Cervical Cancer: The Silent Killer
Cervical cancer, also known as cancer of the cervix, is often termed a silent killer as it can develop without any symptoms during its early stages. Cervical cancer is caused by human papillomavirus (HPV) and is a significant global health concern. While it rarely affects women below 20 years of age, it is frequently diagnosed among women between the age group of 30 and 45 (1).
This is why regular screenings and raising awareness are crucial. This blog will provide detailed information about cervical cancer, its causes, risk factors, prevention methods, and treatment.
Understanding Cervical Cancer
Cervical cancer is a malignancy that affects the cervix, the lower part of the uterus. The cervix, which acts as a bridge between the uterus and the vagina, is an integral part of the female reproductive system (2). The human papillomavirus (HPV), a sexually transmitted infection, is the primary cause of most cases of cervical cancer.
HPV is a common infection, but certain high-risk strains, such as HPV-16 and HPV-18, are known to cause cellular changes in the cervix (3).
HPV may integrate its DNA into host cells and can disrupt standard cellular control and play a role in the development of cervical cancer. The virus can transform normal cells into abnormal ones. This causes precancerous lesions, also known as cervical intraepithelial neoplasia or cervical dysplasia (4).
Cervical dysplasia, or the emergence of unusual cells in the cervical tissue, is a condition that occurs in the cells of the cervix before cancer occurs. If left unchecked, the aberrant cells have the potential to develop into cancerous ones that eventually invade the cervix and its surrounding tissues.
Risk Factors of Cervical Cancer
The infection of the HPV virus causes more than 70% of cervical cancer cases (5). If a woman is at substantial risk of HPV infection, then some risk factors increase the chance of developing cervical cancer (2, 6, 7, 8). These include:
Weekend Immune System
A weak immune system is less equipped to fight against infections. Individuals who are immunocompromised either due to HIV/AIDS or immunosuppressive medications are more vulnerable to HPV infections that become chronic and lead to cancer.
Smoking
The risk of cervical cancer is higher among those who smoke or inhale second-hand smoke. The more someone smokes or is around second-hand smoke, the higher the risk.
Reproductive factors
Women with many children or those using oral contraceptives have a higher risk of getting cervical cancer. However, it is unclear why these occur.
Obesity
It is challenging to conduct screening for cervical cancer among obese women, which increases the risk of cancer and lowers the detection of precancers.
Early Sexual Activity
Engaging in sexual activity at an early age increases the risk of HPV. Education on safe sex practices can contribute to preventing cervical cancer.
Family History
The risk of developing cervical cancer increases if it runs in the family. Women should track their symptoms and get screened if their mother or sister once had cervical cancer.
Miscarriage Prevention Medication
Exposure to diethylstilbesterol (DES) is observed to increase the risk of cervical cancer among women. DES was administered to pregnant women between 1940 and 1971 to avoid miscarriage and premature birth. Clear cell adenocarcinoma of the vagina and cervix, as well as abnormalities in the cervical cell, are more common in women whose mothers took DES during pregnancy.
Prevention
Routine Screening
Early detection is crucial in preventing the progression of abnormal cell growth to invasive cervical cancer. Regular screenings, like Pap smears, can detect these changes early, enabling timely intervention and preventing the progression to invasive cervical cancer.
Regular Pap screenings, starting at age 21 and continuing until age 65, are the most crucial steps a woman can take to prevent cervical cancer.
Every three years, if everything is normal, a Pap test should be performed. Every five years, women 30 years of age and above should have a Pap smear and be tested for HPV (9). Also, self-sampling kits and HPV vaccinations are crucial in avoiding initial infections with high-risk HPV types, reducing the risk of cervical cancer development.
HPV Vaccine
World Health Organization (WHO) estimates that a single Pap test will prevent 74 million new cases and 62 million deaths of cervical cancer if they reach the elimination goal. The WHO global strategy aims to eliminate cervical cancer by vaccinating 90% of girls by age 15, providing treatment to 90% of women with cervical cancer, and screening 70% of women between age 35 and 45 years (10).
Public Awareness
The public and healthcare providers can collaborate to implement preventive measures by identifying and addressing these risk factors. An all-encompassing strategy to lower the incidence of cervical cancer and improve women’s health must include regular vaccinations, screenings, lifestyle changes, and awareness campaigns (11).
Symptoms of Cervical Cancer
Cervical cancer symptoms are observed after the cancer has spread. It is exceedingly rare to notice any symptom during the initial stages of cancer, making it hard to detect. In rare cases, symptoms do appear in the preliminary stages of cancer, and these are (12):
- Unusual vaginal bleeding either after sex or menopause
- Pelvic pain
- Pain during intercourse
- Changes in vaginal discharge- watery and has a strong odor or contains blood.
The above symptoms are commonly observed in advanced stages along with other symptoms like:
- Painful or difficult bowel movements
- Rectum bleeding during bowel movements
- Difficult or painful urination
- Abdominal pain
- Backache, swelling in legs, and lethargy.
All the symptoms are common and can be experienced with other conditions. To be sure, speaking with a healthcare professional is imperative.
Prevalence
Cervical cancer is one of the most common cancers that affects women’s health. In 2020, about 3,42,000 deaths and 6,42,000 new cases were reported. The incidence and mortality rates vary geographically, with Eastern Africa (including Zimbabwe) having the highest rates and Western Asia having the lowest.
It is the second most prevalent kind of cancer in women in Southeast Asia and a leading cause of cancer-related mortality in women living in low- and middle-income nations (LMICs). In these regions, limited access to healthcare, lack of screening programs, and challenges in HPV vaccination contribute to the higher prevalence (13).
Treatments
HPV vaccine provides optimal protection against the virus by preventing precancerous lesions and lowering the incidence of cancers. The vaccine is given to children 12 or 13 years of age and people at higher risk of infection. The significance of HPV vaccination goes beyond preventing cervical cancer; it also protects against other diseases and cancers linked to HPV, highlighting its effectiveness as a public health intervention (14).
In most cases, cervical cancer is treatable. But it depends on the stage of cancer, size, location of its spread, type of cancer, and overall health of a woman. The specialist care team guides the patient with treatment options, benefits, and side effects and provides a tailored treatment plan.
Treatment options include surgery, chemotherapy, or radiotherapy. These treatments are given either independently or along with each other. It depends entirely on the cancer stage and how well the patient responds to the treatment (15).
Surgery
For cervical cancer, it serves as the primary therapeutic option. Different types of surgeries can remove cancer cells. It depends entirely on the type of cancer and its spread. These surgeries include the removal of part of the cervix, cervix, and upper part of the vagina, the cervix, and the womb.
After the treatment, if cancer comes back or there is no other option left, then surgery will include removal of the cervix, womb, ovaries, fallopian tube, and different parts of the bladder, bowel, vagina, or rectum.
Chemotherapy
Chemotherapy is a standard treatment option used to kill cancerous cells in the body using medicines. The treatment can be given along with radiotherapy before the surgery to make cancer cells small and after the surgery to prevent cancer from coming back. The method is used when the cancer cells spread to other body parts.
Radiotherapy
This method kills cancerous cells using high-energy X-rays. This radiation damages the DNA of the cells. Two types of radiation therapy used in the treatment of cervical cancer are external and internal radiation therapy.
If the cancer has reached the advanced stage or has come back, then cervical cancer can be treated using a specific medicine called bevacizumab. This medicine does not eradicate cancer but helps to reduce the size of the tumor or stop it from getting any longer (16).
Stage of Cervical Cancer and Treatment Options
- Stage 1: Surgery
- Stage 1B or 2A: Chemoradiotherapy
- Stage 2B, 3, 4A: Chemoradiotherapy
- Stage 4B: Chemotherapy, radiotherapy, immunotherapy, surgery.
Conclusion
In summary, cervical cancer is still a primary global health concern that affects women. Hence, everyone must understand this disease. Making regular check-ups a priority helps us combat cervical cancer and becomes a potent weapon. About 70% of cervical cancer cases could be prevented if a woman is screened just once after the age of 35 years. The percentage could rise if everyone is vaccinated.
Without question, the best medicine is prevention, and effective treatment depends significantly on early detection. Despite the challenges posed by cervical cancer, Novel treatments and developing technologies promise a day when cervical cancer can be successfully treated, if not completely eradicated.
By: Nishtha Kathuria (MSc. Global Public Health)
Edited by: Damilola Elewa
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