Cervical Cancer: Causes, Symptoms, Diagnosis and Treatment

January is observed as the cervical cancer awareness month, with the aim of raising awareness about causes, diagnosis, prevention, and treatment. As per statistics, India alone is the contributor to almost one third of all cervical cancer fatalities, worldwide. This has been attributed to the lack of awareness, limited or restricted access to healthcare services etc. On the other hand, cervical cancer is also one of the most successfully treated and preventable cancer, if detected and diagnosed early and managed efficiently.  

Cancer is a disease, in which the cells inside the body grow out of control. Cervical cancer is when the cancer starts at cervix. Cervix connects vagina (also known as the birth canal) to the uterus (also known as womb or where a baby grows). This often occurs in people who are aged 30 and above. There exist three diverse types of cervical cancer, namely:  

• Mixed carcinoma  
• Adenocarcinoma: forms in the cells producing mucus  
• Squamous cell carcinoma: most common type and forms in the lining of cervix. 

What causes cervical cancer?

Cancer develops when healthy cells in the cervix starts to mutate (changes) in DNA. In normal situation, healthy cells multiply, grow and die at a set time. But in mutation the cells multiply, grow and do no die. This leads to the accumulation of the abnormal cells which then forms a mass, also known as tumour. These cancerous cells invade nearby tissues and can very well break and spread from cervix to any other part of the body (metastasize). 

Well, one of the most common causative factors in causing cervical cancer is strains of HPV (human papilloma virus) a sexually transmitted infection. Initially when the body is exposed to HPV, the immune system prevents it from causing harm. But in some cases, the virus survives inside the body for years and contributes to the transition of cervical cells to cancerous cells. The risk factors or  cervical cancer symptoms include:  

• Sexual activity and sexual partners: Risk of HPV is increased when a person involves in sexual activity at an early age. The higher the number of sexual partners, the higher number of partner’s sexual partners, greater will be the risk of acquiring HPV.  
• Sexually transmitted infections: Occurrence of other STIs - HIV/AIDS, chlamydia, gonorrhoea, syphilis also increases risk of HPV. 
• Smoking: raises odds of having cervical cancer and is associated with squamous cell cervical cancer. 
• Compromised immune system: incidence of HPV and a weak immune system is more likely to attract cervical cancer. 
• Exposure of fetus to the drug “diethylstilbestrol,” while carrying, has an increased risk in acquiring clear cell adenocarcinoma, a type of cervical cancer stages.
• Prolonged intake of birth control pills.

How does cervical cancer feel like? 

Usually, the body does not let out any signs during the initial stages of cancer. But a lot of changes can be observed when the cancer progresses to a more advanced stage, the signs and symptoms at this stage includes: 

• A heavy foul smelling watery and bloody vaginal discharge. 
• Pelvic pain 
• Pain during intercourse 
• Vaginal bleeding after intercourse and after menopause. 

So, when one experiences these symptoms or notices any sign, it is better to get diagnosed.  

Cervical Cancer Diagnosis: The most common and important cervical cancer screening is the broader use of Pap smear (also known as Papanicolaou test) and high-risk HPV test. Pap smear test is a part of women’s regular check-up test as well, where the cells from cervix surface is collected and viewed under microscope. Any abnormality in this will lead to the next step, which is biopsy, where a part of the cervical tissue is taken for testing and confirming.  

A pelvic exam, aka colposcopy, also carried out if there is any unusual findings in Pap smear.  

Conization is a removal process (a part of the cervix), using a LEEP (loop electrosurgical excision procedure), or a scalpel, or laser. A simple procedure, usually done for minimally invasive tissues, under anaesthesia, where the patient can leave home in the same day.   

Treatment: The course of treatment can be internal, external or both.  If cancer is present only on the surface, then process like conization will be carried out by doctors to destroy or remove the cancerous cell.   Surgery is recommended and needed of the cells have passed beyond the surface through a layer called the basement membrane, and if the disease has invaded into the deeper layers of the cervix.  

A hysterectomy is carried out if the tumor is found to be spread across the uterus. 

Radiation therapy, use of high energy rays is employed to damage cancer cells and to prevent them from growing further. This therapy, just like with surgery, affects the cancer cells only in the treated area. The course of treatment spans over a period of 5-6 weeks, wherein a beam of radiation is targeted over the pelvic area.  

Chemotherapy- use of powerful drugs to kill the cancerous cells. Used in cases where it is locally spread or advancing/spreading to other parts of the body. This treatment takes place in cycles of treatment with recovery period in between, as it is very intensive. 

Immunotherapy/Biological therapy: An advanced and recently emerging technique, which targets checkpoints in immune cells to alter the immune response, to block proteins on the cells which will cause shrinkage or slows down the growth of the cell.  “Prevention” plays a vital role!!! 

As said, earlier, cervical cancer prevention is vast and can be successfully treated if detected earlier. So, what must be done?? 

• Visit your medical expert and as a primary step, get yourself vaccinated with cervical cancer vaccines against HPV. The FDA approved HPV vaccine provides protection against two strains that causes 70% of cervical cancers and against 50% of precancerous lesions occurring in the vulva, vagina, and cervix.  
• Getting a Pap smear test at least once in a year, if 21 year or older.  
• Using a barrier while indulging in sexual activity.  
• Quitting smoking.