Cervical Cancer: All You Need to Know

Cervical cancer is one of the most common types of gynaecologic cancer affecting women in India. A woman in India has a 2.5 percent chance of getting cervical cancer in her lifetime, which is double the risk as compared to the figure worldwide which stands at 1.3 percent. It is estimated that cervical cancer will occur in approximately 1 in 53 Indian women (the likelihood is higher in rural India) during their lifetime, compared with 1 in 100 women in more developed regions of the world. Given the increasing instances of cervical cancer, it is important for every woman to be aware about its signs and symptoms, and the available treatment options, should the worst happen. That’s why in this blog post, we cover all you need to know about cervical cancer including its types, causes and risk factors, diagnostic process, treatment options, along with some preventive measures. Let’s begin with understanding the disorder. 

What is Cervical Cancer?

Cervical cancer develops in the cervix which is the lower part of the womb (uterus), often called the “neck” of the womb. Cervical cancer typically begins in the cells lining the cervix, primarily caused by persistent infection with certain strains of the Human Papillomavirus (HPV). The two main types of cells on the cervix are squamous cells and glandular cells, and both can develop into cancerous cells, leading to different types of cervical cancer. Abnormal growth in these cells often begins with precancerous changes, which can be detected through regular screening methods.

What are the Common Types of Cervical Cancer?

Cervical cancer can be classified into several types based on the origin of these cells. Here are the common types of cervical cancer:

Squamous cell carcinoma

This type originates in the squamous cells, which are the thin, flat cells lining the outer part of the cervix (the ectocervix). It is the most common type of cervical cancer, accounting for about 90% of cases. Squamous cell carcinomas often develop at the transformation zone, where the outer squamous cells meet the inner glandular cells.

Adenocarcinoma

This type starts in the glandular cells that line the cervical canal (the endocervix), which produce mucus and other fluids. Adenocarcinomas are less common than squamous cell carcinomas but have been increasing in incidence. Adenocarcinoma can be more challenging to detect with Pap smears because it occurs higher up in the cervical canal.

Adenosquamous/Mixed carcinoma

This type contains features of both squamous cell carcinoma and adenocarcinoma. It is relatively rare compared to the other two types. Adenosquamous carcinoma has mixed histological features, showing both glandular and squamous differentiation.

Small cell neuroendocrine carcinoma

This is a rare and aggressive type of cervical cancer that arises from neuroendocrine cells. It is much less common than the other types. Small cell neuroendocrine carcinoma tends to grow and spread quickly, often requiring more intensive treatment.

Major Risk Factors and Causes of Cervical Cancer

There are more than 100 types of HPV; of these, about 15 high-risk types cause most of the cases of cervical cancer, two of these types (16 and 18) are believed to cause 70% of these cases (76.7% in India). That said, besides persistent infection with high-risk types of HPV, several other factors can increase the risk. Here are the major risk factors and causes of cervical cancer:

• Human Papillomavirus (HPV) infection: The most significant risk factor for cervical cancer. High-risk strains of HPV, particularly types 16 and 18, are responsible for the majority of cervical cancer cases.
• Smoking: Women who smoke are about twice as likely as non-smokers to develop cervical cancer. Tobacco smoke and its byproducts can damage the DNA of cervical cells and contribute to cancer development.
• Weakened immune system: Women with weakened immune systems, such as those with HIV/AIDS or those taking immunosuppressive drugs, are at a higher risk because their bodies are less able to fight off HPV infections.
• Long-term use of oral contraceptives: Long term use of the contraceptive pill (more than 10 years) can slightly increase the risk of developing cervical cancer, but the benefits of taking the pill outweigh the risks for most women.
• Multiple full-term pregnancies: Women who have had three or more full-term pregnancies have an increased risk of cervical cancer, possibly due to hormonal changes and increased exposure to HPV.
• Family history of cervical cancer: A family history of cervical cancer can indicate a genetic predisposition to the disease.
• Exposure to Diethylstilbestrol (DES): Women whose mothers took DES (a hormone given between 1940 and 1971 to prevent miscarriage) have an increased risk of developing a rare type of cervical adenocarcinoma.
• Poor nutrition: Diets low in fruits and vegetables may increase the risk of cervical cancer due to a lack of essential nutrients and antioxidants that help protect against cancer.

Note: Many women have heard that having sexual intercourse at an early age and having multiple sexual partners can increase the risk of developing cervical cancer. They may be distressed that friends and family could think they fall into these categories. It is important to remember that although these factors can increase the chances of catching the HPV virus, many women who have only had one sexual partner have HPV, and may go on to develop CIN or cervical cancer. So, there is no reason for yourself or others to feel that you are to blame for having cervical cancer. 

What are the Signs and Symptoms of Cervical Cancer?

Cervical cancer often does not cause noticeable symptoms in its early stages, which is why regular screening is crucial. As the cancer progresses, several signs and symptoms may become apparent. Here are the common signs and symptoms of cervical cancer:

• Abnormal vaginal bleeding: This includes bleeding between menstrual periods, after sexual intercourse, after menopause, or having heavier and longer menstrual periods than usual.
• Unusual vaginal discharge: Watery, pink, or foul-smelling discharge that is different from normal.
• Pain during intercourse: Discomfort or pain during sexual activity.
• Pelvic pain: Pain in the lower abdomen or pelvis that may be constant or intermittent.
• Painful urination: Discomfort or pain when urinating, which could indicate that the cancer has spread to surrounding tissues.
• Frequent or urgent urination: Needing to urinate more often or suddenly feeling the urge to urinate.
• Back or leg pain: Persistent pain in the back or legs, which may occur if the cancer has spread to nearby tissues or nerves.
• Swelling in the legs: Unexplained swelling of one or both legs, which can occur if the cancer has spread to lymph nodes or obstructed blood flow.

These symptoms can also be caused by conditions other than cervical cancer. If you experience any of these symptoms, it is important to see a healthcare provider for evaluation and appropriate testing. Early detection through regular screening, such as Pap smears and HPV testing, can help identify cervical cancer at an early, more treatable stage.

What are the Stages of Cervical Cancer?

Cervical cancer is classified into different stages based on how far the cancer has spread. The most commonly used staging system is the FIGO (International Federation of Gynecology and Obstetrics) system. Here are the stages of cervical cancer:

Stage 0

• Carcinoma in Situ: Abnormal cells are present only in the innermost lining of the cervix and have not invaded deeper tissues.

Stage I

• Stage IA: Cancer is only visible under a microscope. It has invaded the cervical tissue but is still confined to the cervix with measure in depth of upto 5 mm.
• IA1: Invasion is 3 mm.
• IA2: Invasion is more than or equal to 3 mm and less than 5 mm depth but not more than 5 mm deep and 7 mm or less wide.
• Stage IB: Cancer is visible and confined to the cervix or has larger but still limited invasions.
• IB1: Tumor is 5 mm or more deep and 2 cm or less in size.
• IB2: Tumor is more than 2 cm but not more than 4 cm.
• IB3: Tumor is more than equal to 4 cm.

Stage II - Cancer has spread beyond the uterus but has not extended into the mid of vagina or to the pelvic wall to the upper two-thirds of the vagina but not to the tissues around the uterus.

• Stage IIA: Involvement limited to upper two third of vagina without involving side tissues of uterus. 
• Tumor is less than 4 cm.
• IIA2: Tumor is 4 cm or more.
• Stage IIB: Cancer has spread to the tissues around the cervix (parametrium) but not to the pelvic wall or lower third of the vagina.

Stage III

• Stage IIIA: Cancer has spread to the lower third of the vagina but not to the pelvic wall.
• Stage IIIB: Cancer has spread to the pelvic wall and/or causes kidney problems (hydronephrosis) or non-functioning kidneys.
• Stage IIIC: Cancer has spread to the lymph nodes in the pelvis and/or around the aorta.
• IIIC1: Spread to pelvic lymph nodes.
• IIIC2: Spread to para-aortic lymph nodes.

Stage IV

• Stage IVA: Cancer has spread to nearby organs, such as the bladder or rectum.
• Stage IVB: Cancer has spread to distant organs beyond the pelvis, such as the lungs, liver, or bones.

Understanding the stage of cervical cancer is crucial for determining the most appropriate treatment plan and assessing the prognosis. Regular screening and early detection are key to identifying cervical cancer at an earlier, more treatable stage.

How is Cervical Cancer Diagnosed?

Diagnosing cervical cancer involves several steps, including a combination of screening tests, diagnostic procedures, and imaging studies. Here is an overview of the key methods used to diagnose cervical cancer:

Screening tests

• Pap smear (Pap test): Pap smear (Pap test) involves collecting cells from the cervix and examining them under a microscope to detect precancerous or cancerous changes. It is a routine screening tool that helps in early detection of cervical cancer.
• HPV DNA test: This test checks for the presence of high-risk types of human papillomavirus (HPV) that can cause cervical cancer. It is often done in conjunction with a Pap smear.

Diagnostic procedures

• Colposcopy: If abnormalities are detected on a Pap smear or HPV test, a colposcopy may be performed. During this procedure, a colposcope (a special magnifying instrument) is used to closely examine the cervix. A vinegar solution may be applied to highlight abnormal areas.
• Biopsy: If suspicious areas are observed during a colposcopy, a biopsy may be taken. Several types of biopsies can be performed:
• Punch biopsy: A small piece of cervical tissue is removed using a circular blade.
• Endocervical curettage: A small, spoon-shaped instrument (curette) is used to scrape cells from the cervical canal.
• Cone biopsy (conization)/ LEEP Biopsy: A larger, cone-shaped piece of tissue is removed from the cervix for examination. This can be done using a scalpel (cold knife cone biopsy) or a loop electrosurgical excision procedure (LEEP).

Imaging tests

• X-rays: Used to check for spread to the lungs or other areas.
• CT (Computed Tomography) scan: Provides detailed cross-sectional images of the body to detect tumors and determine their size and location.
• MRI (Magnetic Resonance Imaging): Uses magnetic fields to create detailed images of soft tissues, helping to identify the extent of the cancer.
• PET (Positron Emission Tomography) scan: Uses a small amount of radioactive material to highlight cancer cells throughout the body.
• Ultrasound: Uses sound waves to create images of internal organs, helping to evaluate the spread of cancer.

Laboratory tests

• Blood tests: While not used to diagnose cervical cancer directly, blood tests can help assess overall health and organ function and monitor for potential spread or effects of the cancer.

These diagnostic methods help healthcare providers determine the presence, stage, and extent of cervical cancer, allowing them to develop an appropriate treatment plan. Early detection through regular screening is crucial for improving the prognosis and effectiveness of treatment.

Treatment options for cervical cancer

Cervical cancer treatment involves various approaches depending on the stage and spread of the disease, as well as the patient’s overall health and preferences. Here’s an elaboration on the main treatment options:

Radiation therapy

Radiation therapy uses high-energy rays to destroy cancer cells. It can be used alone or in combination with chemotherapy to enhance effectiveness.

• External beam radiation: This method delivers radiation from outside the body, targeting the pelvic region to destroy cancer cells. It is typically administered over several weeks.
• Brachytherapy: Involves placing radioactive material directly inside or near the tumor. This localized approach allows higher doses of radiation to the cancer while sparing surrounding healthy tissue.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells or stop them from growing. It can be used at various stages of cervical cancer treatment.

• Systemic chemotherapy: Administered through the bloodstream to reach cancer cells throughout the body. It can be used alone or with radiation (chemoradiation) to treat advanced stages or recurrent cervical cancer.

Surgery

Surgical options aim to remove cancerous tissues and, in some cases, preserve fertility in younger patients.

• Laser surgery: Uses a focused beam of light to remove or destroy cancerous tissues. It is often used for treating precancerous changes or very early-stage cancers.
• Cryosurgery: Involves freezing and destroying abnormal cells in the cervix using a special cold probe. This method is typically used for early-stage cancer or precancerous lesions.
• Simple Hysterectomy: Involves the removal of the uterus and cervix but not the surrounding tissues. It is often used for early-stage cervical cancer.
• Trachelectomy: A fertility-preserving surgery where the cervix and surrounding tissue are removed, but the uterus is left intact. This is an option for early-stage cervical cancer in women who wish to preserve their fertility.

Targeted therapy

Targeted therapy involves drugs designed to specifically attack cancer cells based on certain markers.

• Bevacizumab (Avastin): This drug inhibits the growth of blood vessels that supply nutrients to the tumor, thereby slowing its growth. It is often used in combination with chemotherapy for advanced cervical cancer.

Immunotherapy

Immunotherapy helps the body’s immune system recognize and attack cancer cells more effectively.

• Checkpoint inhibitors: Drugs like pembrolizumab (Keytruda) enhance the immune system's ability to fight cancer. They are particularly used for advanced or recurrent cervical cancer that has not responded to other treatments.

Note: Each treatment option has specific indications based on the stage and characteristics of the cervical cancer, as well as the patient's overall health and preferences. A multidisciplinary approach often involving a combination of these treatments can provide the best outcomes. 

Complications of Advanced Cervical Cancer

Advanced cervical cancer can lead to various complications that can significantly affect a patient’s health and quality of life. These complications arise due to the cancer's progression and its impact on surrounding tissues and organs. Here are some common complications of advanced cervical cancer:

• Metastasis: The spread of cancer to other parts of the body, such as the lungs, liver, bladder, bones, and other organs, leading to additional symptoms and health issues depending on the location affected.
• Kidney failure: Advanced cervical cancer can block the ureters (the tubes that carry urine from the kidneys to the bladder), leading to a build-up of urine in the kidneys (hydronephrosis). This can cause kidney damage or kidney failure over time.
• Bladder and bowel problems: Cancer spreading to these areas can cause symptoms such as blood in the urine, difficulty urinating, frequent urination, constipation, diarrhea, and obstruction of the bowel.
• Fistulas: The development of abnormal connections (fistulas) between the bladder and vagina (vesicovaginal fistula) or the rectum and vagina (rectovaginal fistula), leading to the leakage of urine or feces through the vagina.
• Excessive bleeding: Tumors can cause significant bleeding from the vagina, bladder, or rectum. This can be life-threatening and may require urgent medical intervention.
• Infections: Cancer and its treatments can weaken the immune system, increasing the risk of infections. Additionally, fistulas and other complications can lead to recurrent infections.
• Weight loss and malnutrition: Advanced cancer can lead to significant weight loss and nutritional deficiencies due to decreased appetite, difficulty swallowing, and increased metabolic demands of the body.
• Fatigue: Chronic fatigue is a common symptom in advanced cancer due to the disease itself and as a side effect of treatments like chemotherapy and radiation therapy.
• Emotional and psychological impact: Living with advanced cancer can cause significant emotional and psychological distress, leading to anxiety, depression, and a decreased quality of life.

How to Prevent Cervical Cancer?

Preventing cervical cancer involves several proactive steps, primarily centered around reducing the risk of human papillomavirus (HPV) infection and promoting early detection through regular screening. Here are key strategies for cervical cancer prevention:

HPV vaccination

• Vaccinate early: The HPV vaccine is most effective when given before an individual becomes sexually active. It is recommended for girls and boys starting at ages 11 to 12, but can be given as early as age 9.
• Catch-up vaccination: Vaccination is also recommended for everyone through age 26 if they were not vaccinated when younger. Some adults ages 27 through 45 may also benefit from the HPV vaccine.

Regular screening

• Pap smear (Pap Test): Women should start getting regular Pap smears at age 21. This test detects precancerous or cancerous cells on the cervix.
• HPV test: This test checks for the presence of high-risk HPV types that can cause cervical cancer. It is often used in combination with the Pap smear for women aged 30 and older.

Safe sexual practices

• Use condoms: Using condoms during sexual intercourse can reduce the risk of HPV infection, though it does not eliminate it entirely.
• Limit number of sexual Partners: Reducing the number of sexual partners decreases the likelihood of contracting HPV and other sexually transmitted infections (STIs).

Healthy life choices

• Quit smoking: Smoking is a risk factor for cervical cancer. Quitting smoking can improve overall health and reduce the risk of developing cervical cancer.
• Healthy diet: Maintaining a healthy diet rich in fruits and vegetables can support the immune system. A strong immune system can help the body clear HPV infections more effectively.
• Managing other health conditions: Keeping conditions like HIV under control with proper medical care can reduce the risk of persistent HPV infections.
• Regular healthcare visits: Regular visits to a healthcare provider for regular check-ups and discussions about reproductive health can help in early detection and management of any abnormalities.

By following these prevention strategies, the risk of developing cervical cancer can be significantly reduced. That said, early detection through regular screening remains a critical component of preventing cervical cancer and ensuring timely treatment if needed.

Final words

Though cervical cancer is one of the most common cancers affecting women worldwide, it can often be successfully treated if detected at an early stage. If you or someone you know has any concerns about cervical cancer or needs guidance on prevention, early detection, or treatment options, consult a specialist at Max Hospitals to ensure you receive the best possible care and advice tailored to your needs. We offer comprehensive cervical cancer care with a team of experienced specialists dedicated to providing personalized treatment and support. Schedule an appointment with a specialist at Max Hospitals today.