Cervical cancer is the fourth most common cancer in women with an estimated 570,000 new cases in 2018, accounting for 6.6% of the total number of female cancers. About 90% of cervical cancer deaths occur in low- and middle-income countries.
Cervical cancer develops in the cervix of women who enter the uterus from the vagina. It mainly affects sexually active women between the ages of 30 – 45 years old.
What is cervical cancer?
- Cervical cancer is cancer that starts from the narrow cervix into the uterus from the vagina.
- Most cervical cancer begins with normal cells gradually developing into precancerous changes then developing into cancer.
- About 70% of all cervical cancers are caused by human papillomavirus (HPV) types 16 and 18, a common sexually transmitted disease.
- The most common cervical cancer is squamous cell carcinoma, accounting for 80% of the cases. Adenocarcinoma is less common and is more difficult to diagnose because it starts higher in the cervix.
Types of cervical cancer
Cervical cancer is classified based on the type of cell where it grows. The most common types of cervical cancer are:
- Squamous cell carcinoma: This is the most common cervical cancer and is found in 80-90% of cases. It develops in the cervical mucosa.
- Adenocarcinoma: This type of cervical cancer develops in glandular cells that produce cervical mucus. About 10-20% of cervical cancers are adenocarcinoma.
- Mixed epithelial carcinoma: Sometimes cervical cancer has the characteristics of squamous cell carcinoma and adenocarcinoma.
In some rare cases of other cancers such as neuroendocrine (small and large cell cervical cancer), melanoma, sarcoma and lymphoma are found in the cervix.
What is the cause of cervical cancer?
Most cervical cancers are caused by human papillomavirus (HPV) infection that is usually spread from person to person through sexual contact. The lifetime risk of a normal person being infected with HPV is about 80%.
There are over 200 types of HPV most of them are harmless and go away on their own, but at least a dozen types of HPV can last and sometimes lead to cancer. Two special types of HPV, 16 and 18, lead to the majority of cervical cancers, which are called high-risk HPV.
The risk of cervical cancer
The biggest risk factor for cervical cancer is having one of the high-risk types of HPV.
Besides HPV there are other things that increase your risk of cervical cancer including:
- Personal history of cervical, vaginal or vulvar dysplasia
- Family history of cervical cancer
- Other infections like chlamydia
- Immune system problems like HIV / AIDS make it harder to fight off infections like HPV
- Take a medicine called diethylstilbestrol (DES) during pregnancy
- Age: The average age at which cervical cancer is diagnosed is over 40 years old. It rarely affects people under the age of 20.
Not everyone with risk factors will get cervical cancer. However, if a woman has risk factors, she should discuss it with your doctor.
Screening for cervical cancer
Over the years the cells lining the cervical surface undergo a series of changes. In rare cases these precancerous cells can become cancerous. However, cell changes in the cervix can be detected at a very early stage and treatment can reduce the risk of developing cervical cancer.
Cervical cancer screening is called a Pap test that helps find cervical cancer at an early stage. When detected early, the chance of successful treatment is greatest.
- Women aged 25 to 49 are screened every three years
- Women aged 50 to 64 years are recommended for screening every 5 years.
- Women 65 and older may not need further testing if you haven’t had an abnormal Pap or HPV test result in the past 10 years.
Only those who have not been screened since they were 50 years old or who have recently had abnormal tests are offered a screening.
Symptoms of cervical cancer
In its earliest stages cervical cancer is usually asymptomatic. This is why regular Pap tests are important, especially for sexually active women.
When cervical cancer has symptoms, they can change. Some symptoms of cervical cancer include:
- Bloody vaginal discharge
- Vaginal bleeding after sex
- Abnormal vaginal bleeding: after menopause, mid-cycle or too heavy
- Pee more often
- Pain during sex
- Swollen legs
These symptoms are not always a sign of cervical cancer. However, it is important to discuss any symptoms with your doctor, as they may signal other health problems.
Diagnosis of cervical cancer
If your Pap test results show you have symptoms of cancer, your doctor will recommend that you do some additional tests.
Common tests to diagnose cervical cancer are:
- Colposcopy: This test uses an instrument called a colposcopy to look closely at an abnormal area of tissue on the cervix, vagina or vulva.
- Biopsy: During a biopsy to look for cervical cancer the doctor will take a small amount of tissue from the cervix to look under a microscope. Types of cervical biopsy may include: cone biopsy or large ring excision of the area of change (LLETZ)
- Imaging tests may include: CT scan, MRI scan, PET scan, chest X-ray or ultrasound.
- Endoscopic retroperitoneal dissection: In this minimally invasive surgical procedure the lymph nodes are removed to help find out if the cancer has spread.
If cervical cancer is detected it will be staged, from stage 0 which means abnormal cells only found in the surface layer of cervical liners to stage IV means is cancer that has spread to nearby organs such as the bladder or rectum or possibly other organs. This helps your doctors plan the best treatment for you.
Stage of uterine cancer
The following stages are used to describe cervical cancer:
- IA: Cancer involving the cervix but has not spread to nearby tissue. A very small amount of cancer visible only under a microscope is found deeper in the tissues of the cervix
- IB: Cancer involving the cervix but has not spread nearby. A large amount of cancer is found in the tissues of the cervix.
- IIA: The cancer has spread to nearby areas, but is still in the pelvic area. Cancer has spread beyond the cervix to the upper two thirds of the vagina.
- IIB: The cancer has spread to nearby areas, but is still in the pelvic area. Cancer has spread to the tissues around the cervix
- Cancer has spread throughout the pelvis. Cancer cells may have spread to the lower part of the vagina. The cells may also have spread to block the tubes connecting the kidneys to the bladder.
- IVB: Cancer has spread to other parts of the body such as the bladder or rectum, organs close to the cervix
- IVB: Cancer has spread to distant organs such as the lungs, organs far from the cervix.
How to treat cervical cancer?
If you are diagnosed with cervical cancer, your doctor will discuss the best options to treat it. This depends on a number of factors, including: your age and overall health, stage of cancer and size of the tumor.
Treatment for cervical cancer may be one or a combination of the following:
Is common for women with small tumors found only in the cervix. The type of surgery will depend on the stage of the cancer, the types of surgery include:
- Cut off the cervix
- Hysterectomy: removal of the uterus and may also include cervical removal
- Removal of lymph nodes
- Cut off the sides of salpingo-oophorectomy
- Ovarian permeability or displacement
- Pelvic hemorrhage
Using X-rays to kill cancer cells may be left behind after surgery. Radiotherapy may also be used to reduce the size of the cancer and to reduce pain or other symptoms.
Types of radiation therapy can be used to treat cervical cancer:
- External radiotherapy: uses a machine outside the body to send radiation towards cervical cancer.
- Internal radiotherapy implant (brachytherou): is inserted through the vagina into the cervix, where they are located next to the tumor.
- Adjustable intensity radiotherapy (IMRT): treatment tailored to the specific shape of the tumor or enlarged lymph nodes.
- Use anti-cancer drugs to help kill cancer cells that may have spread to other areas of your body. Chemotherapy reduces the likelihood of cancer coming back.
- More advanced cases of cervical cancer are usually treated using a combination of chemotherapy and radiation.
In some cases of cervical cancer, your doctor may talk to you about palliative care. Palliative care aims to improve the quality of your life by reducing cancer symptoms.
As well as slowing the spread of cervical cancer palliative treatment can relieve pain and help control other symptoms. Treatment may include radiation, chemotherapy or other drug therapies.
Prospects for cervical cancer patients
For cervical cancer, the survival rate is nearly 100% when precancerous or early cancer changes are found and treated. The prognosis for invasive cervical cancer depends on the stage of the cancer when it is found.
The stage of cancer is a measure of how far it has progressed, namely what other organs or tissues have been invaded.
- stage 0 more than 90% of women survive at least 5 years after diagnosis
- Phase I has a 5-year survival rate of 80- 93%.
- Phase II has a 5-year survival rate of 58-63%.
- Stage III has a 5-year survival rate of 32-35%
- Stage IV surviving after 5 years is 16% or less.
People who are currently diagnosed with cervical cancer may have a better outlook than these numbers show. Treatments improve over time and these numbers are based on people diagnosed and treated at least 5 years earlier.
Source of Cervical Cancer Reference:
- Source mayoclinic.org article Cervical Cancer : https://www.mayoclinic.org/diseases-conditions/cervical-cancer/symptoms-causes/syc-20352501 , updated July 31, 2019.
- Source webmd.com Cervical Cancer article : https://www.webmd.com/cancer/cervical-cancer/cervical-cancer#1 , updated January 14, 2018.
- A reputable source index-china.com sums up the article What is cervical cancer?: https://index-china.com/cervical-cancer/, updated 14/3/2020.
Assoc.Prof.Dr. Tran Ngoc Anh is currently Hanoi Medical University Hospital, Associate Professor, Department of Internal Medicine, Gastroenterology and Head of Department of General-Uematology of Hanoi Medical University. Consulting doctor at ThuocLP Vietnamese health.
Professional qualifications, Academic degrees – Education:
Graduated from General Practitioner System, Hanoi Medical University
Graduated with a Master degree in Internal Medicine, Hanoi Medical University
Graduated from the training program specialized in Gastrointestinal, Henri Mondor Institute Center, University of Paris 6, French Republic 1996-1997; 1999
Graduated from the training program specialized in Gastrointestinal, North Royal Sydney Hospital, Australia; 2002
Graduated from a training program specialized in chronic liver diseases, Pizza, Italy 2009
Graduated with a PhD in Gastrointestinal, Hanoi Medical University
Associate Professor, Gastroenterology, Hanoi Medical University
Training and Scientific Research:
Published more than 200 articles in domestic and international specialized journals
Editor of many monographs and participates in compiling 2 textbooks.
Guide many students and graduate students of Hanoi Medical University
Manager of many grassroots research projects
Certificate of Good Clinical Practice (GCP: 2012, 2015), Ministry of Health
Specialized certificates: General gastrointestinal endoscopy, Interventional gastrointestinal endoscopy, General gastrointestinal ultrasound, Interventional gastrointestinal ultrasound (Bach Mai BV), Chronic liver disease.