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Cervix Cancer

What is cervix?

Cervix which is the lower, narrow part of the uterus. The uterus holds the growing fetus during pregnancy. The cervix connects the lower part of the uterus to the vagina and, with the vagina, forms the birth canal

What is type of cervix cancer?

Cervical cell abnormalities prior transformation to cancer:

  1. The Atypia
    Atypia refers to minor changes to the cells, which can be detected in a Pap test. These changes may worsen or return to normal. If a Pap test picks up atypical changes, the woman will be advised to have another test in six months to see whether the changes have disappeared.
  2. Dysplasia (also known as CIN or SIL)
    Dysplasia is a type of abnormal change in the cells of the cervix. It is also called cervical intraepithelial neoplasia (CIN) and squamous intraepitheliallesion (SIL).

There are two main types of cervical cancer :

  1. Squamous cell carcinoma
    The most common type of cervical cancer, starts in the squamous or skin-like cells of the cervix.
  2. Adenocarcinoma
    Is a less common type of cervical cancer. It starts in the glandular cells. In addition cervical cancer may be either microinvasive or invasive

What are the risk factors for cervix cancer?

A risk factor is anything that increases a person’s chance of developing cancer. There are risk factors that can be controlled, such as smoking, and risk factors that cannot be controlled, such as age and family history.

The following factors can raise a woman’s risk of developing cervical cancer:

  1. Human Papillomavirus (HPV) infection
    The most important risk factor for cervical cancer is infection with HPV. HPV is passed from one person to another during sexual intercourse. Factors that raise the risk of being infected with HPV include becoming sexually active at an early age, having many sexual partners (or having sex with a man who has had many partners), and/or having sex with a man who has penile warts.
  2. Human immunodeficiency virus (HIV) infection
    Infection with HIV, the virus that causes acquired immune deficiency syndrome (AIDS), is a risk factor for cervical cancer
  3. Herpes
    Women who have genital herpes are at greater risk of developing cervical cancer.Daughters of women who used the drug diethylstilboestrol (DES) during pregnancy to prevent a miscarriage
  4. Smoking
    Which increases the risk of cervical cancer fourfold

What are the symptoms of cervix cancer?

Most women do not have any signs or symptoms of a precancer or early stage cervical cancer. Symptoms usually do not appear until the cancer has spread to other tissues and organs.

Any of the following could be signs or symptoms of cervical dysplasia or cancer:

  • Blood spots or light bleeding between or following periods
  • Menstrual bleeding that is longer and heavier than usual
  • Bleeding after menopause
  • In Bleeding after intercourse, douching, or a pelvic examination
  • Pain during sexual intercourse
  • creased vaginal discharge

If you have this symptom, please consult your doctor immediately

How you diagnose cervix cancer?

  • Pap test
    The Pap test is used to detect abnormal cell changes in the cervix before cancer develops. Cell samples from the surface of the cervix are sent to a pathologist for analysis under a microscope. Results are usually available within a week of the test.
    The doctor will insert a speculum into your vagina. This holds the vaginal walls apart so that he or she can see your cervix. The doctor will use an instrument like a spatula to take the cells from your cervix.
    It is recommended that women have a Pap test once every two years.
  • Colposcopy
    The doctor may do a colposcopy to check the cervix for abnormal areas. A special instrument called a colposcope (an instrument that magnifies the cells of the cervix and vagina, similar to a microscope) is used. The colposcope gives the doctor a lighted, magnified view of the tissues of the vagina and the cervix. If you are pregnant a colposcopy is quite safe. However, you should always tell your doctor if you are or think you may be pregnant as this may mean you would need different treatment
  • Biopsy
    A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. During a biopsy, the doctor removes a small sample of tissue and sends it to the laboratory.
  • Cystoscopy and proctosigmoidoscopy
    These procedures are done while you are under anaesthetic. They check whether the cancer has spread to other organs in your abdomen.
  • Computed tomography (CT or CAT) scan
    A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine.
  • Magnetic resonance imaging
    This test is similar to a CT scan but it uses magnetic fields instead of x-rays to build up a series of very clear and detailed images.

What is treatment for cervical cancer?

  1. Treatment for dysplasia
    If you are diagnosed with dysplasia, you may need treatment to remove the abnormal cells from the cervix.
    In mild cases, all that may be needed is regular Pap tests. In more severe cases, the abnormal cells may be removed using cryosurgery (freezing), cauterisation (burning) or laser surgery.
  2. Treatment of cervical cancer
    The treatment of cervical cancer depends on the size and location of the tumor, whether the cancer has spread, and the woman’s overall health. The most common treatments for cervical cancer are surgery, radiation therapy, and chemotherapy.
  3. Surgery
    In surgery, the doctor operates on the patient to remove the cancerous tissue. For cervical cancer that has not spread beyond the cervix, these procedures are often used:

    • Conization uses the same procedure as a cone biopsy to remove all of the abnormal tissue. It can be used to remove microinvasive cervical cancer.
    • LEEP uses an electrical current passed through a thin wire hook. The hook removes the tissue. It can be used to remove microinvasive cervical cancer.
    • A hysterectomy removes the uterus and cervix. Hysterectomy can be either a simple hysterectomy, which involves removal of the uterus and cervix, or a radical hysterectomy which involves a removal of the uterus, cervix, upper vagina, and the tissue around the cervix. In addition, a radical hysterectomy includes an extensive pelvic lymph node dissection (removal of the lymph nodes). If needed, bilateral salpingo-oophorectomy (the removal of both fallopian tubes and both ovaries) is done at the same time as the hysterectomy.
  4. Radiotherapy
    Radiotherapy is the use of radiation to destroy cancer cells. Radiotherapy may be advised if you are not well enough for a major operation. It may also be advised if the tumour has spread into the tissues around the cervix, as this would be difficult to sure by surgery alone. Radiotherapy may also be used after surgery or combined with chemotherapy.
    Side effects from radiation therapy depend on the dosage and the area of the body being treated. Common side effects include tiredness, mild skin reactions (such as dry or reddened skin at the site of radiation treatment), loss of appetite, nausea, vomiting, urinary discomfort, and diarrhea. Side effects of internal radiation therapy may include abdominal pain and bowel obstruction. Most side effects usually go away soon after treatment is finished.
  5. Chemotherapy
    Chemotherapy is the treatment of cancer using anti-cancer drugs. The aim is to kill cancer cells while doing the least possible damage to normal cells. The drugs work by stopping the cancer cells from growing and reproducing.
    Common side effects include nausea and vomiting, loss of appetite, diarrhea, fatigue, low blood cell count, bleeding or bruising after minor cuts or injuries, numbness and tingling in the hands or feet, headaches, hair loss, and darkening of the skin and fingernails. Side effects usually go away when treatment is completed.
  6. Palliative treatment
    Palliative treatment is treatment that relieves or soothes pain and other symptoms of illness. Palliative care is available for all people who experience pain and distress associated with cancer, whatever their stage of cancer treatment. It is a particularly important type of treatment for people with advanced cancer, who cannot be cured but can expect to live without undue pain and distress.

The Role of HPV (Human Papillomavirus) Vaccine

Recently, 2 types of HPV vaccine (Gardasil and Cervarix) are available. These vaccine can prevent up to 70% of cervical cancer and is given to women less than 26 years old who has not had prior sexual intercourse or who are still not known to have been infected by HPV (Human Papillomavirus).

Last Reviewed : 26 April 2012
Writer : Dr. Arief Budiman Abdul Aziz
Reviewer : Dr. Haris Njoo Suharjono