CERVICAL CANCER
CERVICAL CANCER
Cervical cancer or cancer of the cervix is a major concern for many women. The cervix is a ring of muscle at the top of the vagina. It is the entrance to the womb. The cervix is the opening of the uterus connected to the upper vagina and known as the neck of the uterus.
The surface layer of the cervix is made up of two different types of cells, flat cells called squamous cells and tall column-like gland cells called columnar cells. This produces a mucous membrane, but the mucous membrane of the cervix is smooth. The place where squamous and columnar cells meet is known as the transformation zone and this is the area of the cervix where cancer most commonly arises.
Cervical cancer forms in the interior lining of the cervix, the junction of the vagina and uterus. The development of cervical cancer is slow and occurs over a period of years. The cancer cells may be present in the cervix for 4-10 years before becoming invasive, affecting the deeper tissues and giving rise to symptoms. Even when the cancer is invasive, there is an 80% chance of successful cure. But once it spreads through the pelvic to the vagina, uterus, bladder it is much more difficult to cure.
CAUSES:
Although the exact cause of cervix cancer are unknown but several risk factors appear o be linked with the disease such as-
- 1. Infection HPV virus:
More than 90% of women with cervical cancer are infected with the Human Papilloma Virus (HPV). HPV is the single most important cause for cervical cancer and usually causes warts in the genital area. The viruses are passed from one person to another during unprotected sex. Because HPV is spread mainly through sex, women who start having sex at a young age, who have multiple sexual partners.
- Early sexual activity is one of the causes because the cells lining the cervix do not fully mature until the age of 18 and this increases the risk of HPV and cervical cancer.
- Other sexually transmitted diseases (STDs) and sexually transmitted infections (STIs) including Gonorrhea, HIV/AIDS are also increases the risk of HPV.
- Long term use of oral contraceptives.
- Cigarette smokers also develop the chances of cervix cancer.
SYMPTOMS:
Early cervical cancer generally produces no symptoms but as the cancer grows symptoms may include-
- Abnormal vaginal bleeding
- An unusual vaginal heavy white discharge
- Vaginal bleeding after the menopause
- Discomfort during sexual intercourse
- Bladder pain during urination
- Bleeding from vagina between regular menstrual periods and after sexual intercourse
- In advanced stages it causes symptoms like pelvic pain, vaginal leakage of urine, anorexia, weight loss and anemia.
TYPES:
There are mainly two types of cervical cancer. The most common types of cervical cancer is called Squamous cell carcinoma. It develops from the flat cells which cover the outer surface of the cervix at the top of the vagina. About 85% of cervical cancers are squamous cell cancer
The other type is called Adeno carcinoma and is less common. It develops mucus producing glandular cells of the endo-cervix.
About 3-5% of cervical cancers have characteristics of both squamous and adenocarcinomas and are called Adenosquamous carcinomas.
DIAGNOSIS:
Cervical cancer is most often diagnosed in middle aged women between the ages of 35-55. It is very rarely seen in women less than 20 years of age but 20% of cases occur in women over 65 years. There are several different tests that can be used to determine a cervical cancer.
1. Pap Smear Test:
Pre cancerous changes in the cervix can be detected in a screening test known as pap smear test.
2. Colposcopy:
An instrument called a colposcope is used to take a close detailed look at the cervix and vagina.
3. Biopsy:
Cervical biopsy is a test in which a protein of tissue sample is taken from the cervix for microscopic examination.
4. Cone Biopsy:
Cone biopsy, in it a cone shaped samples of cervical tissues are removed for examination.
5. Conization:
Sometimes a large cone shaped biopsy specimen may have to be taken and this procedure is known as conization.
6. Loop-electro surgical excision procedure (LEEP):
In this biopsy method there is an electrical wire which is used to slice off a thin, round piece of tissue for laboratory analysis.
7. Endo cervical curettage (ECC):
In this a small spoon shaped instrument called a curette to scrape tissue from inside the cervical opening and examined for cancer cells.
8. CT scan:
A computerized tomography scan involves taking X-rays at different angles to build up a 3-dimensional image of the body.
STAGES:
The chances of cure are determined by the stages of the cancer at the time of diagnosis for better treatment.
Stage – 1:
This stage is an invasive cancer with cancer confined to the cervix only and probability of cure is 85-90%.
Stage – 2:
This stage describes the cancer that has spread beyond the cervix but is still limited to the pelvic area. The probability of cure is 75-80%.
Stage – 3:
The cancer has extension beyond the cervix but not to the pelvic reason. The cancer may be blocking the uterus. The probability of cure is 50%.
Stage – 4:
This stage includes cancer that has spread to the bladder and the probability of cure is 30%.
TREATMENT:
Treatment for cervical cancer depends on the tumor size, its location, disease stages and the patient's age and overall health. Cervical cancer is curable by removing or destroying the pre-cancerous tissue. Cervix cancer most often treated with one or a combination of treatments like surgery, radiation and chemo-therapy.
1) Surgery:
Surgery is the primary treatment for cancer of the cervix in the early stage.
i. Hysterectomy - This surgical procedure is used to remove the cervix and uterus.
ii. Bilateral salpingo oophorectomy - This surgical procedure is used to remove the ovaries and fallopian tubes.
iii. Pelvic extension – It is a surgical procedure used to remove the cervix, vagina, ovaries, lower colon, rectum, and bladder and nearby lymph nodes. Artificial openings are made for urine and stool to flow from the body.
iv. Cry-O-surgery – This surgery technique uses an instrument to freeze and destroy abnormal tissue.
v. Laser surgery – A surgical procedure that uses a laser beam as a knife to make bloodless cut in tissue to remove a small piece of tissue.
vi. Loop electrosurgical excision procedure (LEEP) - A treatment that uses electrical current passed through a thin wire loop as a knife to cutting out the abnormal cells.
2) Radiation Therapy:
If the tumor has spread more than a small amount beyond the cervix, then radiotherapy is the usual treatment. Radiation therapy uses X-rays or other high energy particles to kill cancer cells. Treatment is concentrated on a specific area. The most common type of radiation is called External beam radiation which is radiation given from a machine outside the body. Patient may receive both internal and external radiation.
3) Chemotherapy:
Chemotherapy, the use drugs to kill cancer cells. It is used to destroy cancer remaining after surgery, slow the tumors growth or reduce symptoms.
WAYS TO REDUCE CERVICAL CANCER:
1) Girls less than 18 years of age should avoid sexual activity.
2) Have fewer sexual partners and make sure your partner is having sex only with you.
3) Use condom, which may help prevent the transmission of HPV.
4) Annual pelvic examinations, including a pap smear should begin when a woman becomes sexually active.
5) All women over the age of 20 should have a cervical screen test at least every five years.
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