Cervix Cancer
What is cervix cancer and cervical cancer?
The cervix is the lower part of the womb, also called the neck of the womb. The womb and the cervix are part of a woman’s reproductive system.
The reproductive system is made up of the:
- Vagina
- Womb, including the cervix
- Ovaries
The cervix is the opening to the vagina from the womb. It is a strong muscle. The diagram shows the position of these organs in the body.
Cervical cancer and its origin Cell types
The cervix is covered with a layer of skin – like cells on its outer surface, called the ectocervix. Inside of the cervix, there are glandular cells that produce mucus. This is called endocervix.
The skin-like cells of the ectocervix can become cancerous, leading to squamous cell cervical cancer. This is the most common type of cervical cancer. The glandular cells of the endocervix can also become cancerous, leading to adenocarcinoma of the cervix.
Transformation zone
The area where cervical cells are most likely to become cancerous is called the transformation zone. It is the area just around the opening of the cervix that leads on to the endocervical canal. The endocervical canal is the narrow passageway that runs up from the cervix into the womb.
Cervical Screening
The transformation zone is the area that your doctor or nurse checks during cervical screening. Cervical screening is not a test for cancer. It is a test to pick up abnormal cervical cells. If left untreated, the abnormal cells might develop into cancer.
How common it is?
Cervical cancer is the fourth most common cancer in women with 122,844 cases in India with mortality of up to 17/100,000 in 2018.
Why have I developed cervical cancer?
Cervical cancer is more common in younger women under the age of 45.
The main cause of cervical cancer is a long – lasting (persistent) infection of certain types of human papillomavirus (HPV).
HPV is a common virus, and in most cases, your immune system clears the infection without any problems. Most sexually active people come into contact with HPV during their lifetime. But for most, the virus causes no harm and goes away on its own.
Types of HPV
There are many different types of HPV. Most are harmless but some cause genital warts, and other cause changes that can develop into cancer. As well as cervical cancer, HPV can cause anal, vaginal, vulval, penile and some types of mouth and throat cancers. HPV can be passed on through close skin to skin contact, usually during sexual activity. Around 12 types of HPV are considered high risk for cancer of the cervix.
Two of these types cause about 7 out of 10 (70%) cervical cancer cases. For most people, the immune system clears the HPV infection within two years. But sometimes this doesn’t happen. If you have a long – lasting (persistent) infection with a high – risk type of HPV, you are more at a risk of developing cervical cancer.
Sex
Practicing safer sex by using barrier methods like condoms will reduce your risk of getting HPV and passing it on. But they wont protect you completely. Practicing safer sex will also help protect you against many sexually transmitted diseases.
Vaccines
There are now vaccines to prevent HPV infection. All the girls below 16 years of age and women who have never been sexually active, can be offered the HPV vaccine. In some countries, it is the part of the national programme. These vaccines protect against the types of HPV that are most likely to cause cervical cancer. But they don’t protect against all types. So, you still need to take part in cervical screening, even if you have had the HPV vaccine.
Human immunodeficiency virus (HIV)
Having a human immunodeficiency virus (HIV) or AIDS increases the risk of developing cervical cancer. This risk might be reduced in women who are undergoing treatments for HIV.
Other sexually transmitted infections
The risk of cervical cancer may increase in women who have a sexually transmitted infection (STI) along HPV. Women with both HPV and chlamydia might have a higher risk of cervical cancer.
Smoking tobacco
Smoking tobacco increases your risk of getting cervical cancer. The risk increases with the more cigarettes you smoke a day and the younger your age when you start smoking. Smoking also makes it harder to treat abnormal cells in your cervix. Its never too late to stop smoking but the sooner you stop the better.
Contraceptive pill
One in every ten cases of cervical cancer is linked to taking the contraceptive pill. Taking the pill for more than five years increases the risk of cervical cancer. Taking the pill for more than five years increases the risk of cervical cancer. The increased risk begins to drop as soon as you stop taking it. After ten years the risk is the same as if you had never taken it. The pill can also slightly increase the risk of breast cancer. But it is important to know that taking the pill can help reduce the risk of the womb and ovarian cancers.
What are the symptoms?
- Blood spots or light bleeding between or following periods.
- Menstrual bleeding that is longer and heavier than usual.
- Bleeding after intercourse, douching, or a pelvic examination.
- Increased vaginal discharge.
- Pain during sexual intercourse.
- Bleeding after menopause.
- Unexplained, persistent pelvic, and/or back pain.
What investigations will I be subjected to?
Biopsy from the cervix, MRI scan, CT or PET scan. You may sometimes need to have a look with the camera in the bladder if cancer has spread locally.
What are the types of cervical cancer?
There are different types of cervical cancer. The most common type is squamous cell cancer. Cancer cells are divided into three grades.
At what stage is cancer?
The stage of cancer tells you how big it is and whether it has spread. This type means the type of cell cancer started from.
Stage1 means that the cancer is only in the neck of the womb(cervix).
Stage2 means cancer has spread outside the cervix, into the surrounding tissues.
Stage 3 means cancer has spread from the cervix into the structures around it and lymph nodes in the lower half of the abdomen.
Stage 4 means cancer has spread.
What treatment is needed?
Your treatment depends on where in the cervix your cancer is, how big it is, whether it has spread anywhere else in your body and your general health. You usually have surgery or a combination of chemotherapy and radiotherapy (chemo-radiotherapy).
Treatment decisions
Find out who your doctor decides which treatment you need, and about the types of treatment, you might have.
Surgery
Surgery is one of the main treatments for cervical cancer. Find out about radical hysterectomy, and what to expect before and after your operation.
Chemo-radiotherapy
Chemotherapy and radiotherapy are both given together.
Radiotherapy
Find out about your radiotherapy planning session and how you have treatment, and about the possible side effects from the doctors.
Chemotherapy
Chemotherapy uses anti-cancer drugs to destroy cancer cells. The team will tell you when and how you might have chemotherapy for cervical cancer.
What kind of surgery is done for cervical cancer?
Surgery is one of the main treatments for cervical cancer. Find out about radical hysterectomy and radical trachelectomy, and what to expect before and after your operation.
The conventional treatment for early – stage cancer of the cervix is complete womb removal (hysterectomy) or pelvic radiotherapy and chemotherapy. These treatments make a woman unable to conceive or carry a child. Radical trachelectomy aims to treat cervical cancer by removing the cervix but leaving behind the uterus so you could become pregnant and carry a child in the future.
Radical trachelectomy is a surgical technique that has been developed in recent years by skilled gynaecological oncologists in only a few specialist centres throughout the world. A radical trachelectomy is only suitable for women whose cancer is small and confined to the cervix. It is done vaginally for cancers less than 2cm and abdominally for cancers less than 4cm (needs more evidence). Radical hysterectomy involves removing the uterus(womb), cervix (neck of the womb) and tissues around the cervix, the upper third of the vagina, lymph glands in the pelvis and sometimes, the fallopian tubes and ovaries. The gold standard is with open surgery (cut on the tummy), the current evidence is supporting better survival with an open procedure. You can discuss keyhole operations (Laparoscopic or Robotic) with your surgeon.
