Cervical Cancer: Information on Causes, Diagnosis & Treatments

Cervical Cancer Overview

Cervical Diagram Cervical cancer develops when abnormal cells in the lining of the cervix – the narrow part of the womb (uterus) – begin growing and reproducing uncontrollably and eventually form a cancerous (malignant) or non-cancerous (benign) tumor. Malignant tumors can spread to other areas of the body while benign tumors do not spread. All cases of cervical cancer begin as noncancerous abnormal cells. However, over time, dysplasia begins with slow changes in the cells that will eventually develop into a cancerous mass. Many times, the precancerous abnormal tissue can be destroyed or removed without causing damage to healthy tissue. Other times the removal of the cervix and uterus through a hysterectomy is necessary to prevent the development of cervical cancer.

Cervical Cancer Types

Doctors and scientists classify cervical precancer conditions and cervical cancer by how the abnormal cells appear under the microscope. The categorization of these diseases typically falls under three different classifications involving squamous cell carcinoma, adenocarcinoma, and mixed carcinomas.

  • Squamous Cell Carcinomas – Nearly 90 percent of all cervical cancers are categorized as squamous cell carcinomas that develop from abnormal cells in the exocervix, the protective mucous membrane on the outside of the cervix. Most commonly, squamous cell carcinoma develops in the cervix transformational zone where the endocervix meets the exocervix.

  • Adenocarcinomas – Cancerous adenocarcinoma typically starts in endocervix mucus- producing gland cells. The rate of cervical adenocarcinoma cases has risen dramatically over the last three decades.

  • Mixed Carcinomas (adenosquamous carcinomas) – Though rare, women can develop mixed carcinomas or adenosquamous carcinomas that have features of both squamous cell carcinoma and adenocarcinoma.

While the list above represents nearly all cervical cancer cases, there are other forms of the disease that can grow in the cervix from other areas of the body. These include melanoma, lymphoma, and sarcoma that develop in distant body areas and metastasize (spread) to the cervix.

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Risk Factors for Developing Cervical Cancer

While elderly women have an increased risk of developing cervical cancer compared to teenagers between 14 and 18 years of age, all women between the ages of 19 and 100 are at risk.

There are specific risk factors involved in the development of cervical cancer that may or may contribute to developing the condition. These factors include:

  • Multiple Sexual Partners – The chances of acquiring HPV (human papilloma virus) rises significantly if the woman has many sexual partners.

  • Early Sexual Activity – Participating in sexual activity at an early age can significantly increase the potential risk of acquiring human papillomavirus (HPV).

  • Multiple Births – Women who have experienced at least three full-term pregnancies are twice as likely to develop life-threatening cervical cancer compared to women who have not had more than two full-term pregnancies.

  • Acquiring Other STIs (sexually transmitted infections) – Women who have acquired syphilis, gonorrhea, chlamydia, HIV, and AIDS are at greater risk of acquiring HPV.

  • Smoking – Women who smoke increase their chances of developing squamous cell cervical cancer.

  • Weakened Immune System – Women suffering from a weakened immune system caused by the human papillomavirus or another health condition have an increased potential risk of developing cervical cancer compared to those with healthier immune systems.

  • The Use of Oral Contraception – Women who have used oral birth control medications for five years or longer have an increased potential risk of developing cervical cancer. However, this risk diminishes within a few years after the medication is no longer taken.

Out of the more than a hundred varieties of human papillomavirus, up to forty types can be sexually transmitted, and of those, fifteen varieties can cause cervical cancer. Studies show that up to eight out of every ten women will eventually contract human papillomavirus at some stage in their life. While men can acquire HPV, there is currently no test to determine if they have it.

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Symptoms of Cervical Cancer

Many women who suffer from cervical cancer never had any noticeable symptoms when the disease was in its earliest stages. Because of that, it is crucial to undergo routine screenings to quickly identify abnormal cells growing on the cervix. If found in the early stage, the disease can be monitored and effectively treated producing significantly better outcomes. Gynecologists often recommend routine Pap smear screening because the test is both highly effective and reliable at revealing normal cells.

The most common cervical cancer symptoms include:

  • Vaginal Bleeding – Women with early-stage and advanced-stage cervical cancer often bleed between periods, after engaging in sexual intercourse or after going through menopause.

  • Unusual Vaginal Discharge – A foul-smelling, pink, watery discharge often accompanies cervical cancer.

  • Pelvic Pain – Many women with cervical cancer will experience severe pain in the pelvic region while participating in sexual intercourse or at any time.

Typical advanced age cervical cancer symptoms include:

  • Back pain

  • Weight loss

  • Bone fractures

  • Leg swelling and/or pain

  • Fatigue

  • Vaginal leakage of feces or urine

Many of the symptoms are indicative of advanced ages of cervical cancer after it has metastasized (spread) within the pelvis or to distant sites in the body including the lymph nodes.

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Diagnosing Cervical Cancer

The first indicators that a woman has developed cervical cancer are revealed in an abnormal Pap test result. When the disease is identified, the doctor will typically recommend further testing to verify the disease. Initially, the doctor will obtain a complete personal medical history to determine if the woman experiences pain during intercourse or has had abnormal vaginal bleeding. If the condition is diagnosed, the doctor will typically refer their patients to a gynecologic oncologist who specializes in women’s reproductive system cancers.

The doctor will complete a comprehensive physical examination to evaluate the woman’s overall health and likely perform a pelvic examination and an evaluation of lymph nodes to look for evidence of the spread of cancer (metastasis). Because a Pap test is not a diagnostic test but a screening test, the doctor will likely need to perform additional testing including cone biopsies, endocervical scraping, or a colposcopy to obtain a biopsy.

If the diagnosis reveals a precancerous condition, the physician will usually perform procedures to stop the progressive action of the cancer cells. Other diagnostic tools would include a chest x-ray, MRI (magnetic resonance imaging) scan, CT (computed tomography) scan, intravenous urography, PET (positron emission tomography) scan and others.

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Treating Cervical Cancer

The treatment for cervical cancer recommended by a gynecologic oncologist will depend on the stage of the disease. However, the doctor may choose a medical procedure, chemotherapy, or surgery.

  • Medical Procedures include teletherapy, Brachytherapy, radiation therapy, loop electrosurgical excision procedure, or cervical conization (cone biopsy).

  • Chemotherapy can destroy abnormal cell growth that is multiplying too quickly. Common drugs used during cervical cancer chemotherapy treatments include carboplatin and fluorouracil.

  • Surgical Options could include hysterectomy, cryosurgery, cervicectomy, lymph node dissection, and retroperitoneal lymph node dissection.

Procedures used to eradicate cancerous and pre-cancerous cells in the cervix are performed by a radiation oncologist, OB/GYN doctors, oncologists, gynecologic oncologists, and primary care providers. After treatment, many women no longer experience the pains and symptoms of cervical cancer that include weight loss, nausea, fatigue, abnormal vaginal discharge, abnormal vaginal bleeding, and pain in the pelvis and during sexual intercourse.

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Sources:

https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm383757.htm

https://www.cancer.gov/about-cancer/treatment/drugs/cervical

https://www.cancer.org/health-care-professionals/american-cancer-society-prevention-early-detection-guidelines/cervical-cancer-screening-guidelines.html

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