Cervical Cancer

What Is Cervical Cancer?

The cervix is part of a woman's reproductive system. It is the lower part of the uterus (womb).
The uterus is the hollow, pear-shaped organ where a baby grows during a woman's pregnancy.
The cervix forms a canal that opens into the vagina (birth canal), which leads to the outside of
the body. Cancer of the cervix (also known as cervical cancer) begins in the lining of the
cervix. Cervical cancers do not form suddenly. This condition usually develops over time.
Normal cervical cells gradually develop pre-cancerous changes that turn into cancer. Doctors
use several terms to describe these pre-cancerous changes, including cervical intraepithelial
neoplasia (CIN), squamous intraepithelial lesion (SIL), and dysplasia.

Cancer of the cervix is the second most common cancer in women worldwide and is a leading
cause of cancer-related death in women in underdeveloped countries. Most (80-90%) invasive
cervical cancer develops in flat, scaly surface cells that line the cervix (called squamous cell
carcinomas). Approximately 10-15% of cases develop in glandular surface cells (called
adenocarcinomas).

Causes of Cervical Cancer

The cause of cervical cancer is unknown. Most scientific studies have found that human
papillomavirus (HPV) infection is responsible for virtually all cases of cervical cancer.

• Human papillomavirus infection

• Multiple sexual partners
• Sexual intercourse at a young age
• Poor penile hygiene of the partner
• Herpes virus hominis type II infection
• A weak immune system
• Smoking
• Multiple pregnancies
• Have HIV

Sign & Symptoms of Cervical Cancer

Early cervical cancer is often asymptomatic (does not produce symptoms). In women who
receive regular screening, the first sign of the disease is usually an abnormal Pap test result.
Symptoms that may occur include the following:

• Abnormal vaginal bleeding (e.g., spotting after sexual intercourse, bleeding between
menstrual periods, increased menstrual bleeding)
• Abnormal (yellow, odorous) vaginal discharge
• Low back pain
• Painful sexual intercourse (dyspareunia)
• Painful urination (dysuria)

Cervical cancer that has spread (metastasized) to other organs may cause constipation, blood
in the urine (hematuria), abnormal opening in the cervix (fistula), and ureteral obstruction
(blockage in the tube that carries urine from the kidney to the bladder).

Diagnosis of Cervical Cancer

If the Pap test finds serious changes in the cells of the cervix, the doctor will suggest more
powerful tests such as a colposcopy. Diagnosis is made by doing a biopsy of the cervix, or a
magnified visual inspection of the cervix aided by using an acetic acid (e.g. vinegar) solution
to highlight abnormal cells on the surface of the cervix. . In this procedure, the doctor uses a
tool called a colposcope to see the cells of the vagina and cervix in detail.

If there are still some concerns of precancerous cells, the doctor may use the LUMA Cervical
Imaging System. The doctor uses this device right after a colposcopy. The colors and patterns
on the map help the doctor tell between healthy tissue and tissue that might be diseased.

Tests for Women with abnormal Cervix

Because the Pap test is a screening test rather than a diagnostic test, if you have an abnormal
result, you will need to have other tests colposcopy and biopsy etc.

• Colposcopy: If certain symptoms suggest cancer or if the Pap test shows abnormal
cells, you will need to have an additional test called a colposcopy. In this procedure
you will lie on the exam table as you do with a pelvic exam. A speculum is placed in
the vagina to expose the cervix. The doctor will use the colposcope to examine the
cervix.
• Cervical biopsies: Several types of biopsies are used to diagnose cervical precancers
and cancers.
• Colposcopic biopsy: For this type of biopsy, a doctor first examines the cervix with a
colposcope to find the abnormal areas. Using a biopsy forceps, he or she will remove
a small section of the abnormal area on the surface of the cervix. The abnormal area
of cervix around 1/8-inch is removed.
• Endocervical curettage: This procedure is usually done at the same time as the
colposcopic biopsy. A narrow instrument is inserted into the endocervical canal. Some
of the tissue lining the endocervical canal is removed by scraping with the curette.
• Conization: In this procedure, the doctor removes a cone-shaped piece of tissue
from the cervix.
• LEEP (LLETZ): The tissue is removed with a thin wire loop that is heated by
electrical current and acts as a scalpel.
• Cold knife cone biopsy: A surgical scalpel or a laser as a scalpel is used rather than
a heated wire to remove tissue.

Preventions for Cervical Cancer Only some women with pre-cancerous changes of the
cervix will develop cancer. This process usually takes several years but sometimes can happen
in less than a year. For most women, pre-cancerous cells will remain unchanged and go away
without any treatment. But if these precancers are treated, almost all true cancers can be
prevented.

• By getting regular Pap tests and pelvic exams, your health care provider can find and
treat the changing cells before they turn into cancer.
• By avoiding exposure to HPV
• Limiting your number of sexual partners
• HPV can spread through skin-to-skin contact with any infected part of the body, but
using a condom every time you have sex can significantly reduce your risk of
contracting HPV. Condoms provide some protection; it can reduce the infection rate
by about 70%.
• Vaccines have been developed that can protect women from HPV infections. Although
the vaccine could prevent up to 70 percent of cervical cancer cases, it can't prevent
infection with every virus that causes cervical cancer. Routine Pap tests to screen for
cervical cancer remain important.

Treatments of Cervical Caner

Pre-invasive stage
Treatment of cervical cancer in the pre-invasive stage, when it has affected only the outer
layer of the lining of the cervix, may include:
 • Conization: This simple surgery involves removing with a scalpel a cone-shaped
piece of cervical tissue where the abnormality is found.
• Laser surgery: This operation uses a narrow beam of intense light to kill cancerous
and precancerous cells.
• Loop electrosurgical excision procedure (LEEP): This technique uses a wire loop
to pass electrical current, which cuts like a surgeon's knife and remove cells from the
mouth of the cervix.
• Cryosurgery: This technique involves freezing and killing cancerous and
precancerous cells.
• Hysterectomy: This major surgery involves removal of the cancerous and
precancerous areas, the cervix and the uterus.

Invasive stage
Many women are treated successfully for invasive cervical cancer and live full, productive lives. Treatment
may involve:

• Hysterectomy: Surgery is usually recommended for younger women because it

often can preserve one or both ovaries along with their estrogen production, which is
important in maintaining bone strength.
• Radical trachelectomy: Women with early-stage cervical cancer may be able to
preserve their fertility by having this surgical procedure, which involves removing the
cervix and the lower part of the uterus.
• Radiation: High-energy rays shrink tumors by killing the cancer cells. The radiation
destroys the ability of cancer cells to reproduce.

These treatments are almost always effective in destroying precancers and preventing them
from developing into true cancers. You will need follow-up exams to make sure that the
abnormality does not come back. For further clarity about the Cervical Cancer please visit your
consultant.

Concerned Doctor
• Ajit Naniksingh Kukreja (M.S)
• S.M.Bose (MS,FRCS,FAMS,FTCS,FACG,FACS)
• sanjay d. kava (M.B.B.S. M.D.(medicine))
• Shekhar Pathak (M D Phy)
• RAMNARAYAN BHUYAN (MS(gen. surgery))
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