Cervical / Uterine Cancer

The Function of the Cervix and Complications Associated with Cervical Cancer

The cervix is the lower, narrow part of the uterus that connects it to the vagina. It plays a key role in reproductive health: producing mucus that changes during fertility, protecting the uterus from infection, and allowing the passage of menstrual blood and childbirth. Diseases affecting the cervix—such as cervical cancer—can lead to serious complications including severe bleeding, reproductive issues, and metastasis to nearby tissues.

Categories Associated With Primary and Secondary Cervical Tumors

• Primary Cervical Cancer: Originates in the cervix itself. The most common types include:
  • Squamous cell carcinoma, which arises from the surface lining cells (about 70–80% of cases).
  • Adenocarcinoma, developing from glandular cells deeper in the cervical canal (10–25% of cases).
• Secondary (Metastatic) Cervical Cancer: Rare; involves spread to the cervix from cancers originating elsewhere—e.g., endometrial, ovarian, or gastrointestinal tumors.

Causes and Risk Factors for Cervical Cancer

Persistent infection with certain types of human papillomavirus (HPV)—especially types 16 and 18—is the most significant risk factor. Additional contributors include:

• Early initiation of sexual activity and multiple sexual partners
• Smoking, which lowers immune defenses
• Long-term oral contraceptive use
• Immunosuppression (e.g., HIV infection)
• High parity (multiple full-term pregnancies)
• Co-infection with other sexually transmitted infections

Signs and Symptoms of Cervical Cancer

Early-stage disease is often asymptomatic; symptoms usually appear as cancer advances:

• Abnormal vaginal bleeding, especially postcoital or postmenopausal
• Unusual vaginal discharge, possibly foul-smelling or watery
• Pelvic or back pain, particularly in later stages
• Pain during intercourse (dyspareunia)
• Advanced disease may lead to urinary or bowel symptoms if cancer invades adjacent structures

Diagnosis of Cervical Cancer

Diagnosis involves several steps:

• Medical history and screening: via Pap smear (cytology) and/or HPV testing.
• Colposcopy: Visual examination of the cervix with biopsy if abnormalities are found.
• Cone biopsy or LEEP: Diagnostic and sometimes therapeutic procedures.
• Imaging (MRI, CT, PET-CT): Used to stage disease and detect metastasis.
• Lab work: Includes CBC, renal, and liver panels to assess treatment readiness.

Staging: The FIGO (International Federation of Gynaecology and Obstetrics) system is used, based on tumor size, local spread, and distant metastasis.

Best Treatment for Cervical Cancer

Management depends on the cancer stage, histologic type, patient health, and fertility desires.

A. Traditional Treatments

• Surgical Procedures:
  • Conization or LEEP for early precancerous lesions (CIN).
  • Radical hysterectomy for early invasive cancer.
  • Trachelectomy can preserve fertility in select young patients.
• External Beam Radiation Therapy (EBRT): Used postoperatively or combined with chemotherapy for advanced disease.
• Systemic Chemotherapy: Agents such as cisplatin and paclitaxel are used concurrently with radiation or for metastatic disease.

B. Advanced Treatments for Cervical Cancer

• Brachytherapy (Internal Radiation): Delivers radiation directly to the cervix via intracavitary placement.
• Targeted Therapies: Bevacizumab (anti-VEGF) for recurrent/metastatic cases, often combined with chemotherapy.
• Immunotherapy: Pembrolizumab (anti-PD-1) approved for PD-L1 positive recurrent/metastatic disease.
• Minimally Invasive Procedures: Advanced laparoscopic techniques for hysterectomy or lymph node sampling reduce recovery time.

Prevention and Lifestyle Management

• HPV vaccination (HPV16/18 and others) ideally before sexual debut
• Regular cervical screening with Pap and/or HPV testing
• Safe sex practices (condom use, limiting partners)
• Smoking cessation
• Addressing immunosuppressive conditions (e.g., HIV testing/treatment)

Prognosis and Survival Rates

• CIN lesions treated early have near 100% cure rates.
• Early invasive disease (stage I): 5-year survival ~90%.
• Stage II–III: 5-year survival ranges 60–75%.
• Stage IV or recurrent disease: 5-year survival drops below 30%.

Adding concurrent chemoradiation and advanced therapies has significantly improved outcomes in recent years.

Conclusion

Cervical cancer remains a leading cause of morbidity and mortality worldwide—despite being highly preventable and treatable. Early detection through vaccination and screening, combined with timely and appropriate therapy, offers excellent outcomes, particularly when precancerous changes are identified early. Advances in radiation, targeted therapies, and immunotherapy continue to improve survivorship and quality of life for affected individuals.