Cervical Cancer: What to Know

Cervical cancer is diagnosed most often between the ages of 35-44. It’s rare to develop in women younger than 20-years-old. However, many women on the older side of the spectrum may be unaware that cervical cancer is a disease that progresses slowly. Most of the symptoms won’t manifest in a patient until the latter stages of the disease. Many women may also consider the first symptoms related to something else; they might believe that the symptom is related to a yeast infection, their menstrual cycle, or even a urinary tract infection. While there may be no noticeable signs in the early stages, the symptoms become more apparent as cancer grows and spreads to nearby tissue.

And as with all cancers, speed of detection is critical. Early detection vastly improves the chances of survival, reduces the risk of complications, and makes treatment more likely to be effective. Through preventative methods and keeping a sharp eye on the early warning signs, women can detect cervical cancer earlier.

Earliest Symptoms

Here are the most common symptoms associated with the onset of the disease:

• Abnormal vaginal bleeding – This symptom could become apparent after vaginal sex and between period cycles in women. Bleeding may become heavier than usual during periods themselves. Women who are already in menopause could also experience bleeding. Women who douche may also notice abnormal bleeds.
• Unusual vaginal discharge – While vaginal discharge is normal, there is cause for concern when the discharge has an unusual smell or signs of blood and occurs between periods and after menopause. The discharge may also be watery.
• Pain during vaginal sex – Another often-overlooked symptom is pain during sex for women. Some women may dismiss it as usual discomfort with sex, but significant pain (or if accompanied by blood) during sexual contact is a symptom.
• Frequent and painful urination – Often mistaken for a urinary tract infection, this symptom is another early indicator of cervical cancer, especially if accompanied by pain during urination.

These early symptoms may turn out to be nothing, but it is crucial to see a doctor and have an exam to rule out any possibility of cervical cancer or to detect it as early as possible. Other vital symptoms to look out for often appear in the cancer’s more advanced stages.

These include:

• Swelling in the legs
• Difficulty in urination or during bowel movement
• Bloody urine
• Persistent pain in the back, leg, or pelvic region
• Unusual weight loss, fatigue, and a loss of appetite
• Unpleasant-smelling discharge and vaginal discomfort

Again, these symptoms could indicate another condition other than cervical cancer, but it’s essential to have them checked immediately. As always, experts recommend regular screening tests instead, as the best chances of a successful treatment happen when the patient does not wait for symptoms to appear in the first place.

HPV is a significant cause of cervical cancer. Recent years have revealed a substantial amount of information that gives doctors a better understanding of cervical cancer and its development.

Cervical cancer is considered the second most common cancer in women living in underdeveloped regions. There are an estimated 570,000 new cases in 2018 in these areas, 84% of all worldwide cases. Approximately 311,000 women died in 2018 from cervical cancer, with the ratio skewed toward low- and middle-income countries. Around the world, cervical cancer is the fourth most frequently diagnosed cancer in women.

Several risk factors could lead to a woman developing cervical cancer.

HPV infection

This is the most critical risk factor in developing cervical cancer, responsible for many cases around the world. HPV can affect numerous areas of the body, not just the cervix. It can infect the skin, genital lining, mouth, throat, and even the anus. However, it does not affect the blood or other internal organs. HPV spreads during skin-to-skin contact between people, primarily through sexual activity. It’s a significant risk during vaginal, anal, and even oral sex. Chronic HPV infections can lead to severe cancers and not just cervical cancer.

Sexual history

People who have become sexually active at a young age, especially before the age of 18, have a higher risk of getting infected with HPV and are more at risk of developing cancer. Having a more significant number of sexual partners also increases that risk. People who have a partner who is considered high risk are, in turn, making themselves high risk for cancer.

Smoking

Smoking exposes an individual to numerous cancer-causing factors, thus heightening the likelihood of developing cervical cancer. Women who smoke are twice as likely to develop cervical cancer than those who do not. Tobacco byproducts have been found in the cervical mucous of women who regularly smoke. Researchers believe that the substances the body absorbs through smoking travels through the lungs and is carried by the bloodstream through the body. They finally end up damaging the DNA of cervix cells.

Weak immune system

Women who have weaker immune systems are more susceptible to HPV infections. HIV (human immunodeficiency virus), which causes AIDS, is one such cause of weaker immune systems, leading to a higher HPV risk. A job of the immune system is to slow pre-cancer and cancer cells' growth and prevent them from spreading. But for a woman with weaker immunity, the pre-cancer cells might develop into invasive cancer faster than average.

Other Sexually Transmitted Agents

Exposure to other infections like chlamydia, herpes simplex, syphilis, and gonorrhea cause issues like inflammation or weakens the body’s defense against other similar infections. It puts the patient at additional risk of getting HPV, which can also be sexually transmitted.

Long-term contraceptive use

Some studies also show evidence that long-term use of OCPs or oral contraceptives can increase the likelihood of cervical cancer. However, the risk goes down as she stops taking them, eventually returning to normal risk levels years later.

Multiple pregnancies

Women with three or more pregnancies carried to full term also have an increased risk of cervical cancer. Some studies indicate that this could be due to the hormonal changes that could make women more susceptible to HPV infections or cancer growth in the area. Another theory suggests that pregnant women’s immune systems might be weaker.

Economic status

Numerous low-income women do not have as much access to healthcare or may not be able to afford regular cervical cancer screening or vaccination against HPV. This puts them at greater risk of contracting the virus and having it develop into invasive cancer without realizing it was there until the cancer advanced to later stages.

Diethylstilbestrol

This is one risk factor for cervical cancer that has no real solution. DES is a hormonal drug that had been prescribed to women between 1938 to 1971. At the time, its purpose was to prevent miscarriages. Women with mothers who took the drug during pregnancy developed clear-cell adenocarcinoma in the vagina or their cervix more frequently than expected. These cancers are extremely rare otherwise. Their daughters, in turn, have an increased risk of developing squamous cell cancers and pre-cancers.

Cervical cancer is diagnosed through a combination of screening and diagnostic tests. Screening for any pre-cancerous cells or indications of cervical cancer should ideally begin at age 21.

Screening Tests

• Pap Test - The doctor scrapes and brushes cells from the cervix, and the cells are then examined for any abnormalities.
• HPV DNA Test – Cells collected from the cervix are tested for the presence of an HPV infection that could lead to cervical cancer.

Diagnostic Tests

• Punch Biopsy – Using a sharp tool to excise small samples of cervical tissue, doctors can biopsy the samples for the presence of cancer or pre-cancerous cells.
• Endocervical Curettage – Doctors use an instrument called a curet, a spoon-shaped tool, to scrape a tissue sample for biopsy.
• Electrical Wire Loop – A thin electrical wire is used to emit a low-voltage that then picks up a tissue sample. This is done under local anesthesia.
• Cone Biopsy or Conization – Doctors may use this test to collect cervical cells from deeper layers for more comprehensive laboratory testing. This procedure is done under general anesthesia.

Staging tests are performed when a doctor confirms a diagnosis of cervical cancer. These tests can indicate how far along the disease has advanced and allows doctors to make better treatment decisions.

These include:

• Imaging tests – Doctors use X-rays, CT, and MRI to check cancer's spread through or beyond the cervix.
• Visual bladder and rectum examination – Through select scopes, doctors visually check the condition of these areas.

Medications:

The FDA has approved several drugs to prevent and treat cervical cancer. Vaccines like Cervarix, Gardasil, and Gardasil 9 are used to prevent and protect against HPV infection. Drugs used to treat cervical cancer include Avastin, Bevacizumab, Bleomycin Sulfate, Hycamtin, Keytruda, Mvasi, Pembrolizumab, and Topotecan Hydrochloride.

Diet & Lifestyle:

The first and most widely-recommended lifestyle change. to prevent cervical cancer is to schedule vaccinations for both girls and boys. Furthermore, avoiding multiple sexual partners can significantly reduce the risk of contracting HPV. Doctors also recommend a diet rich in fruits and vegetables, focusing on carotenoids and folate foods. These include legumes, whole grains, fruits, and vegetables.

Therapy and Procedures:

Surgery is one of the primary procedures performed to treat cervical cancer, especially in the early stages. The type of surgery needed will depend on the cancer’s size and stage.

• Cone biopsy – Surgery to cut away malignant cells can be performed for small cancers. It may be possible to remove cancer through a cone biopsy altogether as well.
• Trachelectomy – This procedure is performed for early-stage cervical cancer. It removes the cervix along with the surrounding tissue. For women who still want to get pregnant, the uterus remains intact.
• Hysterectomy – Through a radical hysterectomy operation, the cervix, uterus, part of the vagina, and lymph nodes may be removed, curing early-stage cancer and preventing recurrence. However, this also makes it impossible to become pregnant.

Radiation and chemotherapy are other procedures performed to treat cervical cancer, directing radiation and targeted drug treatments to kill the cancer cells growing in the cervix.

Today, research into cervical cancer continues. In recent years, having accurate data on the course and treatment of cervical cancer has become critical to research on cervical cancer. And because HPV is an infectious disease, the careful study of infection, patient history, family, and regular screening has become extremely valuable to understanding the underlying causes of cervical cancer. Collecting data through medical records is one of the most powerful tools doctors and scientists have to better understand HPV and cervical cancer.

By digitizing medical and patient records, doctors can get a more accurate view of patients’ family and treatment histories. Knowing if their mothers also developed cervical cancer, their sexual partners' health, and how often they were screened can make a world of difference in patient care. Doctors can request the right tests, make the right diagnoses, and prescribe better treatments.