Cervical Cancer

Cervical Cancer

Cervical cancer originates in the cervix, the lower portion of the uterus that opens at the top of the vagina.

Causes, Incidence, and Risk Factors

Globally, cervical cancer ranks as the third most prevalent cancer among women. Its occurrence is significantly lower in the United States due to widespread Pap smear utilization. The disease begins in cells lining the cervix, predominantly squamous cells. Typically, cervical cancer progresses slowly, originating as dysplasia, a precancerous state detectable via Pap smears, which are 100% treatable.

Regular Pap smears are crucial in early detection. Failure to address precancerous changes can lead to cervical cancer development and metastasis to adjacent organs over years. Nearly all cervical cancers stem from human papillomavirus (HPV) infection, a sexually transmitted virus. Various HPV strains may cause cervical cancer, with risk factors including early sexual debut, multiple sexual partners, economic constraints hindering regular screening, partners engaging in high-risk sexual behaviors, maternal use of DES during pregnancy in the 1960s, and compromised immune function.

Symptoms

In its early stages, cervical cancer often manifests without symptoms. When present, symptoms may include abnormal vaginal bleeding between periods, after intercourse, or postmenopause, persistent vaginal discharge, prolonged and heavy menstruation, and pelvic discomfort. Advanced cervical cancer symptoms may encompass bone pain, fatigue, weight loss, urinary or fecal leakage, leg swelling, and appetite loss.

Signs and Tests

Precancerous and cancerous cervical changes necessitate specialized tests. Pap smears facilitate precancer and cancer screening but do not yield definitive diagnoses. Abnormal findings prompt colposcopy, a magnified cervix examination, with tissue biopsy for histological analysis. Additional diagnostic tests may involve endocervical curettage (ECC), cone biopsy, and imaging studies such as chest X-ray, CT scan, cystoscopy, intravenous pyelogram (IVP), and MRI to stage cancer extent.

Treatment

Cervical cancer treatment is tailored to cancer stage, tumor characteristics, patient age, health status, and fertility desires. Early-stage cervical cancer often responds to tissue removal or destruction while preserving fertility. Surgical options include loop electrosurgical excision procedure (LEEP), cryotherapy, or laser therapy.

Hysterectomy, typically sparing ovaries, is less common for localized cancer. Advanced disease may necessitate radical hysterectomy or pelvic exenteration. Radiation therapy, either external or internal, targets locally advanced or recurrent cancers. Chemotherapy, employing drugs such as 5-FU, cisplatin, carboplatin, ifosfamide, paclitaxel, and cyclophosphamide, may complement surgery or radiation. Combination therapy may precede or follow surgery, aiming to enhance treatment efficacy.