Cervical Cancer – Symptoms and Causes of Cervical Cancer

Cervical cancer: malignant cancer of the cervix uteri or cervical area. It may present with vaginal bleeding but symptoms may be absent until the cancer is in its advanced stages, which has made cervical cancer the focus of intense screening efforts using the Pap smear. In developed countries, the widespread use of cervical screening programs has reduced the incidence of invasive cervical cancer by 50% or more.

The cervix is the lower part of the uterus (womb). It is sometimes called the uterine cervix. The body (upper part) of the uterus, is where a fetus grows. The cervix connects the body of the uterus to the vagina (birth canal). The part of the cervix closest to the body of the uterus is called the endocervix. The part next to the vagina is the exocervix (or ectocervix). The place where these 2 parts meet is called the transformation zone. Most cervical cancers start in the transformation zone.

About 85% of cervical cancers are squamous cell carcinomas, which develop in the scaly, flat, skinlike cells covering the cervix. Most other cervical cancers are adenocarcinomas, which develop from gland cells, or adenosquamous carcinomas, which develop from a combination of cell types.

Symptoms of Cervical Cancer

Symptoms usually don’t appear until abnormal cervical cells become cancerous and invade nearby tissue. When this happens, the most common symptom is abnormal bleeding, which may start and stop between regular menstrual periods or may occur after sexual intercourse.

Bleeding from the vagina that is not normal,or a change in your menstrual cycle that you can’t explain.

Menstrual periods that last longer and are heavier than before. Bleeding after sexual intercourse, douching, or a pelvic exam.

Pain during urination: Bladder pain or pain during urination can be a symptom of advanced cervical cancer. This cervical cancer symptom usually occurs when cancer has spread to the bladder.

Causes of Cervical Cancer

Cervical cancer most commonly begins in the thin, flat cells that line the bottom of the cervix (squamous cells). Squamous cell carcinomas account for about 80 percent of cervical cancers. Cervical cancer can also occur in the glandular cells that line the upper portion of the cervix.

Genetic material that comes from certain forms of HPV has been found in cervical tissues that show cancerous or precancerous changes.

Most cervical cancer is caused by a virus called human papillomavirus, or HPV. You get HPV by having sex with someone who has it. There are many types of the HPV virus. Not all types of HPV cause cervical cancer. Some of them cause genital warts, but other types may not cause any symptoms.

The virus is a sexually transmitted disease. There are more than 50 types of human papilloma virus (HPV) that infect humans. Types 6 and 11 usually cause warts, while types 16, 18, 31 and 33 usually result in high-grade cervical dysplasia (CIN-2 and CIN-3) and carcinomas.

More than 90 percent of all cervical cancers are squamous cell carcinomas, and researchers believe that this cancer may be a sexually transmitted disease. There is much evidence that cervical carcinoma is related to sexually transmitted organisms.

Chemical exposure: Women who work on farms or in the manufacturing industry may be exposed to chemicals that can increase their risk of cervical cancer.

Women who have HIV, the virus that causes AIDS, often take drugs that weaken the body’s natural immunity or its ability to fight off disease. These women also have an increased risk for cervical cancer and should be closely monitored by their gynecologist for the development of precancerous changes to the cervix.

What Are Cervical Cancer Symptoms That Every Woman Should Look For?

Well the symptoms of this disease typically aren’t conspicuous and the symptoms may still happen even if you doesn’t have cancer. You must be careful enough in watching the signs of cervical cancer and its symptoms. However there are some cases that unfortunately, the cervical cancer symptoms are not noticeable enough until the cancer is in its advanced stage because early cervical cancer is usually do not give any of its symptoms. That’s why there is proper screening for it because it is so important. These are the following symptoms and the signs of the more advanced cancer of the cervix:

Abnormal Bleeding: experiencing the abnormal vaginal bleeding where there is a heavy or a light bleeding during the menstrual period. Also after sexual intercourse there is an abnormal bleeding occurrence. There may also be new bleeding even if a woman had stopped having menstruation (menopause).

Pelvic Pain: the pain of the pelvic that is not connected from menstrual cycle. These may be having the sufferings of dull ache to a pain that is so sharp that will last for a couple of hours. This cervical symptom may be severe or mild.

Pain during urination: the bladder pain or the ache during urinating can be the symptom of an advanced cancer of the cervix. This is typically the occurrence of cancer because it had spread out to the bladder. There is blockage of the kidneys or from the ureter that causes trouble in using the restroom. You may notice that there is a matter that is fecal in you vagina. These is because of the abnormal bleeding happens to the rectum, vagina, or bladder.

The bleeding between regular menstrual periods, after sexual intercourse, douching or pelvic exam: during these activities there is bleeding of the vagina. This is due to the cervix that is irritated. There are many situations that bleeding may occur like after doing sex, but a cervix that is healthy just had a small bleeding amount. If there is unusual bleeding, this may be one of the symptoms of the cervical cancer.

Unusual heavy discharge: the increase of the vaginal discharge may result to a symptom of a cervical cancer. This may have mucus that is so very thick, sticky, watery, and have a very unpleasant odor that may found to the vagina.

Cancer symptoms have some common symptoms like the abnormal bleeding. Noticing the bleeding on odd times of your menstruation or anything that will contact to your cervix will bleed there is a possibility of a cervical cancer.

It is important to report any unusual vaginal discharge to your doctor. Other cervical cancer symptoms include changes in your menstrual cycle. Having excessively heavy, exceptionally light, or bleeding at odd times during your cycle can all be cervical cancer symptoms. These are the symptoms that you have a cervical cancer and most of the women who suffered these symptoms causes lose of weight. These cancer symptoms are one of the big signs that you have been the deadly disease that is so very risky.

Cervical Cancer – Symptoms of Cancer of the Cervix

Cervical cancer is the second most common malignancy in women worldwide, and it remains a leading cause of cancer-related death for women in developing countries. In the United States, it is the fourth most common malignant neoplasm in women, after carcinoma of the breast, colorectum, and endometrium. The incidence of invasive cervical cancer has declined steadily in the United States over the past few decades; however, it continues to rise in many developing countries. The change in the epidemiological trend in the United States has been attributed to mass screening with Papanicolaou tests (Pap smears).

History:

Because women are screened routinely, the most common finding is an abnormal Pap smear result.

Clinically, the first symptom is abnormal vaginal bleeding, usually postcoital.

Vaginal discomfort, malodorous discharge, and dysuria are not uncommon.

The tumor grows by extending upward to the endometrial cavity, downward to the vagina, and laterally to the pelvic wall. It can invade the bladder and rectum directly.

Symptoms that can evolve, such as constipation, hematuria, fistula, and ureteral obstruction with or without hydroureter or hydronephrosis, reflect local organ involvement.

The triad of leg edema, pain, and hydronephrosis suggests pelvic wall involvement.

The common sites for distant metastasis include extrapelvic lymph nodes, liver, lung, and bone.

Physical:

In patients with early-stage cervical cancer, physical examination findings can be relatively normal.

As the disease progresses, the cervix may become abnormal in appearance, with gross erosion, ulcer, or mass. These abnormalities can extend to the vagina.

Rectal examination may reveal an external mass or gross blood from tumor erosion.

Bimanual examination findings often reveal pelvic metastasis.

Leg edema suggests lymphatic/vascular obstruction from tumor.

If the disease involves the liver, some patients develop hepatomegaly.

Pulmonary metastasis usually is difficult to detect upon physical examination unless pleural effusion or bronchial obstruction becomes apparent.

Causes:

Early epidemiological data demonstrated a direct causal relationship between cervical cancer and sexual activity. Major risk factors observed include sex at a young age, multiple sexual partners, promiscuous male partners, and history of sexually transmitted diseases. However, the search for a potential sexually transmitted carcinogen had been unsuccessful until the last decade, when a breakthrough in molecular biology enabled scientists to detect viral genome in cervical cells.

Strong evidence now implicates human papillomaviruses (HPVs) as prime suspects. HPV viral DNA has been detected in more than 80% of squamous intraepithelial lesions (SILs) and invasive cervical cancers compared to a consistently lower percentage in controls. Both animal data and molecular biologic evidence confirm the malignant transformation potential of papilloma virus-induced lesions. SILs are found predominantly in younger women, while invasive cancers are detected more often in women aged 10-15 years older, suggesting slow progression of cancer.

HPV infection occurs in a high percentage of sexually active women. Most of these infections clear spontaneously within months to a few years, and only a small proportion progress to cancer. This means that other crucial factors must be involved in the process of carcinogenesis.

Three main factors have been postulated to influence the progression of low-grade SILs to high-grade SILs. These include the type and duration of viral infection, with high-risk HPV type and persistent infection predicting a higher risk for progression; host conditions that compromise immunity, such as multiparity or poor nutritional status; and environmental factors such as smoking, oral contraceptive use, or vitamin deficiencies. In addition, various gynecologic factors, including age of menarche, age of first intercourse, and number of sexual partners, significantly increase the risk for cervical cancer.

Medical Care:

The treatment of cervical cancer varies with the stage of the disease. For early invasive cancer, surgery is the treatment of choice. In more advanced cases, radiation combined with chemotherapy is the current standard of care. In patients with disseminated disease, chemotherapy or radiation provides symptom palliation. The treatment of choice for stage Ia disease is surgery.

Stage IB or IIA

For patients with stage IB or IIA disease, treatment options are either combined external beam radiation with brachytherapy or radical hysterectomy with bilateral pelvic lymphadenectomy.

Most retrospective studies have shown equivalent survival rates for both procedures, although such studies usually are flawed due to patient selection bias and other compounding factors. However, a recent randomized study showed identical overall and disease-free survival rates.

Quality-of-life data, particularly in the psychosexual area, is relatively scant.

Postoperative radiation to the pelvis decreases the risk of local recurrence in patients with high-risk factors.

A recent randomized trial showed that patients with parametrial involvement, positive pelvic nodes, or positive surgical margins benefit from a postoperative combination of cisplatin-containing chemotherapy and pelvic radiation.

Stage IIB-IVA

For locally advanced cervical carcinoma (stages IIB, III, and IVA), radiation therapy traditionally has been the treatment of choice.

For treatment with radiation alone, 5-year survival rates reportedly are 65-75%, 35-50%, and 15-20% for stages IIB, III, and IVA, respectively.

Treatment begins with a course of external beam radiation to reduce tumor mass to enable subsequent intracavitary application. Brachytherapy is delivered using afterloading applicators that are placed in the uterine cavity and vagina.

Combined chemotherapy plus radiation therapy for cervical cancer

Recently, the report of 3 well-conducted studies of concurrent chemoradiation has changed the standard of care in this group of patients.

In the Radiation Therapy Oncology Group trial, 403 patients with bulky IB and IIB-IVA cancers were randomized to either radiotherapy to a pelvic and paraaortic field or pelvic radiation with concurrent cisplatin and fluorouracil. Rates of both disease-free survival and overall survival were significantly higher in the group that received combination treatment.

Rose and associates conducted a Gynecologic Oncology Group (GOG) trial for patients with stage IIB, III, or IVA cancer, comparing the combination of radiation with 3 different chemotherapy regimens (cisplatin alone, cisplatin/5-fluorouracil/hydroxyurea, and hydroxyurea alone). Overall survival rates were significantly higher in the 2 groups that received cisplatin-containing regimens.

In another GOG trial, patients with bulky stage IB disease were randomized to either radiation alone or a combination of weekly cisplatin and radiation. All patients had adjuvant hysterectomy. Both disease-free survival and overall survival rates were significantly higher in the combined-therapy group at 4 years of follow-up.

Based on the aforementioned study results, using cisplatin-based chemotherapy in combination with radiation for patients with locally advanced cervical cancer now is a reasonable option.