryotic cells are seen in some cases, which means that some cells of the cervix are abnormal, but are not cancerous.
• Depending on the degree of the abnormality of the cells, cervical dysplasia is classed as:

1. Mild - This is when there are only slight cell Changes, which is sometimes called CIN 1 (cervical intraepithelial neoplasia).
2. Moderate(CIN 2).
3. Severe(CIN 3) - This is when the cells are very abnormal but are still not cancerous.

• In many cases the abnormal cells do not progress to become cancerous and can revert back to normal within a few months.
• However, in some cases, often years later, the abnormal cells may turn cancerous.
• If a woman has just slight abnormal Changes (CIN 1), she may simply be offered another test sooner than normal. Treatment may be offered if the abnormality persists.
• For women with moderate or severe abnormal changes, the cervix of the abnormal cells can be cleared with proper treatment before they develop into cancer.

A woman is very unlikely to develop cervical cancer, if she has regular cervical screening tests at the times advised by the doctor, and she has treatment when advised if abnormal cells are detected.

Causes of Cervical Cancer

• A cervical tumour starts from one abnormal cell, but the exact reason for a cell to become cancerous is unclear.
• This makes the cell very abnormal and multiplies ‘out of control’.
• The initial ‘pre-cancerous‘ abnormality of cervical cells is usually caused by prior infection with the human papillomavirus.

Human Papilloma Virus (HPV) and Cervical Cancer

• Of the many strains of HPV, two types - HPV 16 and 18 - are involved in the development of most cases of cervical cancer. Other strains cause genital warts.
• The strains of HPV associated with cervical cancer are usually passed on by having sexual intercourse with an infected person.
• An infection may be devoid of symptoms, So it is impossible to tell if the woman herself or the person with whom she has sexual intercourse are infected with one of these strains to HPV.

9 out of 10 infections with HPV will be cleared completely from the body within two years. Which shows that most women Who are infected with these strains of HPV will not develop cancer.

• From the age of 12, HPV vaccine has been introduced for girls.
• Studies have shown that the HPV vaccine is very effective at stopping the cancer of the cervix developing and it works better when administered at a younger age.
• However, even if a woman has had the HPV vaccine, she must regularly undergo cervical screening.

Other Factors

• Smoking: Smokers are more likely to develop certain cancers than non-smokers, including cervical cancer. The risk is compounded if you smoke and have HPV infection.
• Poor Immune System: People with AIDS or if taking immunosuppressant medication is at an increased risk.
• Oral contraceptive pill: A possible link between the oral contraceptive pill and an increased risk of cervical cancer if the pill is taken for more than eight years, has been noted.

Symptoms of Cervical Cancer

• Woman may have no symptoms when the tumour is small.
• In most cases, as the tumour becomes larger, the first symptom to develop is abnormal vaginal bleeding, such as:

• Bleeding between normal periods (intermenstrual bleeding).
• Bleeding after having sex (post-coital/bleeding).

• Any vaginal bleeding in women past menopause.
• In some cases, an early symptom can be pain during sex or vaginal discharge that smells unpleasant or discomfort.
• In time, if cancer spreads to other parts of the body, various other symptoms can develop.

Above mentioned symptoms can be caused some other common conditions also. But if a woman develops any of these symptoms, she should have it checked out by a doctor.

Diagnosis and Assessment of Cervical Cancer

• To confirm the diagnosis

• Usually, the doctor will do a vaginal examination if a woman has symptoms which indicate cervical cancer.
• The doctor may feel an abnormal cervix.
• Colposcopy (a more detailed examination of the cervix) is advised if cervical cancer is suspected.
• The test takes about 15 minutes.
• During colposcopy, a small piece of tissue from the cervix (biopsy) will be usually taken. The biopsy sample is then examined under a microscope to check for cancer cells.

• Assessing the extent and spread

• CT scan
• An MRI scan
• A Chest x-ray
• An ultrasound scan
• Blood tests or other tests.
• This assessment is called ‘staging’ of cancer. The aim of staging is to find out:
• The tumour growth, and whether it has grown to other nearby structures such as the bladder or rectum.
• Whether cancer has spread to local lymph glands (nodes), or other areas of the body.
• Exactly what tests are needed depends on the initial assessment and the biopsy results.
• Finding out the stage of cancer helps doctors advise on a treatment option, and gives a reasonable indication of outlook.

Treatment Options for Cervical Cancer

• Treatment options which may be considered include surgery, radiotherapy, Chemotherapy, or a combination of these treatments best determined by the treating doctor.
• The treatment advised for each case depends on factors including the stage of cancer and the general health of the patient.
• The goals of the treatment are generally cured (complete remission), living with cancer without much symptoms (partial remission) or palliation (generally for advanced disease to control the symptoms such as pain for giving a better quality of life without any realistic hope of cure)

Surgery

• Suitable for early stage disease.
• If the aim is to cure, an operation to remove the cervix and uterus (hysterectomy) is a common course of action.
• In some cases where the cancer is at a very early stage, it may be possible to just remove the part of the cervix affected by cancer without removing the entire uterus, for fertility preservation.
• If cancer has spread to other parts of the body, surgery may still be advised, often in addition to other treatments.

Radiotherapy

• Radiotherapy is a treatment which uses high energy beams of radiation which are focused on cancerous tissue thus killing the cancer cells or stopping them from multiplying.
• For early-stage cervical cancer, Radiotherapy alone can be curative and can also be an alternative to surgery.
• Radiotherapy may be advised in addition to other treatments, for more advanced cancers.
• External and internal radiotherapy are used for cervical cancer, where both types are used in many cases:

• External Radiotherapy - This is the common type of radiotherapy used for many types of cancer, where radiation is targeted on cancer from a machine.
• Internal Radiotherapy -This treatment involves placing a small radioactive implant next to the cancerous tumour for a short time and then it is removed.

Chemotherapy

• Chemotherapy is a treatment using anti-cancer drugs which kill cancer cells or stop them from multiplying.
• In certain situations, Chemotherapy may be given in addition to radiotherapy or surgery.
• Nowadays, concomitant chemoradiotherapy is the preferred method of treatment for stage ll and stage lll cervical cancer.