Cervical cancer refers to the formation of a tumor in the cervix. Rarely, it is also called pelvic cancer, as the organ is situated in the pelvic region.
The cervix is an important part of the female reproductive system that connects the vagina with the uterus. When the cells present in the cervical lining start dividing uncontrollably, it leads to the formation of a tumor.
It is possible to reduce the risk of cervical cancer through specific cervical cancer prevention and screening practices.
In developing countries like India, cervical carcinoma is still a burden. It is the second most common cancer diagnosed among Indian women. The risk of cervical cancer is found to increase around the age of 45 and peak at 55.
A large percentage of invasive cervical tumor cases are associated with chronic HPV infection.
There are different types of cervical cancer based on the cell type from which it arises. A few cervical carcinoma types are more common than the others.
The following are the most common types of cervical cancer:
Squamous cell carcinoma arises from the flat cells in the ectocervix, the bottom portion of the cervix. Squamous cell carcinoma accounts for about 80–90% of cervical tumor cases and is therefore the most common type of cervical cancer.
Adenocarcinoma arises from the glandular cells in the endocervix, the upper portion of the cervix. Adenocarcinoma of the cervix accounts for about 10–20% of cervical carcinomas.
The following are rare types of cervical carcinoma:
Adenosquamous carcinomas, also known as mixed carcinomas, carry the characteristic features of both squamous cell carcinomas and adenocarcinomas.
Glassy cell carcinomas are a rare and aggressive form of cervical carcinoma. The glassy cell carcinoma cells have a glass-like appearance when observed under a microscope, thus the name. This is one of the more aggressive types of cervical cancer, with a poor prognosis.
Neuroendocrine carcinomas account for a small percentage of cervical carcinomas. Neuroendocrine carcinomas arise from the hormone-producing cells associated with the neuroendocrine system. It is one of the rare types of cervical carcinoma.
The staging of cervical carcinoma is done to determine the extent of the disease's spread. Cervical cancer stages 0, 1, and 2 refer to the early stages of cervical tumors, while cervical cancer stages 3 and 4 refer to advanced-stage cervical cancers. The following are the indicators of different stages of cervical cancer:
Stage 0 cervical cancer refers to the earliest stage, where only cervical cell abnormalities are observed. The cancer cells are present on the surface and have not invaded the deeper tissues.
In this stage, cervical carcinoma remains confined to the organ and has not spread to the surrounding tissues or organs. Stage 1 cervical tumors have a favorable prognosis.
Stage 2 cervical cancer means that the disease has begun to spread beyond the cervix but is still confined to the pelvic region. To treat stage 2 cervical carcinoma, doctors often recommend a multimodal treatment approach.
In stage 3, the disease has spread to the lower part of the vagina or the pelvis's side walls. Stage 3 cervical carcinoma needs an aggressive treatment regimen.
In stage 4, the disease has advanced significantly; from the pelvic region to distant sites, such as the bladder, rectum, or other organs, the disease has spread to various parts of the body. It will need a multimodal approach, and often the treatment goal is to delay disease progression, prolong survival, reduce the pain and discomfort caused by the disease, and improve the quality of life.
Cervical cancer may not have any symptoms in its early stages, and even if they do appear, they are mild and can only be detected by a doctor. In most cases, symptoms of cancer of the cervix become apparent only in the advanced stages, when the disease has spread to other parts of the body.
A few symptoms of cervical cancer may be similar to symptoms of other cervix problems, and therefore, they may be ignored in some cases. This may lead to a delayed diagnosis and a poor treatment prognosis.
Paying attention to the different signs and symptoms of cervical cancer and understanding the possible causes of cervical cancer can aid in the early detection and timely treatment of this condition.
Cervical cancer is one of the most common cancers among women. The risk of cervical cancer is found to increase around the age of 45 and peak around the age of 55.
Those who have had an HPV infection for years have a higher chance of developing cervical cancer.
That said, anyone can get diagnosed with cervical cancer, and it is therefore important to undergo regular screening, which helps in the early detection and timely treatment of cervical cancer.
Not all women with cervical cancer experience the same symptoms. Being aware of the different symptoms of cervical cancer can help women seek medical attention at the right time and put themselves a step ahead of the disease. The following are some of the important cervix cancer signs and symptoms:
Women must keep an eye on abnormal vaginal bleeding, as this is one of the most common symptoms of cervical cancer. Bleeding between periods, bleeding after sexual intercourse, or bleeding after menopause are some of the signs of cervical cancer, and it is important to see a doctor for a definitive diagnosis.
Any changes in the vaginal discharge with respect to its volume, texture, odor, and color should not be ignored, as this is also one of the important stage 1 cervical cancer symptoms.
Women with cervical cancer may experience pain, which may range from a dull ache to pronounced discomfort. If this pain is persistent, one must see a doctor for a proper evaluation.
Women with cervical cancer may also experience pain during sexual intercourse, also known as dyspareunia. This may or may not be accompanied by abnormal bleeding. This symptom should not be ignored, as it is one of the most important signs of cervical cancer.
Pain and discomfort while urinating could also be cervix cancer early symptoms. That said, painful urination can be caused by other problems too, and therefore, it is advised to see a doctor for a proper evaluation. This could be one of the stage 2 cervical cancer symptoms.
Women with cervical cancer may experience menstrual irregularities, namely heavier periods, prolonged periods, and bleeding between periods. In such cases, women must seek immediate medical attention.
As the disease progresses, women with cervical cancer may experience unintended weight loss and extreme tiredness. This could be one of the cervical cancer stage 3 symptoms.
The symptoms of cervical cancer may vary depending on the type of cancer. The following are the possible symptoms of different types of cervical cancer:
Squamous cell carcinoma may present with symptoms like vaginal bleeding, pain during intercourse, changes in the vaginal discharge, and discomfort in the pelvic region.
This type of cervical cancer may present with unusual vaginal discharge and pain and discomfort in the pelvic region.
Adenosquamous carcinomas can present with symptoms of both squamous cell carcinomas and adenocarcinomas. Women with adenosquamous carcinomas may experience vaginal bleeding, vaginal discharge, pain, and discomfort in the pelvic region.
This rare type of cervical cancer may cause symptoms like bleeding, discomfort, and pain.
Women with neuroendocrine carcinoma of the cervix experience abnormal vaginal discharge and bleeding, pelvic pain, and pain during intercourse.
Presently, the exact cause of cervical cancer is unknown. However, over the years, a few factors that can increase the risk of cervical cancer have been identified.
Human papillomavirus (HPV) infection is one of the biggest risk factors for cervical cancer, and it could be one of the potential causes of cervical cancer.
Becoming sexually active at a young age is also found to increase cervical cancer risk in women.
Smoking is one of the potential causes of cervical cancer, as tobacco contains harmful chemicals that can weaken the immune system and make one more susceptible to HPV infection.
Although the connection between long-term use of oral contraceptives and cervical cancer risk is not fully understood, it is also observed to be one of the possible risk factors or possible causes of cervical cancer.
Multiple full-term pregnancies are also considered one of the possible causes of cervical cancer.
Having multiple sexual partners is also found to increase one’s chances of developing cervical cancer due to increased exposure to the HPV virus.
Women who are exposed to diethylstilbestrol in utero (prenatal exposure) have a higher chance of being diagnosed with cervical cancer.
Having a positive family history of cervical cancer or having certain inherited genetic disorders that are associated with cervical cancer development can increase one’s chances of developing cervical cancer.
A lack of awareness, low levels of education and income, and limited access to healthcare may possibly increase one’s risk of developing cervical cancer.
A weaker immune system, which may be caused by certain diseases like HIV/AIDS, can also be a reason for cervical cancer.
Poor hygiene practices may also become a risk factor for cervical cancer.
Certain signs and symptoms of cancer of the cervix are similar to those of other less serious gynecological problems. However, it is important not to ignore the different signs of cervical cancer, especially if they last for more than two weeks or begin to worsen. Promptly seeing a doctor in such cases can support an early diagnosis and timely treatment of cervical cancer.
Cervical cancer is a significant health concern in India, and it necessitates a deep understanding of the disease and a thorough exploration of its diagnostic and treatment protocols. At HCG, our specialists employ modern diagnostic and treatment protocols to diagnose, treat, and manage cervical cancer.
Specialists use multiple tests for cervical cancer diagnosis, and upon arriving at a conclusive diagnosis, they create a personalized treatment plan. The following are the most recommended tests for the diagnosis of cervical cancer:
A Pap smear test, also considered a cervical cancer screening tool, involves collecting and examining cells from the cervical lining for abnormalities.
The HPV DNA test involves collecting cervical cells and examining them for the presence of the DNA of high-risk human papillomavirus (HPV) strains that are associated with cervical cancer.
Colposcopy involves visually examining the cervix for the presence of precancerous lesions or tumors. A colposcope is a specialized instrument that is externally positioned near the vaginal opening, and the regions of the vulva, vagina, and cervix are examined for any abnormalities.
A biopsy is an important diagnostic test for cervical cancer and is usually recommended for a conclusive diagnosis. During this procedure, a small sample of the cervix tissue is removed and examined under a microscope to look for the presence of cancerous cells.
Endocervical curettage is a type of biopsy wherein a spoon-like instrument, called a curette, is used to scrape tissue from the endocervical canal. The tissue collected is examined for the presence of cancerous cells.
The loop electrosurgical excision procedure (LEEP) is a type of biopsy wherein a thin wire loop is used to collect the cervical tissue sample. Electric current is passed through the wire loop, which then excises the tissue from the suspected area, and it is further examined in the lab for the presence of cancerous cells.
A cone biopsy is a form of biopsy wherein a cone-shaped piece of cervix tissue is collected. This procedure allows technicians to obtain a larger tissue sample. A cone biopsy may be recommended to treat abnormal cellular changes and precancerous lesions.
Imaging tests help in obtaining images of the internal structures of the organ examined, in this case, the cervix. Apart from the diagnosis of cervical cancer, imaging tests can also help in disease staging, treatment response monitoring, and relapse evaluation. The following are the imaging tests used for the diagnosis of cervical cancer:
Computed tomography (CT) scans are recommended to study the anatomical structure of the cervix. This imaging technique uses X-rays to obtain detailed images of the organ.
Magnetic resonance imaging (MRI) scans use powerful magnetic fields and radio waves to create detailed images of the organ. Along with being an important diagnostic test for cervical cancer, it also serves as a staging tool for cervical cancer.
Positron emission tomography (PET) is another important imaging technique used in diagnosing cervical cancer through radiotracers. Unlike other imaging tests, a PET scan is used to study the biochemical activities of the tumor. PET scans help in assessing nodal involvement and distant metastases. For more accurate results, PET is often combined with CT.
Upon arriving at a definitive diagnosis, a personalized cervical cancer treatment plan is devised. The treatment may be unimodal (one treatment) or multimodal (a combination of two or more treatments) depending on multiple factors, such as the type of cervical cancer, its stage, its grade, the patient’s age, the patient’s overall health, and lastly, the patient’s preferences.
Surgery is often the first line of cervical cancer treatment or pelvic cancer treatment. Surgery is often recommended as a treatment for stage 1 cervical cancer. The goal of surgery is to remove as much tumor tissue as possible. Surgery may remove only the tumor or the entire organ, depending on the extent of the disease’s spread. Surgery is often combined with other treatment options like chemotherapy and radiation therapy to improve the overall effectiveness of the treatment.
Hysterectomy refers to the removal of the uterus. It is recommended as a cervical cancer treatment to treat cancer that has spread beyond the cervix but is confined to the pelvic area.
Trachelectomy is recommended as an early-stage cervical cancer treatment, wherein the cervix is removed and the uterus is left intact. This form of cervical cancer therapy is highly recommended for patients who wish to preserve their fertility.
This procedure involves the removal of lymph nodes close to the cervix and in the pelvic region and their examination for the presence of cancerous cells. Lymph node dissection plays a pivotal role in disease staging and guides cervical cancer treatment decisions.
Radiation therapy, or radiotherapy, is also one of the important cervical cancer treatment options. Radiotherapy for cervical cancer involves targeting the tumor with powerful and intense radiation beams, which damage the DNA structure of the tumor cells and stop them from growing. With the advanced technology available today, we can precisely target the tumor while reducing damage to the nearby healthy tissues.
Radiotherapy for cervical cancer is often recommended after surgery to destroy the residual cancer cells, which is important in reducing the risk of recurrence.
External beam radiation therapy is a form of radiation therapy wherein the radiation beams are delivered from an external source through a linear accelerator. External beam radiation therapy is highly precise and effective in shrinking tumors, destroying residual cancer cells, alleviating pain and discomfort associated with cervical cancer, and reducing the risk of recurrences.
Brachytherapy for cervical cancer, or internal beam radiation therapy, involves placing a radiation source inside (interstitial) or close to the tumor (intracavitary). This form of cervical cancer therapy facilitates better targeting and high-dose radiation delivery while minimizing damage to nearby tissues.
Chemotherapy is another important cervical cancer treatment option, wherein specialists recommend potent medication for cervical cancer management. Cervical cancer chemotherapy involves the use of powerful drugs to destroy cancerous cells throughout the body. This treatment is usually recommended if the disease has spread to different organs in the body.
Chemotherapy may be administered before the surgery (neoadjuvant chemotherapy) or after the surgery (adjuvant chemotherapy) to shrink the tumor or destroy the residual cancer cells, respectively. Cervical cancer chemotherapy is administered orally or intravenously, depending on individual case parameters.
Systemic chemotherapy involves administering powerful anti-cancer drugs into the bloodstream; these drugs circulate throughout the body and destroy the cancer cells. Systemic chemotherapy is recommended for advanced-stage cervical cancers. Systemic chemotherapy for cervical cancer may or may not be combined with other cervical cancer treatment options. Systemic chemotherapy is used to slow down the disease progression and alleviate symptoms associated with cervical cancer.
Concurrent chemoradiation is also an important cervical cancer treatment approach that combines chemotherapy with radiation therapy. The enhanced effectiveness of this combined treatment approach positively impacts clinical outcomes and supports better success rates. Chemotherapy may sensitize the cancer cells to radiation therapy, which improves the overall treatment effectiveness. Concurrent chemoradiation helps shrink the tumor size, destroy the residual cancer cells, and delay disease progression.
Targeted therapy is one of the latest cervical cancer treatments, wherein specific molecules and cellular pathways that are responsible for cancer growth are targeted. Cervical cancer medicines administered as a part of targeted therapy block the activity of those specific molecules and pathways and affect cancer growth. Targeted therapy is often recommended when standard treatments fail to show a desirable response. One of the biggest advantages of targeted therapy is that it significantly reduces damage to healthy tissues in the body.
Immunotherapy is one of the new treatments for cervical cancer, wherein the patient’s immune system is re-engineered to identify and attack the cancer cells in the body. For cervical cancer, immune checkpoint inhibitors are administered as a part of immunotherapy, and they work by blocking the proteins that stop the immune system from identifying and attacking the cancer cells. Immunotherapy for cervical cancer may be recommended when the standard treatments become ineffective, or it may be recommended along with the standard treatments for better treatment effectiveness.
Clinical trials involve testing new drugs, treatment combinations, and treatment approaches for effective cervical cancer management. Those cervical cancer patients who have exhausted all their treatment options may enroll in clinical trials, as these provide them with an option to try out new treatments before they are widely available.
Participation in clinical trials is voluntary, and patients must have a detailed discussion with their expert team before enrolling, as not all patients are eligible to participate in a clinical trial. To learn more about enrolling in clinical trials for cervical cancer management, please talk to a specialist.
As the best cervical cancer treatment hospital in India, HCG is committed to delivering the highest quality diagnostic and treatment support to cervical cancer patients across the country. The entire team at HCG practices a personalized and patient-centric care approach wherein the patient is at the center of their treatment journey and receives the treatment, care, and attention that are designed just for them.
Along with access to leading-edge diagnostic and treatment facilities, patients are also given access to clinical trials to help them access newer treatment approaches to manage and improve their condition. The comfortable care setting at HCG has helped millions of patients receive the best treatment for cervical cancer.
Cervical cancer is one of the most common cancers among Indian women. Although we do not know the exact cause of cervical cancer, it is understood that a few lifestyle and non-lifestyle-related factors can contribute to increased cervical cancer risk.
Becoming aware of various cervical cancer risk factors and following appropriate cervical cancer preventive measures can help women reduce their cervical cancer risk.
One’s risk of developing cervical cancer is influenced by multiple factors. These may be specific lifestyle and non-lifestyle factors. Lifestyle factors are also called controllable or modifiable factors, and non-lifestyle factors are referred to as uncontrollable or non-modifiable factors.
Having a better understanding of these risk factors plays a pivotal role in potential cervical cancer prevention and early detection.
Increasing age is an important risk factor for cervical cancer. The risk of cervical cancer increases around the age of 45 and peaks at age 55.
Having a positive family history of cervical cancer or certain other cancers can increase one’s chances of developing cervical cancer. It is also understood that certain genetic factors can influence an individual’s susceptibility to HPV infection, which is also an important risk factor for cervical cancer.
Diethylstilbestrol, or DES, is an artificially synthesized non-steroid estrogen that was recommended to prevent miscarriages between the 1940s and 1970s. Its usage was stopped when many doctors found a strong association between uterine exposure to DES and the incidence of cervical cancer and vaginal cancer. Women whose mothers were prescribed the drug diethylstilbestrol (DES) during pregnancy may have a higher chance of developing cervical cancer. DES-exposed women should opt for regular cervical cancer screening.
The early onset of menstruation is also an important risk factor for cervical cancer. Early menstruation causes women to have increased exposure to hormones that impact cervical cell growth. Those who have had their first period before the age of 12 should pay extra attention to their health, follow appropriate cervical cancer preventive measures, and opt for cervical cancer screening.
Getting pregnant or having multiple pregnancies before the age of 20 can increase one’s risk of developing cervical cancer. The hormonal changes due to early pregnancy and the increased susceptibility to HPV infection contribute to the increased cervical cancer risk.
Another important risk factor for cervical cancer is having multiple full-term pregnancies. Women who have multiple pregnancies experience hormonal changes and have repeated exposure to HPV, and these factors contribute to their increased cervical cancer risk.
Ethnicities prevalent in developing countries are prone to having an increased cervical cancer risk. Hispanic and black women are found to have a higher risk of developing cervical cancer. Also, a few studies have found that certain Asian ethnic groups are also at increased risk of cervical cancer. A lack of awareness, lower rates of screening, and limited access to healthcare facilities may contribute to this disparity.
Many reports suggest that certain socioeconomic factors also contribute to an increased risk of developing cervical cancer. Lower levels of education, income, and health literacy, along with limited access to healthcare facilities, are some of the common socioeconomic factors that can influence the incidence of cervical cancer.
Reports suggest that having certain sexually transmitted infections (STIs), such as gonorrhea and chlamydia, can increase one’s cervical cancer risk. Inflammation and cellular changes caused by these infections can make one more susceptible to HPV infection, which, in turn, increases the cervical cancer risk.
A compromised immune system, or weakened immune system, makes an individual more susceptible to persistent infections like HPV and subsequent cervical cancer formation. A compromised immune system may be caused by diseases like HIV/AIDS, organ transplants, immunosuppressants, or other lifestyle factors. Those with a weakened immune system should take appropriate measures to reduce the risk of infection and opt for regular screening.
Smoking is also identified as one of the cervical cancer risk factors. The carcinogens present in tobacco damage cervical cells and lead to inflammation, which can increase cervical cancer risk. It may also weaken the immune system, which is, again, a risk factor for cervical cancer.
Obesity is also one of the most important cervical cancer risk factors. Obesity causes inflammation and hormonal imbalances in the body, which, in turn, increase the risk of cervical cancer. Also, obese people tend to have a weaker immune system, which may make them more susceptible to HPV infection and thereby cervical cancer.
Using oral contraceptives for an extended period may increase one’s risk of developing cervical cancer. For more information on the consumption of oral contraceptives and the possible cervical cancer risk, one must talk to a specialist.
Although there are no known ways to prevent cervical cancer, there are a few measures that can help women reduce their cervical cancer risk. The following are the important measures that can help women achieve possible prevention of cervical cancer:
HPV infection is one of the most important cervical cancer risk factors. Vaccination against HPV is administered as a part of primary prevention for cervical cancer. HPV vaccination should be taken between the ages of 9 and 14. However, it can be taken until age 45. HPV vaccination may be administered in two or three doses, depending on the patient's age.
Reducing the risk of HPV infection is an important measure for cervical cancer prevention. Safe sex habits are an important preventive measure and are part of primary prevention for cervical cancer. Important safe sex habits include using condoms, avoiding multiple sexual partners, and avoiding unusual sexual practices.
Regular cervical screening can help catch cervical cancer in its early stages and prevent advanced-stage cancers. Commonly, cervical cancer screening involves tests like Pap tests and HPV tests. Pap tests help in looking for abnormal changes in the cells that line the cervix. HPV tests are performed to look for the presence of HPV, especially types 16 and 18, in the cell sample collected from the cervical canal. Cancer screening falls under the category of secondary prevention for cervical cancer.
Since tobacco contains harmful chemicals, quitting smoking can help one reduce their risk of developing HPV infection and cervical cancer. Smoking cessation falls under the category of primary prevention for cervical cancer.
The human body needs nourishment to fight against various diseases, including cancer. It is important to have a balanced diet that comprises whole grains, lean proteins, fruits, and vegetables that are rich in essential nutrients. Consuming a balanced diet plays an important role in reducing the risk of cervical cancer.
Engaging in regular physical activity can also play a significant role in reducing cervical cancer risk. It helps regulate hormones, boosts the immune system, and contributes to overall better health.
It is important to educate oneself on various aspects of cervical cancer. Learning about the risk factors, preventive measures, and screening tests available for cervical cancer can help women reduce their cervical cancer risk. HPV awareness falls under the category of primary prevention for cervical cancer.
Regular health check-ups or screenings can aid in early detection and prevent advanced-stage cervical cancer.
It is important to note that 100% prevention and control of cervical cancer are not possible as we do not know the exact cause of the disease.
HPV vaccination is considered one of the most effective preventive measures for cervical cancer.
HPV vaccination is recommended as a cervical cancer preventive measure for girls between the ages of 9 and 26.
Presently available HPV vaccines include Cervarix, Gardasil, and Gardasil 9, along with the country’s first ingenious tetravalent vaccine, Cervavac. These vaccines provide protection against the following HPV strains:
1. Cervavix: HPV 16 and 18
2. Gardasil: HPV 6, 11, 16, and 18
3. Gardasil 9: HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58
4. Cervavac: HPV 6, 11, 16, and 18
HPV 16 and 18 are found to be responsible for about 70% of HPV-related cervical cancers, and all the vaccines listed above confer protection against these strains. Types 6 and 11 are responsible for anogenital warts.
It is interesting to note that these vaccines not only reduce the risk of cervical cancer but also other cancers like vaginal cancer, vulvar cancer, anal cancer, and oropharyngeal cancer.
For all these reasons, it is important for young adults to consider taking the HPV vaccination to protect themselves against cervical cancer and other cancers.
Although HPV vaccination reduces the risk of cervical cancer significantly, it does not prevent it. Therefore, it is important for women to undergo regular cervical cancer screening even after taking the vaccine.
There are multiple factors that contribute to cervical cancer risk. Women above age 45, women who have a family history of cervical cancer, those who have been exposed to DES in utero, those who have had early menstruation, early pregnancy, or multiple pregnancies at a very young age, those who lead a sedentary life, and those who smoke are found to have a higher chance of developing cervical cancer.
Cervical cancer is a significant burden in India. It is also found to be more common in women from rural areas than in women from urban areas. A lack of awareness, limited access to screening facilities, fear associated with the disease, etc., have become the biggest contributors to the increasing incidence. Becoming aware of this cancer, its early signs and symptoms, and its risk factors helps reduce the risk of this condition and ensure timely medical attention.
