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

  • If abnormalities are found: Colposcopy—visual examination of the cervix with biopsy

  • Cone biopsy or loop electrosurgical excision procedure (LEEP) for diagnostic and sometimes therapeutic purposes

  • Imaging (MRI, CT, PET-CT) to stage the disease and detect metastasis

  • Lab work (CBC, renal/liver panels) to assess treatment readiness

Staging:
International Federation of Gynaecology and Obstetrics (FIGO) system—based on tumor size, local spread, and distant metastasis—informs treatment planning.

Best Treatment for Cervical Cancer

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

A. Traditional Treatments

  1. Surgical Procedures

    • Conization or LEEP for early precancerous lesions (CIN).

    • Radical hysterectomy (removal of uterus, cervix, upper vagina, lymph nodes) for early invasive cancer.

    • Less radical surgery (e.g., trachelectomy) can preserve fertility in select young patients.

  2. External Beam Radiation Therapy (EBRT)

    • Often used postoperatively for high-risk features or combined with chemotherapy as primary treatment for locally advanced disease.

  3. Systemic Chemotherapy

    • Common agents include cisplatin and paclitaxel, used concurrently with radiation or for advanced metastatic disease.

B. Advanced Treatments for Cervical Cancer

  1. Brachytherapy (Internal Radiation)

    • Delivers high-dose radiation directly to the cervix via intracavitary placement of radioactive sources; a crucial component of definitive therapy for stages IB2–IVA.

  2. Targeted Therapies

    • Bevacizumab (anti‑VEGF) is approved for recurrent/metastatic cervical cancer, often in combination with chemotherapy, offering improved survival.

  3. Immunotherapy

    • Pembrolizumab (anti‑PD‑1) is FDA approved for PD-L1 positive recurrent/metastatic disease, enhancing immune-mediated tumor control.

  4. Minimally Invasive Procedures

    • These include advanced laparoscopic techniques for hysterectomy or lymph node sampling, potentially reducing recovery time.

Prevention and Lifestyle Management

Preventive strategies include:

  • HPV vaccination (HPV16/18, and other types) 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

Prognosis depends on stage at diagnosis:

  • 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.