Cervical Cancer: Causes, Symptoms, and Treatment Options

Introduction

As an oncologist, I’ve had the privilege of working with many women facing the challenge of cervical cancer. My name is Dr. Ekta Vala, and my goal is to provide clear, compassionate care and education about this critical health issue. Cervical cancer is a significant concern for women globally, and understanding its causes, symptoms, and treatment options is vital.

In this blog, I will guide you through the essential aspects of cervical cancer, with a special emphasis on the importance of screening cervical cancer.

Understanding the disease

Cervical cancer occurs in the cells of the cervix, the lower part of the uterus that connects to the vagina. The primary cause of cervical cancer is persistent infection with high-risk types of human papillomavirus (HPV). HPV is a common virus that is transmitted through sexual contact, and while most HPV infections resolve on their own, some high-risk types can lead to cervical cancer if left untreated.

Causes of the disease

1. Human Papillomavirus (HPV) Infection:
   • The most significant risk factor is persistent infection with high-risk HPV types. HPV types 16 and 18 are responsible for the majority of cervical cancer cases.
     
2. Sexual Activity:
   • Early sexual activity, multiple sexual partners, and having a partner with multiple sexual partners increase the risk of HPV infection, thereby raising the risk.
     
3. Weakened Immune System:
   • Women with weakened immune systems, such as those with HIV/AIDS or those on immunosuppressive medications, are at higher risk.
     
4. Smoking:
   • Tobacco smoke contains harmful chemicals that can damage the DNA of cervix cells and contribute to the development.
     
5. Family History:
   • A family history can increase the risk, indicating a possible genetic predisposition.

Symptoms of the disease

Early stages of cervical cancer often do not produce noticeable symptoms, making regular screening crucial. When symptoms do appear, they may include:

1. Abnormal Vaginal Bleeding:
   • This can occur between menstrual periods, after sexual intercourse, or after menopause.
     
2. Unusual Vaginal Discharge:
   • Discharge that is watery, bloody, or has a foul odor can be a symptom.
     
3. Pelvic Pain:
   • Pain in the pelvis or lower back may indicate advanced cervical cancer.
     
4. Pain During Intercourse:
   • Discomfort or pain during sexual intercourse can be a symptom of cervical cancer.

Screening the disease

Screening is a critical preventive measure that can detect precancerous changes in the cervix, allowing for early intervention and treatment. The two primary methods for screening are:

1. Pap Test (Pap Smear):
   • The Pap test involves collecting cells from the cervix and examining them under a microscope to detect abnormalities. Regular Pap tests can identify changes in cervical cells before they turn into cancer.
     
2. HPV Test:
   • The HPV test detects the presence of high-risk HPV types in cervical cells. It can be done alone or in combination with a Pap test (co-testing).

Recommended Screening Guidelines

• Ages 21-29:
  • Women should have a Pap test every three years.
    
• Ages 30-65:
  • Women should have a Pap test combined with an HPV test (co-testing) every five years or a Pap test alone every three years.
    
• Ages 65 and Older:
  • Women who have had regular screenings with normal results may stop screening cervical cancer, but those with a history of cervical pre-cancer should continue testing for at least 20 years.

Treatment Options for Cervical Cancer

The treatment depends on the stage of the disease, the size of the tumor, and the patient’s overall health. The main treatment options include:

1. Surgery:
   • Surgery is often the primary treatment for early-stage cervical cancer. The types of surgery include:
     • Conization: Removal of a cone-shaped section of abnormal tissue.
     • Hysterectomy: Removal of the uterus and cervix. It can be total (removing the entire uterus and cervix) or radical (also removing parts of the surrounding tissues).
     • Trachelectomy: Removal of the cervix and upper part of the vagina, preserving the uterus for potential future pregnancies.
       
2. Radiation Therapy:
   • Radiation therapy uses high-energy X-rays or other radiation to kill cancer cells. It can be delivered externally or internally (brachytherapy). Radiation therapy is often combined with chemotherapy for treatment.
     
3. Chemotherapy:
   • Chemotherapy uses drugs to kill cancer cells or stop them from growing. It is usually administered intravenously and can be used alone or in combination with radiation therapy.
     
4. Targeted Therapy:
   • Targeted therapy drugs specifically target cancer cells while sparing normal cells. Bevacizumab is a targeted therapy used in combination with chemotherapy for advanced cervical cancer.
     
5. Immunotherapy:
   • Immunotherapy helps the body’s immune system fight cancer. Pembrolizumab is an immunotherapy drug approved for certain cases of advanced cervical cancer.

Prevention of the disease

Preventing involves a combination of lifestyle changes, vaccination, and regular screening. Key preventive measures include:

1. HPV Vaccination:
   • The HPV vaccine protects against the most common high-risk HPV types that cause the disease. It is recommended for girls and boys starting at ages 11-12 but can be given as early as age 9 and up to age 26.
2. Safe Sexual Practices:
   • Using condoms and limiting the number of sexual partners can reduce the risk of HPV infection.
3. Regular Screening:
   • Adhering to recommended screening guidelines can detect precancerous changes early and prevent the disease from developing.
4. Quit Smoking:
   • Avoiding tobacco can lower the risk of cervical and other cancers.

Conclusion

Cervical cancer remains a significant health issue, but with the right knowledge and proactive measures, it can be effectively prevented and treated. As an oncologist, I cannot stress enough the importance of screening cervical cancer regularly. Early detection through Pap tests and HPV tests is crucial in identifying precancerous changes and initiating timely treatment. By following screening guidelines, getting vaccinated against HPV, and maintaining a healthy lifestyle, we can reduce the risk of cervical cancer and ensure better outcomes for women worldwide. Remember, your health is your greatest asset, and regular screening cervical cancer is a vital step in safeguarding it.