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What are the causes and symptoms of cervical cancer?

Nearly all cervical cancers are caused by an infection with certain high-risk types of human papillomavirus (HPV). You can get HPV from:-

• Any skin-to-skin contact of the genital area.
• Vaginal , anal of the oral sex
• Sharing of Sex Toys.

Main symptoms of cervical cancer

Symptoms of cervical cancer include:

• Vaginal bleeding that’s unusual – including bleeding after sexual intercourse.
• Changes to vaginal discharge
• Pain during sex
• Pain in lower back, between the hip bones (pelvis), or in lower tummy.

If women have another condition like fibroids or endometriosis, may get symptoms like these regularly.

What are the risk factors for cervical cancer?

Human papillomavirus (HPV) infection is the major risk factor for cervical cancer. Risk factors for cervical cancer include the following:

• Being infected with human papillomavirus (HPV). This is the most important risk factor for cervical cancer.
• Being exposed to the drug DES (diethylstilbestrol) while in the mother’s womb.

In women who are infected with HPV, the following risk factors add to the increased risk of cervical cancer.

• Giving birth to many children.
• Smoking cigarettes.
• Using oral contraceptives (“the Pill”) for a long time.

There are also risk factors that increase the risk of HPV infection:

• Having a weakened immune system caused by immunosuppression. Immunosuppression weakens the body’s ability to fight infections and other diseases. The body’s ability to fight HPV infection may be lowered by long-term immunosuppression from:
• Being infected with human immunodeficiency virus (HIV).
• Taking medicine to help prevent organ rejection after a transplant.
• Being sexually active at a young age.
• Having many sexual partners.

Older age is a main risk factor for most cancers. The chance of getting cancer increases as you get older.

How can risk be decreased?

Cervical cancer can often be prevented by having regular screenings with Pap tests and HPV tests to find any precancers and treat them. It can also be prevented by receiving the HPV vaccine.

What are the screening tests done to keep check on cervical cancer?

Screening is used to detect precancerous changes or early cancers before signs or symptoms of cancer occur. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer before signs or symptoms appear. The overall goals of cancer screening are to:

• Reduce the number of people who die from the cancer, or completely eliminate deaths from the cancer.
• Reduce the number of people who develop the cancer.

The following tests and procedures may be used to screen for cervical cancer:

1. HPV test. This test is done on a sample of cells removed from the cervix, the same sample used for the Pap test. This sample is tested for the strains of HPV most commonly linked to cervical cancer. HPV testing may be done by itself or combined with a Pap test. This test may also be done on a sample of cells collected from the vagina, which women can collect on their own.
2. Pap test. The Pap test has been the most common test for early changes in cells that can lead to cervical cancer. This test is also called a Pap smear. A Pap test involves gathering a sample of cells from the cervix. It is often done at the same time as a bimanual pelvic exam as part of a gynaecologic check-up. A Pap test may be combined with an HPV test.
3. Visual inspection with acetic acid (VIA). VIA is a screening test that can be done with a few tools and the naked eye. During VIA, a dilution of white vinegar is applied to the cervix. The health care provider then looks for abnormalities on the cervix, which will turn white when exposed to vinegar. This screening test is very useful in places where access to medical care is limited.

How often should women screen for cervical cancer?

Women aged 21-29

Screening for cervical cancer should begin at the age of 21. Women need to get a Pap smear every three years from the ages of 21 to 29. If the test comes back as abnormal, the woman might also have to undergo an HPV test.

Women aged 30-65

Women have two options for screening for cervical cancer once they reach the age of 30. They can get a Pap smear and HPV test every five years, or they can get a Pap test every three years. They must continue this testing until they reach the age of 65.

After the age of 65

Women do not have to get cervical cancer screening after they reach the age of 65 as long as the guidelines are met. First, they need to have maintained regular screenings over the last 10 years. If they have not, they need to get a screening for cancer.

Second, they can only stop screenings if precancers have not been found in the last two decades. Screenings need to continue for 20 years after finding precancerous cells.

Are there any preventive measures?

Cervical cancer can often be prevented by having regular screenings with Pap tests and HPV tests to find any precancers and treat them. It can also be prevented by receiving the HPV vaccine.

The HPV vaccine Gardasil is approved by the U.S. Food and Drug Administration (FDA) for prevention of cervical cancer caused by HPV for people between ages 9 and 45. Gardasil 9 is available in the United States for preventing infection from HPV16, HPV18, and 5 other types of HPV linked with cancer. There were 2 other vaccines previously available in the United States: Cervarix and the original Gardasil. However, because of newer vaccines becoming available, these 2 are no longer available in the United States. However, these vaccines may still be in use outside of the United States.

Additional actions people can take to help prevent cervical cancer include:

• Delaying first sexual intercourse until the late teens or older.
• Limiting the number of sex partners.
• Practicing safe sex by using condoms and dental dams.
• Avoiding sexual intercourse with people who have had many partners.
• Avoiding sexual intercourse with people who are infected with genital warts or who show other symptoms.
• Quitting smoking.

Once diagnosed, how curable is it? What are the treatment options?

Cervical cancer is generally viewed as treatable and curable, particularly if it is diagnosed when the cancer is in an early stage. This disease occurs in the cervix, or the passageway that joins the lower section of the uterus to the vagina.

TREATMENT OPTIONS:

Five types of standard treatment are used:

Surgery

Surgery (removing the cancer in an operation) is sometimes used to treat cervical cancer. The following surgical procedures may be used:

• Conization: A procedure to remove a cone-shaped piece of tissue from the cervix and cervical canal. A pathologist views the tissue under a microscope to look for cancer cells. Conization may be used to diagnose or treat a cervical condition. This procedure is also called a cone biopsy.

Conization may be done using one of the following procedures:

• Cold-knife conization: A surgical procedure that uses a scalpel (sharp knife) to remove abnormal tissue or cancer.
• Loop electrosurgical excision procedure (LEEP): A surgical procedure that uses electrical current passed through a thin wire loop as a knife to remove abnormal tissue or cancer.
• Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumour.

The type of conization procedure used depends on where the cancer cells are in the cervix and the type of cervical cancer.

• Total hysterectomy: Surgery to remove the uterus, including the cervix. If the uterus and cervix are taken out through the vagina, the operation is called a vaginal hysterectomy. If the uterus and cervix are taken out through a large incision (cut) in the abdomen, the operation is called a total abdominal hysterectomy. If the uterus and cervix are taken out through a small incision in the abdomen using a laparoscope, the operation is called a total laparoscopic hysterectomy.

Hysterectomy. The uterus is surgically removed with or without other organs or tissues. In a total hysterectomy, the uterus and cervix are removed. In a total hysterectomy with salpingo-oophorectomy, (a) the uterus plus one (unilateral) ovary and fallopian tube are removed; or (b) the uterus plus both (bilateral) ovaries and fallopian tubes are removed. In a radical hysterectomy, the uterus, cervix, both ovaries, both fallopian tubes, and nearby tissue are removed. These procedures are done using a low transverse incision or a vertical incision.

• Radical hysterectomy: Surgery to remove the uterus, cervix, part of the vagina, and a wide area of ligaments and tissues around these organs. The ovaries, fallopian tubes, or nearby lymph nodes may also be removed.
• Modified radical hysterectomy: Surgery to remove the uterus, cervix, upper part of the vagina, and ligaments and tissues that closely surround these organs. Nearby lymph nodes may also be removed. In this type of surgery, not as many tissues and/or organs are removed as in a radical hysterectomy.
• Radical trachelectomy: Surgery to remove the cervix, nearby tissue and lymph nodes, and the upper part of the vagina. The uterus and ovaries are not removed.
• Bilateral salpingo-oophorectomy: Surgery to remove both ovaries and both fallopian tubes.
• Pelvic exenteration: Surgery to remove the lower colon, rectum, and bladder. The cervix, vagina, ovaries, and nearby lymph nodes are also removed. Artificial openings (stoma) are made for urine and stool to flow from the body to a collection bag. Plastic surgery may be needed to make an artificial vagina after this operation.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

• External radiation therapy uses a machine outside the body to send radiation toward the cancer. Certain ways of giving radiation therapy can help keep radiation from damaging nearby healthy tissue. This type of radiation therapy includes the following:
• Intensity-modulated radiation therapy (IMRT): IMRT is a type of 3-dimensional (3-D) radiation therapy that uses a computer to make pictures of the size and shape of the tumor. Thin beams of radiation of different intensities (strengths) are aimed at the tumor from many angles.
• Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. External and internal radiation therapy are used to treat cervical cancer, and may also be used as palliative therapy to relieve symptoms and improve quality of life.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells.

Monoclonal antibody therapy is a type of targeted therapy that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

Bevacizumab is a monoclonal antibody that binds to a protein called vascular endothelial growth factor (VEGF) and may prevent the growth of new blood vessels that tumors need to grow. Bevacizumab is used to treat cervical cancer that has metastasized (spread to other parts of the body) and recurrent cervical cancer.

Immunotherapy

Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or biologic therapy.

Immune checkpoint inhibitor therapy is a type of immunotherapy.

• Immune checkpoint inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. When PD-1 attaches to another protein called PDL-1 on a cancer cell, it stops the T cell from killing the cancer cell. PD-1 inhibitors attach to PDL-1 and allow the T cells to kill cancer cells. Pembrolizumab is a type of immune checkpoint inhibitor used to treat recurrent cervical cancer.

Immune checkpoint inhibitor. Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help keep immune responses in check. The binding of PD-L1 to PD-1 keeps T cells from killing tumor cells in the body (left panel). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows the T cells to kill tumor cells (right panel).

Can the stage of cancer be determined and how would treatment differ if caught at a later stage?

The FIGO (International Federation of Gynecology and Obstetrics) staging system is used most often for cancers of the female reproductive organs, including cervical cancer. For cervical cancer, the clinical stage is used and is based on the results of the doctor’s physical exam, biopsies, imaging tests, and a few other tests that are done in some cases, such as cystoscopy and proctoscopy. It is not based on what is found during surgery. If surgery is done, a pathologic stage can be determined from the findings at surgery, but it does not change your clinical stage. Your treatment plan is based on the clinical stage.

Cervical cancer stage ranges from stages I (1) through IV (4).

As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means a more advanced cancer. And within a stage, an earlier letter means a lower stage. Cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

Cervical cancer staging can be complex.

The stage of a cervical cancer is the most important factor in choosing treatment.

Stages IIB, III, IVA

Treatment options

Chemo radiation: The chemo may be cisplatin, carboplatin, or cisplatin plus fluorouracil. The radiation therapy includes both external beam radiation and brachytherapy.

Stage IVB

At this stage, the cancer has spread out of the pelvis to other areas of the body. Stage IVB cervical cancer is not usually considered curable. Treatment options include radiation therapy with or without chemo to try to slow the growth of the cancer or help relieve symptoms. Most standard chemo regimens include a platinum drug (cisplatin or carboplatin) along with another drug such as paclitaxel (Taxol), gemcitabine (Gemzar), or topotecan. The targeted drug bevacizumab (Avastin) with chemo, immunotherapy alone with pembrolizumab (Keytruda), the targeted drug tisotumab vedotin-tftv (Tivdak), or pembrolizumab (Keytruda) with chemo (with or without bevacizumab [Avastin]), may also be options.

How long does cervical cancer take to develop?

It takes 15 to 20 years for cervical cancer to develop in women with normal immune systems. It can take only 5 to 10 years in women with weakened immune systems, such as those with untreated HIV infection.

How can cervical cancer and its treatment affect the daily lives of the women who get it?

For some women with cervical cancer, treatment may remove or destroy the cancer. Completing treatment can be both stressful and exciting. You’ll be relieved to finish treatment, yet it’s hard not to worry about the cancer coming back. This is very common if you’ve had cancer.

For other women, the cancer may never go away completely. These women may get regular treatments with chemotherapy, radiation therapy, or other therapies to try to

Control the cancer for as long as possible. Learning to live with cancer that does not go away can be difficult and very stressful.

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Unverbalise is ever the more grateful for this interview from Cervical Cancer Aid for Cervical Cancer Day. We hope to continue to bring in more amazing people to our platform to inspire our readers, so don’t forget to subscribe to our site and share the word around.

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