Charlotte, NC
Gauri Adhikari, MD
Bibhusan Basnet, MD
Cervical cancer, marked by abnormal cell growth in the cervix, the lower part of the uterus connecting to the vagina, is the fourth most prevalent cancer in women. Often linked to Human papillomavirus (HPV), this cancer may progress silently without symptoms, especially in its early stages. Early detection is pivotal for improved prognosis and heightened survival rates. Screening tools like the Pap test play a crucial role. Understanding the significance of cervical cancer, its causes, and the preventive potential of HPV vaccination is essential in fostering awareness and promoting women’s health.
⇒ Cervical Cancer Screening: What is the recommended frequency?
The primary cause of cervical cancer is infection with high-risk strains of the HPV. HPV is a common group of viruses transmitted through sexual contact. While most HPV infections are temporary, and the body’s immune system successfully clears them, persistent infections with certain high-risk strains can lead to cervical cancer. Without treatment, HPV infections can turn into cancerous cells over 15–20 years, but for women with weakened immune systems, like those with untreated HIV, this process may speed up in 5–10 years.
There are several factors attributed to the increased risk of cervical cancer. It is important to note that while these factors can elevate the risk, their presence in itself does not mean that you are going to get cervical cancer.
Women with cervical cancer usually have no symptoms. It can cause symptoms once it has progressed and grows into nearby tissue. The most common symptoms are:
The diagnosis of cervical cancer typically involves a series of steps aimed at detecting abnormalities in the cervix. Here’s an overview of the diagnostic process for cervical cancer:
1. Routine Screening Tests: These tests can be done as a part of routine screening and diagnosis in suspected cases:
2. Biopsy: A biopsy involves the removal of a small tissue sample from the cervix. This sample is then sent to a laboratory for examination by a pathologist to determine if cancerous cells are present. The sample may be taken with the help of a punch biopsy, where a sharp tool is used to punch out the cervical tissue, or via endocervical curettage, where a spoon-shaped instrument is used to scrape off the tissue from the cervix. Suppose the results of these tests are suspicious of cancer. In that case, an electrical wire loop can be used to take tissue samples in a procedure called a loop electrosurgical excision procedure (LEEP). Another procedure is called conization, where a cone-shaped tissue sample can be collected from the deeper layers of the cervix for confirmation.
3. Imaging Studies: In some cases, imaging studies such as magnetic resonance imaging (MRI) or computed tomography (CT) scans can be performed to assess the extent of cancer spread, especially if cervical cancer is confirmed.
4. Staging: Once cervical cancer is diagnosed, it is staged to determine the extent of its spread. Staging also helps guide treatment decisions. The stages range from 0 (early, confined to the cervix) to IV (advanced, involving nearby or distant organs).
The treatment options for cervical cancer depend on various factors, including the stage of cancer, the individual’s overall health, and personal preferences. Here are the primary treatment options for cervical cancer:
1. Surgery:
2. Radiation Therapy: Radiation uses high-energy X-rays to kill cancer cells. It can be:
3. Chemotherapy: Chemotherapy uses anti-cancer drugs administered orally or intravenously to kill cancer cells or stop their growth. Chemotherapy may be used alone or in combination with radiation therapy.
4. Targeted Therapy: Targeted drugs block specific molecules involved in cancer cell growth and spread. These drugs can be directed toward cancer cells’ blood vessels or tissue factor proteins. This type of therapy is often used in combination with chemotherapy.
5. Immunotherapy: These drugs help boost a person’s immune system. It includes various kinds of drugs like pembrolizumab. They target the immune system cells to help them recognize and kill the cancer cells.
Some women can have a complete cure for cervical cancer if they are in the lower stages of the disease, but for some, it becomes a lifelong disease. For those people who have successfully removed the tumor and are declared to be free of cancer, your doctor will continue to screen you for cervical cancer. Thus, it is essential to continue the follow-up after the treatment.
HPV vaccines are proven to be highly effective in reducing the risk of cervical cancer and other HPV-related diseases. As of 2023, there are six globally available HPV vaccines, all protecting high-risk HPV types 16 and 18. It is administered in one or two doses, depending on the type of vaccine. However, individuals with weakened immune systems may require 2 or 3 doses. The vaccine is recommended for girls aged 9-14 years before they become sexually active. Some countries vaccinate boys to reduce HPV prevalence and prevent penile cancers in men.
It is recommended that women aged 21 to 29 years of age are screened for cervical cancer every three years with cervical cytology alone. For women aged 30 to 65 years, it is recommended to get screened every three years with cervical cytology alone, every five years with high-risk HPV testing (hrHPV) alone, or every five years with hrHPV in combination with cytology (known as contesting)
1. Cervical cytology: Cervical cytology testing is commonly known as Pap smear or Pap test. During this testing, your doctor collects cells from your cervix with the help of a brush or spatula, which are then examined under a microscope. If any abnormalities are found, further diagnostic tests are performed.
2. High-risk HPV testing: The test involves taking cells from your cervix to check for infections with specific HPV types linked to cervical cancer. This test can be done simultaneously with the Pap smear or afterward, especially if the Pap test results show abnormalities.
