Dr. Vivek Sukumar

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What is cervical cancer?

The cervix is the lower part of the uterus and forms the birth canal. A gradual change in the cervical lining will result in abnormal cells, when remains unchecked it progresses to cervical cancer.

Does screening help prevent cervical cancer?

Screening and vaccination are one of the major reasons for the decline in the incidence of cervical cancer in Western countries, However, it remains one of the major causes of cancer death in low and low middle income countries. Regular screening of young women with Pap smear and HPV testing along with vaccination of adolescent girls are the cornerstone of preventive strategies in cervical cancer. A Pap smear can detect precancerous abnormal cells on the cervix as well as early-stage cervical cancer.

Signs and symptoms

  • Abnormal bleeding during menstrual cycles
  • Bleeding in between menstrual cycles
  • Bleeding and pain during sexual intercourse
  • Vaginal discharge
  • Pelvic or low back pain
  • Urinary symptoms for advanced cervical cancer

Causes of cervical cancer?

  • High risk strains of HPV, such as HPV 16 and HPV 18, cause the cervical cells to have abnormal changes. These abnormal changes if uncheck progresses to cancer.
  • The risk is higher in individuals with a weaker immune system which may be due to primary or acquired immune deficiency, or tobacco use or excessive consumption of alcoholic beverages.

Types of cervical cancer

There are two main types of cervical cancer
  • Squamous cell carcinoma (accounting for more than 75 % of all cervical cancers)
  • Adenocarcinoma

Stages of cervical cancer

Once the diagnosis of cervical cancer is established with a biopsy. The staging of cervical cancer is done via imaging. An MRI of the pelvis will help determine the local extent of disease and a PET CT may be taken to determine the extent of disease outside the pelvis.
The main stages of cervical cancer are:

Also known as carcinoma in situ, stage 0 cervical cancer is characterized by the presence of precancerous abnormal cells on the surface of the cervix.

Cancerous cells have advanced beyond the surface of the cervix and grown into deeper layers of cervical tissue, the uterus or nearby lymph nodes.
Cancerous cells have spread beyond the cervix and uterus but not into the lower third of the vagina or the pelvic wall.
Cancerous cells have reached the lower third of the vagina or the pelvic wall.
Cancerous cells have invaded the bladder or rectum or spread beyond the pelvis.

Treatment

  • Early stages of cervical cancer Surgery or radiation therapy. Locally advanced cervical cancer is treated with concurrent chemoradiation.
  • Metastatic cervical cancer Palliative chemotherapy and radiation is used.

Is minimally invasive surgery an option in cervical cancer?

Minimally invasive surgery is now not routinely performed for cervical cancer in view of increasing evidence of greater recurrence after minimally invasive cervical cancer surgery than open surgery.