Cervical Cancer

A Brief about Cervical Cancer

Cervical cancer occurs due to the uncontrollable growth of cells in the cervix. This abnormal growth of cells can seize the space of nearby tissues and spread across the entire body. Eventually, this growth of cells leads to the formation of cancer tumors. At the initial stage of cervical cancer, cells multiply at a slow rate, although they can catch speed and spread quickly.

Commonly found cervical cancer is known as squamous cell carcinoma. The origin of this type of cervical cancer is due to the abnormal growth of squamous cells that lie on the surface of the cervix. This type of cervical cancer contributes up to 80% of all kinds of cervical cancers. The development in oncology has substantially increased the survival rate for most cervical cancer patients. With research, doctors are studying the various possible causes of cervical cancer and approaching early medication and treatment.

What are the types of Cervical Cancer?

Every cervical cancer patient is different. Cervical Cancer starts due to the abnormal growth of cells that line the cervix. If not treated at an early stage, these abnormal cells turn cancerous. Cervical cancer types are of two primary forms: Squamous cell carcinoma and Adenocarcinoma.

 

1.Squamous cell carcinoma: The most common type of cervical cancer is squamous cell carcinoma, which is usually witnessed near the areas of the body that are damaged by UV rays from the sun or due to tanning beds. A slow-growing type of cervical cancer, SCC spreads to the nearby tissues, bones, lymph nodes, which results in urgent treatment and medication. Below are the risk factors that can develop SCC:

 

  • Aging
  • Indefinite exposure to radiation
  • Tanning beds and bulbs
  • Exposure to chemicals like arsenic in the water

 

At an initial stage, SCC can be treated with a minor surgery by the best cervical cancer hospitals. The size and the location of the squamous cell determine the further action taken by the doctors.

 

2.Adenocarcinoma: This type of cancer can occur in places like colon, breasts, esophagus, pancreas, lungs, or prostate. It is a type of cancer that begins in the glands that are lining the organs. In Adenocarcinoma, the growth of cells becomes uncontrollable and spreads to other organs, harming the healthy tissues of the body. Adenocarcinoma can happen in the following parts of the body:

  • Colon and Rectum: Adenocarcinoma starts with a small polyp at first but can turn into a cancerous tumor. Under rectum, this cancer type can start from the place where stool is excreted from the body.
  • Breasts: Adenocarcinoma starts with the uncontrollable growth of tissues in the glands of the breast where the milk is formed.    
  • Esophagus: Adenocarcinoma begins in mucus glands that provide a lining to the lower part of the esophagus.  
  • Pancreas: Adenocarcinoma starts in the ducts of this organ.
  • Lungs: Adenocarcinoma commonly affects the outer part of the lungs and starts developing slowly – habits like smoking results in Adenocarcinoma Lung cancer.

Symptoms of Adenocarcinoma include acute pain, diarrhea, abnormal bleeding, unusual fatigue.  Consult a doctor for  physical examination if you feel major swelling in any of the body parts.

What are the early signs of Cervical cancer?

Usually, there are no signs and symptoms of cancer at a very early stage. For most women, within the early stage of cervical cancer, early signs do typically appear depending on the severity of the issue and to which level the disease has spread. Potential symptoms of cervical cancer are as follows:

 

  • Infrequent spotting or light bleeding between or after periods
  • Menstrual bleeding exceeds the usual number of days.
  • Abnormal bleeding after intercourse, douching or after a pelvic examination
  • Increased vaginal flow or discharge
  • Bleeding after complete menopause
  • Chronic back pain, Persistent Pelvic Pain

If any of the above signs of cervical cancer and symptoms are observed, report to a doctor immediately. The earlier precancerous cells can be treated with medical facilities and minor surgery. If there is a frequent experience of any of the above symptoms, the  concerned physicians will examine your medical history and question you about how often you’ve been experiencing the symptoms. This will help for further diagnosis.

What are the causes of Cervical Cancer?

During recent years, there has been a lot of development and progress in comprehending what happens to the cells in the cervix when a form of cancer develops. There are several causes of cervical cancer that have been identified as reasons to develop cervical cancer.

 

Cancers are generally caused by DNA mutations, also known as gene defects that specifically turn on oncogenes or turn off tumor suppressor genes. HPV, the short abbreviation for Human Papillomaviruses, contain two proteins named E6 and E7, which deactivate some of the tumor suppressor genes, known as P53 and Rb. As a result, this allows the cells lining the cervix to grow invariably and develop additional genes leading to cancer.

As per a study, HPV is not the definite cause of cervical cancer. Women with HPV usually  don’t get cervical cancer. Other risk factors like smoking and HIV infection become the main reason why women are exposed to develop cervical cancer.

How to prevent Cervical cancer

It is vital to make the necessary changes in the lifestyle to reduce the risk of getting cervical cancer. The following are multiple steps that women can take to prevent cervical cancer. This includes:

  • Regular Pap Testing: With regular checkups, one can remain aware of underlying symptoms or early stages of cervical cancer. 
  • Proper Vaccination: Three vaccines named Gardasil, Gardasil 9, and Cervarix have been developed to maintain immunity balance and increase the fighting power of cells. The HPV Vaccine is recommended for individuals ranging from 12-26 years of age. These vaccines are found to be effective in preventing infection with some strains of HPV. HPV can also lead to vulvar, vaginal, penile, and anal cancers if proper vaccination is not taken.
  • Quit smoking: Tobacco, in recent years, has been the major reason for a decrease in immunity in most of the cases, paving the way for cancerous growth of cells. 
  • Limiting the number of sexual partners, or using the right protection, can reduce the risk of infection found in cervical cancer stages.
  • Under most circumstances, it is advised to consult your respective dermatologist for routine skin checks. Also, avoid exposure to the sun during peak hours like noon. For delicate areas of skin, use sunscreen daily to avoid irritation and itchy skin. Avoid tanning beds as well.

Risk factors involved in Cervical Cancer:

Risk factors concerning the growth of cancer in the cervix are due to multiple reasons. According to a recent study, cancer hospitals have identified proper risk factors based on studying women affected by cervical cancer.  In most cases, cervical cancer is caused by HPV, a common virus that can be passed from one person to another during sexual intercourse. There are types of HPV which can either cause changes in a woman’s cervix or cause genital and skin warts. Other factors that can increase the risk of cervical cancer are listed below:

  • Diagnosed with HIV or another condition that makes the immunity of the body weaker
  • Aggressive smoking
  • Consumption of birth control pills for a longer period of time
  • Having several sexual partners.

Diagnosis of Cervical Cancer:

Symptoms of cervical cancer will require an immediate diagnosis. The diagnosis of cervical cancer is made after detecting certain abnormal growth of cells in the routine checks. List of diagnostic procedures are as follows:

Colposcopy: When diagnosed with cervical cancer, the next step is colposcopy. This test looks for  abnormalities in the cervix and is conducted by a nurse, who is specifically called a colposcopist. The concerned colposcopist will use a device named speculum to open the woman’s vagina (also a part of cervical screening). Doctors would use a microscope for thorough examination. 

To understand the growth of cancerous cells, a small part of the tissue is collected as a sample to examine the cervix; the procedure is called a biopsy. After a biopsy is done, the patient can encounter vaginal bleeding for a time period of 6 weeks.

Remember, not all abnormalities confirm cancer symptoms, so consult a gynecologist for further treatment. 

After the results of the colposcopy confirm to be positive, the next steps work towards confining the cancer cells and stopping them from spreading to other parts of the body. Some further tests are prescribed for detailed report analysis:

  • Pelvic examination  is done under general anesthetic, the womb, vagina, rectum, and bladder will be checked for cancerous cells.
  • Blood tests: Some blood tests are done to assess the condition of the liver, kidneys, and bone marrow.
  • CT Scan: A CT scan report will help the oncologist to identify cancerous tumors cells and whether they have started to spread to nearby areas.
  • PET Scan: This test is combined with a CT Scan to see if the cancerous cells have started to grow uncontrollably and also to check if the patient is responding to the current medication prescribed.
  • Pap Smear: Also known as Pap Test, Pap smear is a procedure to test for cervical cancer in women. This test involves collecting the cells from the cervix. Early detection of cervical cancer through the pap smear test gives you a greater chance for it’s  cure.

Treatment for various stages of Cervical cancer

Cancer treatments are often complex, with different cancer patients showing positive results to different treatments. Best cervical cancer treatments involve using multidisciplinary teams, MDTs, to treat cervical cancer and adapt the treatment program for the cancer patient.

Various treatment options are available at the best cervical cancer hospitals such as Chemotherapy or subjected therapies, Radiation therapy, Surgeries, Hormone therapy, Immunotherapy, and Bone marrow or stem-cell therapy.

Staging is a measurement to know how far the cancer has spread. After conducting various cancer tests, cervical cancer stages are analyzed.

1.Stage 0: 

Precancerous cells are present. Stage 0, also known as Carcinoma in situ, is treated  by providing local ablative or by performing excisional measures such as:

  • Cryosurgery: A type of surgery that is performed by expert surgeons. Under this surgery, the abnormal tissues are destroyed by using extremely cold temperatures. It involves the usage of liquid nitrogen, carbon dioxide, and argon.
  • Laser ablation: This is the process of removing abnormal cervical cells through laser therapy so that healthy cells can grow back in its place.

The survival rate under stage 0 cervical cancer is 100%, as the cancerous cells can be treated at the initial stage. According to a study, more than 90% of the women survive for five years after stage 0 diagnosis.

 

2.Stage 1

 

In stage I, cancer cells are detected and can be found in the cervix only. Stage I is then divided into stages IA and IB, depending on the size of the tumor and the deepest point of invasion.

  • STAGE IA: Under this stage, there are sub-categories known as IA1 and IA2, depending on the deepest point of tumor invasion.
  • STAGE IA1: Small amounts of cancerous cells are seen with the help of a microscope. The deepest point of tumor invasion is 3 millimeters or less.
  • STAGE IA2: The deepest point of invasion is more than 3 millimeters but less than 5 millimeters. This stage can be seen under a microscope in the tissues of the cervix.

 

  • STAGE IB: STAGE IB is categorized into stages IB1, IB2, IB3, based on the size of the cancer cell and the deepest point of tumor invasion.
  • STAGE IB1: Under this stage, the tumor cell is sized up to 2 centimeters or smaller, and the point of invasion is more than 5 millimeters.
  • STAGE IB2: The cancerous tumor is larger than 2 centimeters but lesser than 4 centimeters.
  • STAGE IB3:  Under this stage, the tumor is seen under a microscope and is larger than 4 centimeters.

To eliminate such early cervical cancer signs, Hysterectomy is followed by a course of radiotherapy to prevent the cancer from coming back. Two types of hysterectomies are designed to treat cervical cancer:

  • Simple Hysterectomy: Some parts of the woman’s reproductive system, namely the cervix, womb, ovaries, and fallopian tubes, are removed. 
  • Radical Hysterectomy:  Preferred mode of treatment only when the cancer reaches stage 1 or an early stage 2 cervical cancer. The cervix, womb, top of the vagina, surrounding tissues, lymph nodes, fallopian tubes, and if advised, ovaries are all removed.    

For women who are in Stage I of cervical cancer have 80-90% chances of survival given the treatment options are performed.

 

3.Stage 2:

 

Under STAGE II, the cancerous cells have reached the upper two–thirds of the vagina and across the tissue around the uterus. STAGE II is divided into STAGES IIA and IIB, depending on how far the tumor cells have spread:

  • STAGE IIA:  In this case, the cancer cells have spread from the cervix to the upper two-thirds of the vagina but have not reached the tissues around the uterus. STAGE IIA is categorized into STAGES IIA1 and IIA2, based on the size of the tumor.
  • Under STAGE IIA1: The cancerous tumor is 4 centimeters or smaller
  • Under STAGE IIA2: The tumor is larger than 4 centimeters.
  • STAGE IIB: The cancer has escalated from the cervix to the tissue surrounding the uterus.

Radiotherapy can be used with another form of surgery for the elimination of cervical cancer at Stage 2. Radiotherapy can be delivered either:

  • Externally: A machine with high-radiative energy is used to beam waves into the pelvis to remove cancerous cells.
  • Internally:  In such cases, a radioactive implant is planted beside the tumor inside the vagina. This treatment is known as Brachytherapy, which aims to lessen the harm to the surrounding tissue by administering the radiation closer to the tumor.

Chemotherapy : This treatment option involves using either a single chemotherapy drug or a merger of different medical drugs to destroy the cancer cells. This treatment is used to slow the progression of cancer cells and relieve its symptoms. Chemotherapy is given directly into the vein using a drip.

According to a recent study, approximately 60% of cervical cancer patients survived after 5 years from their radiation therapy. However, along with chemotherapy, survival chances are improved.

 

4.Stage 3:

 

In the section of STAGE III, the cancer has spread to the lower third of the vagina and/or to the pelvic wall and/or has caused kidney issues. STAGE III is categorized into STAGES IIIA, IIIB, and IIIC, depending on how far the cancer has spread.

  • STAGE IIIA: The tumor has spread to the lower section of the vagina but not to the pelvic wall
  • STAGE IIIB: Cancer has crossed the pelvic wall, and/or the tumor has grown enough to block one or both the ureters or has caused any of the kidneys to function abnormally.
  • STAGE IIIC: STAGE IIIC is divided into further two stages; IIIC1 and IIIC2, depending on the increased rate of cancer cells to the lymph nodes:
  • STAGE IIIC1: Cancer has advanced to the lymph nodes in the pelvis.
  • STAGE IIIC2: Cancer has now reached to the lymph nodes in the abdomen near the aorta.

Trachelectomy: When cervical cancer is identified at the stage III, then this treatment is best suited for the cancer patient. During this procedure, the cervix and the upper section of the vagina are removed. The womb sits at its original place and will be reattached to the lower section of the vagina. Also, it is advised to wait for a period of 6 to 12 months to conceive as the womb and vagina needs time to heal.

Cervical Cancer patients with stage III experience a 5-year survival rate of 63%. The chances of the cancerous cells hitting back are reduced to 42% by providing best-in-class treatment.

 

5.Stage 4:

 

Under STAGE IV, the tumor has spread beyond the pelvis or has spread nearby to the lining wall of the bladder or rectum, or has extended to the other tissues of the body. STAGE IV is divided into further two stages IVA and IVB:

  • STAGE IVA: The cancer has developed in the nearby organs such as the bladder or rectum.
  • STAGE IVB: Cancer has passed on to the other parts of the body like the liver, lungs, bones, or distant lymph nodes.

Large Loop Excision of the Transformation Zone (LLETZ): Under this cancer treatment, the cancerous cells are removed by using a fine wire with an electric current. This treatment is done by giving local anesthetic and can be performed at the same time as a colposcopy.

Cone Biopsy: During this surgery, surgeons remove a cone-shaped area of the abnormal tissue. This is usually performed under general anesthetic.

Pelvic Exenteration: This cancer treatment option is usually recommended when cervical cancer hits back after its first treatment and diagnosis. This surgery is performed if the cancer returns to the pelvis but has not started to spread beyond that area. A pelvic exenteration has two phases:

  • The cancerous cells, along with the vagina, are removed. In some cases, it might involve removing the bladder, rectum, or lower section of the bowel.      
  • Stoma holes are created in the tummy, which allows passage of stool and pee out of the body into pouches known as colostomy bags.

Stage IV cervical cancer patients have a survival rate of 57%, based on the treatment options mentioned above. The patients who are diagnosed in stage IV and decide not to continue with the treatments mentioned above have a lifespan of 6 months to a year.

Integrative Treatment for Cervical Cancer:

Some of these treatments cannot ascertain the total recovery of cancer patients. The patients are advised and recommended to make minor changes in their living environment, diet plans, sleep patterns, workout schedule that will help reduce the stress after a particular treatment. Support from the community, cervical cancer awareness programs, and attending workshops that address cervical cancer survivors and promote routine checkups also help in a major part of the recovery.

Life in Remission

Cervical cancer survivors need to make changes in their lifestyles to undergo successful remission. Symptoms like acute fatigue, unusual pain may also ease up or stop completely. Under remission, it is recommended to see a doctor for a routine checkup to make sure it doesn’t start up again.  Remission is of two types:

Partial: The medical examinations and treatments given have destroyed the cancerous cells to an extent, but tests show they might still have some side effects.

Complete: All signs of cancer are gone.

All cervical cancer treatments have some side effects that might stay for a while. Consult an oncologist to decide which treatment suits best. Once in remission, take these healthy steps to keep the cancer at bay:

  • Consume a balanced diet that involves the intake of fresh fruits, veggies, and whole grains.
  • Quit smoking.
  • Maintain a balanced weight by exercising and practicing fitness regimes.
  • Avoid alcohol consumption to a moderate extent
  • Participate in anger management or stress management classes.

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  • Nourish yourself: It is vital to consume nutritious food, which is rich in antioxidants, good fats, vitamins, and minerals, especially after months of Chemotherapy and other targeted therapies. Maintaining a healthy diet is crucial towards developing a strong immunity, and working towards a healthy life in remission. 
  • Stay fit : After undergoing months of cancer treatment and therapies, it is essential to maintain a healthy weight and positive outlook towards life. Invest your time in light exercises, yoga sessions, meditation, and try to maintain a normal lifestyle by indulging in your day to day activities.
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