Overview
 
Cervical cancer is a type of cancer that originates in the cells of the cervix, which is the lower part of the uterus that connects to the vagina. It predominantly affects women under the age of 45. The primary cause of cervical cancer is an infection from certain types of human papillomavirus (HPV). When the body’s immune system cannot effectively combat this virus, it can lead to cervical cancer.
Type of cancer
 
Cervical cancer primarily occurs in two main types, which are distinguished based on the appearance of cells under a microscope:
1. Squamous Cell Carcinoma: This is the most common type of cervical cancer, accounting for about 80-90% of cases. It originates in the thin, flat cells lining the bottom of the cervix, which leads into the vagina.
2. Adenocarcinoma: This type accounts for most of the remaining cases and starts in the glandular cells lining the upper part of the cervix.
 
Stage
Stages of Cervical Cancer:
1. Stage 0: Also known as carcinoma in situ, this stage is characterized by abnormal cells that are confined to the inner lining of the cervix.
2. Stage I: At this stage, the carcinoma has become invasive but remains within the cervix.
3. Stage II: The cancer has extended beyond the uterus but has not reached the pelvic wall or the lower third of the vagina.
4. Stage III: The cancer has spread to the lower third of the vagina or the pelvic wall and may be causing kidney issues.
5. Stage IV: This stage indicates distant spread of the cancer, which now affects the bladder or rectum, or has metastasized to other body parts.
 
 
Incidence Rates
Cervical cancer stands as the fourth most common cancer among women globally. In 2020, there were approximately 604,000 new cases and 342,000 related deaths, with 90% occurring in lower to middle-income countries. The U.S. has a lower rate, with around 13,000 new cases and 4,000 deaths per year.
 
The annual incidence rate of cervical cancer is 7.7 per 100,000 women, and the death rate is 2.2 per 100,000. China saw the most significant number of new cases in 2017 and the largest rise in age-standardized rates from 2007 to 2017.
 
Pre-cancerous conditions of the cervix are more common than invasive cancer and are frequently diagnosed. Screening through Pap tests has led to a considerable reduction in the cervical cancer death rate. Asia reports over half of the world's cervical cancer cases, with India and China accounting for 21% and 18%, respectively. These two countries also represent a large proportion of deaths from this disease – 23% and 17%, respectively.
 
However, these figures can change due to various factors like healthcare availability, screening programs, and HPV vaccination rates.

Symptoms
Symptoms of Cervical Cancer:
· Unusual vaginal bleeding, such as bleeding after intercourse, spotting between periods, or bleeding after menopause.
· Changes in menstrual cycles, with heavier and more prolonged bleeding.
· Persistent watery, bloody discharge that may have an odor.
· Pelvic pain and discomfort during sexual intercourse.
· In advanced cases, symptoms may include leg swelling, difficulty in urination or defecation, and blood in urine.
 
Cause and Risk factors
The main cause of cervical cancer is a long-standing infection with certain types of human papillomavirus (HPV), which is a common virus that is transferred through sexual contact. Although the body's immune system typically stops the virus from causing any damage, in a few cases the virus survives for years, eventually leading some cervical cells to become cancerous.
 
Most women with HPV infection will not develop cervical cancer. However, other factors, such as smoking and an HIV infection, can determine which women with HPV are more likely to see such progression. Lowering the risk of developing cervical cancer is possible by undergoing regular screening tests and getting vaccinated against HPV.
 
Diagnosis and Test
Diagnosis:
1. Pap Smear: This routine screening involves collecting cells from the cervix to check for abnormalities that might indicate pre-cancer or cancer.
2. HPV Test: This test checks for infection with the human papillomavirus, a virus that can cause cervical cells to become cancerous.
3. Colposcopy: If abnormalities are detected, a colposcopy may be performed. This involves inspecting the cervix with a colposcope, an instrument equipped with a bright light and magnifying lens, after applying a vinegar solution to highlight abnormal areas. This often includes taking a tissue biopsy.
4. Biopsy: Several types of biopsies, such as punch biopsy, endocervical curettage, LEEP, and cone biopsy, can be performed to check for cancer.
5. Advanced Genomic Testing: In some cases, the tumor may be examined for DNA alterations that are driving the growth of the cancer.
 
Treatment
The treatment of cervical cancer involves a variety of options:
1. Surgery: This is often used for cervical cancer, with procedures ranging from a cone biopsy, which can effectively treat very small, early-stage cancers, to a trachelectomy.
2. Radiation Therapy: This method uses high-energy x-rays or other types of radiation to kill cancer cells or prevent their growth by damaging their DNA.
3. Chemotherapy: This is a drug-based approach used to kill or inhibit the growth of cancer cells.
4. Targeted Therapy: This treatment focuses on specific molecules involved in the growth and spread of cancer, with the aim of blocking their activity.
5. Immunotherapy: This approach enhances the immune system’s ability to identify and combat cancer cells.
The choice of treatment is primarily determined by the stage of the cancer. However, other factors can also influence treatment options, including the exact location of the cancer within the cervix, the type of cancer (whether it’s squamous cell or adenocarcinoma), the patient’s age and overall health, and whether the patient wishes to have children in the future.
A common treatment for early-stage cervical cancers is a radical hysterectomy, which involves removing the cervix, uterus, part of the vagina, and nearby lymph nodes. This procedure can cure early-stage cervical cancer and prevent its recurrence. However, it also eliminates the possibility of carrying a pregnancy.
 
Prognosis:
1. Early-Stage Diagnosis: When cervical cancer is diagnosed at an early stage, the 5-year relative survival rate is 91%.
2. Locally Advanced Cancer: If cancer is found after it has spread outside the cervix, it may still respond well to treatment and can often be kept under control. This type of cancer has a 92 % relative survival rate if it is detected while it’s still confined to the cervix and uterus.
3. Radical Hysterectomy: Most early-stage cervical cancers are treated with a radical hysterectomy operation, which involves removing the cervix, uterus, part of the vagina and nearby lymph nodes. A hysterectomy can cure early-stage cervical cancer and prevent recurrence. However, removing the uterus makes it impossible to become pregnant.
 
Supportive
Supportive care plays a pivotal role in the treatment regimen for patients diagnosed with cervical cancer. It ensures that women are provided with comprehensive assistance to navigate the physical, practical, emotional, and spiritual challenges that accompany a cervical cancer diagnosis. A multitude of programs and services are available to enhance the quality of life for those living with cancer, as well as their loved ones, particularly after the completion of treatment.
Supportive care includes a variety of services:
1. Physical Support: This involves managing the side effects of treatment, providing pain relief, offering dietary guidance, and facilitating access to rehabilitation services.
2. Practical Support: This can include assistance with transportation for treatments, financial advice regarding treatment costs, and help with daily tasks.
3. Emotional Support: Services such as counseling, stress management techniques, support groups, and online communities contribute to emotional well-being.
4. Spiritual Support: Spiritual solace can be found through engagement with a chaplain, participation in religious services, or practicing meditation.
It’s crucial for patients to maintain open and honest communication with their healthcare providers about any struggles they’re experiencing, whether they’re physical, emotional, or practical. The healthcare team is equipped to provide resources or refer patients to specialists for additional support.