cervical cancer

Cervical Cancer – Its various Stages along with Symptoms, Treatments and Vaccines available

Cervical cancer is one of the most common cancers that affect a woman’s reproductive organs.

Cervical cancer is the rapid, uncontrolled growth of severely abnormal cells on the cervix, the lower part of the uterus that opens into the vagina.

Fortunately, when detected at an early stage, cervical cancer is highly curable.

Pap test screening, when done regularly, is the single most important tool for preventing cervical cancer because it can detect abnormal cervical cell changes before they become cancerous, when treatment is most effective.

Various strains of the human papillomavirus (HPV), a sexually transmitted infection, are responsible for most cervical cancer cases. When exposed to HPV, a woman’s immune system typically prevents the virus from doing harm.

In a small group of women, however, the virus survives for years before it eventually converts some cells on the surface of the cervix into cancer cells. Half of cervical cancer cases occur in women between ages 35 and 55.

There are two main types of cervical cancer: squamous cell (epidermoid) cervical cancer and adenocarcinoma cervical cancer. About 75% of all cervical cancer is squamous cell cancer.

Cervical Cancer Causes

Cervical cancer causes may be different from other types of cancers. Cervical cancer is caused by severe abnormal changes in the cells of the cervix. Most precancerous or cancerous cell changes occur in the cervix at the transformation zone because these cells normally undergo constant change. During this natural process of change, some cervical cells can become abnormal, especially if one is infected with high-risk types of HPV.

Other factors that may play a role in causing cervical cancer include:

  • Smoking or a history of smoking.
  • Having an impaired immune system, such as from having human immunodeficiency virus (HIV).
  • Using birth control pills for more than 5 years. This may be related to infection with HPV.

Regular Pap test screening is the single most important tool to identify cervical cell changes early before they progress to cancer.

Stages of Cervical Cancer

The stage of cervical cancer tells the doctor how far it has spread.  It is important because treatment is often decided according to the stage of a cancer.  Doctors use different systems to stage cancers.  The system usually used for cervical cancer simply numbers the different stages from 0 to 4.

Stage 0

This stage is also called carcinoma in situ.  It means that there are cancerous cells in the cervix.  But they have not spread away from where they started or begun to grow into the deeper tissues of the cervix.  So this is not an invasive cancer.

Stage 1

This stage is often divided into two

  • Stage 1a
  • Stage 1b

In both these stages the cancer has started to grow into the deeper tissues of the cervix.  These days, stage 1A and 1B are both divided into two smaller groups

  • Stage 1A1 and stage 1A2
  • Stage 1B1 and stage 1B2

In stage 1a the growth is so small it can only be seen with a microscope. Stage 1A1 means the cancer has grown less than 3 millimeters into the tissues of the cervix.  Stage 1A2 means the cancer has grown between 3 and 5 mm into the cervical tissues.  Both the sub stages are still less than 7mm wide.

In stage 1b the cancerous areas are larger, but the cancer is still only in the tissues of the cervix and has not usually spread.  It can usually be seen without a microscope, but not always.  In stage 1B1 the cancer is no larger than 4 centimeters.  In stage 1B2 the cancer is larger than 4cm across.

Stage 2

In this stage, the cancer has begun to spread outside the neck of the womb into the surrounding tissues.  Stage 2 can be divided into two:

  • Stage 2a
  • Stage 2b

In stage 2a the cancer has not spread into the womb but may have spread down into the top of the vagina.  In stage 2b there is spread up into the tissues around the cervix.

Stage 3

In stage 3 the cancer has spread away from the area surrounding the cervix and through the pelvis.  It may have grown down into the lower part of the vagina.  It may have grown up to block one or both the ureters.

Stage 4

This stage is advanced cervical cancer.  The cancer has spread to other body organs outside the cervix and womb.  If the cancer has spread to nearby organs such as the bladder or rectum (back passage) it is stage 4a.  If the cancer has spread to organs further away such as the lungs then it is stage 4b.

Cervical Cancer Symptoms or Signs of Cervical Cancer

Since abnormal cervical cell changes rarely cause symptoms, it is important to have regular Pap test screening. As cervical cell changes progress to cervical cancer, symptoms may develop. Early cervical cancer generally produces no signs or symptoms. As the cancer progresses, signs and symptoms may appear. Cervical Cancer Symptoms or Signs of Cervical Cancer can be as follows:

  • Vaginal bleeding after intercourse, between periods or after menopause
  • Abnormal vaginal discharge containing mucus that may be tinged with blood that may be heavy and have a foul odor
  • Pelvic pain or pain during sexual intercourse
  • Significant unexplained change in the menstrual cycle.
  • Bleeding when something comes in contact with the cervix, such as during sexual intercourse or insertion of a diaphragm.
  • Anemia because of abnormal vaginal bleeding.
  • Ongoing pelvic, leg, or back pain.
  • Urinary problems because of blockage of a kidney or ureter.
  • Leakage of urine or fecal content into the vagina because an abnormal opening (fistula) has developed between the vagina and the bladder or rectum.
  • Weight loss.

Cervical Cancer Treatment

Cervical cancer detected in its early stages can be cured with treatment and close follow-up.

Cervical cancer treatment choices may be divided into two types: the pre-invasive stage treatment and the invasive stage treatment.

The different treatment options for both the stages are categorized as follows:

Pre-invasive stage: Treatment of cervical cancer in the pre-invasive stage, when it has affected only the outer layer of the lining of the cervix, may include:

  • Conization: This type of surgery is a simple procedure which involves removing with a scalpel a cone-shaped piece of cervical tissue where the abnormality is found.
  • Laser surgery: This type of operation uses narrow beam of intense light to kill cancerous and precancerous cells.
  • Loop electrosurgical excision procedure (LEEP): This technique uses a wire loop to pass electrical current, which cuts like a surgeon’s knife and remove cells from the mouth of the cervix.
  • Cryosurgery: This type of technique involves freezing and killing cancerous and precancerous cells.
  • Hysterectomy: This major surgery involves removal of the cancerous and precancerous areas, the cervix and the uterus.

Invasive stage: Many women are treated successfully for invasive cervical cancer and live full, productive lives. The treatment may involve:

  • Hysterectomy: This type of surgery is usually recommended for younger women because it often can preserve one or both ovaries along with their estrogen production, which is important in maintaining bone strength. A simple hysterectomy removal of the cancer, the cervix and the uterus is typically an option only when there is an invasion of less than 3 mm into the cervix. A radical hysterectomy removal of the cervix, uterus, part of the vagina and lymph nodes in the area is the standard surgical treatment when there’s an invasion of greater than 3 mm into the cervix and no evidence of tumor on the walls of the pelvis.
  • Radical trachelectomy: Women with early-stage cervical cancer may be able to preserve their fertility by having this surgical procedure, which involves removing the cervix and the lower part of the uterus. This type of surgery is performed on women who want to bear children in future. Lymph nodes in the pelvis are also removed during this procedure to determine whether the cancer has spread.
  • Radiation: High-energy rays shrink tumors by killing the cancer cells. The radiation destroys the ability of cancer cells to reproduce. Premenopausal women will experience menopause because their ovarian functions are destroyed by the radiation.
  • Chemotherapy: These anti-cancer drugs enter the bloodstream and travel throughout the entire body (systemic treatment). Chemotherapy enhances the effects of radiation in the treatment of cervical cancer.

Some women with early-stage cervical cancer are treated with a simple hysterectomy or radical trachelectomy alone. However, women with more advanced cancer and women who are at high risk of recurrence are usually treated with a radical hysterectomy, a regime of combined radiation and chemotherapy, or a combination of all of these approaches.

Cervical Cancer Vaccine

A vaccine against one strain of the virus that causes cervical cancer is 100 per cent effective, early US trial results reveal.

Large-scale trials of a very similar vaccine that protects against multiple viral strains are now underway. If successful, such a vaccine could save thousands of lives every year and make regular cervical smear testing obsolete.

Human papilloma virus causes almost every case of cervical cancer. There are about 80 subtypes of HPV but only a few dramatically increase the cancer risk.

Women infected with this particular subtype are 100 times more likely to develop cervical cancer compared to those that are virus free.

Vaccines are producing good results in clinical trials. This vaccine, which contains two strains of HPV thought to cause 70 per cent of cervical cancers, had prevented 90 per cent of new infections and all persistent infections. Another vaccine with similar results  which contains the same two cancer-causing HPV strains plus two strains that cause genital warts is also introduced.

This vaccine has set up a clash between health advocates who want to use the shots aggressively to prevent thousands of malignancies and social conservatives who say immunizing teenagers could encourage sexual activity.

Cervical Cancer Prognosis and Survival Rate

Prognosis by stage

For any type of cancer the prognosis or the outcome of the disease depends on the stage of the cancer. Of all those women diagnosed with cancer of the cervix, about 70% will be alive for 5 years after diagnosis. Younger women have a better survival rate than older women.  This is at least partly because the disease in younger women tends to be diagnosed at an earlier stage.

The cervical cancer prognosis and survival rate can be studied by stage as follows:

Stage 0

This is the earliest stage of cervical cancer before it has become invasive.  This stage is also called as a pre-cancerous stage.  Because the cells are confined to the outer tissues of the cervix, the cancer cannot spread.  Just about every woman diagnosed at this stage will be cured.

Stage 1

Stage 1 cervical cancer is often divided into two stages – 1A and 1B.  Of all those women diagnosed with stage 1A cervical cancer, 95% will be alive for 5 years more.  For stage 1B cervical cancer 70 to 90% will be alive for 5 years more.

Stage 2

Stage 2 is divided into 2 groups – stage 2A and 2B.  For all those women diagnosed with stage 2A cervical cancer, on average 70 to 90% will be alive for 5 years more.

For stage 2B the figures are slightly lower.  60 to 65% of women will be alive  for 5 years more after diagnosis.

Stage 3

As it is quiet evident that the survival statistics fall with the more advanced stages of cervical only 30 to 50% live at least five years after a diagnosis.

Stage 4

As it is the most advanced stage, and the cancer will have already spread, the survival statistics are lowest for stage 4 cervical cancers.  Only 20 to 30% will live 5 years or longer.

Other factors affecting the prognosis of cervical cancer are the age and general physical condition of the woman are the common factors.

The 5-year survival rates (the chance of still being alive 5 years after the diagnosis) for women with cervical cancer who have appropriate treatment are approximately:

  • 80 to 85% for tumors limited to the cervix and uterus
  • 60 to 80% when the upper part of the vagina is involved
  • 30 to 50% for tumors beyond the cervix and upper vagina, but still in the pelvis
  • 14% when the cancer has invaded the bladder or rectum or has spread beyond the pelvis

Without treatment, or when treatment fails, cervical cancer is fatal within two years for about 95% of women.