Definition
It is essential to mention that the cervix is the lower part of the uterus, the main organ of a woman’s reproductive system, and the walls of the cervix are formed by muscular and connective tissue (Cohen et al., 2019). In addition, the upper part of the cervix opens into the uterus and the lower part into the vagina, and the cervix has a vaginal and a supravaginal part. The inner surface of the vaginal part is lined with multi-layered squamous epithelium, which ends at the external pharynx. A single-layer glandular epithelium covers the inner part of the cervical canal (Cohen et al., 2019). The cervical canal is normally closed; during menstruation, it opens slightly so as not to obstruct the discharge. The condition of the cervical epithelium is crucial in diagnosing precancerous conditions and cancer (Cohen et al., 2019). Therefore, cervical cancer is a malignant tumor of the mucous membrane of the vaginal portion and or cervical canal.
Statistics
Significantly, cervical cancer ranks fourth in the world in terms of prevalence among all malignant tumors in women. In 2017, almost thirteen thousand new cases of cervical cancer were diagnosed in the United States alone, and more than four thousand women died from this tumor (Cohen et al., 2019). According to statistics from the International Agency for Research on Cancer, in 2020, 604,000 women were diagnosed with cervical cancer. Approximately 341,000 cases of the disease were fatal. Moreover, the disease is most often diagnosed in patients aged 30-65 (Cohen et al., 2019). Furthermore, the average age at diagnosis is 50, and the disease rarely affects girls in their early twenties or older women.
Causes of the Disease
The development of cervical cancer is not associated with the presence of known hereditary syndromes. Clinicians consider the human papillomavirus (HPV) of oncogenic genotypes to be the leading cause of the disease (Vu et al., 2018). HPV introduces its genes into the structure of DNA cells; they stop maturing and can actively divide. As a result, a malignant tumor appears in place of the mutated cell, and over time it enlarges and metastasizes. In addition, early sexual debut, promiscuity of sexual partners, and refusal of barrier contraceptives are considered risk factors for developing this pathology (Vu et al., 2018). Furthermore, long-term use of hormonal contraception and immunosuppressive therapy for autoimmune conditions are reasons for the disease. Additionally, the highest infection rate is observed among young women through sexual activity.
Symptoms of the Disease
In its initial stages, the cancer process is asymptomatic and is only detected during an extensive gynecological examination. Symptoms that a cancerous tumor has grown through the upper layer of the mucosa into the underlying tissue include bloody discharge or vaginal bleeding, leukorrhea, and prolonged menstruation (Vu et al., 2018). It is also essential to mention vaginal bleeding during menopause, pain during intercourse, and painful urination. However, there may also be general symptoms, such as sudden weight loss, the presence of blood in the urine, and increased frequency of urination (Vu et al., 2018). In addition, patients with advanced malignancy complain of dysuria and difficulty in defecation.
Stages
At the null stage, cancer cells are only on the surface of the cervical canal. At this stage, they do not form a tumor and do not penetrate deep into the tissues. The next step is the first phase, when the cancer is localized in the cervix and can grow into the uterus and nearby lymph nodes. The tumor does not extend beyond the organ or spread to other internal organs (Cohen et al., 2019). After that, in the second stage, the neoplasm penetrates the body of the uterus or extends beyond it and spreads to the upper parts of the vagina. Moreover, the tumor process does not involve the pelvic wall and the lower third of the vagina, but the surrounding organs and lymph nodes are not affected.
In addition, at the third stage, the tumor affects the lower third of the vagina and the pelvic wall, can block the ureters, reach a large size, and affect the nearest lymph nodes. Even at stage four, the tumor is widespread around the cervix, affecting lymph nodes, the bladder, the rectum, and other distant organs. Also, each stage has several substages, and doctors use the A1, A2, B1, and others to make an accurate diagnosis (Cohen et al., 2019). It is important to note that histologically, there are 2 main groups of cervical cancer: squamous cell cancer (70-80%) and glandular cancer (10-20%). Approximately 10% of cases have low-differentiated cancer (Cohen et al., 2019). Furthermore, the most malignant and extremely rare type is sarcoma.
Cervical Cancer Diagnosis
Regular gynecological examinations are one of the essential methods of early detection of any woman’s disease. Since the clinical manifestations of precancerous and background conditions are not pronounced, the differential diagnosis of cervical cancer can help detect changes. It includes cytological screening, a study of smears, which helps detect the onset of a pathological process (Bedell et al., 2020). Colposcopy is also a primary diagnostic method. If appropriate, it is supplemented by manipulations, such as biopsies, smear cytology, cervical cervix treatment with acetic acid to detect squamous condylomas, and cervical canal scraping (Bedell et al., 2020). Precancerous lesions in the cervix can be treated with cryosurgery, cauterization, or laser surgery.
It is also significant to consider cervical biopsy, a primary diagnostics method. Thus, it is a surgical procedure in which a small amount of epithelium is taken from the cervix (Bedell et al., 2020). This method of tissue sampling is usually carried out after a gynecologist detects an abnormality during a routine examination. Moreover, a biopsy can detect the presence of human papillomavirus or precancerous cells, or cervical cancer. In addition, cervical epithelial monitoring also uses diagnostic methods such as optical coherence tomography, ultrasound, fluorescence spectroscopy, rectoscopy, and MRI (Bedell et al., 2020). However, the physician decides which tests are appropriate on a personal basis.
Cancer Treatment
Treatment depends on many factors, including the stage of the malignancy. At stages 0 and 1 of oncology, surgery is usually used as the only independent therapeutic approach. Additionally, precancerous cells are removed under local anesthesia. Treatment for stage 2 cervical cancer is combined: radiation with surgery. In addition, radiation therapy is used after surgery if the doctor believes that cancer cells may be present in the body (Bedell et al., 2020). Surgery is usually no longer used if cancer has spread beyond the cervix. Treatment of stage 3 cervical cancer requires more extensive treatment, which usually includes radiation therapy or a combination of it and chemotherapy (Bedell et al., 2020). For stage 4 cancers, radiation and palliative therapies are used.
Prognosis of the Disease
Early diagnosis, a vaccine to prevent HPV infection, screening tests, and treatment of cervical cancer in women is crucial to reducing mortality rates. If the neoplasm is detected at stages 0 and 1, the cure rate ranges from 80 to 100 percent (Prognosis, n.d). Five-year survival rate by stage of cervical cancer can be expressed as follows: 80-90% at stage 1. The other 65-70% and the third 40% are survival rates. In the fourth stage of cervical cancer, the survival rate is also 20% (Prognosis, n.d). However, other factors, such as general health and how cancer responds to treatment, can affect the prognosis for a particular patient.
References
Bedell, S. L., Goldstein, L. S., Goldstein, A. R., & Goldstein, A. T. (2020). Cervical cancer screening: Past, present, and future. Sexual Medicine Reviews, 8(1), 28-37.
Cervical Cancer, Cleveland Clinic, n.d., Web.
Cervical Screening, Cervical Screening Programme, n.d., Web.
Cohen, P. A., Jhingran, A., Oaknin, A., & Denny, L. (2019). Cervical cancer. The Lancet, 393(10167), 169-182.
Diagnosis, American Society of Clinical Oncology, n.d., Web.
Prognosis for Invasive Cervical Cancer, Mortakis, n.d., Web.
Symptoms of Cervical Cancer, Renown Health, n.d., Web.
The Stages of Cervical Cancer, Live Long Lyndhurst, n.d., Web.
Vu, M., Yu, J., Awolude, O. A., & Chuang, L. (2018). Cervical cancer worldwide. Current Problems in Cancer, 42(5), 457-465.