Cancer is one disease that people are really scared of, in fact, to a lot of people it is a death sentence (to a lot of people and not everyone) but, how won't it look like a death sentence when its treatment can be very painful in most cases, life-threatening, and expensive. I remember a friend's father who was undergoing chemotherapy which was very expensive in a country where people do not have insurance, and he was in pain as well. He didn't survive it actually, and since, my friend has been scared (real scared) when it comes to Cancer. In my post today, I will be sharing about cervical cancer, its pathophysiology, risk factor, symptoms, diagnosis, treatment, and prevention.
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As the name implies, Cervical cancer is referred to as the cancer of the cervix. Cervix is found in the female reproductive system, it is a small canal connecting the uterus and vagina together. It is caused exclusively by the Human Papillomavirus virus (HPV) with type 16 and 18 giving a higher risk of Cervical cancer, while type 6 and 11 are low-risk causes of cervical cancer. Cervical cancer is one of the most gynaecological cancer in the world, based on different journals, it is said to be the third of the fourth most gynaecological cancer worldwide, and the average age of cervical cancer is in the 50s. Adult women above 50 are at risk of having cervical cancer.
The cervix can be divided into the ectocervix and the endocervix. The endocervix is the tunnel in which the vagina connects to the Uterus. From the Vagina to the cervix is an opening known as the external cervical os, while from the Cervix to the Uterus is another opening known as the internal cervical os. The point where the ectocervix meets with the endocervix is known as the transformation zone.
There are different types of cervical cancer, and the Squamous cell carcinoma accounts for up to 80 - 95% of all cervical cancer. The squamous cells are the cells that line the cervix. Another type of cervical cancer is the Adenocarcinoma which accounts for about 5% to 20% of all cervical cancer. It affects younger patients and it affects the endocervix in the form of Endocervical adenocarcinoma. Another type of cervical cancer is the small cell cancer and another is the Adenosquamous.
The Human Papillomavirus virus (HPV) has a non-enveloped double straded-DNA virus, with over 100 types, and about 15 to 20 types are oncogenic. Patients that suffer from HPV virus infection often suffer from repeat infection. When HPV attacks the cells of the stratum basale the cells the are infected produces E6 protein, which inhibits P53, which prevents tumor. The inhibition of P53 and Rb, will allow Dysplasia (continuous growth and increase of abnormal cells), causing cancer as time goes on.
Patients who experience repeated infection from HPV virus are at high risk of having cervical cancer. Unprotected sex with birth controls can also be a risk factor for having cervical cancer, family history, previous history of STDs, young age sexual intercouse can also be a risk factor, smoking, vitamin deficiencies and malnutrition, and immunocompromised.
Clinical features of cervical cancer will include vaginal discharge which cam be red/brown in color, vaginal bleeding, post-coital bleeding, vaginal discomfort, dysuria, back pain/pelvic pain. At the early stage, there can be no clinical manifestation, so when caught and treated early.
Diagnosing Cervical cancer can be done through Pap smear (Papanicolaou) which help to detect precancerous changes, HPV serology testing, Colposcopy which can be diagnostic colposcopy and Therapeutic Colposcopy. While diagnosing, cervical cancer can be categorized based on the FIGO staging pattern.
Treatment of Cervical cancer includes Radiation such as External beam radiation (EBRT), and Brachytherapy, Chemotherapy, Surgery such as Laser surgery, Cone biopsy, Cryosurgery, Trachelectomy, and Pelvic exenteration, other treatments includes Targeted therapy, and Immunotherapy. Prevention starts with vaccination against HPV, Pap smear on a regular allowing to identify early changes of Cervical cancer.
National Library of Medicine - Anatomy of the uterine cervix and the transformation zone
National Library of Medicine - Human papillomavirus and cervical cancer
clevelandclinic.org - Cervical Cancer
World Health Organization - Cervical cancer
Centers for Disease Control and Prevention - Basic Information about HPV and Cancer
Cancer.org - Types of cervical cancer
Cancercenter.com - Cervical cancer types
Cancer.gov - What Is Cervical Cancer?
National Library of Medicine - Cervical Cancer
Training.seer.cancer.gov - FIGO Staging of Gynecologic Tumors