Cervical Cancer
Cervical cancer is one of the most malignant
tumors and the third common type of cancer in women. Generally it begins as an
abnormality in the cervical cells. However, the cervix is the lower part or the
neck of the uterus connecting the body of the uterus to the vagina (birth
canal). Normal cervical cells grow and divide to form new cells as the body
needs them. When the normal cells grow old or get damaged, they die, and new
cells take their place. But when this process gets wrong, new cells are formed when
the body doesn’t need them and the old or the damaged cells do not die as they
should. The building of the extra cells forms the tumor. Growths on the cervix
can be either benign of malignant:
- Benign
growths like cysts, polyps, or genital warts are rarely life threatening
and doesn’t have the ability to metastases.
- Malignant
growths threat the life by invading the nearby tissues and spreading to
the body parts.
Cervical cancer can be either
in situ meaning that it is limited to the epithelial surface. Or invasive which
means that it crosses the basement membrane.
Approximately about 90% of the cervical cancer cases are said to be
squamous cell carcinomas originating in the thin, flat, sqaumous cells on the
surface of the cervix (ecto-cervix), the part of the cervix that is next to the
vagina. Also about 10% of the cervical cancer cases are said to be
adinocarcinoma arising from the mucus secreting cells in the inner cervical
potion (endo-cervix) near the body of the uterus (women’s cancer research
foundation). Few cases of cervical cancer posses both the sqamous cell
carcinoma and the adinocarcinoma, it’s called mixed carcinoma or adenosquamous
carcinomas.
 |
| Figure 1 showing normal, abnormal, and invasive cancer cells |
Cells Involved in Cervical cancer:
Initially normal cervical cells start to change their
characteristics, however these initial changes aren’t considered to be
cancerous cells. These precancerous cells stats to develop lesions known as
dysplasia or the intraepithelial lesions (SIP). Dysplasia is a common condition
were it is not necessary to become cancerous sometimes it’s capable of
disappearing. However, sometimes it’s capable of transforming into cancerous
cell within less than a year or within many years. Once it become cancerous
these cells are capable of proliferating uncontrollably resulting going down to
a deeper layers of the cervix. Cervical cancer cells can spread by breaking
away from the cervical tumor, traveling through lymphatic vessels to nearby
lymph nodes. Also it’s capable of traveling via blood vessels to other body
organs. Once reaching other organs it is capable of forming a secondary tumor.
Around 529,000 new cases of cervical cancer are detected every year, with
nearly half of these cases dying.
 |
| Figure 2: showing a cervix having cancer |
Cervical Cancer Symptoms
Since
the early detection of the cervical cancer does help in reducing the risk of
having a malignant metastatic cervical cancer and also does have a relation in
decreasing the mortality rate it is very important for every women to know the
symptoms as well as the risk factors that may induce cervical cancer. However
in the early stages cervical cancer do not have obvious symptoms but the most
common symptoms to cervical cancer are:
1-
Vaginal
discharge that may contain some blood
2-
Pain
during sexual intercourse, and often bleeding after sexual intercourse
3-
Changes
in the menstrual cycle by having heavy and long periods
4-
Bleeding
between 2 menstrual cycles
5-
Bleeding
after menopause
However,
infections or other health problem may cause similar symptoms. But any women
suffering from such symptoms should make the Pap test (diagnostic test for
cervical cancer).
Women
having more advanced stages of cervical cancer may have the following
additional symptoms:
-
Pain
in the pelvic region or in the back
-
One
leg being swollen, or pain in one leg
-
Leaking
of urine from the vagina
-
Bone
fracture
-
Loss
of appetite, loss of weight and fatigue
However,
when a woman gets these symptoms the doctor first will ask about her family
history to check if any of her relatives do have cervical cancer. He will make
a physical exam to evaluate her general state of her health. Then he will make
the pelvic exam and the Pap test. In most of the cases the doctor will check
the near lymph nodes to see if there is any metastasis.
Diagnostic tests
1. The Pap Test:
The Pap
test (Papanicolaou test) is one of the great methods used for the early
detection of the cervical cancer. During this test the health care proffetional
places the speculum into the vagina. The speculum is a metal or plastic
instrument used to keep the vagina open and to make the cervix clearer to be
visualized. Then using a small spatula small number of cells is taken from the
outer surface of the cervix (exocervix). Then using the cotton swab cells are
taken from the inner part of the uterus (endocervix). These cells are prepared
to be viewed under the light microscope. Thus this test is a quick, painless
test using a simple procedure the doctor is capable of taking a sample of cells
and mucus and observing them by microscope. However the best day to make the Pap
test more efficient is the fifth day after the menstrual period stops, and make
sure that you stop sexual activity 2 days before making the test. Some people
do pelvic exam with the Pap test. Pelvic exam is done by the doctor by sensing
the outer reproductive organs. However, pelvic exam alone isn’t helpful to
detect the cervical cancer.
 |
| Figure 3 showing Pap test procedure |
Pap
test results are described based on the Bethesda system the results are grouped
based on the 3 general categories:
1-
Negative
intraepithelial lesions or malignancy: this indicates that there are no signs
of cancer but some abnormalities are seen.
2-
Epithelial
cell abnormality: indicates a change in the lining wall of the cervix or the
vagina. These changes might be cancerous or precancerous. The epithelial
squamous cell abnormality is termed A-typical squamous cell. These cells can be
either squamous cells of uncertain significance; such cells cannot be known if
they originate from infection or irritation or are pre-cancerous cells. Or high-grade
squamous intraepithelial lesion.
3-
Other
malignant neoplasm: Squamous cell carcinoma, Adinocarcioma, or A typical
glandular cells
 |
| Figure 4 showing a micrograph of a Pap test smear |
2. The HPV DNA Test
However another test can be applied which is the HPV DNA test
to check the presence of the HPV infection in the cervical secretion. This test
is usually done after the negative Pap test results. There are more than 40
different types of HPV that are classified into high risk HPV and low risk HPV.
The low risk HPV causes the genital warts, and certain changes in the cell
which will be seen by the Pap test. However such changes are not prolonged and
will not induce cervical cancer. The high risk HPV infection is much prolonged
and together with certain genetic as well as epigenetic alteration it may
induce cervical cancer. Since 97.7 % of the women having cervical cancer are
infected by the HPV virus, HPV DNA test is widely used to know whether there
exist a risk factor of having cervical cancer or not. By using the HPV DNA test
doctors are capable of knowing which type of HPV causes the infection by simply
taking the DNA from the cervical cells.
 |
| Figure 5 showing a genital wart caused by HPV infection |
When a woman is exposed to HPV, her immune
system usually prevents the virus from doing any serious harm. But in a small
number of women, the virus survives for years. Eventually, the virus can lead
to the conversion of normal cells on the surface of the cervix into cancerous
cells.
 |
| Figure 6 showing HPV infected cervixes |
3. Other Tests Done Upon Having a Negative Pap Test
Results
The Risk Factors
of Cervical Cancer
• HPV infection is the major risk factor
• Smoking
• Immunosuppressant
• Females taking birth control pills
• Females having a lot of children
The Cause of
Cervical Cancer
Stages of Cervical Cancer
Cervical cancer has many stages and depending on the stage the treatment is applied:
 |
| Figure 7 showing different stages of cervical cancer |
Stage zero: Describes the cancer cells found only on the surface of the cervix,
Stage I: is when the cancer has not spread beyond the cervix
Stage II: means the tumor have spread into the upper part of the vagina
Stage III: means the tumor have spread into the lower part of the vagina and may block the urine flow
Stage IV: the tumor has reached the bladder or rectum, or cancer cells have spread to other parts of the body and formed new tumors.
General Idea about
Cervical Cancer Treatment
If the female develops the cervical cancer and has an early detection surgery
is the best treatment. Treatment of cervical cancer depends on the stage of the
cancer, the size and the shape of the tumor, the age of the women, and her
desire to have children in the future. According to the type of the cancer and
its position the following options are done:
1-
Cone
biopsy: a procedure by which a portion of the cervix it removed. Usually when
treated in such way the cancer is more likely to come back in most of the
women.
2-
Hysterectomy:
a surgical removal of the uterus and the cervix
If
the cancer have invaded deeper layers of the cervix, and have spread into the
uterus more extensive treatment may be involved. Modified radial hysterectomy
is done: during this type of surgery the cervix the uterus and the upper part
of the vagina will be removed. Based on the extent of the cancer and the age of
the women the ovaries are left on their place.
Radiation
therapy is sometimes used before the surgery to shrink the tumor size.
Radiation therapy and chemotherapy can be done if the female age or medical
conditions aren’t suitable for surgery. However, radiation therapy and
chemotherapy can each be done alone. In combination with the chemotherapy the
Biological response modifier BRM which are substances used to strengthen the
immune system to fight the cancer.
Side Effects of Cervical Cancer Therapy
Chemotherapy has many side effects
including the following:
·
Nausea
and vomiting
·
Loss
of appetite
·
Loss
of hair
·
Mouth
sores
·
fatigue
Cervical
Cancer Prognosis
Survival
rates show the percentage of women who live for a specific length of time after
being told they have cancer. The rates are specific to women with a certain
type and stage of cancer. The most commonly used is the five-year survival
rate, which is the percentage of the women living 5 years after diagnosis. The
percentage of the women who survived 5 years are different depending on the
stage’s difference.
Conlusion
Cervical
cancer is a deadly cancer when it metastasizes to other body organs. However,
if it is early detected it can be treated easily using the surgery,
chemotherapy or radiation therapy. In early detected cancerous stages
chemo-radiotherapy can cure 80-95% of women. All women should know the common
symptoms of cervical cancer since this would efficiently help in increasing the
survival rate. Also women should make the Pap test and the HPV test every 3
years after the age of 21. This would help for the early detection as well as
in increasing the probability of being cure.
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