CervicalCancer

What is Cervical Cancer?

Cancer is a disorder in which the body's cells become uncontrollably proliferate. Even if cancer spreads to other body parts later, it is always named after the part of the body where it begins. Cervical cancer is defined as cancer that begins in the cervix. The cervix connects the vaginal canal to the uterus' upper section. When a woman is pregnant, the uterus (or womb) is where the baby grows.

Cervical cancer normally takes a long time to develop. Before cancer develops in the cervix, the cells of the cervix undergo dysplasia, which causes aberrant cells to emerge in the cervical tissue. The abnormal cells may eventually turn into cancer cells and begin to develop and spread deeper into the cervix and surrounding tissues. Cervical cancer in children is quite uncommon.

The fourth most frequent cancer in women is cervical cancer. Cervical cancer was diagnosed in around 5,70,000 women worldwide in 2018, with approximately 3,11,000 women dying from the disease.

The infection with high-risk human papillomaviruses (HPV), an exceedingly prevalent virus spread through sexual contact, is connected to almost all cervical cancer cases (99 per cent).

Cervical cancer can be prevented with screening tests and the HNDIPV vaccine. According to the Indian Cancer Society, if cervical cancer is detected early, it is highly curable and linked to a long survival time and excellent quality of life.

What are the signs & symptoms of Cervical Cancer?

There has been a lot of progress in understanding what happens in cervix cells when cancer develops in recent years. Furthermore, various risk factors have been found that increase a woman's chances of developing cervical cancer. Normal human cell development is largely dependent on the information stored in the cells' DNA. Our genes, which determine how our cells run, are made up of DNA, a material found in our cells. Because our DNA comes from our parents, we look like them. However, DNA has an impact on more than simply our appearance. Oncogenes are genes that help cells grow, divide, and stay alive by controlling when they grow, divide, and die.

Tumor suppressor genes help keep cell growth under control or cause cells to die at the appropriate moment.

DNA mutations (gene faults) that turn on oncogenes or turn off tumour suppressor genes can cause cancer.

E6 and E7 are two proteins found in human papillomaviruses (HPV) that switch off certain genes.

Cervical cancer is caused by a variety of factors, including HPV. The majority of women infected with HPV do not get cervical cancer and other risk factors such as smoking and HIV infection impact which women are more likely to acquire cervical cancer after being exposed to HPV.

Cervical cancer may not show any signs or symptoms early on. Advanced cervical cancer can cause unusual bleeding or discharge from the vaginal area, such as bleeding after sex. Consult your doctor if you notice any of these symptoms. It's possible that they're caused by something other than cancer, but the only way to find out is to visit your doctor, as recommended by the Indian Cancer Society.

What are the risk factors of Cervical Cancer?

A risk factor is something that raises your risk of developing a disease like cancer. The risk factors for various cancers differ. Exposure to bright sunlight, for example, is a risk factor for skin cancer. Smoking is linked to a variety of cancers. However, having one or more risk factors does not guarantee that you will develop the condition.

Cervical cancer is a disease that can be caused by a number of reasons. Cervical cancer is uncommon in women who do not have any of the risk factors. Despite the fact that these risk factors enhance the likelihood of having cervical cancer, many women who are exposed to them do not develop the disease.

Risk factors that can be changed

Human papillomavirus (HPV) infection

The foremost risk factor for cervical cancer is the infection by the human papillomavirus (HPV). HPV is a virus family that includes over 150 different viruses. Some of them create papilloma, more popularly known as warts, which are a form of growth.

HPV can infect cells on the skin's surface, as well as those that line the genitals, anus, mouth, and throat, but not the blood or internal organs like the heart and lungs.

HPV can be passed from one person to the next through skin-to-skin contact. Sexual activity, such as vaginal, anal, and even oral sex, is one way HPV spreads.

Various forms of HPV cause warts on various regions of the body. Others tend to cause warts on the lips or mouth, while others cause ordinary warts on the hands and feet.

Warts on or around the female and male genital organs, as well as in the anal area, can be caused by certain forms of HPV. These are called low-risk HPV varieties named because they are rarely connected to cancer.

Other HPV kinds are known as high-risk varieties because they are significantly connected to cancers. These varieties are usually found on cervix, vulva, and vaginal cancer in women, penile cancer in men, and cancers of the anus, mouth, and throat in both men and women.

HPV infection is common, and most people's bodies can clear the infection on their own. However, in certain cases, the infection persists and becomes chronic. Chronic infection, particularly when caused by certain high-risk HPV varieties, can lead to cancer, including cervical carcinoma.

Although there is presently no treatment for HPV infection, there are ways to treat warts and abnormal cell growth that HPV produces. Additionally, HPV vaccinations are available to help prevent infection by specific types of HPV as well as some of the malignancies associated with those types of HPV.

Sexual history

Cervical cancer risk might be increased by a number of factors related to your sexual history. Increased chances of HPV exposure are most likely affecting the risk. Getting sexually active at an early age (particularly before the age of 18), having a large number of sexual partners or having a partner who is considered a high-risk partner (someone with HPV infection or who has many sexual partners) puts you at risk of contacting the infection.

Having multiple full-term pregnancies

Cervical cancer is more likely in women who have had three or more full-term babies. This is assumed to be owing to the higher risk of HPV infection associated with sexual activity. Furthermore, hormonal changes during pregnancy have been linked to women being more susceptible to HPV infection or cancer progression, according to research. Another theory is that pregnant women's immune systems are weakened, allowing HPV infection and cancer progression.

Having a weakened immune system

The virus that causes AIDS, the human immunodeficiency virus (HIV), impairs the immune system and puts people at risk for HPV infections.

The immune system aids in the destruction of cancer cells as well as the halting of their growth and spread. In HIV-positive women, a cervical pre-cancer may progress to invasive carcinoma more quickly than it would otherwise.

Women who are taking drugs to suppress their immune response, such as those being treated for autoimmune disease (in which the immune system perceives the body's own tissues as foreign and attacks them as if they were germs) or those who have had an organ transplant, are also at risk for cervical cancer.

Long-term use of oral contraceptives (birth control pills)

There is evidence that long-term use of oral contraceptives (OCs) increases the risk of cervical cancer. According to research, the risk of cervical cancer increases the longer a woman uses OCs, but the risk decreases if the OCs are stopped, and returns to normal many years later.

A woman and her doctor should talk about whether the advantages of using OCs outweigh the concerns.

Chlamydia infection

Chlamydia is bacteria that can infect the reproductive system and is relatively common. Sexual contact is how it spreads. Women with chlamydia often have no symptoms and may not even be aware that they are infected until they are tested during a pelvic exam. Infection with Chlamydia can induce pelvic inflammation, which can lead to infertility. with Chlamydia can induce pelvic inflammation, which can lead to infertility.

According to several researchers, women who had signs of chlamydia infection in their blood or cervical mucus had a greater risk of cervical cancer.

Smoking

When someone smokes, they and people around them are exposed to a variety of cancer-causing substances that have an impact on organs other than the lungs. These toxic compounds are absorbed through the lungs and circulated throughout the body via the bloodstream.

Cervical cancer is twice as common in women who smoke as in women who do not smoke. Women who smoke have been found to have tobacco by-products in their cervical mucus. The DNA of cervix cells is thought to be damaged by these compounds, which may lead to the development of cervical cancer, according to researchers. Smoking impairs the immune system's ability to combat HPV infections.

Young age at first full-term pregnancy

Women who had their first full-term pregnancy before the age of 20 are more likely to get cervical cancer later in life than women who waited until they were 25 years old or older.

Economic status

Many low-income women lack simple access to basic health care, such as cervical cancer screening with Pap tests and HPV tests. This means they may not be examined for cervical pre-cancers or treated for them.

A diet low in fruits and vegetables

Cervical cancer may be more common in women whose diets are deficient in fruits and vegetables.

Risk factors that cannot be changed

Diethylstilbestrol (DES)

DES is a hormone medication that was administered to some women to prevent miscarriage between 1938 and 1971. Clear-cell adenocarcinoma of the vaginal or cervix develops more frequently in women whose moms used DES (when pregnant with them) than would be predicted. Women who have not been exposed to DES are exceedingly unlikely to get these cancers. For 1,000 women whose moms used DES during pregnancy, there is roughly one occurrence of vaginal or cervical clear-cell adenocarcinoma. This indicates that 99.9% of "DES Daughters" are spared from developing these cancers.

The vaginal DES-related clear cell adenocarcinoma is more prevalent than that of the cervix. Women whose moms took the drug during the first 16 weeks of pregnancy appear to be at the greatest risk. Women diagnosed with DES-related clear-cell adenocarcinoma are on average 19 years old. Since the FDA banned the use of DES during pregnancy in 1971, even the youngest DES daughters are now over 40, well past the age of greatest risk.

Despite this, there is no age at which these women are considered protected from DES-related cancer. Doctors are unsure how long these ladies will be vulnerable.

Squamous cell cancers and pre-cancers of the cervix due to HPV may also be more common in DES daughters. Having a history of cervical cancer in your family

Having a family history of cervical cancer

Cervical cancer has been linked to family history in some cases. Your odds of acquiring cervical cancer are higher if your mother or sister had it than if no one in your family has it. Some experts believe that some cases of this family tendency are caused by a genetic issue that makes some women more susceptible to HPV infection than others. Women in the same family as a patient who has already been diagnosed may be more likely to have one or more of the non-genetic risk factors discussed earlier in this section.

Factors that may lower your risk

Intrauterine device ( IUD) use

Women who had ever used an intrauterine device (IUD) had a decreased risk of cervical cancer, according to certain studies. Even women who had an IUD for less than a year saw a reduction in risk, and the protective effect lasted after the IUDs were removed. There are various hazards associated with IUDs.

A woman who wants to use an IUD should first talk to her doctor about the risks and advantages. In addition, regardless of the type of contraception she uses, a woman who has several sexual partners should wear condoms to reduce her risk of sexually transmitted infections.

Screening, Diagnosing & Staging

Screening

To detect or prevent cervical cancer, the Pap smear and the HPV tests are used.

  • A Pap test searches for precancers, which are cell abnormalities in the cervix that might progress to cervical cancer if not treated properly.
  • The HPV test looks for the virus that causes these alterations in cells.
  • Both of these tests can be performed in a doctor's office or a clinic
  • During the Pap test, the doctor will enlarge your vaginal opening with a speculum, which is a plastic or metal device. This allows the doctor to examine the vagina and cervix, as well as collect a few cells and mucus from the cervix and surrounding area. The cells are taken to a lab for analysis.
  • During the HPV test, your cells will be tested for HPV.
When to Get Screened
  • If You Are 21 to 29 Years Old : After the age of 21, you should begin obtaining Pap tests. If your Pap test results are normal, your doctor may advise you to wait three years before having another one.
  • If You Are 30 to 65 Years Old : Consult your doctor to find out which of these options is suitable for you:

  • Pap Test - If your results are normal, your doctor may advise you to wait three years before having another Pap test.
  • HPV Test - Primary HPV testing is what it's called. If your results are normal, your doctor may advise you to wait five years before having another screening test.
  • Pap + HPV Test - This is referred to as co-testing. If both of your findings are normal, your doctor may advise you to wait five years before scheduling another screening test.
  • If You Are Older Than 65 : If you've had normal screening test results for several years, or if you've had your cervix removed as part of a total hysterectomy for non-cancerous issues like fibroids, your doctor may advise you that you don't need to be checked any longer.

Diagnosed

If you've been diagnosed with cervical cancer, you will be referred to a gynecologic oncologist, a doctor who specialises in cancers of the female reproductive system. This doctor will collaborate with you to develop a treatment strategy.

The stage refers to the severity of the disease. The size of the cancer or how far it has spread is frequently used to determine the stage. This information is used by doctors to plan treatment and track success.

Types of Treatment

Cervical cancer can be treated in a variety of ways. It is dependent on the type of cervical cancer and the extent to which it has spread. Surgery, chemotherapy, and radiation therapy are all options for treatment.

  • The surgical plan means that during an operation, doctors remove cancerous tissue.
  • Chemotherapy is the use of specific drugs to shrink or destroy cancer cells. The drugs can be pills that you consume or medicines that are injected into your veins, or both.
  • Radiation therapy is the use of high-energy rays (similar to X-rays) to kill cancer cells.

Depending on your medical condition, different doctors may provide different therapies.

Staging

Doctors determine the cancer stage by examining the tumour and determining whether the cancer has spread to other places of the body.

The results of a physical exam, imaging scans, and biopsies are used to determine the stage of cancer.

  • Stage I: The cancer has moved from the cervical lining to deeper tissue, but it has only been discovered in the uterus. It hasn't spread to any other body parts.
  • Stage II: The cancer has spread outside of the uterus to surrounding sites such as the vaginal canal or tissue around the cervix, but it is still contained inside the pelvic area. It hasn't spread to any other body parts.
  • Stage III: The tumour has progressed to the pelvic wall, caused kidney swelling called hydronephrosis, prohibits a kidney from functioning, and/or involves nearby lymph nodes. Lymph nodes are little bean-shaped structures that aid in infection prevention. There is no far-reaching spread.
  • Stage IVA: The cancer has progressed to the bladder or rectum but not to other organs.
  • Stage IVB: The cancer has progressed to other regions of the body

Coping & Support

Coping with physical side effects

The Types of Therapy section lists the most common physical adverse effects associated with each cervical cancer treatment strategy. Learn more about cancer's side effects and how to prevent or control them, as well as how to prevent or control them. The stage of your cancer, the length and dose of treatment, and your overall health all have a role in how your physical health changes.

Talk to your healthcare team about how you're feeling on a frequent basis. Any new side effects or changes in current side effects must be communicated to them. They can identify strategies to reduce or manage your side effects if they know how you're feeling, making you feel more at ease and maybe preventing any unwanted effects from escalating.

Coping with emotional and social effects

Following a cancer diagnosis, you may experience emotional and social consequences. This could include dealing with difficult emotions like grief, worry, or rage, as well as stress management. It might be tough for people to explain their feelings to their loved ones at times.

Some people have discovered that talking to an oncology social worker, counsellor, or a member of some religious group can help them create more effective ways of coping with cancer and talking about it.

Coping with the stigma of cervical cancer

Cervical cancer, like other cancers affecting the sex organs, can be difficult to talk about. Many types of cancer, including testicular, penile, vaginal, and vulvar tumours, can cause embarrassment in people who talk about these sensitive areas of their bodies. This should never prevent you from requesting and receiving the emotional assistance you need, and your treatment team will never be humiliated if you bring up these concerns with them. Your team can also assist you in feeling more at ease discussing this with others.

Because HPV is linked to cervical cancer, patients may fear that they will not receive as much sympathy or assistance from others because they believe their actions contributed to the disease. Although HPV is responsible for nearly all cervical malignancies, it is crucial to remember that the majority of genital HPV infections do not result in cancer. Cervical cancer can strike anyone at any time.

Patients who are subjected to this stigma may feel guilty, helpless, embarrassed, ashamed, and alienated. If any of these emotions affect patients or their families, they should inform the medical team. Cervical cancer patients can get aid from a variety of sources. Some people feel comfortable talking to their doctor, nurse, family, and friends about their sickness and experiences. Others seek assistance from a support group or other sources.

Caring for a loved one with cancer

In caring for a person with cervical cancer, family and friends typically play a crucial role. This is what it means to be a caretaker. Even if they reside far away, caregivers can provide physical, practical, and emotional support to the patient.

Caregivers may be responsible for a variety of tasks on a daily or as-needed basis, including:

  • Providing support and encouragement
  • Talking with the health care team
  • Giving medications
  • Helping manage symptoms and side effects
  • Coordinating medical appointments
  • Providing a ride to and from appointments
  • Assisting with meals
  • Helping with household chores

Questions to ask the Health Care Team

Questions to ask

Q1. Questions to ask about prevention

Q2. Questions to ask after a diagnosis of cervical cancer or precancer

Q3. Questions to ask about choosing a treatment and managing side effects

Q4. Questions to ask about having surgery

Q5. Questions to ask about having radiation therapy

Q6. Questions to ask about having therapies using medication

Q7. Questions to ask about planning follow-up care