A closer look at Cervical Cancer: Understanding diagnosis and treatment strategies”

Cervical cancer is one of the most common types of cancer in the world. As the name suggests, cervical cancer begins in the cervix. The cervix is a body part that connects vagina to the uterus. 

Given that this type of cancer starts in the reproductive organs in a woman’s body, some people confuse between ovarian cancer and cervical cancer. While both are gynaecological cancers, they affect separate sections of the reproductive system and have distinct risk factors, symptoms, treatment options, and survival rates.

The majority of cervix cancers are caused by the Human Papilloma Virus (HPV), which can be spread during sexual contact. Cervical cancer generally develops gradually over time, beginning with the formation of aberrant cells in the cervical tissue. Later, cancer cells begin to develop and spread further into the cervix and surrounding tissues.

Commons symptoms and signs of cervical cancer

The stages of cervical cancer range from 1-4. The lowest score indicates that the cancer only affects the cervix. As the numbers increase, the cancer advances. Stage 4 cervical cancer may have spread to adjacent organs or other parts of the body.

Women with pre-cancers and early cervical cancers typically exhibit no signs or symptoms. Signs and symptoms develop once the cancer has progressed to an advanced stage. More severe symptoms may appear in the later stages. 

Symptoms associated with cervical cancer may include:

  • Irregular menstrual bleeding 
  • Abnormal vaginal bleeding, particularly during sexual intercourse and pelvic examination,
  • Postmenopausal bleeding and spotting.
  • Unusual vaginal pain or odorous discharge from the vagina, which may contain blood and can occur between periods or after menopause
  • Pain during sex
  • Back, leg, or pelvic pain
  • Fatigue, weight loss, and lack of appetite
  • Swelling in one leg.

If you experience these symptoms, consult a gynaecologic oncologist—a healthcare professional who has been trained to treat gynaecologic cancers, including cervical cancer.

Diagnosis of cervical cancer

The majority of cervical cancers can be avoided by early detection, which involves a pelvic screening of all women in the target age group (30-49 years) and treating any pre-cancerous lesions found. 

Cervical cancer can be diagnosed with effective clinical evaluations and tests, and they are usually followed by a referral for treatment services such as surgery, radiotherapy, and chemotherapy, as well as palliative care to provide supportive care and pain relief.

Other procedures to detect the presence of abnormal cells include:

  • Colposcopy
  • Endocervical curettage, or endocervical scraping
  • Cone biopsy, or conization

It detects cancer in women who are symptom-free and appear to be in good health. Screening is important since both precancerous lesions and early cervical malignancies can be successfully treated at this stage. Cervical cancer is treated through a variety of methods. It depends on the type of cervical cancer and the extent to which it has spread.

Treatment options for cervical cancer

Cervical cancer screening: Visual inspection with acetic acid (VIA).

  • It is a simple test that can detect cervical precancerous lesions and early invasive carcinoma.
  • VIA results are immediately available and do not require any laboratory or specialised assistance.
  • 3-5% acetic acid is administered to the mouth of the cervix area. Any white lesions are detected after one minute of administration.
  • Under normal conditions, the vaginal canal may appear red or pink due to light reflection.
  • In cases of inflammation, benign and malignant growth, you may notice a dense white area over the mouth of the cervix. This is considered a VIA positive test.
  • VIA-positive women should be managed.

Cervical cancer screening using the Papanicolaou (Pap) test

Commonly used to screen for cervical cancer.

Pap test/smear procedure

  • A tiny brush is used to gather cells from the cervix’s surface and surrounding areas.
  • The cells are examined under a microscope to determine if they are abnormal.

Cervical cancer screening using HPV-DNA test

  • This test detects high-risk HPV DNA in cervical cells.
  • The technique is the same as a Pap smear test. WHO recommends HPV DNA tests over cytology-based tests such as pap smears or VIA tests.
  • It has been shown to be more successful in avoiding cervical cancer since it is objective diagnostic, leaving no room for interpretation of the results.
  • For the general population of women, HPV-DNA detection is recommended as the primary screening approach, beginning at the age of 30 and continuing every 5-10 years. HPV-DNA detection is advised for HIV-positive women beginning at the age of 25, with regular screening every 3-5 years thereafter.

How HPV testing can help with cervical cancer? 

Human Papillomavirus (HPV) testing plays a crucial role in the prevention and early detection of cervical cancer. HPV is a common sexually transmitted infection that can lead to the development of cervical abnormalities and, ultimately, cervical cancer. By identifying the presence of high-risk HPV types through testing, healthcare providers can assess the risk of cervical cancer in women.

HPV testing is often used in conjunction with pap smears, enhancing the accuracy of cervical cancer screening. While pap smears identify abnormal cervical cells, HPV testing directly detects the virus responsible for these abnormalities. This dual approach allows for a more comprehensive evaluation of a woman’s cervical health.

Early detection of HPV infections enables timely intervention, reducing the likelihood of cervical cancer development. Additionally, HPV testing helps determine the appropriate follow-up care for women with persistent infections or abnormal cells. 

What can you do to reduce the risk of cervical cancer? 

The tests mentioned above help in the diagnosis and early intervention. However, when it comes to reducing the risks of cervical cancer, there may be some things you can do. Cervical cancer can be genetic, and there may be a likelihood of you developing it if it is in your family, but you can still take some steps to minimise this risk. 

  • Do not neglect HPV vaccination. It can be given starting at the age of 9. Any woman between the age of 9-26 can get the vaccination. Women older than 26 are not recommended to get vaccination, however they can after having a word with their doctor. 
  • You must use protection during sexual intercourse. Using condoms doesn’t only prevent pregnancies but infections. HPV infection can also be prevented if you use protection. 
  • Do not smoke as it weakens your immune system and makes you more vulnerable to infections. Secondly, carcinogenic HPV-infected cells are exposed to smoking carcinogens that can cause DNA damage while HPV oncoproteins block cell cycle arrest and apoptosis. 

Closing thoughts 

Cervical cancer is a disease that can be avoided by minimising risk factors. Fortunately, vaccinations have been developed to protect people against infection with HPV types related to cancer development. Early diagnosis and treatment of precancerous lesions can prevent the majority of cervical cancers. All women aged 30 and up should be checked for cervical cancer at least once every five years.

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