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Cervical Cancer

Cancer of the Cervix

Cervical cancer is the cancer that originates in the cervix of women. It is the 3rd most common cause of cancer related deaths worldwide.

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Presentation

The early stage of cervical cancer is symptomless. During the later stages, as the disease progresses, women would experience vaginal bleeding, pain during intercourse and malodorous vaginal discharge. During more advanced stages when the cancer has spread to other body parts such as the lungs and abdomen, symptoms include fatigue, unexplained weight loss, heavy bleeding from vagina, pain in the legs, back ache, pain in the pelvic region, and decreased appetite, followed by urine or feces leakage from the vagina. In addition to these symptoms, women in the advanced stage of cancer would also be prone to frequent bone fractures.

Fatigue
  • The primary endpoint was fatigue. It was evaluated by the Multidimensional Fatigue Inventory (MFI), and Fatigue Questionnaire (FQ). The secondary endpoints consisted of anxiety and depression.[ncbi.nlm.nih.gov]
  • Hematotoxic adverse events observed during the chemotherapy were grade 4 neutropenia, grade 3 anemia, and grade 4 thrombocytopenia, and the non-hematotoxic adverse events were grade 3 diarrhea and grade 3 fatigue.[ncbi.nlm.nih.gov]
  • The primary presentation was general fatigue and body weight loss. The patient also presented with a mass formation that mimicked cervical cancer on magnetic resonance imaging.[ncbi.nlm.nih.gov]
  • Learn more about discharge in the video below: Fatigue PeopleImages/Getty Images Anderson says you can add cervical cancer to the long list of health issues that could make you feel fatigued or sluggish.[prevention.com]
  • Fatigue, loss of weight and appetite. A general feeling of illness. Dull backache or swelling in the legs.[my.clevelandclinic.org]
Weight Loss
  • The primary presentation was general fatigue and body weight loss. The patient also presented with a mass formation that mimicked cervical cancer on magnetic resonance imaging.[ncbi.nlm.nih.gov]
  • In later stages, symptoms include heavy vaginal bleeding, pain during intercourse, pain in the pelvic region, malodorous discharge from vagina, weight loss, and loss of appetite, also leakage of urine and feces from vagina.[symptoma.com]
  • Weight loss Most forms of cancers decrease or even suppress appetite. The swelling of the cervix can compress the stomach, resulting in decreased appetite and weight loss. Please note that these symptoms do not necessarily signify cervical cancer.[familyshare.com]
  • Get the latest health, weight loss, fitness, and sex intel delivered straight to your inbox. Sign up for our "Daily Dose" newsletter.[womenshealthmag.com]
  • Symptoms of advanced cervical cancer can include: back or pelvic pain difficulty urinating or defecating swelling of one or both legs fatigue weight loss HPV is transmitted through sexual contact.[healthline.com]
Splenectomy
  • At one year follow-up after splenectomy, the patient is free of any recurrent disease.[ncbi.nlm.nih.gov]
  • The main surgical procedures performed included atypical hepatectomy (in five cases) and splenectomy (in one case). In all cases, the cervical origin of the lesions was revealed by histopathological studies.[ncbi.nlm.nih.gov]
Camping
  • Only 4,269 (31.2%) out of 13,500 women who were motivated and counseled attended the camp and 2,369 (55.1%) of them underwent a Pap smear examination.[ncbi.nlm.nih.gov]
Loss of Appetite
  • A 50-year-old woman with headache, vertigo, amnesia and loss of appetite was admitted for persistent vomiting. Contrast enhanced computed tomography showed a solitary right frontal cerebral lesion with ring enhancement and uterine cervical tumor.[ncbi.nlm.nih.gov]
  • In later stages, symptoms include heavy vaginal bleeding, pain during intercourse, pain in the pelvic region, malodorous discharge from vagina, weight loss, and loss of appetite, also leakage of urine and feces from vagina.[symptoma.com]
  • Symptoms of advanced cervical cancer may include: Back pain Bone pain or fractures Fatigue Leaking of urine or feces from the vagina Leg pain Loss of appetite Pelvic pain Single swollen leg Weight loss Exams and Tests Precancerous changes of the cervix[ufhealth.org]
  • These treatments may cause flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Sometimes patients get a rash, and they may bleed or bruise easily.[drugs.com]
  • These include: tiredness loss of appetite diarrhoea pain when passing urine a skin reaction. The skin between your buttocks may feel sore, like the feeling you get from sunburn. Ask your doctor or nurse for a cream to relieve this burning feeling.[cancernz.org.nz]
Colic
  • In this report we present the case of a 51 years old female who underwent a total supralevator exenteration with ileo colic neobladder reconstruction with good oncologic and functional outcomes.[ncbi.nlm.nih.gov]
Thrombosis
  • Suspicion of this diagnosis in an oncology patient with complicating pulmonary emboli but no evidence of deep vein thrombosis is important, especially in cervical cancer patients with extensive pelvic lymph node metastasis and vascular invasion of a primary[ncbi.nlm.nih.gov]
  • Read more about treating deep vein thrombosis Bleeding If the cancer spreads into your vagina, bowel or bladder, it can cause significant damage, resulting in bleeding.[nhsinform.scot]
Back Pain
  • “If the cancer spreads to the side wall, it can cause back pain or leg swelling.” Traditional treatment: The appropriate course of treatment will depend on the type of cervical cancer and how advanced it is.[nydailynews.com]
  • Symptoms of advanced cervical cancer may include: Back pain Bone pain or fractures Fatigue Leaking of urine or feces from the vagina Leg pain Loss of appetite Pelvic pain Single swollen leg Weight loss Exams and Tests Precancerous changes of the cervix[ufhealth.org]
  • pain All these symptoms are common to many conditions and may not mean you have cervical cancer.[cancernz.org.nz]
  • Other symptoms that may occur include: Unusual vaginal discharge Pain in the pelvic area Excessive tiredness Swollen or painful legs Lower back pain. Diagnosis Several different tests are used to diagnose cervical cancer.[southerncross.co.nz]
Leg Pain
  • pain or swelling low back pain.[cancer.org.au]
  • Symptoms of advanced cervical cancer may include: Back pain Bone pain or fractures Fatigue Leaking of urine or feces from the vagina Leg pain Loss of appetite Pelvic pain Single swollen leg Weight loss Exams and Tests Precancerous changes of the cervix[ufhealth.org]
  • If early cell changes develop into cervical cancer, the most common signs include: vaginal bleeding between periods bleeding after intercourse pain during intercourse unusual vaginal discharge vaginal bleeding after menopause excessive tiredness leg pain[cancernz.org.nz]
  • pain or swelling low back pain It is important to know these symptoms, but it is equally important to know cervical cancer often develops without symptoms.[cancerwa.asn.au]
Fracture
  • […] in Men Mar. 6, 2018 — Sporting-related cervical fractures increased by 35 percent from 2000 to 2015, mainly due to an increase in cycling-related injuries, according to new research.[sciencedaily.com]
  • In addition to these symptoms, women in the advanced stage of cancer would also be prone to frequent bone fractures.[symptoma.com]
  • Symptoms of advanced cervical cancer may include: Back pain Bone pain or fractures Fatigue Leaking of urine or feces from the vagina Leg pain Loss of appetite Pelvic pain Single swollen leg Weight loss Exams and Tests Precancerous changes of the cervix[ufhealth.org]
Vaginal Discharge
  • A rare case of 40-years-old women presented with yellow-white and clear yellow mucous vaginal discharge, foul smell and itching per vagina 7 months ago. She had pleuritic chest pain and amenorrhea for 2 years.[ncbi.nlm.nih.gov]
  • Advanced-stage cervical cancer almost always presents either with abnormal vaginal bleeding or with foul-smelling vaginal discharge. We present here a rare case, where a postmenopausal lady presented almost silently with stage IVA cervical cancer.[ncbi.nlm.nih.gov]
  • We present an unusual case of a 57 years old female who presented with chief complaints of Serosaguineous vaginal discharge of one year duration and irregular firm cervix with contact bleeding and was clinically diagnosed to have cervical cancer.[ncbi.nlm.nih.gov]
  • During the early stage of treatment, her symptoms were slightly improved by RA treatment; however, after eight months of treatment, she showed absolute resistance to RA treatments and complained of a profuse vaginal discharge with severe foul odor.[ncbi.nlm.nih.gov]
  • The first identifiable symptoms of the disease are likely to include: Watery or bloody vaginal discharge which may be heavy and can have a foul odor. Vaginal bleeding after intercourse or exercise, between menstrual periods, or after menopause.[my.clevelandclinic.org]
Vaginal Bleeding
  • In conclusion, although its rarity, clinicians should suspect of cervical cancer in a pregnant woman complaining of vaginal bleeding.[ncbi.nlm.nih.gov]
  • Advanced-stage cervical cancer almost always presents either with abnormal vaginal bleeding or with foul-smelling vaginal discharge. We present here a rare case, where a postmenopausal lady presented almost silently with stage IVA cervical cancer.[ncbi.nlm.nih.gov]
  • A woman presented to the hospital due to postcoital vaginal bleeding. The patient was initially diagnosed with cervical carcinoma by clinicians at a local hospital.[ncbi.nlm.nih.gov]
  • Women reported the first symptom was unusual vaginal bleeding that forces them to seek care. The bleeding could be profound and accompanied by offensive odor. Fear of stigmatization could make women reluctant to seek timely care.[ncbi.nlm.nih.gov]
  • A 40-year-old female patient complained of a small amount of vaginal bleeding after intercourse over the past seven years, and then was diagnosed as cervical squamous cell carcinoma IIa, with moderate anemia and leucopenia.[ncbi.nlm.nih.gov]
Pelvic Pain
  • Pelvic pain maclifethai/Getty Images Along with abnormal bleeding, Anderson refers to pelvic pain as "one of the biggies." He says the pain could be diffuse, or it could show up in any area of your pelvis.[prevention.com]
  • Later, you may have pelvic pain or bleeding from the vagina. It usually takes several years for normal cells in the cervix to turn into cancer cells.[nlm.nih.gov]
  • If you do have symptoms, they may include: pain or bleeding during or after sex, douching, or a pelvic examination pelvic pain unusual vaginal discharge blood or bleeding beyond your normal menstrual period Since other conditions can cause these symptoms[mskcc.org]
  • Signs and symptoms of more-advanced cervical cancer include: Vaginal bleeding after intercourse, between periods or after menopause Watery, bloody vaginal discharge that may be heavy and have a foul odor Pelvic pain or pain during intercourse When to[mayoclinic.org]
Postcoital Bleeding
  • Bleeding after having sex (postcoital bleeding). Any vaginal bleeding in women past the menopause. A vaginal discharge that smells unpleasant. Discomfort or pain during sex. All the above symptoms can be caused by various other common conditions.[patient.info]
  • bleeding; leukorrhea in increasing amounts and changing over time from watery to dark and foul; and a history of chronic cervical infections.[medical-dictionary.thefreedictionary.com]
  • bleeding) bleeding outside of your normal periods new bleeding after the menopause Vaginal bleeding is very common and can have a wide range of causes, so it doesn't necessarily mean you have cervical cancer.[nhsinform.scot]
Foul Smelling Vaginal Discharge
  • Advanced-stage cervical cancer almost always presents either with abnormal vaginal bleeding or with foul-smelling vaginal discharge. We present here a rare case, where a postmenopausal lady presented almost silently with stage IVA cervical cancer.[ncbi.nlm.nih.gov]
  • vaginal discharge (serosanguineous or yellowish color) [3] , [4] Pelvic, epigastric, or low back pain (with large lesions) [3] , [5] Hemiparesis, headache (cancer recurrence with brain metastases) [4] Bowel and bladder problems (later stages) [5] Clinical[physio-pedia.com]
  • Internal radiation results in some cramping because of dilation of the cervix and in a foul-smelling vaginal discharge because of cell destruction.[medical-dictionary.thefreedictionary.com]

Workup

The preliminary examination would consist of Pap smear test which if reveals abnormal mass or growth would call for further evaluation for diagnosing the condition. The following tests would be required to diagnose cervical cancer [6]:

  • Colposcopy is carried out to detect presence of abnormalities inside the cervix.
  • Cone biopsy which involves removing a cone shaped region of the cervix to detect for presence of cancer cells.
  • CT scan and MRI for detecting spread of cancer to the neighboring regions.
Right Pleural Effusion
  • A month ago, the patient was seen at an internal medicine clinic and was found to have a right pleural effusion.[ncbi.nlm.nih.gov]
Pneumoperitoneum
  • Eight milliliters of ICG were injected in the 4 quadrants of the cervix after having obtained an adequate pneumoperitoneum and having inspected the abdominal cavity. SLNs were identified in both hemipelvises in both patients.[ncbi.nlm.nih.gov]
Human Papillomavirus
  • Malondialdehyde levels did not differ significantly (p 0.05) between human papillomavirus-positive and human papillomavirus-negative women living in remaining communities.[ncbi.nlm.nih.gov]
  • Human papillomavirus types by age in cervical cancer precursors: predominance of human papillomavirus 16 in young women. Cancer Epidemiol Biomarkers Prev . 2009 Mar. 18(3):863-5. [Medline] . [Full Text] . Surveillance Epidemiology and End Results.[emedicine.medscape.com]
  • Cause Human papillomavirus is the common cause of cervical cancer in 90% of cases.[symptoma.com]
  • Nearly all cervical cancer is caused by the human papillomavirus (HPV). As many as 93% of cervical cancers could be prevented by screening and HPV (human papillomavirus) vaccination.[health.ny.gov]
Penicillium
  • Of these, Penicillium sclerotiorum extract (PSE), significantly affected the viability of HeLa cells in a dose-dependent manner. The extract of P.[ncbi.nlm.nih.gov]

Treatment

Treatment of cervical cancer depends on the stage of the cancer. Early stages of cervical cancer can be treated using surgical methods to remove the cervix. This can be combined with either radiation therapy or chemotherapy to prevent spread of the cancer [7].The following methods are employed for treatment of cervical cancer:

  • Mainly 3 types of surgical procedures such as radical trachelectomy, hysterectomy and pelvic exenteration are employed depending on the stage of cancer.
  • Radiotherapy involves administration of high beam radiation to body parts where the cancer has spread. Both internal and external radiation can be employed.
  • Chemotherapy can be given either through medication or intravenously to arrest the growth of cancer cells. It is given in combination with other methods to relieve the symptoms [8].

Prognosis

The prognosis of cervical cancer greatly depends on the stage at which the cancer was diagnosed. Women who are diagnosed in stage I have a very good prognosis with survival rate over 90%. Those diagnosed in the later stages have survival rate ranging from 60 – 30% [5].

Etiology

About 90% of cervical cancer is known to be caused by HPV which is also known as the human carcinogen [2]. Genital infections which occur as a result of human papillomavirus are transmitted through sexual contact. Indulging in sex at a young age, or having multiple sexual partners and promiscuous male partner poses high risk for women to develop such a type of cancer.

In addition to HPV, other factors such as smoking tobacco and human immunodeficiency virus also account for 10% cases of cervical cancers. Women who have a past history of sexually transmitted diseases are also at an increased risk of developing cervical cancer.

Epidemiology

Cervical cancer is the 3rd most common type of cancer amongst women. The incidence of this type of cancer has decreased in US owing to regular screening of women by the Pap smear test. From the year 2004, the rate of cervical cancer has undergone a significant decline in the US, almost at the rate of 2.1% per year for women under the age of 50 years and by 3.1% for women older than 50 years. Statistical reports produced by ACS reported that in the year 2012, there were about 4220 deaths due to cervical cancer in US. However, the scenario is different for developing countries. It has been estimated that as high as 86% new cases of cervical cancer will be detected in the developing countries. The mortality rate due to cervical cancer has been estimated to be about 52% [3].

Sex distribution
Age distribution

Pathophysiology

Sexually active women have higher chances of contacting cervical cancer. For a cancer of this kind to develop, an infection by HPV is necessary. However, research has revealed that about 90% of HPV infections get corrected on their own requiring no treatment. This further indicates that there needs to be certain other additional factors along with viral infection for the cancer to develop. These include poor immunity status, the type and strain of HPV and the exposure to environmental factors; all these factors significantly contribute to development of cervical cancer. Genetic abnormalities and tumor necrosis factor are also associated with HPV infections which gradually give rise to cancer development amongst the affected population [4].

Prevention

Onset of cervical cancer can be prevented by regular screening through the Pap smear test. As per the European guidelines issued in the year 2010, women should get regularly screened from the age of 20 years. In addition, getting vaccinated against HPV also dramatically reduces the incidence of cervical cancer. Two HPV vaccines are available, namely Cervarix and Gardasil which are designed to provide protection against cervical cancer [9] [10]. Use of condoms during intercourse offers protection against sexually transmitted disease which is otherwise known to increase risk of cervical cancer.

Summary

Cervix is the organ that connects the uterus and the vagina. Abnormal growth and division of cells in this region gives rise to development of cervical cancer. It is mainly caused by the Human papillomavirus (HPV) [1]. Early stages of the disease seldom produce any symptoms and therefore it is advised that women get their Pap smear test done regularly. In countries where there is poor accessibility to Pap smear screening, cervical cancer remains the second most common form of cancer amongst the women population.

Patient Information

Definition

Cervical cancer is the cancer that originates from the cervix. It is one of the most leading causes of deaths due to cancer in women. Abnormal development of cells in the cervical region due to human papillomavirus (HPV) infections causes cervical cancer. It has been estimated that the year 2012, witnessed about 528,000 cases of cervical cancer and 266,000 associated deaths.

Cause

Human papillomavirus is the common cause of cervical cancer in 90% of cases. In addition to this, smoking, poor nutritional status and initiation of sexual activity at young age are also factors that significantly contribute to development of cervical cancer in women.

Symptoms

The early stages of the cancer do not produce any symptoms and therefore the disease gets diagnosed in the later stages. In later stages, symptoms include heavy vaginal bleeding, pain during intercourse, pain in the pelvic region, malodorous discharge from vagina, weight loss, and loss of appetite, also leakage of urine and feces from vagina.

Diagnosis

Diagnosis of the disease is made by a preliminary Pap smear tests. If the test produces abnormal results, then further tests such as cone biopsy, colposcpy, CT scan and MRI are conducted. Blood tests are also done to assess the functioning of various organs.

Treatment

Treatment of cervical cancer depends on the stage at which the disease was diagnosed. The various treatment methods that are employed include surgery, chemotherapy and radiation therapy.

References

Article

  1. Muñoz N, Franceschi S, Bosetti C, et al. Role of parity and human papillomavirus in cervical cancer: the IARC multicentric case-control study. Lancet 2002; 359:1093.
  2. Bouvard V, Baan R, Straif K, Grosse Y, Secretan B, El Ghissassi F, et al. A review of human carcinogens--Part B: biological agents. Lancet Oncol. Apr 2009;10(4):321-2.
  3. Ries LAG, Melbert D, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2004. National Cancer Institute; Bethesda, MD 2007
  4. Liebrich C, Brummer O, Von Wasielewski R, Wegener G, Meijer C, Iftner T, et al. Primary cervical cancer truly negative for high-risk human papillomavirus is a rare but distinct entity that can affect virgins and young adolescents. Eur J GynaecolOncol. 2009;30(1):45-8.
  5. Feng SY, Zhang YN, Liu JG. [Risk factors and prognosis of node-positive cervical carcinoma]. Ai Zheng 2005; 24:1261.
  6. ACOG practice bulletin. Diagnosis and treatment of cervical carcinomas. Number 35, May 2002. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. Jul 2002;78(1):79-91.
  7. Bansal N, Herzog TJ, Shaw RE, et al. Primary therapy for early-stage cervical cancer: radical hysterectomy vs radiation. Am J ObstetGynecol 2009; 201:485.e1.
  8. Moore DH. Chemotherapy for advanced, recurrent, and metastatic cervical cancer. J NatlComprCancNetw. Jan 2008;6(1):53-7.
  9. Mahdavi A, Monk BJ. Vaccines against human papillomavirus and cervical cancer: promises and challenges. Oncologist 2005; 10:528.
  10. Brooks M. One HPV shot may be enough to protect against cervical cancer. Medscape Medical News [serial online]. November 4, 2013;Accessed November 11, 2013. 

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Last updated: 2018-06-22 09:02