Cervical Cancer

The cervix is part of the female reproductive system and is located at the base of the Uterus and is connected to the vagina.  Cancer, regardless of where it occurs in the body, occurs when cells grow out of control.  There may not be symptoms of cervical cancer initially.  When symptoms do occur, they can include:

• Abnormal vaginal bleeding
• Unusual vaginal discharge
• Pain during sex
• Pelvic pain
• With advanced disease:
• Swelling in legs
• Blood in urine
• Problems with urination and defecation
• Kidney failure
• Bone pain
• Weight loss
• Lack of appetite
• Fatigue (WebMD, 2021)(ACS, 2020)

There are several risk factors for Cervical Cancer.  Human Papillomavirus (HPV) is a risk factor for Cervical Cancer.  HPV is a virus spread through sexual contact.  Most women who contract HPV do not develop Cervical Cancer, however, there are several strains of  that can cause Cervical Cancer (Medline, 2021)(Mayo, 2021).  Other risk factors include:

• Many sexual partners - increases potential exposure to HPV.  Increased number of partners increases risk.
• Early sexual activity - the younger a woman is when she initiates sexual activity, the increased exposure, potentially, to an increased number of partners.
• Other sexually transmitted infections 
• Weakened immune system - due to diminished ability to fight infections
• Smoking
• Exposure to miscarriage prevention drug, diethylstilbestrol
• Using Birth Control Pills for more than 5 years - risk decreases after stopping use
• Giving birth to more than 3 children - due to possible increased exposure.  Studies also show that hormonal changes during pregnancy may possibly make women more susceptible.
• Young age with first full term pregnancy 
• Economic status - can affect a woman's access to health care.
• Diet - a diet low in fruits and vegetables increases risk
• Family history (ACS, 2020)(Medline Plus, 2021)(CDC, 2021)(Mayo Clinic, 2021)(WebMD, 2021)

There are several types of Cervical Cancer.  These types include:

• Squamous Cell Carcinoma - occurs in the squamous cells that line the cervix on the portion projecting into the vagina.  Makes up approximately 90% of cases.
• Adenocarcinoma - occurs in glandular cells in the cervical canal that produce mucous.
• Mixed carcinoma - has features of both Squamous Cell Carcinoma and Adenocarcinoma.  (WebMD, 2021)(Mayo Clinic, 2021).

In order for Cervical Cancer to be diagnosed, certain tests can be performed.  The primary test to screen for Cervical Cancer is the Pap Smear.  The Pap Smear involves obtaining cells from the cervix in order to detect precancerous or cancerous cells.  Another screening test that can be helpful is an HPV test (Mayo Clinic, 2021).  After these screening tests are performed, if Cervical Cancer is suspected, other tests can be done to confirm the diagnosis.  These tests include:

• Colposcopy - colposcope (magnifying instrument) is used to help identify abnormal cells in cervix,
• Punch Biopsy - can be performed with Colposcopy and small samples are removed from the cervix for examination.
• Endocervical Curettage - either a small spoon shaped instrument or a brush scrapes a cervical sample for examination.
• Electrical Wire Loop - low voltage electrified wire is used to remove a sample of tissue for examination.
• Cone Biopsy - deeper layers of cervix are removed as a cone shaped sample to include the transformation zone.  This is the boundary between the exocervix (outer layer of cervix) and endocervix (inner layer of cervix).  It is in this zone that precancerous cells and cancers are most likely to be found and begin.
• Loop Electrosurgical Excursion Procedure (LEEP) -  a wire loop, heated by electricity, is used to remove a tissue sample for examination (ACS, 2020)(Mayo Clinic, 2021)(WebMD, 2021).

Once Cervical Cancer is diagnosed, tests can be performed to assess whether the cancer has metastasized, or moved to other areas of the body.  These tests may include:

• Cystoscopy: - tube with lens and light is inserted into bladder to assess cells.
• Proctoscopy - a tube with light is inserted into rectum to inspect visually.
• Imaging studies 
• Chest X-ray - used to view the lungs
• Computed Tomography (CT Scan) - used to find larger tumors and looking for metastasis
• Magnetic Resonance Imaging (MRI) - examines soft tissues
• Positron Emission Tomography (PET Scan) -  radioactive sugar is injected into blood where it will collect in cancer cells.  When used with CT scan can produce detailed picture (Mayo Clinic, 2021)(ACS, 2020)

After diagnosis, treatments are available.  Which treatments are used may depend on how far along the cancer is, or which stage it is.  When Cervical Cancer is diagnosed and treated early, the survival rate is high.  If cell changes are found before the become cancerous (precancerous), with treatment, the survival rate is almost 100%.  For stage 0, the survival rate is 90%.  In Stage I, the survival rate is 80-93%.  Once Cervical Cancer reaches stage II, survival drops to 58-63%.  Stage III survival is 32-35% and Stage IV survival rate is 16% (WebMD,  2021).  Treatments include:

• Cone Biopsy - technique used for diagnosis can also be used as treatment when cancer is early
• Cryosurgery -  cold probe freezes cells, killing them
• Laser Ablation - laser is used to vaporize abnormal cells
• Surgery - typically with early stages where the cancer is removed.
• Trachelectomy -  removal of  cervix and upper vagina
• Hysterectomy - uterus and cervix are removed.  Ovaries and lymph nodes may or may not be removed.
• Chemotherapy - medications are used to kill cancer cells
• Targeted Therapy -  medication therapy focuses on the weaknesses of the cancer cells, killing them.
• Radiation - high powered beams kill cancer cells.
• Immunotherapy - Medications that help immune system attack cancer cells (ACS, 2020)(Mayo Clinic, 2021).

There are ways to protect yourself from Cervical Cancer.  First, limit the number of sexual partners.  This limits exposure to HPV.  Routinely be screened for Cervical Cancer with Pap Smears and HPV.  Also, don't smoke.  If you currently smoke, take steps to quit.

If you have been diagnosed with Cervical Cancer, use this link to an American Cancer Society website for resources:  https://www.cancer.org/treatment/understanding-your-diagnosis.html

ACS. (2020)  About Cervical Cancer.  American Cancer Society.  Retrieved from https://www.cancer.org/cancer/cervical-cancer/about.html

CDC. (2021)  Basic Information About Cervical Cancer.  Center for Disease Control and Prevention.  Retrieved from https://www.cdc.gov/cancer/cervical/basic_info/index.htm

Mayo Clinic. (2021) Cervical Cancer.  Mayo clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/cervical-cancer/symptoms-causes/syc-20352501

Medline Plus. (2021)  Cervical Cancer.  Medline Plus.  Retrieved from https://medlineplus.gov/cervicalcancer.html#cat_92

WebMD. (2021)  Cervical Cancer.  WebMD.  Retrieved from https://www.webmd.com/cancer/cervical-cancer/cervical-cancer