cervical cancer | Cervical Cancer (Cervical Cancer)

Cervical Cancer
(Cervical Cancer)





Description
Cervical cancer affects the cervix which is an organ of the female genital tract. The cervix is the lowest part of the uterus (The matrix) and is located at the top of the vagina. The cervix is normally formed of healthy cells that can become abnormal cells.

Cancer is a term that refers to a type of condition that is characterized by abnormal and uncontrolled cell proliferation. The term tumor or neoplasm applies to abnormal cell development. Tumors can be non-cancerous (benign) or cancerous (malignant). A benign tumor does not invade tissues or neighbouring organs and it usually does not reappear after being removed. On the other hand, a malignant tumor can spread (e.g. from the cervix) and infiltrate other tissues or invade other organs.

Cervical cancer is the third most common type of gynecological cancer in North America and the fourth most common cancer among women worldwide. The incidence of cervical cancer has declined dramatically since the years 1950. The Pap test (also known as smear cervicovaginal) is a factor that has played a significant role in this decline. The PAP test is used to detect changes in cervical cells.

As mentioned beforehand, some of these changes are non-cancerous, but a small number may become cancerous. If precancerous cells are not detected and no treatment is used, they can evolve into a cancer that will invade the cervix. Therefore, regular screening using the PAP test allows early detection of precancerous cells and the imposition of treatment before these cells become cancerous.

In 2015, 1 500 new cases of cervical cancer were estimated to have been diagnosed in Canada. Among these cases, it is anticipated that about 380 women will not survive their cancer. The lifetime risk of cervical cancer is estimated at 1 in 149 for a Canadian resident. Almost all cervical cancers can happily be cured when diagnosed at an early stage. The rate of cure for cervical cancer at Stage 1 (invasive cancer limited to the cervix) is between 80% and 90%.

Given that certain types of human papillomavirus (HPV) may cause cervical cancer, an HPV vaccine has been offered in Canada since 2006. It would be desirable for the female population aged 9 to 26 to receive the HPV vaccine to protect against HPV strains responsible for approximately 70% of cervical cancers.

Although men are not able to contract cervical cancer, they can still take advantage of the benefits of HPV vaccine. It helps to prevent the spread of HPV and reduce their risk of acquiring anus cancer and genital warts that are also attributable to HPV. In Canada, two of the HPV vaccines can be administered to boys and young men aged 9 to 26.

Most cases of cervical cancer can be prevented or cured when they are detected in the initial stages.

Causes

So far, we do not fully understand what causes cell anomalies and their anarchic proliferation. Some factors increase the risk of cervical cancer.

HPV: The most important risk factor is HPV infection of the cervix. An HPV infection is one of the most common sexually transmitted infections (STIs). It is estimated that 75% of people of childbearing age will be affected at least 1 time in their lives by an HPV infection. While some types of HPV cause genital warts, other strains of the virus can infect the cervix and cause abnormal cellular changes that will slowly lead to cancer. It is important to note that most women with cervical cancer have previously suffered from HPV infection; However, not all women with HPV disease contract this type of cancer.

Sexual activity: An early sex life has been linked to a greater risk of cervical cancer. In addition, certain sexual behaviours (such as many sexual partners or a partner with many sexual partners) may increase the likelihood of HPV infection, and therefore the risk of cervical cancer.

Smoking: People who smoke are at greater risk of cervical cancer and other cancers. The occurrence of cervical cancer has also been associated with smoking and exposure to second-hand smoke (ambient tobacco smoke). In fact, the risk increases depending on the duration of smoking and the number of cigarettes smoked daily.

Weakened immune system: Our immune system helps our body fight infections. As a result, medications and conditions that weaken the immune system can increase the risk of HPV infections and the possibility of cervical cancer. Drugs that weaken immune systems are corticosteroids (long-term) and chemotherapeutic products. Women infected with the human immunodeficiency virus (HIV) are at greater risk of precancerous changes in the cervix when they become HPV.

Diethylstilbestrol (DES): The DES is a form of estrogen that has been prescribed between 1940 and 1971 to pregnant women. According to some studies, the daughters of these women ran an increased risk of precancerous changes and squamous carcinoma of the cervix.

Age: Most cervical cancers tend to affect women who are less than 50 years old.

Socio-economic status: it is less likely that PAP tests will be performed regularly among women with relatively low incomes, so they are at higher risk for cervical cancer.

Oral contraceptives: Prolonged use of oral contraceptives (more than 10 years, for example) increases the risk of cervical cancer. This risk decreases after the use of this method of contraception is stopped.

Multi-bet: Women who have given birth several times are more likely to contract cervical cancer and this risk increases with the number of deliveries. 

Other risk factors: Other potential risk factors have been associated with increased risk of cervical cancer. However, there is not enough evidence at the present time to hold them as major risk factors. These factors include a history of sexually transmitted infections and a family history of cervical cancer.

Symptoms and Complications

Symptoms do not always occur during the initial stages of cervical cancer. It is very important to note that another health condition can trigger symptoms similar to cervical cancer.

Among the early symptoms, one can find:

Pain during sexual intercourse or bleeding after intercourse

A serous vaginal discharge of a clear or nauseating appearance;

An increased amount of white losses

abnormal vaginal bleeding or spotting between the rules.

At more advanced stages, symptoms may occur as tumours grow or invade other organs:

Anemia (causing a lack of energy and shortness of breath);

constipation;

pelvic or dorsal pain;

shortness of breath;

Urine leakage (incontinence) or blood in the urine (a hematuria);

Weight loss

Loss of appetite or anorexia

Blood in the stool.

Diagnosis

Cervical cancer is detected primarily through the PAP test. It is used to highlight cancer or precancerous cells that can lead to cancer. This examination owes its name to its inventor, George Papanicolaou.

The PAP test is a quick and simple process. A doctor rubs the surface of the cervix with a small brush, or a spatula, to collect cells. The exam usually does not cause pain. The cells are then examined in a laboratory.

In case the PAP test shows a transformation or abnormalities in the cervical cells, additional examinations or surgical procedures may take place. Your doctor will tell you which analyses or interventions would be best for you:

Another PAP test in a few months to check if the transformations persist;

An HPV screening test may be conducted in conjunction with the PAP test to identify cervical cancer, or it may be a complementary examination if the Pap test reveals abnormalities. Given that the majority of cervical cancers begin with HPV infection, this test detects the presence of the virus in cervical cells. Specifically, the HPV screening test establishes whether a woman is infected with a type of HPV that could cause cervical cancer;

A colposcopy that involves using a colposcope (an instrument with a light and a binocular magnifier) to examine the cervix. A dye is applied to the tissues to make the anomalies more visible;

A biopsy consists of extracting a small amount of tissue to be examined in a laboratory that will confirm whether cervical cells are benign, precancerous or cancerous.

At this time in Canada, it is recommended that women aged 25 to 69 undergo regular screening for cervical cancer every 3 years. However, the recommendations may differ according to your province's or territory's practice guides on screening and the results of your previous tests. Women who are at high risk for cervical cancer may need more frequent screening tests. Ask your doctor to tell you how often and when you should be tested.

Treatment and prevention

The treatment options indicated for cervical cancer include surgery, radiotherapy, and chemotherapy.

Treatment decisions are made by an oncologist (a cancer specialist) based on the following factors: tumor size, stage of cancer (severity or presence of precancerous transformations), factors Women's personal (e.g., age, desire to have children), general health status and prior treatment.  The oncologist will discuss the treatment options best suited to a particular case.

The surgery

Cryosurgery is a process of destroying abnormal cells by freezing them with liquid nitrogen. This type of surgery is usually performed to treat precancerous changes in the cervix.

Laser surgery uses a high-energy light beam to destroy abnormal cells. It helps to destroy precancerous or cancerous cells. Laser surgery is usually performed when the affected cervical area cannot be reached by cryosurgery.

Electro-Surgical excision at the cove is a technique of ablation practised by means of a small loop of metallic fine wire traversed by electrical energy. The process takes place under local anesthesia.

Hysterectomy is a surgical removal of the uterus; It is required when it comes to invasive cancer (more scalable or larger tumors). Other organs, such as ovaries, fallopian tubes, lymph nodes and parts of the vagina can also be removed at the same time. There are different types of hysterectomy:

Total hysterectomy to extract the cervix and uterus;

A radical hysterectomy that involves the extraction of the cervix, uterus, upper part of the vagina, supporting tissues and the affected lymph nodes.

Radiotherapy

Radiotherapy uses high-energy radiation, particles or radioactive elements to destroy cancer cells located in a region of the body. Radiotherapy aims to kill the cancer cells while cleaning the surrounding normal cells.

Chemotherapy

Chemotherapy can be used in combination with radiation therapy. Chemotherapy has at least one anticancer drug that prevents cancer cells from dividing and reproducing. It can be used in the treatment of metastatic cancer (which spreads to other organs) and recurrent tumors.

Prevention

Women can minimize their risk of cervical cancer by not acquiring HPV infection. The virus is most commonly transmitted through sexual contact and during sexual intercourse. By refraining from touching the genitals of an infected person, and using a condom, you will reduce the risk of an HPV infection. It should not be forgotten that condoms are of relative efficacy, since they only protect the part of the body they cover. Other forms of female contraceptive products such as contraceptive pills, diaphragms and IUDs do not protect women from HPV infection.

When a woman who is in the habit of smoking gives up smoking, she decreases her risk of cervical cancer.

Vaccination is another way to prevent cervical cancer. The first HPV vaccination in the world was approved in Canada and the United States in 2006. Immunization is immunized against 4 different types of HPV. It is estimated that 2 of these types of HPV cause 70% of cervical cancer cases. Three different vaccines are now available in Canada.

Given that the vaccine is more effective for women who have not yet been exposed to HPV, it is preferable for women to receive it before they start their sex life. But women who already have an active sex life can also benefit from the benefits of the vaccine if they have not yet contracted HPV.

Whereas the vaccine does not provide protection against all types of HPV that may cause cervical cancer, it is essential that a PAP test be performed regularly to prevent a disease caused by HPV infection.