What is cervical cancer?

Cervical cancer occurs when abnormal cells on the cervix grows out of control. The cervix consist of 2 parts: Endocervical part-covered with cylindrical epithelium. Exocervical part covered with stratified squamous epithelium.

The transition zone of the epithelium is the site formation processes and precancerous cell.

Growths on the cervix

-Benign growths:-polyps, cysts, or genital warts. They are rarely a threat to life and dont invade the tissues around them. -Malignant growths (cervical cancer): may sometimes be a threat to life, can invade nearby tissues and organs , can spread to other parts of the body.

 Human papillomavirus infection(16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59) Weakened immune system-HIV infection Using birth control pills for a long time >5yrs Lack of regular Pap tests Smoking Cervical trauma during childbirth Early sexual activity Family history Use of drugs during pregnancy-DES (diethylstilbestrol) which helped in preventing miscarriage.

Causes/Risk factors


Transmission of HPV by skin-to-skin contact. Basal cells of stratified squamous epithelium may be infected by HPV. Other cells types appear to be relatively resistant. It is assumed that the HPV replication cycle begins with entry of the virus into the cells of the basal layer of the epithelium. Once inside the host cell, HPV DNA replicates progress to the surface of the epithelium. In the basal layer, viral replication is considered to be nonproductive, and the virus establishes itself as a lowcopynumber. In the differenciated keratinocytes of the suprabasal layer of the epithelium, the virus switches to a rolling-circle mode of DNA replication, amplifies its DNA to high copy number, synthesizes capsid proteins, and causes viral assembly

Signs and symptoms

The early stages of cervical cancer may be completely asymptomatic. Most of the time, women complain of : Abnormal bleeding/spotting which occurs after sexual intercourse, between periods. Increased vaginal discharge- watery, pink, brown, bloody, or foul-smelling Periods become heavier and last longer than usual. Extra mass found during examination.

Signs and symptoms

Advanced cervical cancer may include: Back pain Fatigue Heavy bleeding from the vagina Leaking of urine or feces from the vagina-Fistula formation Leg pain Loss of appetite/Weight loss Pelvic pain Anemia Swollen legs Blood in urine.

TNM FIGO classification stage Tx T0

Insufficient data to assess tumor Primary tumor cannot be determined

Staging
Description

Tis T1 T1a T1 a1 T1 a2 T1b T1b1 T1b2 T2 T2a T2b T3 T3a T3b T4 M1

0 1 IA IA a IA 2 IB IB1 IB2 II IIA IIB III IIIA IIIB IVA IVB

Preinvasive carcinoma Cancer, limited the cervix (exclusive of the uterus) Invasive tumors only a microscopically. Stromal invasion up to 3.0 mm in depth and up to 7.0 mm surface Stromal invasion up to 5.0 mm in depth and up to 7.0 mm on the surface Clinically-defined lesion, limited neck or microscopically defined lesion larger chemT1A/1A2 Clinically-defined lesion to 4.0 cm in greatest dimension Clinically-defined lesion more than 4.0 cm Tumor of the cervix with spread outside the uterus, but no germination pelvic wall or lower third of vagina No invasion of parametric With the invasion of the parametric Cervical cancer with spread to the pelvic wall, damage to the lower third of the vagina, impaired kidney function The tumor affects the lower third of the vagina, but not to pelvic wall Tumor extends to pelvic wall and / or causes hydronephrosis and non-functioning kidney The tumor spreads to the mucous membrane of the bladder or rectum and / or beyond the pelvis Distant metastasis

Staging

Diagnosis

Vaginal examination with speculum/Rectovaginal palpation Pap smear or cervical smear is a simple test used to look at cervical cells cytology smear Biopsy-histological changes Human papilloma virus testing Ultrasound of the pelvic organs and abdominal cavity CT or MRI depending on the stage.

Diagnosis
Colposcopy: The doctor uses a colposcope to look at the cervix. The colposcope combines a bright light with a magnifying lens to make tissue easier to see. It is not inserted into the vagina. A colposcopy is usually done in the doctor's office or clinic.
The following are simple Guidelines that may help insure a truer result from your test: Try to schedule your pap smear the first two weeks after your period Avoid using things in your vagina - such as tampons, sponges, and diaphragms Avoid intercourse for 48 hours before your test Do not douche for at least 48 hours before your test Do not use bubble bath or oil in bathwater prior to your test

Treatment
It depends on the stage of the cancer. Methods include: Surgery-Hysterectomy and the removal of regional lymph nodes Radiation therapy Chemotherapy


Early cervical cancer can be cured by removing or destroying the precancerous or cancerous tissue. Loop electrosurgical excision procedure (LEEP) -- uses electricity to remove abnormal tissue Cryotherapy -- freezes abnormal cells Laser therapy -- uses light to burn abnormal tissue A hysterectomy (removal of the uterus but not the ovaries) is not often performed for cervical cancer that has not spread. It may be done in women who have repeated LEEP procedures.


Treatment for more advanced cervical cancer may include: Radical hysterectomy, which removes the uterus and much of the surrounding tissues, including lymph nodes and the upper part of the vagina. Pelvic exenteration, an extreme type of surgery in which all of the organs of the pelvis, including the bladder and rectum, are removed. Radiation may be used to treat cancer that has spread beyond the pelvis, or cancer that has returned. Radiation therapy is either external or internal.

Internal radiation therapy uses a device filled with radioactive material, which is placed inside the woman's vagina next to the cervical cancer. The device is removed when she goes home.
External radiation therapy beams radiation from a large machine onto the body where the cancer is located. It is similar to an x-ray. Chemotherapy uses drugs to kill cancer. Some of the drugs used for cervical cancer chemotherapy include 5-FU, cisplatin, carboplatin, ifosfamide, paclitaxel, and cyclophosphamide. Sometimes radiation and chemotherapy are used before or after surgery.