Cervix cancer

Cervix

The cervix is the lower part of the uterus, a reproductive organ in women, that connects to the vagina, forming the birth canal. It is the narrow, lower section of the uterus, playing a critical role in childbirth.

Abnormal Cells

Human Papillomavirus (HPV) infection is the most common cause of abnormal cells that can potentially lead to cervical cancer. HPV affects the healthy outer cells of the cervix. Over time, these cells may change and become cancerous. Initially, only minor cell changes occur, known as Cervical Dysplasia, which are not cancerous but can develop into cancer over several years. Detecting and treating these abnormal cells early can prevent cervical cancer.

Factors affecting treatment decisions include:

• The size of the affected area.
• Desire for future pregnancies.
• Age and general health of the individual.

Types of Cervical Cancer

There are two main types of cervical cancer based on the location of cancer development:

1. Squamous Cell Carcinoma: Accounts for 80-90% of cervical cancers, beginning in the outer surface of the cervix (ectocervix).
2. Adenocarcinoma: Occurs in the glandular cells in the inner part of the cervix (endocervix) and makes up about 10% of cases.

Statistics

According to Globocan 2020, cervical cancer is the third most common cancer among Indian women, with an estimated 123,907 new cases and 77,348 deaths annually. It ranks second in cancer-related mortality among women.

Risk Factors

The primary risk factors for cervical cancer are:

• HPV Infection: HPV is a common sexually transmitted infection, and types HPV 16 and HPV 18 are responsible for the majority of cervical cancers.
• Immune System Deficiency: Conditions like HIV or prolonged use of immunosuppressive drugs increase the risk.
• Smoking: Doubles the risk of cervical cancer.
• Age: The risk increases after 30.
• Sexual Behavior: Multiple sexual partners or early sexual activity increase the risk of HPV infection.
• Oral Contraceptives: Long-term use of birth control pills may slightly increase the risk.
• Socioeconomic Factors: Lack of access to regular screening can delay detection.

Prevention

Cervical cancer is one of the few cancers that can be prevented with regular screenings and vaccinations:

• HPV Vaccine: Given before the start of sexual activity, it protects against the types of HPV that cause cervical cancer.
• Screening: Regular pap smears and HPV testing can detect precancerous changes early.

Screening for Cervical Cancer

Women aged 21 to 65 should undergo regular screening, which includes:

• HPV Test: Detects the presence of HPV virus in cervical cells.
• Pap Test: Examines cervical cells under a microscope for abnormalities.

Symptoms

Precancerous lesions often do not have symptoms, but once cervical cancer develops, symptoms may include:

• Vaginal bleeding outside of menstrual periods.
• Heavy or irregular periods.
• Post-coital bleeding.
• Unusual vaginal discharge.
• Pelvic pain or back pain.

Diagnosis

Cervical cancer is diagnosed through several tests:

• Pelvic Examination: A speculum is used to examine the cervix, uterus, and other reproductive organs.
• Pap Test and HPV Typing: Detects abnormal cells and identifies HPV infection.
• Colposcopy: A magnifying instrument is used to closely examine the cervix.
• Biopsy: A small sample of tissue is taken and examined under a microscope.
• Imaging tests like CT scans, MRI, and PET CT may also be used to assess the spread of cancer.

Stages

(FIGO Staging)

Cervical cancer is staged from I to IV:

• Stage IA1: Tumor is less than 3 mm deep.
• Stage IA2: Tumor is between 3-5 mm deep.
• Stage IB: Tumor is larger but confined to the cervix.
• Stage II: Tumor has spread beyond the cervix but not to the pelvic wall or lower vagina.
• Stage III: Tumor has spread to the pelvic wall or the lower third of the vagina.
• Stage IV: Tumor has spread to nearby organs (like the bladder or rectum) or distant organs.

Treatment

Treatment depends on the stage and may include:

1. Surgery:
• Conization: Removes a cone-shaped portion of the cervix.
• Hysterectomy: Removes the uterus and cervix, sometimes including nearby tissues and lymph nodes.
• Exenteration: Removes the uterus, cervix, bladder, and rectum if the cancer has spread extensively.
2. Radiation Therapy: Uses high-energy beams to kill cancer cells. It can be external or internal (brachytherapy), where radioactive sources are placed near the tumor.
3. Chemotherapy: Drugs are used to kill cancer cells, often used in combination with radiation or surgery.
4. Targeted Therapy: Targets specific cancer cell genes or proteins. Bevacizumab is commonly used.
5. Immunotherapy: Boosts the body’s immune system to fight cancer, with pembrolizumab (Keytruda) being a common drug used in certain cases.

Follow-up

After treatment, regular follow-ups are necessary to manage side effects, check for recurrence, and ensure long-term recovery.

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