Cervical cancer is a cancer arising from the cervix.It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body.
SIGNS AND SYMPTOMS:
Symptoms may include abnormal vaginal bleeding,pelvic pain or pain during sexual intercourse.
Bleeding after sex is due to cervical cancer.
In advanced disease metastasis may be present in the abdomen,lungs or elsewhere.
Symptoms of advanced cervical cancer may include loss of appetite,weight loss,fatigue,pelvic pain,back pain,leg pain,swollen legs,heavy bleeding from the vagina,bone fractures and leakage of urine or faaces from the vagina.
Human papilloma virus(HPV) infections appears to be involved in the developement of more than 90% of cases.
Other risk factors include smoking,a weak immune system,birth control pills,starting sex at a young age and having many sexual partners.
About 90% are squamous cell carcinoma and 10% adenocarcinoma.
Confirmation of the diagnosis of cervical cancer or precancer requires a biopsy of the cervix.
This is often done through colposcopy a magnified visual inspection of the cervix aided by using a dilute acetic acid solution to highlight abnormal cells on the surface of the cervix.
Further diagnostic and treatment procedures are loop electrical excision procedure(LEEP) and conization in which the inner lining of the cervix is removed to be examined pathologically.
Imaging modalities includes ultrasound,CT Scan and MRI of abdomen and pelvis.
Medical imaging is then done to determine whether or not the cancer has spread..
Cervical cancer screening using the PAP smear or acetic acid can identify precancerous changes which when treated can prevent the development of cancer.
Treatment of cervical cancer may consist of some combination of surgery,chemotherapy and radiotherapy.
World wide cervical cancer is both the fourth most common cause of cancer and fourth most common cause of death from cancer in women. In 2012 it was estimated that there were 5,28,000 cases of cervical cancer and 2,66,000 deaths.
Because cervical cancer are radiosensitive ,radiation may be used in all stages where surgical options donot exists.
Microinvasive cancer(Stage I A) may be treated by hysterectomy (removal of whole uterus including part of the vagina)
For Stage IA2 the lymph nodes are removed as well.
Alternative include local surgical procedures such as a loop electrical excision procedure(LEEP) or cone biopsy.
For IA1 disease a cone biopsy is considered curative.
Radiation therapy is given as external beam radiotherapy to the pelvis and brachytherapy (Internal radiation).
Large early stage tumours (IB2 and IIA more than 4 cms) may be treated with radiation therapy and cisplatin based chemotherapy.
Advanced stage tumour (IIA -IV A) are treated with radiation therapy and cisplatin based chemotherapy.
5 year survival rates are
Stage II- 60-75%
Stage III- 30 – 40%
- By checking the cervix by the papanicolaou test or pap smear for cervical cancer
- PAP smear screening every 3-5 years with appropriate follow up can reduce cervical cancer incidence by upto 80%.
- According to the 2010 European guidelines the age at which to start screening ranges between 20 -30 years of age.
- PAP test should be done every three years between the ages of 21 and 65.
There are two HPV vaccines (GARDASIL and CERVARIX) which reduce the risk of cervical cancer.
HPV Vaccines are typically given to women age 9 to 26 as the vaccine is only effective if given before infection occurs and shown to be effective for atleast 4 to 6 years.
HPV vaccines protect against two high risk strains of this family of viruses and may prevent upto 65 to 75% of cervical cancer.HPV type 16 and 18 are the causes of 75% of cervical cancer globally while 31 and 45 are the cause of another 10%.Women who have many sexual partners have a greater risk.