๐งฌ CERVICAL CANCER (Ca Cervix): Complete Details
๐น Definition
Cervical cancer is a malignant tumor arising from the cells of the cervix, which is the lower part of the uterus that connects to the vagina.
๐น Types of Cervical Cancer
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Squamous Cell Carcinoma (≈ 70–80%)
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Arises from the squamous epithelial lining.
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Adenocarcinoma (≈ 10–15%)
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Arises from glandular (columnar) epithelium.
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Adenosquamous carcinoma
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A mix of both squamous and glandular cells.
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Rare types: Small cell carcinoma, neuroendocrine carcinoma
๐น Causes & Risk Factors
Most cervical cancers are caused by persistent infection with high-risk Human Papillomavirus (HPV) types, especially:
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HPV 16 (most common)
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HPV 18
Other risk factors:
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Early onset of sexual activity
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Multiple sexual partners
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Immunosuppression (e.g., HIV)
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Smoking
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Long-term oral contraceptive use
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Poor genital hygiene
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Low socioeconomic status
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Lack of regular Pap smear screening
๐น Symptoms
Early stages are usually asymptomatic.
Common symptoms (as disease progresses):
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Abnormal vaginal bleeding (post-coital, intermenstrual, postmenopausal)
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Foul-smelling vaginal discharge
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Pelvic pain
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Pain during intercourse (dyspareunia)
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Leg swelling (due to lymphatic blockage)
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Hematuria or rectal bleeding in advanced disease
๐น Screening & Early Detection
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Pap Smear (Papanicolaou test)
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Detects precancerous changes (CIN – Cervical Intraepithelial Neoplasia).
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HPV DNA testing
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Identifies high-risk HPV infections.
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Visual Inspection with Acetic Acid (VIA)
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Low-cost screening tool in low-resource settings.
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Colposcopy
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For visual inspection and biopsy.
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WHO recommendation: Begin screening from age 25 or 30; every 3–5 years.
๐น Diagnosis
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Pelvic examination
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Pap smear results (e.g., LSIL, HSIL, ASCUS)
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Colposcopy-guided biopsy
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Endocervical curettage (ECC)
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Imaging for staging:
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MRI (best for local extent)
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CT or PET-CT (for nodal and distant spread)
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๐น Staging (FIGO 2018)
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Stage I – Cancer confined to the cervix
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Stage II – Beyond cervix but not to pelvic wall or lower third of vagina
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Stage III – Involves pelvic wall or lower third of vagina; or causes hydronephrosis
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Stage IV – Involves bladder, rectum, or distant organs
๐น Treatment
๐ Early stage (IA–IB1):
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Surgery:
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Conization (IA1)
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Total or radical hysterectomy
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Pelvic lymph node dissection
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๐ฅ Locally advanced (IB2–IVA):
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Concurrent chemoradiation
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External Beam Radiation Therapy (EBRT)
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Brachytherapy
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Cisplatin-based chemotherapy
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๐ Advanced stage (IVB or recurrent):
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Palliative chemotherapy
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Targeted therapy (e.g., bevacizumab)
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Immunotherapy (e.g., pembrolizumab in PD-L1 positive tumors)
๐น Prevention
✅ Primary Prevention:
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HPV Vaccination (Cervarix, Gardasil, Gardasil 9)
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Recommended for girls and boys aged 9–14 years (before sexual debut)
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Catch-up vaccination up to age 26 (sometimes up to 45)
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✅ Secondary Prevention:
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Regular screening and early treatment of precancerous lesions
✅ Tertiary Prevention:
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Early diagnosis and proper cancer treatment
๐น Prognosis
Depends on stage at diagnosis:
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5-year survival rates:
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Stage I: >90%
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Stage II: ~70–80%
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Stage III: ~50%
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Stage IV: <30%
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๐น Key Public Health Messages
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Regular Pap/HPV screening saves lives.
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HPV vaccination is a powerful preventive tool.
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Educate women about early symptoms and encourage routine gynecological check-ups.
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