Cervical Cancer Definition, Reason, Symptoms, Treatment & Prevention
Understanding
Cervical cancer is the uncontrolled growth of cells in the cervix (cervical). The cervix is part of the female reproductive tract that connects the vagina to the uterus or uterus. All women are at risk of suffering from this cancer.
However, women who are sexually active tend to be more at risk. In its early stages, cervical cancer usually does not cause recognizable symptoms. To get the right diagnosis, the doctor will advise you to undergo a series of examinations and procedures. If cervical cancer growth is suspected, you will be referred to a specialist.
Cervical cancer
| Medical specialist | Obstetrics and gynecology specialist, oncology surgeon |
| Symptom | Bleeding after intercourse outside the menstrual cycle or postmenopause |
| risk factor | Genetic, hereditary factors, having sex with more than one person, sexually transmitted infections |
| How to diagnose | IVA, pap smear, biopsy |
| Treatment | By stage (surgery, chemotherapy, radiotherapy) |
| Drug | Chemotherapy, radiotherapy |
| Complications | Metastases to other organs |
| When to See a Doctor? | Symptoms present, abnormalities on routine screening (IVA, pap smear ) |
Symptom
Symptoms of cervical cancer in general are:
- Spotting or abnormal bleeding from the vagina is the easiest symptom to recognize as a symptom of cervical cancer. Usually, bleeding occurs after sexual intercourse, outside of menstruation, or post-menopause. Immediately consult a doctor if abnormal bleeding occurs more than once
- Pain and discomfort during sexual intercourse
- The discharge from the vagina has a strange smell, is of an unnatural color or contains blood
Stage 4 cervical cancer will spread beyond the cervix to the surrounding tissues and organs.
At this stage, the symptoms experienced will be different, such as:
- Constipation
- There is blood in the urine
- There was swelling in one of the legs
- Bone pain
- Loss of appetite
- Pain in the lower abdomen and pain in the pelvis
- Fatigue
- Weak
- Pain in the back or waist caused by swelling of the kidneys. The condition is called hydronephrosis.
It should be noted that the characteristics of cervical cancer above are not always obvious. In fact, symptoms may not appear at all until the cancer is in its final stages.
That is why, Pap smears need to be done to detect abnormal cells and prevent their development into cervical cancer.
Reason
Initially, healthy cells experience genetic mutations that change the growth of healthy cells to be abnormal. This causes cervical cells to grow rapidly, and uncontrollably. This abnormal cell development occurs as a result of Human Papillomavirus (HPV) infection.
In fact, almost all cases of cervical cancer are caused by HPV. This is a group of viruses that infect humans in the epithelial cells of the skin and mucous membranes, including in the genital area. Until now almost a hundred types of HPV have been identified. Most types of HPV are harmless.
However, there are several types of HPV that are known to interfere with cervical cells to trigger cancer, namely HPV 16 and 18. Cancer cells that appear then attack the surrounding tissue.
Cancer cells can escape from their initial location and spread to other parts of the body. This process is known as metastasis
Risk Factors
Some of the risk factors for cervical cancer are:
- genetics
- Hereditary factor
- Family history of cancer
- Smoke
- Having sex at a young age
- Use of hormonal birth control
- Give birth more than 3 times
- Childbirth at a young age
- Elderly
- Having sex with more than 1 person
- History of sexually transmitted infections
- Take immunosuppressant drugs
- Not vaccinated
Diagnosis
Early detection of cervical cancer can help increase the chances of successful treatment. If the Pap smear results show abnormal cells in the cervix, you will be given a referral to a specialist in the female reproductive system.
Abnormal cell results do not mean you have uterine cancer. If abnormal bleeding occurs in the vagina, the doctor will conduct an examination to find the cause.
In general, the examinations carried out include:
Colposcopy Procedure
This procedure will be recommended by the doctor if the pap smear results show abnormal cells or symptoms that arise are suspected of cervical cancer.
The doctor will use a special microscope with a small light on the end to look at the vagina, vulva and cervix.
This examination aims to see abnormalities in the cervix. If abnormalities are seen, tissue samples will be taken from the cervix to be analyzed for cancer cells in it.
Cone Biopsy
In some cases, a minor surgical procedure known as a cone biopsy may be performed. The patient will be under local anesthesia during the procedure. Cone-shaped tissue will be taken from the cervix to be analyzed whether there are cancer cells in it.
The effect of this examination is that patients can experience bleeding accompanied by pain, similar to menstrual symptoms, up to four weeks after surgery.
If the biopsy results show that the patient has cervical cancer and there are indications that the cancer has spread, the patient will be advised to do some further tests.
Examination usually includes:
-
Blood test
Performed to determine the condition of the liver, kidneys and bone marrow
-
Examination of the pelvic organs
The doctor will examine the vagina, uterus, bladder and rectum for cancer
-
CT scans
Scanning is done to see the condition of the inside of the body with a computer to get a three-dimensional image. This is done to see if there is cancer and whether it has spread
-
MRI scans
This examination uses a strong magnetic field and radio waves to get detailed pictures of the inside of the body. This is done to see the spread of cancer that may have occurred
-
Chest x-ray
Examination to see if the cancer has spread to the lungs
-
PET scans
A special scan where the patient is injected with a radioactive liquid to see cancerous tissue more clearly. When combined with a CT scan, it can show the spread of cancer and the patient’s response to the treatment being carried out
After all examinations have been completed, the stage of the cancer can be determined. Staging is used as a marker of how far the cancer has spread. The higher the stage, the wider the spread of the cancer.
The following are the stages of cervical cancer:
- Stage 0: precancerous stage. There are no cancer cells in the cervix, but there are biological changes that can potentially lead to cancer later in life. This stage is known as cervical intraepithelial neoplasia (CIN) or carcinoma in situ (CIS).
- Stage 1: cancer is still in the cervix and has not spread
- Stage 2: the cancer has spread beyond the cervix and into the surrounding tissue. But it hasn’t reached the pelvic wall or the bottom of the vagina
- Stage 3: cancer has spread to the lower part of the vagina and/or pelvic wall
- Stage 4: cancer has spread to the intestines, bladder, or other organs, such as the lungs
Treatment
The choice of cervical cancer treatment method depends on several factors, for example:
- Cancer stage
- Type of cancer
- Patient age
- Other medical conditions you may be facing
Treatment of cervical cancer based on the stage is divided into two. First, surgical removal of part or all of the uterine organs, radiotherapy, or a combination of both.
Second, the handling of end-stage cervical cancer, namely radiotherapy and/or chemotherapy. Sometimes, surgery is also necessary.
1. Removal of Precancerous Cells
Handling of precancerous cells is needed if the Pap smear results show a biological change that has the potential to become cancerous in the future.
Several procedures for removing precancerous cells include:
- Laser therapy: the use of a laser to burn abnormal cells
- Cone biopsy: namely removal of the area where the abnormal tissue is through a surgical procedure
- Large loop excision of the transformation zone (LLETZ): abnormal cells are cut using a thin wire and an electric current
2. Surgical Removal of Cervical Cancer
There are three surgical procedures for removing cervical cancer, namely:
- Radical Trachelectomy
This procedure aims to remove the cervix, surrounding tissue, and the upper part of the vagina, without removing the uterus.
- Hysterectomy
This procedure is a surgical removal of the uterus. Usually done for early-stage cervical cancer. There are two types of hysterectomy surgery. The first is a simple hysterectomy. Namely, the procedure for removing the cervix and uterus.
In some cases, the ovaries and fallopian tubes may also be removed. This procedure can be done for early-stage cervical cancer. The second, radical hysterectomy. Namely, the process of removing the cervix, uterus, surrounding tissue, lymph nodes, ovaries, and fallopian tubes.
Short-term side effects of hysterectomy surgery include bleeding, infection, risk of injury to the bladder, ureter and rectum, and blood clots.
Long-term complications can include swelling of the arms and legs due to fluid buildup. Another complication is that the production of vaginal fluid will decrease and cause sexual intercourse to feel uncomfortable.
- Pelvic Exenteration
A major surgical procedure performed to remove the cervix, surrounding tissue and the upper part of the vagina. However, the uterus was not removed.
3. Treatment with radiotherapy
In end-stage cervical cancer, radiotherapy will be combined with chemotherapy to control bleeding and pain.
Radiotherapy procedures can be done in two ways, namely:
- External: The radiotherapy machine will shoot high-energy waves into the patient’s pelvis to destroy cancer cells.
- Internal: Radioactive implants will be inserted inside the patient’s vagina and cervix.
Radiotherapy not only destroys cancer cells, it often destroys healthy tissue as well.
Side effects of this procedure include:
- Bleeding from the vagina and rectum
- Diarrhea
- Nauseous
- Damaging the bladder so that the patient loses control of defecation and urination
- Damage to the ovaries, resulting in menopause
- Pain on the pelvic skin
4. Treatment with chemotherapy
Chemotherapy is done to slow the spread and reduce the symptoms that appear. This method uses drugs that function to destroy cancer cells.
Chemotherapy can be done using one type of drug or a combination of drugs. Chemotherapy treatment is given by infusion on an outpatient basis. Patients are allowed to go home after receiving treatment according to the dose.
This treatment affects the whole body. So, not only destroys cancer cells that grow rapidly, healthy cells are also affected.
Patients undergoing chemotherapy treatment should have regular blood tests. This is done to check the health of the kidneys because some chemotherapy drugs can damage the kidneys.
The most common side effects after chemotherapy include:
- Experiencing canker sores
- Loss of appetite
- Feeling exhausted
- Nausea and vomiting
- Hair loss
Prevention
There are several ways to prevent and reduce the risk of developing cervical cancer, namely:
Using Condoms
Using a condom during sex can protect you from HPV. In addition, prevent cervical cancer by limiting the number of sexual partners you have.
HPV vaccine
Vaccines to prevent cancer-causing HPV infection are available. The currently available HPV vaccines are bivalent vaccines for HPV 16 and 18; quadrivalent vaccines for HPV 6, 11, 16 and 18; or nonavalent vaccines for 9 types of HPV namely 4 types plus 31,33, 45, 52, and 58.
Early Detection with Regular Pap Smears
Cervical screening or pap smears are also recommended because they can detect abnormalities in cell changes in the cervix early. When doing a pap smear, a sample of cells is taken from the cervix and examined under a microscope.
The risk of developing cervical cancer can be reduced by undergoing treatment when the cells are still in the precancerous stage. However, it should be understood that cervical screening is not a test to diagnose cervical cancer, but to detect abnormal cells.
Cell changes do not always lead to cancer. Abnormal cells can still return to normal on their own. In certain cases, abnormal cells need to be removed because they have the potential to become cancerous.
For women aged 21-29 years, it is recommended to have a pap smear every 3 years.
As for women aged 30-64 years, a combination of Pap smears and an HPV DNA test can be done every 5 years, or you can also undergo each test separately every 3 years.
In women aged 65 years and over, ask your doctor for advice regarding the need to undergo a pap smear examination.
Women who are sexually active and over the age of 21 and at high risk of sexually transmitted diseases are advised to get tested for diseases such as chlamydia, gonorrhea, and syphilis annually.
If necessary, do an HIV test every year. Ask the doctor who treats you about the HPV vaccine. Getting the HPV vaccine can help you prevent infection with HPV which can also reduce your risk of developing cervical cancer and other cancers related to HPV.
Do Not Smoke and Limit Drinking Alcohol
Don’t smoke, either conventional cigarettes or e-cigarettes, and limit drinking alcohol.
Smoking and drinking alcohol can increase your risk of cervical cancer many times. Smoking can also cause you to get other types of cancer, such as squamous cell cancer.
Increase your body’s power by eating nutritious foods, getting enough rest, and exercising moderately so that your body can also be fitter.
Complications
As with other types of cancer, cervical cancer can also spread or metastasize to other organs causing disruption of organ function.
When to See a Doctor?
When you experience symptoms such as bleeding after having sex outside of the menstrual cycle or after menopause, it is highly recommended to see a doctor immediately.
In addition, when you do routine screening such as IVA or pap smears and find something strange, it is highly recommended to consult a doctor immediately.