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types of cancer

Cervix Cancer

Overview

Cervix is the lower part of the uterus in the female reproductive system and it connects the uterus to the vagina. Cervical cancer develops in the lining of the cervix. An early symptom is abnormal vaginal bleeding. It has been noticed that most cases develop among women in their 30s or 40s. If cervical cancer is diagnosed at an early stage, it can result in better outcomes. Before engaging with uterine cervical cancer treatment, regular cervical screening tests can help in early detection.

What is important is that the patient promptly reports any abnormal vaginal bleeding (bleeding between periods, heavy periods, bleeding after intercourse) or vaginal discharge promptly to a doctor which will help ascertain the treatment of cervical cancer. Even in cases of post cervical cancer treatment, patients are advised to consult their respective doctors to check for any recurrence and early prevention during diagnosis.

TYPES OF CERVICAL CANCER

There are two main types of cervical cancer:

  • Squamous cell carcinoma is the most common type of cervical cancer. This develops when a skin-like cell (a squamous cell) that covers the cervix, becomes cancerous
  • Adenocarcinoma cervical cancer is less common. This is part of the glandular cervical cancer where cells develop (a cell that makes mucus) within the cervical canal thereby becoming cancerous.
  • Symptoms

    A woman may have no symptoms when the cervical tumour is small. As the tumour becomes large, the first symptom to be seen is the abnormal vaginal bleeding. Other key symptoms of cervical cancer include:

  • Bleeding between normal periods (intermenstrual bleeding)
  • Bleeding after having sex (post-coital bleeding)
  • Any vaginal bleeding in women past menopause
  • An early symptom of cervical cancer in some cases is a vaginal discharge that smells unpleasant, or discomfort or pain during sex.
  • If the cancer has spread, the symptoms may vary basis which the doctor may ask for specific tests.
  • All of the above symptoms can be caused by various other common conditions. If a woman develops any of these symptoms, she should have it followed-up by a doctor to determine the possibility of cervical cancer treatment.

    Causes

    A cervical tumour begins with the abnormal cell growth (dysplasia) that occurs on the surface lining of the cervix or the endocervical canal commonly known as the opening between the uterus and the vagina. In cases where severe dysplasia is observed, then it is called CIN 3. Common risk factors associated with the formation of cervical tumour:

  • HPV Infection: The initial ‘pre-cancerous’ abnormality of cervical cells is usually caused by a prior infection with the Human papillomavirus (HPV). Of the multiple types of HPV, two types – HPV 16 and 18 are commonly associated with the formation of cervical cancer. Other strains cause genital warts. The cancer-causing HPV strains can be transmitted through sexual intercourse.
    Within two years, 9 out of 10 infections with HPV will clear completely from the body. This implies that most women infected with these strains of HPV do not develop cancer. Vaccination is proven to reduce the risk of cervical cancer among women. The HPV vaccine is recommended for girls aged 11-12 years, as it is reported to act more effectively when administered at a younger age. However, even if a woman has had the HPV vaccine, she must regularly undergo cervical screening, which helps in early detection.
  • Age: The risk of developing cervical cancer among women increases with age.
  • Smoking: Smokers are more likely to develop certain cancers, including cervical cancer than non-smokers. Among those who smoke and have an HPV infection, the risk is compounded. Therefore, it is advised to avoid smoking as a mode of prevention of cervical cancer.
  • A poor immune system: A suppressed immunity contributes to the increased risk of cervical cancer. People with AIDS or people taking immunosuppressant medication are at a higher risk of developing cervical cancer.
  • 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 five years) has been mooted. However, the risk of cervical cancer has been found to decline over time after women stop using oral contraceptives.
  • Diagnosis

    To confirm the diagnosis, the specialist will usually do a vaginal examination if a woman has symptoms which may indicate cervical cancer. If the findings from the physical examination are abnormal, a colposcopy (a more detailed examination of the cervix) is advised. For this test, a speculum is gently put into the vagina, so the cervix can be seen in detail using a magnifier (Colposcope). During a colposcopy, a small piece of tissue from the cervix is taken for a biopsy, which helps in the confirmation and treatment planning for the cancer.

    To assess and confirm the extent to which the cancer may have spread the specialist may advise for a few screening tests like:

  • CT Scan
  • MRI Scan
  • Chest X-ray
  • Ultrasound Scan
  • Blood tests

  • These tests help in the staging of cervical cancer. The aim of understanding cervical cancer treatment by stage is to find out:

  • The extent to which the tumour has grown, and if it has grown to other nearby structures such as the bladder or rectum
  • Whether the cancer has spread to local lymph glands (nodes)
  • Finding out the stage of the cancer helps the specialist to advise on treatment options and gives a reasonable indication of outlook
  • Cervical screening helps in the early detection of cancer and thereby facilitates effective treatment and successful outcome. Guidelines suggest starting screening tests for cervical cancers and precancerous changes from age 21. Cervical screening primarily involves Pap test, during which the physician scraps and brushes cells from the cervix of the patient. The samples are then examined for any abnormalities, which may point towards the risk of cervical cancer.

    Treatment

    “It is important for patients to promptly report any abnormal vaginal bleeding (bleeding between periods, heavy periods, bleeding after intercourse) or vaginal discharge to their physicians, which will help ascertain the treatment of cervical cancer.

    Treatment options for cervical cancer which may be considered to include different types including surgery, chemotherapy and radiotherapy, or a combination of these treatments which is best determined by the specialists. In terms of modalities, the treatment advised for each case depends, on factors including the stage of the cancer and the general health of the patient.

    Surgery: If the cancer is in its early stages, doctors may consider the removal of the cervix only without removing the entire uterus for fertility preservation, which keeps the pregnancy option open for the patient.

    As part of the surgical management of cervical, a surgery is carried out to remove the cervix and uterus (radical hysterectomy) which is a common course of action.

    Post hysterectomy cancer treatment, in case the cancer has spread to other parts of the body, surgery may still be advised, often in addition to other treatments. Even if the cancer is advanced, some surgical techniques may be used to ease the symptoms.

    Chemotherapy: Chemotherapy is a cervical cancer treatment modality that uses anti-cancer drugs to kill cancer cells, or stop them from multiplying. Chemotherapy may be given in addition to radiotherapy or surgery in certain situations. Nowadays concomitant chemo-radiotherapy is the preferred method of treatment for cervical cancer.

    Radiation Therapy: Radiation therapy is a treatment modality, which uses high energy beams of radiation focused on cancerous tissue, killing the cancer cells or stopping them from multiplying. Radiotherapy alone can be curative for early-stage cervical cancer treatment and may be an alternative to surgery which involves laser surgery. For more advanced cancers, radiotherapy may be advised in addition to other treatments.

    Two types of radiotherapy are used for cervical cancer, external and internal. In many cases both types are used:

    External Radiotherapy – This is where radiation is targeted on the cancer from a machine. (This is a common type of radiotherapy used for many types of cancer)

    Internal radiotherapy (Brachytherapy) – This treatment involves placing a small radioactive implant next to the cancerous tumour for a short time. It is a safe and effective procedure. Even if the cancer is advanced and a cure is not possible, radiotherapy may still be used to ease the symptoms.

    Radiotherapy has been a convenient option for outpatient treatment especially for patients who would not like to get into the complexity of hospital admission.

    Even in cases of post cervical cancer treatment, patients are advised to consult their respective doctors to check for any recurrence and early prevention during diagnosis.

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