Guide to understanding cervical cancer
In this guide you will find everything you need to know about cervical cancer: what it is, its symptoms, diagnosis, treatments and alternatives.
What is cervical cancer?
The cervix is the lower part of the uterus, (where the fetus grows during pregnancy) which forms the channel leading to the vagina. The cervix has two different parts and is covered by two types of cells:
- Endocervix: the part of the cervix that is closest to the uterus. It is covered with glandular cells.
- Exocervix or ectocervix: the part closest to the vagina. It is covered with squamous cells.
These two types of cells are found in a place called the transformation zone, which changes depending on conditions such as age, pregnancy and births.
Cervical cancer cells start when the glandular or squamous cells, as in, those found in the transformation zone, start to grow uncontrollably. This does not happen from one moment to the other, but said cells transform gradually and can become cancerous.
Some strains of HPV (human papillomavirus) are causal agents of most types of cervical cancer. When HPV is contracted, usually the immune system stops the virus from doing any damage. However, in some women, the virus can survive for years, which leads to some cells on the surface of the cervix to transform into cancer cells.
If a woman smokes, has a lot of children, has taken contraceptive for many years or is infected with HIV, she has a greater risk of developing cervical cancer.
Symptoms
It is uncommon to show symptoms in the initial stages of cervical cancer. In general it takes several years for normal cervical cells to become cancerous. At that time, when the cancer has spread to the surrounding tissue, the following symptoms start to appear:
- Abnormal vaginal bleeding: bleeding after sex, after menopause, between periods, periods that last for a long time, or more than normal etc.
- Unusual vaginal secretion: liquid secretion that may contain some blood and appear between periods or after menopause.
- Painful sex.
Types of cervical cancer
The type of treatment depends on the type of cervical cancer. The main types of cervical cancer are:
- Squamous cell carcinoma. This is the most common type of cervical cancer. This starts in the flat and thin cells (squamous and epithelial cells) that cover the external part of the cervix, which opens towards the vagina.
- This type of cancer starts in the glandular cells in the shape of a column that covers the cervical canal.
Sometimes, both types of cells are responsible for cervical cancer. These types of tumors are known as adenosquamous carcinomas or mixed carcinomas. Only in very rare cases are cancer produced in other cervical cells.
Causes
One contributing factor to the development of premalignant lesions is HPV. However, it has not been confirmed that HPV is the direct cause of the cervical cancer. It is important to note that most women with HPV do not develop cervical cancer. What we do know, is that there are a number or risk factors that contribute to increasing a women´s (especially those who have been exposed to HPV) chances of suffering from cervical cancer.
Risk factors
Some of the factors that increase the risk of suffering from cervical cancer are:
- HPV: A chronic HPV infection, especially when it is caused by certain types of high-risk HPV, can eventually cause certain cancers, such as cervical cancer.
- Smoking: This is associated with carcinoma of squamous cells. What’s more, smoking causes the immune system to become less effective in fighting HPV infections.
- Weak immune system: The immune system is responsible for destroying cancerous cells, and delaying their growth and expansion. Therefore, if you have another disease that weakens this system, your chances of developing cervical cancer can be higher.
- A diet lacking fruits and vegetable: A diet low in vitamins, minerals and fiber can bring about a greater risk of cervical cancer.
Detection
The earlier cancer is detected, the sooner it can be treated and with a higher chance of success. Usually, it is recommended to start getting tested for cervical cancer and precancerous changes at the age of 21. Detection tests include:
- Pap smear: for this test, the doctor collects cells from the cervix, then examines them in a laboratory to detect anomalies.
This test allows for the detection of abnormal cells in the cervix, including carcinogenic cells and cells that show changed which may increase the risk of cervical cancer.
- DNA test for HPV: This includes the analysis of cells extracted from the cervix to detect an infection by any of the different strains of HPV that have a higher chance of resulting in cervical cancer.
Diagnosis and exams
If you show certain symptoms that could suggest cervical cancer, or if the results of the pap smear show the presence of abnormal cells, it is necessary to carry out additional testing to diagnose cervical cancer.
1. Colposcopy: as a primary measure, a doctor must make a full examination of the cervix. using an instrument with special magnifying lenses (colposcope), which allows the doctor to observe the surface of the cervix close up and check for any abnormal areas. If abnormal cells are found, a small piece of tissue will be extracted (biopsy) to be sent to a laboratory and examined under a microscope. A biopsy is the best way to determine if an abnormal area is precancerous, cancerous or neither:
The biopsy can be carried out in the following four ways:
- Needle biopsy: Small samples of tissue are taken from the cervix using a needle.
- Endocervical scraping: A tissue sample is taken from the cervix using a small instrument in the form of a spoon (scraper) or a fine brush
If the results of the needle biopsy or the cervical scraping are alarming, the doctor will carry out one of the following additional tests:
- Loop electrosurgical excision procedure (LEEP): A thin, low-voltage electrical wire is used to obtain a small sample of tissue. In general, this procedure is carried out in the doctor’s office and the patient receives local anaesthetic.
- Surgical conization or cone biopsy: Samples are obtained from a piece of tissue (in the shape of a cone) from the deepest layers of the cervix, to be analyzed in a laboratory. This procedure is carried out in hospital and the patient receives general anaesthetic.
2. Imaging studies
If your doctor finds signs of cervical cancer, imaging studies can be carried out to examine what is happening in detail. These studies show whether the cancer has spread and where, which is key for deciding on a suitable treatment. Among these imaging studies are:
- Chest x-ray: serves to determine whether the cancer has spread to the lungs
- Computerized tomography: performed if the tumor is larger or to check if it has spread
- Magnetic resonance imaging, MRI: shows the soft tissue in the body, which helps to identify the state of the cancer
- Intravenous urography: also known as an intravenous pyelogram or IVP, it consists of an x-ray of the urinary system, taken after injecting a special dye into a vein, through which any abnormal areas in the urinary tract are identified, caused by the spread of cervical cancer.
- Positron emission tomography, PET scan: uses glucose that contains a radioactive particle. The cancerous cells in the body absorb large quantities of sugar and a special camera can detect such radioactivity.
Stages of cervical cancer
To determine the appropriate treatment, it is also essential to identify the specific stage of the cancer. The stages of cervical cancer are as follows:
- Stage I: the cancer is only present in the cervix.
- Stage II: the cancer is present in the cervix and also the upper part of the vagina.
- Stage III: the cancer has spread internally to the lower part of the vagina or the lateral wall of the pelvis.
- Stage IV: the cancer has spread to nearby organs, such as the bladder or the rectum, or to other parts of the body such as the lungs, liver or bones.
Treatments
The type of treatment depends on many factors, but the most common are surgery, radiation, chemotherapy, targeted therapy and immunotherapy.
Surgery
Depending on the size of the tumor and the stage of the disease, the malignant tissue, the entire cervix, the uterus (preserving the ovaries and the fallopian tubes, or not) can be surgically removed, along with the regional lymph nodes. The types of surgery are:
Conization
This is the same as a cone biopsy, which we mentioned previously as a method of diagnosis. This treatment is used if the cancer is microinvasive.
Radical cervicectomy or trachelectomy
During this surgery, the cervix is removed and the pelvic lymph nodes are dissected, but the uterus is left in tact. This treatment is often recommended for young women who want to preserve their fertility.
Hysterectomy
There are two types: With a simple hysterectomy the uterus and the cervix are removed, and with a radical hysterectomy, the upper part of the vagina is also removed, along with the tissue surrounding the cervix and the pelvic lymph nodes.
Pelvic exenteration
The uterus, vagina, lower colon, rectum and/or bladder are removed if the cancer has spread to these organs following radiotherapy.
Radiotherapy
Radiotherapy can be used alone, or as a single treatment before surgery, or in combination with chemotherapy.
Chemotherapy
This treatment is administered to eliminate malignant cells intravenously, attacking any cells that may remain following radiotherapy.
The most common side effects are nausea, vomiting, diarrhea, fatigue, loss of appetite, low hemoglobin levels, bleeding or bruising, numbness or tingling in the hands and feet, headache, hair loss and darkening of the skin and nails. These symptoms do not appear simultaneously and usually disappear once the therapy as ended.
Targeted therapy
For this treatment, medication or other substances are used to identify and attack specific cancer cells without damaging normal cells.
Immunotherapy
This therapy consists of using medication to stimulate the patient’s immune system, so that it can effectively recognize and destroy the cancer cells. Immunotherapy can be used to treat cervical cancer that has spread or come back (recurred).
Complementary treatments
These therapies work alongside conventional treatments.
Meditation
An alternative that costs nothing and depends entirely on you, is to take time for yourself. Focus on yourself, meditate, feel every part of your body, learn to understand yourself; A bit of self-awareness can help you understand what is happening with your body and learn how to best fight your disease.
Cannabis*
Cannabinoids ease general discomfort, which contributes to the improvement of nausea and vomiting, stimulating appetite and reducing the pain that can be caused by treatments like chemotherapy and radiotherapy.
Together with conventional treatments, cannabinoids can promote the death of tumor cells, reducing their potential to spread and metastasize.
*Always check to see if it is legal in your jurisdiction before obtaining any cannabis-based product.
Healthy habits
Physical activity is recommended for general wellbeing, but it is even more important if you are suffering from cancer. Exercising will improve blood flow and help your metabolism work more effectively. Also try to maintain a balanced diet, rich in fruit and vegetables.
Coping and support strategies
If you have been diagnosed with cervical cancer, or you know a friend or loved one who has, here are some alternatives to help you cope with this news. We know that a cancer diagnosis can pose a huge emotional challenge. Everyone deals with it in their own way, but if you have yet to find out what works best for you, you can try some of the following options.
Know your cancer
The more informed you are about your cancer, the easier it will be to make decisions when it comes to choosing a treatment. Don´t be scared or embarrassed to ask your doctor or look for information in reputable sources. If you would like to know more about cancer, you can visit our full article here
Surround yourself with friends and family
Talking to someone close to you who understands you and supports you, is very important. Knowing that you are supported can help you deal with your diagnosis and make a huge difference. Your wellbeing starts with how you feel.
Find someone to talk to
Find someone who is ready to listen to you and talk to you about your hopes and fears. If you prefer, you can also talk to a therapist, doctor or someone from a support group. It is important to express your thoughts and feelings, to feel heard and to not keep your fears to yourself.
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