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cervical cancer

Unveiling Cervical Cancer: From Stages to Solutions

After the age of 30, women can choose to have a Pap test every three years or co-testing every five years. It's essential to prevent cervical cancer!

Cervical cancer is a cancer of the female reproductive system that originates in the cervix. It’s one of the most common cancers in women, and it’s usually the result of an infection by the human papillomavirus, or HPV. It has also played a huge role in scientific research, thanks to cervical cancer cells from a woman called Henrietta Lacks, which were the first human cells to be grown in a laboratory and which continue to be used to this day in labs around the world.

The cervix is also called the neck of the uterus, and it protrudes into the vagina. The interior cavity of the cervix is called the cervical canal, and it can be divided into two sections. The endocervix is closer to the uterus, not visible to the naked eye, and it’s lined by columnar epithelial cells that produce mucus. The ectocervix is continuous with the vagina, and it’s lined by mature squamous epithelial cells.

Where the squamous epithelium of the ectocervix and the columnar epithelium of the endocervics meet, there’s a line called the squamocolumnar junction.

Right where the two types of cells meet, there is the transformation zone, which is where sub-columnar reserve cells multiply and transform into immature squamous epithelium through a process called metaplasia.

Normally, mature cells are stuck in the G1 or growth one phase of the cell cycle, which is when cells grow and take care of regular cellular business like synthesizing proteins and producing energy.

Eventually, whenever new cells are needed, they’ll exit G1 and keep going through the rest of the cell cycle to eventually divide into two new, identical daughter cells. Sometimes, though, cells can be pushed out of G1 and go through the cell reproduction cycle faster than the body needs new cells. This uncontrolled growth and multiplication is called dysplasia, and it’s exactly how cervical cancer develops from precancerous cells.

Dysplasia in the epithelial layer of the cervix, also called cervical intraepithelial neoplasia, or squamous epithelial lesion, usually starts in the basal layer of the transformation zone, typically in the immature squamous epithelium there. In most cases, cervical intraepithelial neoplasia is caused by an HPV infection. There are over 100 different types of HPV, but only about 15 of them have been linked with cervical cancer. Specifically, HPV-16 is responsible for more than half of all cervical cancers.

The virus is like a house guest that overstays their welcome and starts using the kitchen to make all their favorite foods. It inserts itself into the immature squamous cells of the transformation zone and then integrates its DNA into the host DNA. Using the host DNA, HPV makes huge amounts of

two of its proteins, E6 and E7. These proteins are responsible for pushing mature squamous cells through the cell replication cycle by blocking the action of tumor suppressor genes like P 53.

The end result is uncontrolled replication of cervical epithelial cells, which are resistant to apoptosis or normal programmed cell death.

Stages of cervical cancer

Now, you might see a couple of different ways of describing the stages of cervical intraepithelial neoplasia, but the most common is based on how much of the epithelium is involved.

  • Grade 1, cervical intraepithelial neoplasia affects the lower one third of the epithelium thickness wise.
  • 2nd Grade affects two thirds.
  • Grade 3 affects almost all of the epithelium,
  • and finally, carcinoma in situ affects the entire thickness of the epithelium.

The higher the grade, the more likely the Dysplasia will evolve into cancer. Eventually, carcinoma incites, you can progress to invasive cervical cancer, which is when cancerous cells break through the epithelial basement membrane and into the cervical stroma.

Then it can spread to neighboring tissues, like epithelial layers of the uterus and of the vagina. Finally, it can pass through the pelvic wall and affect the bladder and rectum.

Lastly, it can also spread via the lymphatic and circulatory systems to other areas of the body, like the liver and lungs.

Because HPV tends to invade squamous cells first, the majority of cervical cancer cases are squamous cell carcinomas. The second most common type also associated with HPV is cervical adenocarcinoma, which involves the epithelial gland cells of the cervix.

But either way, the progression from HPV infection to cervical intraepithelial neoplasia to cancer is generally slow, and it can take between ten and 20 years before invasive cervical cancer develops.

Risk of cervical cancer

HPV is a sexually transmitted infection, the risk of developing cervical cancer is highest in females who do not use condoms and have multiple sexual partners. Not every HPV infection results in cervical cancer, though. In fact, the immune system fights off most HPV infections, so it’s believed that there are other factors involved. For example, the risk increases depending on the type of HPV, how long the infection lasts, and if the person is immunocompromised, environmental factors like smoking also increase the risk.

But the good news is that vaccination against HPV immunizes against several HPV types linked with cervical cancer, including HPV 16.

cervical cancer

Symptoms of cervical cancer

The first symptom of cervical cancer is often abnormal vaginal bleeding, especially after sexual intercourse. Other symptoms include vaginal discomfort, vaginal discharge with an unpleasant smell, and pain when urinating.

If the cancer has spread beyond the pelvic wall, it can cause symptoms like constipation and bloody urine.

Screening

Screening for cervical intraepithelial neoplasia and cervical cancer is done with a PAP smear with high risk HPV testing. Pap tests are so good at detecting precancerous cells that screening recommends a PAP smear every three years for females between 21 and 65 years of age.

Together with the HPV vaccine, this has contributed significantly to the drop in cases of cervical cancer worldwide. Now, during a PAP test, some cells from the transformation zone are collected with a brush, and then they’re examined under a microscope for dysplasia.

If the PAP test comes back positive for Dysplasia, it may be followed up with a colposcopy which is when a magnifying device called the colposcope is used to get a zoomed in view of the cervix, and then obtain biopsies.

Prevention

Preventing cervical cancer often involves a combination of age-specific strategies, including vaccination, regular screenings, and lifestyle choices. Here are some recommendations for different age groups:

Adolescents and Young Adults (9-26 years old):

HPV Vaccination: The HPV (human papillomavirus) vaccine is recommended for both males and females. Ideally, it should be administered at ages 11 or 12, but it can be given up to age 26. The vaccine protects against the most common cancer-causing HPV types.

Women in Their 20s:

Cervical Cancer Screening: Starting at age 21, women should begin cervical cancer screenings with Pap tests (Pap smears) every three years.

Women in Their 30s:

Cervical Cancer Screening: After the age of 30, women can choose to have a Pap test every three years or co-testing (Pap test and HPV test) every five years.

HPV Vaccination: If not vaccinated earlier, women up to age 26 can still receive the HPV vaccine.

Women in Their 40s and 50s:

Continue with regular Pap tests or co-testing as recommended by your healthcare provider.

Women 65 and Older:

If you have had regular screenings with normal results, you may stop screening after age 65. However, it’s still important to discuss your individual situation with your healthcare provider.

General Recommendations:

Maintain a healthy lifestyle: Avoid smoking, eat a balanced diet, and exercise regularly to support your overall health and immune system.

Practice safe sex: Use condoms to reduce the risk of HPV and other sexually transmitted infections.

Limit the number of sexual partners: Reducing the number of sexual partners can lower your risk of HPV infection.

It’s essential to follow your healthcare provider’s recommendations for cervical cancer prevention, as the screening guidelines may vary based on individual risk factors and medical history. Additionally, if you experience any unusual symptoms, such as abnormal vaginal bleeding or pelvic pain, consult your healthcare provider regardless of your age. Regular check-ups and open communication with your healthcare team are crucial for early detection and prevention of cervical cancer.

Treatment for cervical cancer

The treatment options for cervical intraepithelial neoplasia include;

  • Cryosurgery where liquid nitrous oxide is used to freeze and kill abnormal cells
  • Conization where the transformation zone and some or all of the endocervix is removed surgically. It can be done with a scalpel called cold-knife conization, laser or by heating a loop of thin wire with electricity called loop electrosurgical excision procedure or large loop excision of the transformation zone.

Treatment of early cervical cancer is to surgically remove either just the tumor, or also the uterus and associated lymph nodes. If the cancer is more advanced radiation and chemotherapy may be done.

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