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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]
  • Signs of advanced cervical cancer include: Weight loss Fatigue Back pain Leg pain or swelling Leakage of urine or feces from the vagina Bone fractures[cancercenter.com]
  • Fatigue, loss of weight and appetite. A general feeling of illness. Dull backache or swelling in the legs.[my.clevelandclinic.org]
Weight Loss
  • 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]
  • 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]
  • 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]
  • Sometimes your doctor may order further testing to confirm results. 6 of 10 Loss of appetite or unexplained weight loss As with many cancers, loss of appetite or unexplained weight loss can be a cause for concern.[prevention.com]
  • Read More Heavenlee0328 weight-loss-i7c1x3 200112 Did anyone have weight loss prior to diagnosis & if so what stage were you ...[inspire.com]
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]
  • Cassels 1 characterized the vaccine debate as the “just do it” camp, which focuses on averting potential cervical cancer deaths, versus the “what's the hurry” camp, which focuses on residual unknowns such as costs, effectiveness and safety.[doi.org]
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]
Prostitute
  • […] partners had a high risk index and who engaged in sexual practices known to increase the risk of exposure to HPV, such as having had intercourse before the age of 17 years, having had six or more sexual partners, and having a history of contact with prostitutes[content.nejm.org]
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]
  • Sometimes your doctor may order further testing to confirm results. 6 of 10 Loss of appetite or unexplained weight loss As with many cancers, loss of appetite or unexplained weight loss can be a cause for concern.[prevention.com]
  • 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 Precancerous changes of the cervix and cervical cancer[nlm.nih.gov]
  • […] of appetite Weight loss Fatigue Pelvic pain Back pain Leg pain Single swollen leg Heavy bleeding from the vagina Leaking of urine or feces from the vagina Bone fractures Exams and Tests Return to top Pre-cancerous changes of the cervix and cervical cancer[web.archive.org]
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. Celsius.[ncbi.nlm.nih.gov]
Back Pain
  • Signs of advanced cervical cancer include: Weight loss Fatigue Back pain Leg pain or swelling Leakage of urine or feces from the vagina Bone fractures[cancercenter.com]
  • JANE HARRIS: A lot of the symptoms mimic other things like bloating and pelvic pain and back pain and indigestion, but when you put them all together there is actually a story that is being told.[abc.net.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 Precancerous changes of the cervix and cervical cancer[nlm.nih.gov]
  • pain Leg pain Single swollen leg Heavy bleeding from the vagina Leaking of urine or feces from the vagina Bone fractures Exams and Tests Return to top Pre-cancerous changes of the cervix and cervical cancer can not be seen with the naked eye.[web.archive.org]
Leg Pain
  • Signs of advanced cervical cancer include: Weight loss Fatigue Back pain Leg pain or swelling Leakage of urine or feces from the vagina Bone fractures[cancercenter.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 Precancerous changes of the cervix and cervical cancer[nlm.nih.gov]
  • pain Single swollen leg Heavy bleeding from the vagina Leaking of urine or feces from the vagina Bone fractures Exams and Tests Return to top Pre-cancerous changes of the cervix and cervical cancer can not be seen with the naked eye.[web.archive.org]
  • However, if you’re experiencing many of these symptoms along with extreme fatigue, it's worth mentioning to your doctor. 8 of 10 Leg swelling or pain Leg pain or swelling is a sign of cervical cancer, though it might not show up until later stages of[prevention.com]
Fracture
  • Signs of advanced cervical cancer include: Weight loss Fatigue Back pain Leg pain or swelling Leakage of urine or feces from the vagina Bone fractures[cancercenter.com]
  • […] 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 Precancerous changes of the cervix and cervical cancer[nlm.nih.gov]
Arthritis
  • Herein, the authors report a case of a patient who was diagnosed with parane- oplastic rheumatoid arthritis (RA)-like arthritis with synchronous cervical cancer.[ncbi.nlm.nih.gov]
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]
  • Abstract Advanced-stage cervical cancer almost always presents either with abnormal vaginal bleeding or with foul-smelling vaginal discharge.[ncbi.nlm.nih.gov]
  • When this happens, the most common symptoms are: Abnormal vaginal bleeding, such as bleeding after vaginal sex, bleeding after menopause, bleeding and spotting between periods, and having (menstrual) periods that are longer or heavier than usual.[cancer.org]
  • Abstract 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]
  • When this happens, the most common symptoms are: Abnormal vaginal bleeding, such as bleeding after sex (vaginal intercourse), bleeding after menopause, bleeding and spotting between periods, and having longer or heavier (menstrual) periods than usual.[web.archive.org]
Vaginal Discharge
  • Abstract 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]
  • 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]
  • Abstract Advanced-stage cervical cancer almost always presents either with abnormal vaginal bleeding or with foul-smelling vaginal discharge.[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]
Pelvic Pain
  • 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.[medlineplus.gov]
  • Pelvic pain : Pain during intercourse or at other times may be a sign of abnormal changes to the cervix, or less serious conditions. All of these cervical cancer symptoms should be discussed with your doctor.[cancercenter.com]
  • JANE HARRIS: A lot of the symptoms mimic other things like bloating and pelvic pain and back pain and indigestion, but when you put them all together there is actually a story that is being told.[abc.net.au]
Postcoital Bleeding
  • However, the most serious cause of postcoital bleeding is cervical cancer.[ncbi.nlm.nih.gov]
  • 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]
  • Postcoital bleeding. Diagnosis The following procedures may be used to diagnose cervical cancer: History and physical exam. Pelvic exam. Cervical cytology (Pap smear). HPV test. Endocervical curettage. Colposcopy. Biopsy.[cancer.gov]
Dyspareunia
  • Local dermal toxicity (oedema, erythema, pigmentation, fibrosis and ulceration) is reported in 20% of patients and gynaecological toxicity (vaginitis, dryness, narrowing, shortening, dyspareunia, necrosis or ulceration of the cervix, uterus infection,[doi.org]
  • Dyspareunia. Postcoital bleeding. Diagnosis The following procedures may be used to diagnose cervical cancer: History and physical exam. Pelvic exam. Cervical cytology (Pap smear). HPV test. Endocervical curettage. Colposcopy. Biopsy.[cancer.gov]

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.
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 (8.02nmols/mL) were almost five times higher in human papillomavirus-positive compared to human papillomavirus-negative women (1.70nmols/mL) living in Itaituba (statistically significant difference; p 0.05) between human papillomavirus-positive[ncbi.nlm.nih.gov]
  • Simon Horenblas , Human Papillomavirus and Squamous Cell Carcinoma of the Penis , Human Papillomavirus , 10.1007/978-3-540-70974-9_6 , (121-129) , (2009) .[doi.org]
  • A preponderance of evidence supports a causal link between human papillomavirus infection and cervical neoplasia. The presence of high-risk human papillomavirus genital subtypes increases the risk of malignant transformation.[ncbi.nlm.nih.gov]
  • KEYWORDS: HPV; Latina; Pap test; cervical cancer; human papillomavirus; prevention; promotoras de salud; screening[ncbi.nlm.nih.gov]
  • Comparison of the in vitro transforming activities of human papillomavirus types. EMBO J 1988 ;7: 1815 - 1820 30. McDougall JK. Immortalization and transformation of human cells by human papillomavirus.[doi.org]

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