CERVICAL CANCER

Outline

Introduction

Description;what is cervical cancer,parts of the cervix and types of

cervical cancer

Signs and symptoms

Causes/risk factors

Treatment/prevention

Complication

INTRODUCTION
Overview
Globally, cervical cancer is the fourth most common cancer in women, with 604 000 new cases in
2020. About 90% of the 342 000 deaths caused by cervical cancer occurred in low- and
middle-income countries. The highest rates of cervical cancer incidence and mortality are in
sub-Saharan Africa (SSA), Central America and South-East Asia. Regional differences in the
cervical cancer burden are related to inequalities in access to vaccination, screening and treatment
services, risk factors including HIV prevalence, and social and economic determinants such as sex,
gender biases and poverty. Women living with HIV are 6 times more likely to develop cervical
cancer compared to the general population, and an estimated 5% of all cervical cancer cases are
attributable to HIV. The contribution of HIV to cervical cancer disproportionately affects younger
women, and as a result, 20% of children who lose their mother to cancer do so due to cervical
cancer.

DESCRIPTION

Cervical cancer is a type of cancer that affects the cervix, which is the lower narrow end of the
uterus(womb).The cervix connects the uterus to the vagina. It usually starts with abnormal cell
changes in the cervix and can develop into cancer over time.

Before cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia,
in which abnormal cells begin to appear in the cervical tissue. Over time, if not destroyed or
removed, the abnormal cells may become cancer cells and start to grow and spread more deeply
into the cervix and to surrounding areas.
The cervix has two main parts:
* The ectocervix (also called exocervix) is the outer part of the cervix that can be seen during a
gynecologic exam. The ectocervix is covered with thin, flat cells called squamous cells.
* The endocervix is the inner part of the cervix that forms a canal that connects the vagina to the
uterus. The endocervix is covered with column-shaped glandular cells that make mucus.
The squamocolumnar junction (also called the transformation zone) is the border where the
endocervix and ectocervix meet. Most cervical cancers begin in this area.

Types of cervical cancer

Cervical cancers are named after the type of cell where the cancer started. The two main types are:
* Squamous cell carcinoma: Most cervical cancers (up to 90%) are squamous cell carcinomas.
These cancers develop from cells in the ectocervix.
* Adenocarcinoma: Cervical adenocarcinomas develop in the glandular cells of the endocervix.
Clear cell adenocarcinoma, also called clear cell carcinoma or mesonephroma, is a rare type of
cervical adenocarcinoma.
Sometimes, cervical cancer has features of both squamous cell carcinoma and adenocarcinoma.
This is called mixed carcinoma or adenosquamous carcinoma. Very rarely, cancer develops in other
cells in the cervix.

SIGNS AND SYMPTOMS

When it starts, cervical cancer might not cause symptoms. As it grows, cervical cancer might cause
signs and symptoms, such as:

* Watery, bloody vaginal discharge that may be heavy and have a foul odor.
* Fatigue or ongoing tiredness.
* Unexplained weight loss.
* Back pain or discomfort.
* Swelling in the legs.
* Changes in bowel habits.
* Abnormal vaginal bleeding, such as between periods, after sex, or after menopause.
* Pelvic pain or discomfort during sexual intercourse
* Pain during urination.
* Changes in menstrual cycle or heavier periods.

CAUSES/RISK FACTORS

Almost all cervical cancers are caused by human papillomavirus (HPV), a common virus that can
be passed from one person to another during sex. There are many types of HPV. Some HPV types
can cause changes on the cervix that can lead to cervical cancer over time, while other types can
cause genital or skin warts.
HPV is so common that most people get it at some time in their lives. HPV usually causes no
symptoms so you can ’ t tell that you have it. For most people, HPV will go away on its own;
however, if it does not, there is a chance that over time it may cause cervical cancer.
Other things can increase the risk of cervical cancer—
* Having HIV (the virus that causes AIDS)
* Tobacco smoking.
* Weak immune system
* Birth control pills
* Having multiple sexual partners or a sexual partner with many sexual partners

TREATMENT/PREVENTION
TREATMENT
1. Surgery
Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. For
cancer that has not spread beyond the cervix, these procedures are often used:
* Conization. The use of the same procedure as a cone biopsy to remove all of the abnormal tissue.
It can be used to remove cervical cancer that can only be seen with a microscope, called
microinvasive cancer.
* Loop electrosurgical excision procedure (LEEP). The use of an electrical current passed through
a thin wire hook. The hook removes the tissue. It can be used to remove microinvasive cervical
cancer.
* Hysterectomy. The removal of the uterus and cervix. A hysterectomy can be either simple or
radical. A simple hysterectomy is the removal of the uterus and cervix. A radical hysterectomy is
the removal of the uterus, cervix, upper vagina, and the tissue around the cervix.
* Bilateral salpingo-oophorectomy. If needed, this surgery is the removal of both fallopian tubes
and both ovaries.
* Radical trachelectomy. A surgical procedure in which the cervix is removed, but the uterus is left
intact.
* Exenteration. The removal of the uterus, vagina, lower colon, rectum, or bladder if cervical
cancer has spread to these organs after radiation therapy.Exenteration is rarely recommended. It is
most often used when cancer has come back after radiation therapy.
Complications or side effects from surgery vary depending on the type and extent of the procedure.
Occasionally, patients experience significant bleeding, infection, or damage to the urinary and
intestinal systems.
2. Radiation therapy
Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells.
Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and
loose bowel movements. Most side effects usually go away after treatment is finished.
3. Therapies using medication
The treatment plan may include medications to destroy cancer cells. Medication may be given
through the bloodstream to reach cancer cells throughout the body. When a drug is given this way,
it is called systemic therapy. Medication may also be given locally, which is when the medication is
applied directly to the cancer or kept in a single part of the body.

The types of medications used for cervical cancer include:

* Chemotherapy
* Targeted therapy
* Immunotherapy

* Chemotherapy
Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from
growing, dividing, and making more cells.

* Targeted therapy
Targeted therapy is a treatment that targets the cancer ’ s specific genes, proteins, or the tissue
environment that contributes to cancer growth and survival. This type of treatment blocks the
growth and spread of cancer cells and limits damage to healthy cells.
* Immunotherapy
Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system’
s ability to attack cancer cells.

PREVENTION

Following are some methods that can help to prevent cervical cancer:
* HPV vaccine.
* Using condoms during intercourse.
* Quitting smoking.
* Sexual hygiene.
* Regular cervical screening

COMPLICATIONS

Complications of advanced cervical cancer

Some of the complications in advanced cervical cancer are:
* pain
* kidney failure
* blood clots
* bleeding
* fistula
-Pain
There will be severe pain if the cancer spreads into the:
* nerve endings
* bones
* muscles
The pain can usually be managed with medication.

-Kidney failure
In some advanced cancer cases, the tumour can cause a build-up of urine inside the kidneys
(hydronephrosis). This can lead to loss of the kidneys' functions. This is called kidney failure.
Kidney failure can cause a wide range of symptoms, including:
* tiredness
* swollen ankles, feet or hands, caused by water retention
* shortness of breath
* feeling sick
* blood in your pee (haematuria)

-Blood clots
All cancers can make the blood 'stickier' and more prone to forming clots. Bed rest after surgery
and chemotherapy can also increase the risk of developing a clot.
Large tumours can press on the veins in the pelvis. This slows the flow of blood and can lead to a
blood clot developing in the legs.
A major concern in these cases is that the blood clot from the leg vein will travel up to the lungs.
This could block the supply of blood. This is known as a pulmonary embolism and can be fatal.

-Bleeding
If the cancer spreads into the vagina, bowel or bladder, it can cause significant damage. This can
result in bleeding.
Bleeding can occur in the vagina or back passage (rectum), or blood may be present in urine.

-Fistula
A fistula is a rare but distressing complication of advanced cervical cancer.
In most cases, the fistula is a channel that develops between the bladder and the vagina. This can
lead to a persistent discharge of fluid from the vagina. A fistula can sometimes develop between the
vagina and rectum.