Cervical Cancer

By Sabrina Iddir
Though it can become more common after the age of 25, cervical cancer is among one of the most prevalent forms of cancer in young adults[RD1] .
 
Cervical cancer begins after the onset of genetic mutations in the cells of the cervix, which is the area in the female reproductive system that links the vagina to the uterus. The cells of the cervix gradually adopt pre-cancerous changes that can eventually become cancerous. These pre-cancerous changes are detectable and can help to prevent the onset of a tumor later on. [RD2] 
 
There are two main types of cervical cancers: squamous cell carcinomas and adenocarcinomas. These develop from the two main types of cells in the cervix, squamous cells and glandular cells.
Squamous cell carcinomas develop from the squamous cells, contained in the part of the cervix nearest the vagina called the exocervix. These carcinomas constitute between 80 and 90 percent of cervical cancer cases. They most often begin in an area called the transformation zone, where the exocervix and the endocervix, the part of the cervix nearest the uterus, meet.
The endocervix contains glandular cells and is the site of adenocarcinomas. These carcinomas are less common, but have become increasingly more prevalent within the past couple years.
 
Cervical cancer exists in four stages, each with their own subcategories.
In stage I cervical cancer, the cancer has stayed around the cervical area. Stage IA1 is the smallest amount of cancer, with the smallest dimensions, and stage IA2 is the next. Stage IB1 can be seen without a microscope, at the scale of centimeters, and stage IB2 is when this size becomes greater than 4 cm.
Stage II is when the cancer has spread past the cervix and uterus but is still within the pelvic area. If it has not yet spread to the tissues around the cervix, called the parametria, then it is classified as stage IIA. If it has, it is stage IIB.
When the cancer has reached the lower vagina, the pelvis wall, or has caused swelling of the kidneys, it becomes stage III. Stage IIIA is when it has grown to the lower part of the vagina and reached the pelvis wall, and might be blocking the ureters. If it has grown into the pelvis wall, it becomes stage IIIB.
The final stage, stage IV, can be described by a spread to the nearby organs. If it is growing out of the pelvis and has reached the bladder or the rectum, it is stage IVA, and if it has spread beyond the pelvis, it is stage IVB. Organs beyond the pelvis that the cancer may spread to include the lungs, liver, distant lymph nodes, and bones.
 
Especially in the early stages, cervical cancers can be asymptomatic. However, when symptoms do arise, they may constitute abnormal vaginal bleeding, pain during intercourse, vaginal discharge and odor, and pelvic pain. Some of these symptoms may arise as a result of causes other than cancer, such as infections, but still act as cues to consult your doctor.
In later stages, if the cancer has spread to other nearby tissues, some symptoms can include pain during urination, blood in the urine or from the rectum, diarrhea, backaches or leg swelling, fatigue, nausea, and more.
If any of the above symptoms are seen, a visit to the doctor can help to clear up any possibilities of cervical cancer as well as any anxiety about their causes.
 
Human Papillomavirus (HPV) is almost always the source of cervical cancer and is the biggest risk factor. HPV can be spread with skin-to-skin contact, and is especially spread through sexual activity. There are various types of HPV, some labeled as low-risk and include the presence of warts, while others are labeled as high-risk due to their strong links to cancers. These cancers are not limited to the cervix.
Other risk factors include a family history of cervical cancer, smoking, having reduced immunity, long-term use of oral contraceptives, IUD use, full-term pregnancy before the age of 17 or having multiple full-term pregnancies, and more. Multiple risk factors can be explained by a doctor before exposure or when inquiring about cervical cancer.
 
Cervical cancer is the easiest gynecological cancer to avoid with regular screenings and precautions. HPV vaccinations are a great start to prevent contracting the virus, especially before having sex for the first time. Practicing safe sex is also an important step towards prevention.
One common way to screen for cervical cancer is to get a Pap test, which involves extracting a cell sample from the cervix that can be tested for cancer and/or HPV. Women are encouraged to get a Pap test every 3 years from the age of 21, as well as a Pap test and HPV test every 5 years from the age of 30.
Limiting exposure to the risk factors of cervical cancer (for example, by choosing not to smoke) is the best step to take towards active prevention.
 
A diagnosis of cervical cancer can lead to one or few of five main types of treatment: surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy.
Surgery is the main treatment for cervical cancers. There are plenty of different types of surgery that could be performed and depend on the specific stage and state of the cancer itself. Surgery also comes with risks, such as infertility, that can be discussed with a doctor before choosing this treatment.
Radiation therapy stops the growth of cancer cells, with the ability to shrink the tumor. The way that it is given is also dependent on the stage of cancer itself. Radiation can lead to various side effects as well, but they only tend to stick around during the treatment period itself and go away once treatment has been completed.
            Chemotherapy similarly stops the growth of cancer cells, or can also kill the cells, but does so through use of drugs. For cervical cancer, chemotherapy is usually paired with radiation.
            Targeted therapy also aims to kill cancer cells, but does so with attempts to spare the healthy cells. This treatment is usually paired with chemotherapy for effective results.
            Immunotherapy is an approach that utilizes a patient’s immune system to find and kill cancer cells. This can either be aided by supplemental immune substances from a laboratory, or by the immune substances already present within the body.
            Treatment is not limited to only these five types, as there are ongoing clinical trials aiming to improve and develop new cervical cancer treatments in order to provide the best care for patients.
 
Sources
(1) https://www.cancer.org/cancer/cancer-in-young-adults/cancers-in-young-adults.html
(2) https://www.mayoclinic.org/diseases-conditions/cervical-cancer/symptoms-causes/syc-20352501
(3) https://www.womenshealth.gov/cancer/cervical-cancer
(4) https://www.cancer.org/cancer/cervical-cancer/
(5) https://www.cancer.gov/types/cervical/patient/cervical-treatment-pdq#_180
(6) https://www.webmd.com/cancer/cervical-cancer/
(7) https://www.cancercenter.com/cancer-types/cervical-cancer/
 [RD1]
 [RD2]How can they detect it.   What are some symptoms of the Cervical Cancer