What Is Cervical Cancer?
Cervical cancer begins developing in the lining of the cervix, which connects the uterus to the vagina. Cells of the cervix begin to grow out of control until the cancer is formed. There are two types of cells in the cervix that can turn cancerous, glandular cells and squamous cells. The endocervix is the opening of the cervix and has glandular cells. The exocervix, also known as the ectocervix, is the outer part of the cervix and has squamous cells. However, the transformation zone in the cervix contains both types of cells and the location changes if someone gives birth or gets older. The transformation zone is where most cervical cancers begin.
Cervical screening for cancer is used to detect pre-cancerous cells, when the disease is more treatable and in most cases, curable. The most common methods for cervical cancer screening are the Human papillomavirus (HPV) and Pap smear tests. Pap smear tests can detect abnormal changes in the cells of the cervix, while HPV tests can find the infections caused by HPV that can lead to cancer in the cervix. HPV infection can be prevented through vaccines.
The two main types of cervical cancer are squamous cell carcinomas and adenocarcinomas. Squamous cell carcinomas are more common and develop from exocervix cells and are often found in the transformation zone. Adenocarcinomas begin in the mucus-
What Are the Symptoms of Cervical Cancer?
At the time of diagnosis, most patients experience no signs or symptoms if the cancer is in early stages. These cervical cancers are typically found using scheduled screening tests (HPV or Pap smear test). Similar to other cancer types, cervical cancer is more easily treatable when found early.
In patients who do experience symptoms at time of diagnosis, symptoms may include:
- Vaginal bleeding
- Pelvic pain
- Vaginal discharge
- Pain during sexual intercourse
How Iis Cervical Cancer Diagnosed?
Once pre-cancerous cells are detected or cervical cancer is suspected, there are several tests used to confirm a diagnosis. These tests include:
Physical exam: Doctors will first perform an exam to check the patient’s general health, check for signs of disease, and review their medical history.
Pap smear test: This procedure collects cells from the surface of the cervix and surrounding area using a small brush. The sample is viewed under a microscope to look for any abnormalities.
Pelvic exam: The vagina, uterus, cervix, fallopian tubes, and ovaries are examined. The doctor will insert a speculum in the vagina and check for signs of disease. Pap smear tests of the cervix are typically done during this. Then, the doctor inserts a finger into the vagina and checks the placement and size of the ovaries and uterus. Finally, a finger is inserted in the rectum to feel any abnormalities or lumps.
HPV test: This laboratory test collects cells from the cervix and analyses the DNA and RNA to check for the HPV infection. Some types of HPV are linked to the development of cervical cancer. This test may be performed if the Pap smear test shows abnormal cells and can use the same sample previously used.
Colposcopy: This procedure uses a magnifying instrument with a light to check the vagina and cervix for abnormalities. Tissue samples are collected using a curette (a spoon shaped instrument) or brush then viewed under a microscope for signs of cancer.
Endocervical curettage: This procedure uses a curette to collect sample tissue from the cervical canal. A microscope is used to check for signs of cancer and can be done at the same time as a colposcopy.
Biopsy: If abnormal cells are found in one of the previous tests, the same sample of tissue or a new sample is collected from the cervix and checked by a pathologist for signs of cancer. In some cases, a woman may go to the hospital if a larger sample needs to be removed in a cervical cone biopsy.
What Are the Stages of Cervical Cancer?
The stage of cervical cancer is determined by doctors after the diagnosis of cervical cancer is confirmed. Tests will then be performed to find out if the cancer has spread locally or to distant organs in the body. Cervical cancer stages can be defined as:
Stage I: The cancer is found only in the cervix. This stage is divided into A and B based on the deepest point of tumor invasion and the size of the tumor. The tumor is in Stage IB once the tumor’s deepest point of invasion is more than 5 millimeters.
Stage II: The cancer has spread outside the cervix to either the upper two-thirds of the vagina or to the tissue surrounding the uterus. This stage is divided into A and B based on where the cancer has spread. The cancer is stage IIA if it has spread to the upper part of the cervix. The cancer has reached stage IIB once the cancer has spread to the tissue around the cervix.
Stage III: The cancer has spread to the lower third of the vagina, the pelvic wall, or has spread to the kidneys and/or the lymph nodes. This stage of cancer is divided into A, B, and C based on where the cancer has spread. Stage IIIA has spread only to the lower third of the vagina. Stage IIIB has spready to the pelvic wall and/or the tumor is large enough to block one of the ureters and caused the kidney(s) to stop working or grow. In stage IIIB, the cancer has spread to the lymph nodes in the pelvis or abdomen.
Stage IV: The cancer has spread to distant body parts, beyond the pelvis, or to the lining of the bladder or rectum. This stage is divided into A and B based on where the cancer has spread. Stage IVA has spread to the pelvic organs such as the bladder or rectum. Stage IVB has spread to distant parts of the body, usually the lungs, bones, liver, or lymph nodes.
What Are the Treatment Options for Cervical Cancer?
When doctors choose the most suitable treatment options for patients, stage is the most important factor. Other factors include the type of cervical cancer, age, exact location of the cancer, and whether you want to have children in the future. Cervical cancer treatment options include:
Surgery: For early-stage patients where the cancer has not spread outside the cervix, surgery is an option to remove the cancer. There are several methods listed below.
- Conization: This procedure removes a cone-shaped tissue from the cervix and cervical canal to be viewed under a microscope to diagnose or treat cervical cancer.
- Total hysterectomy: In this procedure the entire uterus is removed, which includes the cervix. Where the uterus and cervix are removed from can vary between the vagina, an incision in the abdomen, or an incision using a laparoscope.
- Radical hysterectomy: In this procedure, a part of the vagina, tissues, and ligaments surrounding the reproductive organs are removed. In some cases, the fallopian tubes, ovaries, or lymph nodes are removed.
- Modified radical hysterectomy: In this procedure, less organs and tissues are removed than a radical hysterectomy. The uterus, cervix, upper part of the vagina, and nearby tissues and organs are removed.
- Radical trachelectomy: In this procedure the uterus and ovaries are left while the cervix, nearby lymph nodes, tissues, and the upper part of the vagina are removed.
- Bilateral salpingo-oophorectomy: This procedure removes both the ovaries and the fallopian tubes.
- Pelvic exenteration: In this procedure, the lymph nodes, ovaries, vagina, cervix, and nearby lymph nodes are removed. In addition, the rectum, bladder, and colon are removed. Stoma, or artificial openings, are made so the patient can urinate to a collection bag. In some cases, an artificial vagina may be needed afterward from a plastic surgeon.
Radiation therapy: This treatment uses types of radiation such a high energy x-rays to kill cancer cells by preventing them from growing. The type of radiation used depends on the stage and type of cervical cancer.
- External radiation therapy uses a machine outside the body and places it near the cancer to send radiation to kill the cancer cells. Additional tools can be used to identify the exact location of the tumor to avoid damaging healthy cells during treatment.
- Internal radiation therapy injects radioactive substances in the body near the tumor to kill the cancer cells.
Chemotherapy: This treatment uses drugs to prevent the growth of cancer. The cancer cells are either prevented from growing or killed by the drug. The type of chemotherapy used depends on the stage and type of cervical cancer. Chemotherapy drugs can be taken orally or injected in a vein or muscle to enter the bloodstream and target cancer cells throughout the body, which is called systemic chemotherapy. Some chemotherapies are injected directly near the tumor to only affect the cancer cells nearby, which is called regional chemotherapy.
Targeted therapy: This treatment uses drugs or other substances to locate, identify, and attack cancer cells with specific changes or alterations. Targeted therapies often cause less side effects than other standard treatments because they target changes in cells that are not present in healthy cells. Targeted therapies are commonly used in patients with advanced cancer (Stage III and stage IV cervical cancer).
Monoclonal antibodies: These artificially created immune system proteins attach to cancer cells and prevent them from growing, spreading, or performing other vital cell functions. These drugs are given through an infusion and sometimes carry other drugs, toxins, or radioactive materials to the cancer cells. A common monoclonal antibody in metastatic or recurrent cervical cancer is Bevacizumab, which binds to vascular endothelial growth factors (VEGF) and prevents blood vessels from growing the tumor.
Immunotherapy: This treatment boosts the immune system of the patient to fight cancer and is considered a biologic therapy. Substances are artificially made or made by the body then used to restore the body’s defenses against the cancer.
- Immune checkpoint inhibitor therapy: In the proteins PD-1 and PD-L1 that are located on the surface of cancer cells are responsible for the body’s immune response to infections and disease. When PD-1 attaches to PD-L1, the T-cell is prevented from killing the cancer cells. These immune checkpoint inhibitors are used to prevent these proteins from attaching to each other, allowing the T-cells to kill the cancer cells. Pembrolizumab is a common PD-1 inhibitor used to treat cervical cancer.
Cervical Cancer Clinical Trials
Cervical cancer clinical trials test the latest scientific advancements in cancer treatment and cervical cancer prevention. Patients who choose to enroll in trials can receive cutting-edge treatment and high-quality care under the direction of scientists, doctors, and researchers. Cancer patients might gain access to promising drugs and innovative treatments long before they’re made available to the public.
Massive Bio specializes in finding advanced clinical treatments for every cervical cancer type. If you’ve been diagnosed with any lymphoma subtypes, we’re here to help. If you don’t know which type of lymphoma you have, that’s okay. You can request a free consultation from our specialists. Additional testing can help you determine your exact diagnosis.