Cervical cancer

Introduction

  • Cervical cancer is a type of cancer that occurs in the cells of the cervix, the lower part of the uterus connecting to the vagina.
  • It is primarily caused by persistent infection with high-risk types of the human papillomavirus (HPV).
  • Early detection through routine screening can lead to effective treatment and a high survival rate.

Causes of Cervical Cancer

  1. HPV Infection
    • High-risk HPV types (e.g., HPV 16, HPV 18) are the leading cause.
    • Transmitted through sexual contact.
  2. Risk Factors
    • Early sexual activity or multiple sexual partners.
    • Smoking, which weakens the immune system.
    • Long-term use of oral contraceptives.
    • Immunosuppression (e.g., HIV/AIDS).

Symptoms of Cervical Cancer

  1. Early-Stage Symptoms
    • Often asymptomatic.
    • Irregular vaginal bleeding (e.g., between periods, after intercourse, or post-menopause).
    • Unusual vaginal discharge.
  2. Advanced-Stage Symptoms
    • Pelvic pain or pain during intercourse.
    • Blood-tinged or foul-smelling vaginal discharge.
    • Leg swelling or pain.
    • Difficulty urinating or blood in the urine.

Complications of Cervical Cancer

  • Spread to nearby tissues and organs (e.g., bladder, rectum).
  • Pelvic or back pain due to tumor growth.
  • Lymphatic spread causing swelling in the legs.
  • Kidney failure from ureteral obstruction.

Diagnosis of Cervical Cancer

  1. Screening Tests
    • Pap Smear (Cytology Test): Detects precancerous or cancerous cells.
    • HPV DNA Test: Identifies high-risk HPV types.
  2. Colposcopy
    • Detailed examination of the cervix with a magnifying device, often with a biopsy.
  3. Biopsy
    • Types: Punch biopsy, endocervical curettage, or cone biopsy (LEEP or cold knife).
  4. Imaging Studies
    • Pelvic MRI or CT Scan: Assesses tumor size and spread.
    • PET Scan: Evaluates for metastatic disease.
  5. Staging Workup
    • FIGO (International Federation of Gynecology and Obstetrics) system used to stage cervical cancer.

Treatment Options for Cervical Cancer

1. Surgical Treatments

  • For Early-Stage Cancer
    • Conization: Removes a cone-shaped piece of tissue from the cervix.
    • Hysterectomy: Complete removal of the uterus (with or without ovaries).
  • For Advanced Cases
    • Radical Hysterectomy: Removes the uterus, cervix, part of the vagina, and nearby lymph nodes.

2. Radiation Therapy

  • External Beam Radiation Therapy (EBRT): Targets cancer cells with high-energy rays.
  • Brachytherapy: Internal radiation placed close to the tumor site.

3. Chemotherapy

  • Common Drugs
    • Cisplatin: Standard in chemoradiation therapy.
    • Carboplatin, Paclitaxel for metastatic disease.
  • Cost and Brand Names Drug Brand Name Manufacturer Approx. Cost Cisplatin Platinol Bristol-Myers Squibb $50–$100/dose Carboplatin Paraplatin Teva Pharmaceuticals $100–$200/dose Paclitaxel Taxol Bristol-Myers Squibb $200–$500/dose

4. Targeted Therapy and Immunotherapy

  • Bevacizumab (Avastin)
    • Inhibits blood vessel growth in tumors.
    • Cost: ~$5,000–$10,000 per treatment cycle.
  • Immune Checkpoint Inhibitors
    • Pembrolizumab (Keytruda): Effective in PD-L1-positive tumors.

5. Palliative Care

  • Symptom management for advanced cases, focusing on pain relief and quality of life.

Monitoring Parameters

  • Regular follow-ups with pelvic exams and imaging.
  • Monitor for recurrence through Pap smears and HPV testing.
  • Evaluate response to treatment with imaging studies (e.g., MRI, PET).

Patient Counseling Points

  • Emphasize the importance of routine cervical screening.
  • Encourage HPV vaccination for prevention.
  • Educate on the early warning signs and symptoms of cervical cancer.
  • Provide psychological support and resources for coping with the diagnosis.
  • Discuss fertility preservation options before treatment.

Use in Children

  • Rare in pediatric populations; linked to inherited cancer syndromes.

Use in Pregnancy

  • Treatment depends on gestational age and cancer stage.
  • Early pregnancy: May delay treatment until after delivery.
  • Advanced cases: Prompt treatment prioritized.

Use in Elderly

  • Tailor treatment based on overall health and comorbidities.

FAQs About Cervical Cancer

Q1: What causes cervical cancer?

  • Persistent infection with high-risk HPV types.

Q2: Can cervical cancer be prevented?

  • Yes, through HPV vaccination and regular screening.

Q3: Is cervical cancer curable?

  • Early-stage cervical cancer is highly curable with treatment.

Q4: How often should women get screened?

  • Every 3–5 years, depending on age and screening method.

Q5: What are the symptoms of advanced cervical cancer?

  • Pelvic pain, leg swelling, and difficulty urinating.

Q6: Who is at risk of cervical cancer?

  • Women with persistent HPV infection, multiple sexual partners, or weakened immunity.

Q7: What is the role of the HPV vaccine?

  • Prevents infection with high-risk HPV types linked to cervical cancer.

Q8: Can cervical cancer affect fertility?

  • Yes, especially with treatments like hysterectomy or radiation.

Q9: Are there any alternatives to hysterectomy for early-stage cancer?

  • Yes, conization or trachelectomy (preserves fertility).

Q10: Is chemotherapy always required?

  • Not for early-stage cancer; used in advanced stages or with radiation.

Q11: What foods help prevent cervical cancer?

  • A diet rich in fruits, vegetables, and antioxidants.

Q12: How long does cervical cancer treatment take?

  • Depends on the stage and treatment type; can range from weeks to months.

Q13: What is the survival rate for cervical cancer?

  • Early-stage: 90% 5-year survival rate. Advanced-stage: Varies based on treatment.

Q14: Can men get HPV-related cancers?

  • Yes, HPV can cause penile, anal, and throat cancers in men.

Q15: How is cervical cancer monitored after treatment?

  • Through regular follow-ups, including Pap smears and imaging.
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