Cervical cancer is one of the most common viral infections of the reproductive tract worldwide, often affecting sexually active women. Despite being a leading cause of death among women, the availability of screening tests has led to a steady improvement in survival rates, with about 90% of infected individuals now surviving this cancer.
What is Cervical Cancer?
Cervical cancer is a type of tumor that develops in the cells of the cervix, the lower part of the uterus. This cancer can spread to other parts of the body through the lymph nodes. The leading cause of cervical cancer is infection with the Human Papilloma Virus (HPV), and women aged 35–44 years are at the highest risk.
There are reported cases of this infection in women of various ages, with the highest being one aged 65 years. Unlike other forms of cancer, cervical cancer develops slowly, so there’s adequate time to find and treat it before it causes serious problems.
Types of Cervical Cancers
Two types of cervical cancer are most common among women.
1. Squamous Cell Carcinoma:
It is the most common form of cervical cancer, accounting for up to 90% of cervical cancers. These cancers originate from cells in the ectocervix.
2. Cervical Adenocarcinoma:
It develops in the epithelial cells of the endocervix. It is not as common as the earlier one. This form of cancer has features of both squamous cell carcinoma and adenocarcinoma. Hence, it is often called mixed carcinoma.
Common Causes of Cervical Cancer
The Human Papilloma Virus (HPV), transmitted during sexual intercourse, is the leading cause of cervical cancer. It is the most common sexually transmitted infection (STI). Here are some common causes of cervical cancer:
HPV in Men
Many men who are infected with HPV may not experience any symptoms. However, some may develop genital warts. If a man notices unusual bumps or lesions on his penis, scrotum, or anus, he should seek medical attention. Men are also at risk for HPV-related cancers, particularly those who engage in anal sex and those with a weakened immune system. Men need to consult with their doctor if they notice any abnormal symptoms.
HPV in Women
Almost 80 percent of women are at risk of contracting at least one type of HPV during their lifetime. Like men, women with HPV could be asymptomatic when infected, and the infection may go away without causing any serious health issues.
When infected, women may notice genital warts. These can appear inside the vagina, around the anus, and on the cervix or vulva.
Some strains of the human papillomavirus (HPV) can lead to cervical cancer or cancers of the vagina, anus, or throat. Regular screening can help detect signs of these cancers in women.
Other Risk Factors of Cervical Cancer
Certain risk factors increase the likelihood of a high-risk HPV infection of the cervix becoming persistent and leading to severe cervical cell changes that can develop into cervical cancer. These risk factors include
- A weakened immune system: It can lower the body’s ability to fight HPV infection or other connected diseases. HPV infections are likely to be persistent and progress to cancer in immunocompromised people.
- Smoking or exposure to secondhand smoke (SHS): Those who smoke or inhale secondhand smoke have an increased risk of developing cervical cancer. The risk increases based on the number of times you have exposure to smoke.
- Being sexually active at an early age: High-risk HPV infection that is persistent and leads to cervical cancer tends to be higher in people who have sexual intercourse before attaining the age of 18 and those with multiple sexual partners. This sexual history increases the chances of exposure to high-risk HPV.
- Other factors: Excess use of oral contraceptives (birth control pills) and giving birth to many children are associated with an elevation in cervical cancer risk. The reasons for these associations are yet to be supported by scientific evidence.
It's essential to keep in mind that having any of these risk factors doesn't mean that a person will develop cervical cancer, but it increases the chances of it.
Cervical Cancer Stages
After the diagnosis, the doctor will assign cervical cancer a stage based on its spread, which helps them plan further management.
Cervical cancer has four stages:
- Stage 1: The spread of the cancer cells is minimal. They may have spread to the lymph nodes, but there is no evidence that they are growing elsewhere in the body.
- Stage 2: Cancer has spread outside the uterus/ cervix or the lymph nodes, but no medical evidence is present to suggest malignant growth in other parts of the body.
- Stage 3: Cancer may spread to the lower part of the vagina or the pelvis.
- Stage 4: Cancer may have spread outside of the pelvis to organs like your lungs, bones, or liver.
Is Cervical Cancer Preventable?
Cervical cancer is highly preventable and curable if diagnosed early. HPV vaccination helps to prevent nearly all cervical cancers. Routine cervical cancer screening and appropriate follow-up treatment when needed could also help this cause.
Who Should Get the HPV Vaccination?
The Advisory Committee on Immunization Practices (ACIP) is responsible for developing recommendations regarding vaccination, even HPV vaccination. The present ACIP recommendations for HPV vaccination are:
- Children and adults ages 9 to 26. HPV vaccination works best if taken at 11 or 12 years of age, even though vaccination is permissible from the age of 9 years. HPV vaccination is also recommended for all till they attain the age of 26 years if not adequately vaccinated earlier.
- Adults ages 27 through 45 years. The HPV vaccination is permissible till the age of 45. Administration of this vaccine to adults between 27 to 45 years is avoidable, as it provides less benefit owing to likely exposure to the virus.
Doses of the HPV Vaccine
The HPV vaccination consists of a series of shots depending on age. Dosage is decided based on the age at which the first vaccine of the series is administered. Children who begin the vaccine series before their 15th birthday need only two doses for complete protection. People who start the series at age 15 or older and are immunocompromised need three doses for wholesome protection.
Can I Prevent Cervical Cancer?
The key to the prevention of any form of cancer is its early detection. Regular pelvic examinations and Pap tests are the best ways to do this. Experts recommend a Pap test every three years after the age of 21.
A Pap smear helps diagnose cervical cancer. As part of the test, the doctor collects a sample from the surface of the cervix. These cells undergo examination in a lab for pre-cancerous or cancerous changes. In the event of an abnormality in the test, the doctor may recommend a colposcopy, a procedure for examining your cervix. The doctor might take a biopsy sample of cervical cells during colposcopy. Recommendations for screening include:
- If aged between 30 to 65, get Pap and HPV test every five years. One may stop testing beyond 65 years if doctors suggest low risk.
- No screening is required if one had their cervix removed and has no history of cervical cancer or pre-cancerous lesions.
- Sexually active people are at a higher risk higher risk of contracting STDs, tests for chlamydia, gonorrhea, and syphilis are a must every year. Take an HIV test at least once and more often if in the high-risk category.
How is Cervical Cancer Treated?
Surgery and radiation therapy are the generally recommended treatments for invasive cervical cancer. Other methods of treatment in vogue are chemotherapy and biological therapy. If cancer has spread only on the surface of the cervix, the doctor can remove or destroy the cancerous cells with procedures like LEEP or cold knife conization.
If cancerous cells have passed through a layer called the basement membrane that separates the surface of the cervix from the underlying layers, surgery would be the solution. If cancer has invaded deep layers of the cervix but not spread to other parts of the body, surgical procedures will help remove the tumor. If cancer has spread to the uterus, one may need a hysterectomy. Do remember to talk with the healthcare provider about the pros and cons. Details of the treatment plans are listed below.
- Radiation therapy (or radiotherapy) uses high-energy electromagnetic rays to destroy cancerous cells and further their growth. The radiation can be administered externally or internally and affects cancerous cells only in the treated area. External radiation requires a large machine that beams radiation at the pelvis region. This treat could last a few minutes every day for five days a week. The treatment would last a total of 5 to 6 weeks, and at the end, they may administer an extra dose called a "boost."
- Internal radiation (also known as implant radiation or brachytherapy) uses a radioactive capsule placed in the cervix. This capsular implant beams cancer-killing rays to the tumor while sparing the most healthy tissue around it.
- Chemotherapy uses controlled dosages of drugs to kill cancer cells. Doctors often use this therapy for locally advanced cervical cancer or one with its spread to other parts of the body. Chemotherapy happens in cycles of intensive treatment followed by recovery periods, as it could severely affect one’s immunity.
- Biological therapy or immunotherapy targets some “checkpoints” in the immune cells that are turned on or off to generate an immune response.
Dietary Solutions to Prevent Cervical Cancer
There is no proof to suggest a relationship between diet and cervical cancer. However, the nutritional status appears to be an important cofactor affecting HPV persistence and progression.
Fruits and vegetables in the everyday diet may accord some protection from the onset of cervical cancer. Studies suggest that a diet high in the antioxidants, carotenoids, flavonoids, and folate found in vegan and fruit-rich diets can help the body fight HPV infection and prevent HPV from creating malignancy in cervical cells. It was also found that the blood samples of women following a vegan and fruit-rich diet contained high levels of chemical compounds capable of clearing HPV infections faster than their peers, reducing cancer risk.
Follow-Up After Cervical Cancer Treatment
Regular pelvic examinations and Pap smears are paramount for every woman, especially those with a history of pre-cancerous cells or cervical cancer episodes. After treatment, you need regular follow-up appointments.
There is no set pattern or prescribed schedule for the follow-up, but physical examinations are recommended every 3 to 4 months for two years after treatment. This frequency could be every six months for the next few years and then once a year based on recommendations from the health care providers.
The guidelines are broad and may vary from person to person, and a Pap test every year is advised. If you had a hysterectomy for the removal of the cervix, you would still have cervical cells, and the side effects of the treatment may persist for a few years. Be sure to discuss with your doctor any health problems to help him spot early signs of relapse.