What is Cancer?

Over 100 diseases make-up the complex group called Cancer. The common link among them is uncontrolled cell division and the ability of these cells to spread to other tissues. This is done by the cells migrating to other sites in the body, known by the medical term metastasis, or simply growing into adjacent tissue, known as an invasion.

Caused by DNA damage, the unregulated growth of these cells brings about mutations to vital genes that control several functions, including cell division. These mutations, which can be inherited or acquired, can lead to the formation of a tumor, an abnormal mass of tissue. Not all tumors are malignant (cancerous), upon biopsy many turn out to be benign (not cancerous). Benign tumors are unable to metastasize or invade.

Most cancers can be treated and many can be cured. Much depends on how early the cancer is diagnosed and treatments started. If untreated, most cancers eventually end in death.

What is a Cervix?

The cervix is the lower end of the uterus through which the cervical canal passes, allowing sperm to pass from the vagina into the uterus, and the menstrual flow and the fetus to pass from the uterus into the vagina.

Symptoms of Cervical Cancer

Usually patients with dysplasia (abnormal cells, not yet cancerous) or carcinoma in situ do not experience any symptoms, making screening tests of vital importance. When the cancer becomes invasive, there may be abnormal bleeding, bleeding after menopause, longer/heavier periods, increased vaginal discharge, discolored vaginal discharge, pain during intercourse, or pelvic pain. Because any or all of these symptoms could also be evidence of a sexually transmitted disease; it is important to see a doctor for a proper diagnosis and treatment of any problem.

Testing and Diagnosis

The Papanicolaou test, much more commonly known as can detect cancerous or precancerous cells on the cervix. The vagina is held open by a device called a speculum, and the doctor swabs or scrapes cells from the cervix and the canal to be observed under microscope. This is an office procedure which is usually painless, although many women do report feeling discomfort or pressure.

Colposcopy is a procedure in which a colposcope (a sort of magnifying glass) is used to closely examine the cervix. A biopsy (tissue sample) will be taken of any abnormal areas. This can also be done in the doctor’s office, lying in the same knees up position as the Pap smear and with a speculum to hold the vagina open. If biopsies are needed, you will have local anesthetic. If the abnormal cells go further up the canal than can be seen with the colposcope, you will have a cone biopsy.

A cone biopsy is a minor operation in which the doctor cuts out a cone of tissue from your cervix. The cone includes the whole area of the cervical canal where there is a possibility of abnormal cells. Menstrual type pains are frequently reported after this procedure and it is normal to have bleeding for up to 4 weeks after.

This is usually done under general anesthesia. You might have a same-day surgery hospital stay or you might stay overnight. The Pap smear and the colposcopy can be given to pregnant women. The cone biopsy can weaken the cervix and bring on a miscarriage, and there may be effects on future pregnancies. All that being said, if your doctor suspects cervical cancer, especially an advanced stage, it might be something that will be brought up as a possibility and discussed.

Treatment

Once the patient has been diagnosed as having cancerous cells on the cervix, more tests will be done to find out if it has spread to other parts of the body; this is called staging. There are several tests performed to determine the stage of the cancer, including palpation, colposcopy, endocervical curettage, hysteroscopy, cystoscopy, proctoscopy, and X-ray.

• Palpation is an examination done with the hands; the doctor feels for abnormalities.
• Colposcopy is a procedure in which a special microscope is inserted into the vagina to get a close up look at the cervix.
• Endocervical curettage is the process of scraping the endocervix (opening of the uterus) with a spoon shaped instrument (curette) in order to get a tissue sample.
• Hysteroscopy is a procedure in which a small scope is used to look into the cavity of the uterus.
• Cystoscopy is a telescopic inspection of the bladder and the urethra.
• Proctoscopy is an examination of the rectum using a thin, lighted tube called a proctoscope.
• X-ray examination of the lungs and skeleton involve pictures taken with electromagnetic radiation.

The treatment used for cervical cancer depends on the size of the tumor, the stage of the disease, the patient’s desire for children, and the patient’s age and overall health. If a woman is pregnant, those things will be considered along with how far along into her term she is. Treatment may be delayed. Various treatments for cervical cancer are as follow:

• Chemotherapy—chemical anti-cancer drugs that can be taken through the spine, through the vein, through an injection, and through the mouth.
• Cryosurgery—a procedure that kills the cancerous cells by freezing them.
• Bilateral salpingo-oophorectomy—a hysterectomy is performed and the ovaries and fallopian tubes are removed as well.
• Conization—the removal of a cone-shaped piece of abnormal tissue.
• Hysterectomy—the cervix and uterus are taken out along with the cancer for women who cannot or do not want to have more children. In an abdominal hysterectomy, the uterus is removed via surgery through the abdomen. In a vaginal hysterectomy, the uterus is taken out through the vagina. A radical hysterectomy involves the removal of the cervix, uterus, and part of the vagina. Lymph nodes are also removed. (See lymph node dissection.) Laser Surgery—cancerous cells are killed with a narrow beam of intense light. Loop electrosurgical excision procedure (LEEP)—an electrical current is passed through a thin wire loop and used as a knife.
• Lymph node dissection—Lymph nodes are small bean-shaped structures that store white blood cells at various points of the body’s lymphatic system. If the lymph cells become infected with cancer, they are able to spread it through the whole body. A lymph node dissection is the removal of the infected areas, done at the time of a hysterectomy.
• Radiation therapy--X-rays or other high-energy rays are used to shrink tumors and kill cancer cells. External radiation comes from a machine outside the body that sends rays in. Internal radiation is inserted into the cancer-infected areas of the body via thin plastic tubes. Radiation is used alone and in addition to surgery.

Stages

Stage 0 (also called carcinoma in situ) – Stage 0 is the earliest and most treatable. The abnormal cells are found only in the first layer of cells lining the cervix (epithelium). This treatment at this stage will include one or more of the following: cryosurgery, conization, laser surgery, LEEP, or total abdominal or vaginal hysterectomy. Carcinoma in situ has a 100% 5-year survival rate.

Stage I - The cancer is in the deeper tissues of the cervix but has not spread to nearby organs. This stage is divided into IA and IB. Stage I cervical cancer has an 85% 5-year survival rate.

Stage IA has no legions visible to the naked eye; it is diagnosed only by microscopy. It is usually an invasion less than 3mm in depth and 7mm or less in horizontal spread. It is treated with one or more of the following: conization, internal radiation therapy, total abdominal hysterectomy, radical hysterectomy, and lymph node dissection.

Stage IB is an invasion between 3mm and 5mm deep and 7mm or less in width. It is treated with one or more of the following: internal radiation, external radiation therapy, radical hysterectomy, lymph node dissection, and chemotherapy.

Stage II – The cancer is still contained within the pelvic area but has spread to nearby areas. Stage II cervical cancer has a 50-60% 5-year survival rate. Stage IIA has spread beyond the cervix to the upper two-thirds of the vagina and is treated with one or more of the following: internal radiation, external radiation, chemotherapy, radical hysterectomy, and lymph node dissection. Stage IIB has spread out around the cervix and is treated with internal radiation, external radiation, and chemotherapy,

Stage III – Cancerous cells have invaded the pelvic area. Stage III cancer has a 30% 5-year survival rate.

Stage IIIA has invaded the lower one-third of the vagina and is treated with internal and external radiation plus chemotherapy.

Stage IIIB has extended to the pelvic wall and may have also caused hydronephrosis, a blockage of the tubes that connect the kidneys to the bladder. This is also treated with internal and external radiation plus chemotherapy.

Stage IV – The cancer has spread to other parts of the body. Stage IV cancer has the bleakest outlook with a 5% 5-year survival rate.

Stage IVA has spread to the rectum or the bladder and is treated with internal and external radiation plus chemotherapy.

Stage IVB has greatly advanced and spread to organs as faraway as the lungs. This is treated with chemotherapy, and the patient is given radiation therapy to relieve the symptoms caused by the cancer.

Recurrent – The cancer has returned to the pelvic area or other areas in the body. If the return is to the pelvic area, radiation will be used in combination with chemotherapy. If the cancer has returned to other areas, the doctor will assess the situation and choose a treatment accordingly. The survival rate for recurrent cancer is based on where the cancer appears and when it is discovered.

Risk Factors

Women smokers are about twice as likely as nonsmokers to get cervical cancer. Secondhand smoke is also considered a risk factor.

Women whose mothers took DES (diethylstilbestrol--an estrogen drug prescribed in 1938-1971) during pregnancy are at risk of a rare form of vaginal and cervical cancer.

Diet and weight both factor in. Women with diets low in fruits and vegetables and overweight women both have an increased risk of contracting the disease.

Women who have a family history of cervical cancer or have had multiple full term pregnancies are at higher risk.

Many women of lower socioeconomic status often are uninsured or underinsured and do not have are unable to afford regular pap smears.

Women who have a sexual history that includes multiple partners (or partners who have had multiple partners), intercourse at an early age, unprotected sex, and sexually transmitted diseases (STDs) have increased chances of cervical cancer. Chlamydia, Human Immunodeficiency Virus (HIV), and Human Papilloma Virus (HPV) are three STDs that are often found as forerunners of cervical cancer.

Cervical cancer is the third most common type of cancer among women worldwide. It is much less common in the developed countries where women have routine Pap smears that detect the cancerous cells in their earliest form. Most women diagnosed today with advanced stages of cervical cancer have either not followed up after an abnormal smear or have not gotten Pap smears on a regular basis. If you fall into one of those categories, do yourself a favor and call your doctor today. Don’t become a needless statistic.