Understanding Cervical Cancer: A Comprehensive Guide

Cervical cancer can be a life-threatening condition affecting people with cervices worldwide. Maybe you've heard about it, and now you're curious. As you read on, you will find out everything you need to know about this disease. The good news first: recent diagnostic efforts prove cervical cancer to be largely preventable, and the incidence has reduced drastically compared to what it used to be. For decades, cervical cancer represented a significant public health concern due to the associated complications and excessive-high number of deaths. This was the case until the mid-70s, when death rates dropped by 50% due to the increased cervical screening which detects the abnormal cells before they turn cancerous. That doesn't mean that cervical cancer is no longer a health concern. ‘‘There are a lot of stigmas associated with this medical condition, and so many misconceptions about vaccination of young girls make it even more difficult to control ’’ says Dr. Daniel Kimani, a Clinical Colposcopist. Keep reading to learn more about cervical cancer, what causes it, as well as the risks factors, signs and screening tests that you should be aware of if you’re a cervix owner.

What is Cervical Cancer?

As the name suggests, cervical cancer affects your cervix. For people who may not know of the cervix, it is part of your reproductive organ that connects your uterus (womb) to the vagina. When someone is pregnant and getting close to labor, the cervix can indicate to your healthcare provider when you are likely to give birth. Also, it serves as a passage for sperm cells to get to the eggs in the uterus for fertilization, and it allows menstrual fluid to flow from the uterus to your vagina. Cervical cancer is a condition that turns the normal cells of your cervix cancerous. If you have cancer in your cervix, the normal cells have become problematic, continuously growing and dividing and destroying your cervical tissue. In worst-case scenarios, it spreads to other distant body parts, causing even more harm. Cervical cancer is ranked as the 4th most common cancer affecting people with cervices. In fact, current statistics for 2022 from the American Cancer Society estimate 4280 deaths due to cervical cancer and 19,100 new cases to be diagnosed in the USA. Cervical cancer is most commonly diagnosed between 35 and 44 years old, with 50 being the average age of diagnosis.

What Causes Cervical Cancer?

According to CDC, human papillomavirus HPV is the most common cause of cervical cancers. Over 95% of cervical cancer has been attributed to HPV. HPV is a sexually transmitted infection. 80% of people who are sexually active, have contracted at least one type of genital HPV at some point in their lives. However, not all species of HPV can cause cancer. There are over 100 different strains of HPV. “HPV is a group of viruses. But, there are many subtypes, and the most concern is the one causing cervical cancer, subtypes 16 and 18”says Dr. Daniel Kimani. Some are low-risk HPV, and others high-risk HPV. Low-risk HPVcan cause warts around the male and female genitals; these strains are not cancer-prone. In contrast, high-risk HPV can cause cervical, penile, anal, mouth, and throat cancers. You can contract HPV through skin-to-skin contact, anal, or vaginal sex.

What are the Risk Factors for Cervical Cancer?

With risk factors, your chances of getting a certain infection are increased. Some risk factors of cervical cancer are:

• HPV: Human papillomavirus is the most well-known cause of cervical cancer, and if you're infected with HPV, it increases your chances of cervical cancer.
• Sexual history: HPV is a sexually transmitted infection, so anyone sexually active is susceptible and could contract the virus anytime. If you had an early start to sex, or if you have multiple sexual partners there is a higher probability of contracting HPV. Furthermore, infections such as chlamydia are associated with cervical cancer. A study published in the American medical association journal found that people who have chlamydia infection are 2.5 times more likely to develop cervical cancer,
• Pregnancy and childbirth: Research suggests an existing relationship between childbirth and the development of cervical cancer. The probability is 2.6 times higher with 3-4 births, and about 3.8 times more risk with about 7 births. Although the underlying mechanism is not well understood, some studies speculate that increased risk is due to the changes in the cells of your cervix caused by the trauma of childbirth and hormonal changes experienced in pregnancy.
• Smoking: When you smoke, you inhale harmful substances that cause cellular changes in your cervix that can degenerate into cancer. The American cancer society, says the possibility of developing cervical cancer is twice as much in people who smoke.
• Weak Immune System: When your immune system has been weakened or suppressed, it is harder to fight infections. Some people contract HPV at some point in their lives, and the virus clears on its own without worsening to cervical cancer. While some others whose immunity has been suppressed by infections like HIV, it is tough to fight and clear the virus leading to a persistent case of HPV, a building block for cervical cancer.
• Genetics: If your first-degree relative (parents, siblings and children) had cervical cancer, you will need more intensive follow-up than someone with no family history of cervical cancer. On the contrary, you could have inherited some specific genes that may predispose you to develop cervical cancer.

What are the Signs of Cervical Cancer?

Early stages of cervical cancer do not present with noticeable signs. “Early cases are asymptomatic. That’s why it’s so crucial to conduct early screening to avert progression of this condition” says Dr. Daniel Kimani. We'll talk about screening later in the article; let's start with the signs which are as follows:

• Pain during sexual intercourse
• Abnormal vaginal bleeding
• Persistent vaginal discharge
• Heavy and smelly discharge
• Pelvic pain
• Bleeding after menopause
• Unusual menstrual bleeding

If you notice any symptoms, report to your healthcare provider for proper medical evaluation.

How is Cervical Cancer Diagnosed?

When an individual with a cervix contacts HPV, it goes through different stages of dysplasia before it becomes an invasive cancer. The good news is that this progression does not happen overnight; it can take several years (15-20 in individuals with a healthy immune system and 5-10 when your immunity is weak). At the point of dysplasia, a pap smear will detect the abnormal cells in your cervix, and your doctor can commence treatments to arrest the growth of the infection so that cervical cancer can be avoided. Without a pap smear, you wouldn't know you have dysplasia because it has no visible signs. As a result, the diagnostic effort aims to detect the infection as early as possible using Pap smear and HPV DNA testing. A Pap smear detects abnormal cells or pre-cancer changes in your cervix, while HPV testing detects presence of high-risk HPV that can cause cervical cancer. The following organizations; American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology have established the following cervical cancer screening guidelines for individuals with a cervix:

• If you are less than 21 years, you are not eligible for screening tests.
• If you are between 21 and 29 years, only cytology (pap smear test) is recommended.
• If you are between 30 and 65 years, pap smears are recommended every three years, or pap smear and HPV testing every five years.
• If you had a hysterectomy and have no history of cervical cancer in 20 years, there's no need for a screening test.
• If you are above 65 years, no screening is recommended if all previous screening results have been negative.

What are the Stages of Cervical Cancer?

If the screening tests show presence of cancerous cells, then your doctor follows up with staging. According to Dr. Daniel Kimani, “Staging is key to determine the progression of the disease which gives the clue on what type of treatment to conduct”. Staging tells the size, the depth, and the extent of the cancer spread to other parts of your body. We have four major stages of cervical cancer developed by the International Federation Of Obstetrics and Gynecology : Stage 1: At this point, the cancer is small and only within the cervical tissues. It has not spread to neighboring tissues like the vagina or pelvic walls. Stage 2: Here, cancer has spread to the upper part of the vagina and a small portion of the uterus. But has not yet affected your lymph nodes or other distant sites. Stage 3: The cancer is spreading beyond the cervix. It has gotten to the lower part of the vagina and the pelvic muscles. It has grown large enough that the size of the tumor can block your ureters and stop them from transporting urine from the kidney to your bladder. Stage 4: This is the most severe case of cervical cancer because it has left the origin at the cervix and spread to other distant sites in your body. Here, the cancer has spread beyond your gynecological parts and affects your bowel, bladder, rectum, and possibly bones and lungs.

How is Cervical Cancer Treated?

When you are diagnosed with cervical cancer, you probably have many questions. Why me? What should I do next? Can I still have kids? It's normal to have all these fears. But, don’t panic. There are many treatment options available to help you recover. Treatment choice depends on the cancer stage, size of the tumor, your overall health, and your desire to have kids in the future. You and your doctor will choose the most suitable treatment for you, ranging from radiation therapy, hysterectomy, chemotherapy, immunotherapy, and targeted therapy. You may be concerned about what your sex life will be after treatments, if you can still have kids, or if you are pregnant—how treatment will affect you and your baby. These are legitimate concerns. And you must discuss all the potential side effects of treatment to ensure that whatever treatment option you have to go through is based on the most accurate information found on the best opportunity for success and reduce potential side effects.

The bottom line

HPV vaccination is safe and effective for preventing HPV infections. Ideally, vaccinating all young boys and girls before sexual contact is commenced is the way forward. Furthermore, you should practice safe sex (use condoms during), and follow up with regular screening tests. “My best advice for people with vaginas is to prioritize their health and remember regular health visits, where it is easy to pass HPV and cervical cancer screening. When found in the early stages, it is treatable, sometimes even curable” says Gynecologist Anna Targonskaya.