Cervical cancer is the cancer of cervical region or cervix uteri i.e. the neck of the uterus which is the lower narrow portion of the uterus where it joins the top end of the vagina. It is a malignant condition.
There are different types of cervical cancers: squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma, small cell carcinoma, etc. Melanoma and lymphoma are the non-carcinoma malignancies of the cervix.
Infection by human papilloma virus (HPV) causes cervical cancer in most of the cases. The virus carries out changes in the cervical cells. The virus causes genital warts in infected patients. The infection is transmitted by sexual contact. But all women infected by the human papilloma virus do not develop cervical cancers.
Other risk factors for development for cervical cancer are smoking, multiple pregnancies, hormonal contraception, dietary factors, exposure to hormonal drug diethylstilbestrol, a family history of cervical cancer, clamydia infection and HIV infection.
Besides these, engaging in sexual activity at an early age, having multiple sexual partners, infection with other sexually transmitted diseases and weak immune system are the risk factors for cervical cancer.
There may be no symptoms seen in early stages of this type of cancer. Vaginal bleeding between the periods, after the intercourse or after menopause, vaginal mass (rarely) and contact bleeding may be the symptoms of cervical cancer.
There may be moderate pain during sexual intercourse and vaginal discharge containing blood which may have foul odor. The cancer may metastases in lungs, abdomen or elsewhere in the body.
In the advanced stage the symptoms may be fatigue, weight loss, loss of appetite, leg pain, back pain, pelvic pain, swelling in only one leg, excessive bleeding from vagina, leakage of urine or feces from vagina and bone fractures.
Pre-cancerous changes of the cervical cancer can be identified by screening based on Pap smear test. For confirmation, a biopsy of the cervix is taken. Colposcopy is done for the visual inspection of the cervix and by using dilute acetic acid; abnormal cells can be visualized on the surface of the cervix. If severe cervical intraepithelial cancer is suspected then the inner lining of the cervix is removed for pathological examination. This is done by Loop electrical excision procedure and conization.
Diagnosis of stage of the cervical cancer is done on the basis of palpation, inspection, colposcopy, hysteroscopy, cystoscopy, proctoscopy, intravenous urography, endocervical curettage, cervical conization, laser surgery, cryo surgery, and X-ray analysis of lungs and skeleton.
If the precancerous changes have been found in the Pap smear then the treatment can prevent the development of cancer. Whole uterus including part of vagina is removed, called as hysterectomy in case of Stage IA cancer (Microinvasive Cancer). In case of stage IA2 cancer lymph nodes are also removed. If patient wishes to remain fertile then loop electrical excision procedure, cone biopsy or trachelectomy are the options.
If the cancer has spread to lymph nodes then some of them are also removed for pathological evaluation. For cancers of higher stages radiation, internal radiation (brachytherapy) and chemotherapy along with hysterectomy are the recommended treatments.
Prognosis depends up on the stage of the cancer at which it is diagnosed. And earlier diagnosis leads to a better outcome. If the cancer spreads to other parts of the body, then the prognosis is poor.
Complications are not seen generally. Recurrence of cervical cancer is very rare if it is removed using the technique trachelectomy. In case of women who conceive after the cancer surgery there is risk of pre-term labor or late abortion. It is always better to wait for one year after cervical cancer surgery to get pregnant. Further care of prevention from human papilloma virus and recurrence of cancer should be taken before trying to conceive.
Protection from human papilloma virus infection is important. Vaccination for the prevention of HPV prevents the infection. Regular Screening (PAP Smear) for cervical cancer helps in prevention of the cervical cancer. Eating lots of fruits and vegetables reduces the risk of HPV persistence.
Condoms may also be useful in treating potentially precancerous changes in the cervix. Exposure to semen appears to increase the risk of precancerous changes (CIN 3), and use of condoms helps to cause these changes to regress and helps clear HPV.
