What is the cervix?
The cervix is located in the lower part of the uterus, or in the upper part of the vagina. This is a narrow passage called the cervical canal (or endocervical canal), which exits the vagina to the inner surface of the uterus. It is usually fairly tightly closed, but allows blood to flow out of the uterus during the menstrual period. And also allows the sperm to get inside if you have sex. It opens very widely during childbirth. The surface of the cervix is covered with a layer of cells. There are also several small glands in the lining of the cervical canal that produce mucus.
What is cancer in general?
Cancer is a disease of cells in the body. The body consists of millions of tiny cells. There are different types of cells in the body, and there are many different types of cancer that arise from different types of cells. All types of cancer are united by the fact that cancer cells are abnormal and their reproduction goes out of control.
A malignant tumor consists of cancer cells that continue to multiply. They invade neighboring tissues and organs, causing them serious damage. Malignant tumors can also spread to other parts of the body. This happens if some cells separate from the first (primary) tumor and enter the blood or lymph, and with their help to other parts of the body. These small groups of cells can then multiply several times against the background of "secondary" tumors (metastases) in one or more parts of the body. These secondary tumors grow, invade and damage nearby tissues, spreading further.
Some cancers are more severe than others. Some of them are more easily treated, especially if the diagnosis is made at an early stage.
So, cancer is not an unambiguous diagnosis. In each case, it is important to know exactly what type of cancer is present, how large the tumor has become, and whether there are metastases. This will allow you to obtain reliable information about treatment options.
What is cervical cancer?
There are two main types of cervical cancer.
- Squamous cell carcinoma of the cervix is the most common. It develops from the cells of the membrane that cover the cervix. Subsequently, they become malignant.
- Cervical adenocarcinoma is much less common. It develops from glandular cells (cells that produce mucus) within the cervical canal, which become malignant.
Both types are diagnosed and treated in a similar way. In most cases, cervical cancer develops in women in their 30-40 years. In some cases - in elderly and young women.
Over 100,000 new cases of cervical cancer are diagnosed annually worldwide. Nevertheless, the number of diagnosed cases decreases every year. This is because cervical cancer can be prevented by regular screening (smear) of the cervix - a simple analysis that is being passed in our time by most women.
What is a cervical screening test?
Women around the world are offered regular screening tests. During each analysis, some cells are taken from the surface of the cervix. These cells are sent to the laboratory for examination under a microscope. In most tests, the cells look normal. But sometimes there is cervical dyskaryosis. Dyskaryosis is not cancer of the cervix. This simply means that some cells of the cervix are abnormal, but they are not cancerous. Abnormal cells are sometimes called "precancerous" cells or cell dysplasia. Depending on the degree of abnormality, cervical cells are classified as:
- Mild dyskaryosis. This is when there are only minor changes in cells. Sometimes this is called CIN 1. This speaks of intraepithelial neoplasia of the cervix.
- Moderate dyskaryosis (or CIN 2).
- Deep dyskaryosis (or CIN 3). At this time, the cells look very abnormal, but they are still not cancerous.
In many cases, the "diskyroid" cells do not progress to cancerous cells. In some cases, they return to normal life. However, in some cases, often many years later, abnormal cells degenerate into cancerous cells.
If you have only small abnormal changes (mild dyskaryosis or CIN1), you might simply be offered one more analysis much earlier than usual - after a few months or so. In many cases, several abnormal cells will return to normal functioning for several months. Treatment can be offered if the anomaly persists. For women with moderate or severe abnormal changes, cervical cleansing from "abnormal" cells can be performed before they turn into cancer.
What causes cervical cancer?
Cancer begins with a single cell. It is believed that something changes certain genes in the cell. This makes the cell very abnormal and its reproduction goes out of control. In the case of cervical cancer, cancer develops from a cell that is already abnormal initially. In most cases, abnormal cells are in the body a few years before they begin to multiply and grow into a cancerous tumor. The initial mutation of cells of the cervix is usually caused by infection with the human papillomavirus.
Human papillomavirus (HPV) and cervical cancer.
Most women who develop cervical cancer have been infected with a strain of HPV virus at some point in their lives. There are many strains of the HPV virus. Some of them are associated with cervical cancer.
In some women, strains of the papilloma virus that are associated with cervical cancer seem to affect the cells that cover the cervix. This gives them a better chance of becoming abnormal cells, which can later (usually several years later) turn into cancer cells. But pay attention: the majority of women infected with these strains of the papilloma virus do not develop cancer. In most infections, the immune system copes with the virus without the slightest harm to the body. There are only a small number of women infected with these strains of the papilloma virus that go on to develop abnormal cells, which then in some cases progress to cervical cancer.
The papilloma virus strain is associated with cervical cancer, and almost always is sexually transmitted from an infected person. HPV usually does not cause symptoms. Thus, you can not tell if you or the one with whom you had sex are infected with one of these strains of the human papillomavirus.
At present, tests are being conducted to test vaccines that have been developed for HPV. If HPV infection can be prevented with vaccines, it is likely that the development of cervical cancer will prevent it too.
Factors that increase the risk of developing cervical cancer.
Factors that increase the risk of cervical cancer include:
- Smoking. Chemicals from cigarettes enter the bloodstream and can affect the condition of cells throughout the body. Smoking women are more likely to suffer from diseases than non-smokers. The same applies to some cancers, including cervical cancer. Chemicals from smoking can affect the immune system and in some ways make you less resistant to the damaging effects of HPV.
- Weak immune system. For example, people with AIDS and people taking immunosuppressants have an increased risk. The immune system helps protect against human papillomavirus, and also helps to destroy cells that become "abnormal." If your immune system does not work in full, you are not able to resist HPV infection and the development of abnormal cells, and you have a greater risk of developing cervical cancer.
- Use of birth control pills for five or more years.
- After the birth of five or more children.
- Previous effects of various sexually transmitted infections, such as chlamydia.
What are the symptoms of cervical cancer?
You may not have any symptoms at first, when the tumor is small. Once the tumor becomes larger, in most cases, the first symptom is abnormal vaginal bleeding, such as:
- Bleeding between cycles.
- Bleeding after sex.
- Any vaginal bleeding in women after menopause.
The earliest symptom in some cases is vaginal discharge or pain in sex.
All of the above symptoms can be caused by different conditions. But if you experience any of these symptoms, you should discuss this with your doctor. Over time, if the cancer spreads to other parts of the body, various other symptoms can also develop.
How is cervical cancer diagnosed?
Confirmation of the diagnosis.
The doctor usually does a vaginal examination if you have symptoms that may indicate cervical cancer. If you suspect a cancer, usually a colposcopy will be done. This is a more detailed study of the cervix. For this test, a mirror is inserted into the vagina, so that the cervix can be carefully examined. The doctor uses a magnifying glass (colposcope) to examine the cervix in more detail. The examination will take about 15 minutes. At a colposcopy usually a fence of a piece of a tissue of a neck of a uterus (a biopsy) is made. The sample is then examined under a microscope to check for the presence of cancer cells.
Assessment of the extent and spread of cancer.
If the diagnosis is made, then further research may be asked to assess how much the cancer has spread. For example, to do CT, MRI, chest X-ray, ultrasound, blood tests, research under anesthesia of the uterus, bladder or rectum. This evaluation is called "establishing the degree of cancer". Its purpose is to find out:
- How much the tumor has grown, whether it has touched other nearby organs, such as the bladder or rectum.
- Whether the cancer has spread to the local lymph nodes.
- Whether the cancer has spread to other parts of the body.
Much depends on the initial assessment, as well as the results of the biopsy. For example, a biopsy can show that the cancer is at the earliest stage and remains only in the superficial cells of the cervix. It is unlikely to get widespread, and you do not have to go through many other tests. However, if the cancer appears to be more "neglected" and probably spread further - tests and tests may be necessary. Having learned the stage of cancer, it is easier for doctors to give recommendations on the most optimal treatment options.
Options for treating cervical cancer.
Treatment options that can be considered include surgery, radiation therapy, chemotherapy, or a combination of these treatments. Treatment is recommended in each case and depends on various factors. For example, the stage of cancer (how much the tumor has increased and whether it spreads), and your overall health.
You should discuss your diagnosis in detail with the specialist who is in charge of your case. He will be able to determine the advantages and disadvantages of your situation, the success rate, possible side effects and other information about the different possible treatment options for your type and stage of cancer.
You should also discuss with the specialist the purpose of treatment. For example:
- In some cases, treatment is directed directly at getting rid of cancer. Cervical cancer can be cured, especially if the treatment is in the early stages of the disease. Doctors tend to use the word "remission" instead of the word "cure". Remission means that there is no evidence of cancer after treatment. If you are "in remission" - you are cured at the moment. However, in some cases, the cancer returns after months or years. That's why doctors sometimes do not want to use the word "cure" for cancer.
- In some cases, treatment is aimed at controlling cancer. If cure is not possible, it is often possible to limit the growth and spread of cancer so that it does not progress so quickly. This can keep you free of symptoms for some time.
- In some cases, the treatment aims to alleviate the symptoms. For example, if the cancer has already reached the last stage, the patient may need anesthesia or other treatments to help get rid of pain and other symptoms.
Surgery.
Surgery to remove the uterus (hysterectomy) is a common method of treatment. In some cases, when the cancer is at a very early stage, you can simply remove part of the neck of the cancer victim without removing the entire uterus.
If the cancer has spread to other organs, surgical interventions can still be recommended along with other therapies. For example, in some cases, when the cancer has spread to other nearby organs, extensive surgery may be one option. In this case, it is necessary to remove not only the cervix and the uterus itself, but also parts of the organs that can become affected. This is most often the bladder and / or rectum.
Even if the cancer is in the last stage and can not be cured, some surgical methods can still be used to alleviate the symptoms. For example, to facilitate the blockage of the intestines or urinary tract, which was caused by the spread of cancer.
Radiation therapy.
Radiation therapy is a treatment that uses high radiation beam energies focused on cancer tissue. It kills cancer cells or stops their reproduction. Radiation therapy can be used only in the early stages of cervical cancer and may become an alternative to surgery. For later stages of cancer, radiation therapy can be offered in addition to other methods of treatment.
Two types of radiation therapy are used for cervical cancer: external and internal. In many cases, both types are used.
- External radiotherapy. Here the radiation is directed to the cancer cells from a special apparatus-emitter. This is a common form of radiotherapy, which is used in many types of cancer.
- Internal radiotherapy (brachytherapy). This treatment involves placing a small radioactive implant next to the cancer tumor for a short time and then removing it. Its position is fixed through the vagina.
Even if the cancer can not be cured, radiation therapy can still take place to alleviate the symptoms. For example, radiation therapy can be used to reduce secondary tumors that develop in other parts of the body and cause pain.
Chemotherapy.
Chemotherapy is the treatment of cancer with the help of anti-cancer drugs that kill cancer cells or stop their reproduction. Chemotherapy can be provided in addition to radiation therapy or surgery in certain situations.