Cervical Cancer

Cervical cancer originates in the cervix, the lower part of the uterus connecting to the vagina. It typically develops slowly and can be detected early through regular screening. The primary cause of cervical cancer is persistent infection with high-risk types of the human papillomavirus (HPV). Early-stage cervical cancer often has no symptoms, which is why routine Pap tests and HPV tests are essential for timely detection and intervention.

Causes

Persistent HPV infection (main risk factor)

Early onset of sexual activity and multiple sexual partners

Smoking, which damages cervical cells

Weakened immune system

Long-term use of oral contraceptives

Diagnosis

Pap Test: Detects precancerous or abnormal cervical cells

HPV Testing: Identifies high-risk HPV strains associated with cervical cancer

Colposcopy: Uses a magnifying device to closely examine the cervix for abnormalities

Biopsy: Removes tissue samples to confirm cancer diagnosis

Imaging (CT/MRI/PET): Determines the extent and spread of the cancer in advanced stages

Treatment

Surgery

Surgery is often the first line of treatment for early-stage cervical cancer and may include various procedures depending on the stage and spread of the cancer:

Conization: Conization is the removal of a cone-shaped piece of tissue from the cervix. This procedure can treat early-stage, localized cancer by removing abnormal cells while preserving the rest of the cervix. This is an option for women wanting to retain fertility, especially when cancer is confined to a small area.

Hysterectomy: Total Hysterectomy: Involves removal of the cervix and uterus. It is effective for early-stage cancer that has not spread beyond the cervix. Radical Hysterectomy: Involves removal of the cervix, uterus, part of the vagina, and surrounding tissues, as well as lymph nodes. This option is used when the cancer is at a slightly advanced stage but still localized. Hysterectomy can reduce the risk of recurrence but is not suitable for patients who wish to retain fertility.

Trachelectomy: This procedure removes the cervix and upper part of the vagina but leaves the uterus intact, preserving the possibility of pregnancy. Typically recommended for younger patients with early-stage, small tumors who wish to maintain fertility.

Pelvic Exenteration: For advanced cancer that has spread within the pelvic area, this extensive surgery removes the uterus, cervix, bladder, and parts of the lower colon. This is generally considered only when other treatments are not effective and are often combined with reconstructive surgery.

Radiation Therapy

Radiation therapy uses high-energy beams to kill or shrink cancer cells. It is often combined with chemotherapy (chemoradiation) in advanced cases to increase effectiveness. Types include:

External Beam Radiation Therapy (EBRT): Delivers radiation from an external machine targeting the pelvic area, which can also include nearby lymph nodes. Treatment typically extends over a few sessions each week.

Brachytherapy: Internal radiation where a device containing radioactive material is placed inside the vagina or next to deliver high-dose radiation directly to the cancer cells. Often used in combination with EBRT for more targeted treatment and can be done over a shorter period.

Combined Radiation Therapy: In some cases, both EBRT and brachytherapy are used to achieve maximum effect, especially when the tumor is large or the cancer has spread beyond the cervix.

Chemotherapy

Chemotherapy uses drugs to kill or stop the growth of cancer cells. It is often used in conjunction with radiation therapy (chemoradiation) for advanced cervical cancer or as standalone treatment in recurrent cases.

Concurrent Chemoradiation: Combines low-dose chemotherapy with radiation therapy to make cancer cells more sensitive to radiation, improving the effectiveness of treatment. Cisplatin is a common chemotherapy drug used in this combination.

Systemic Chemotherapy: For more advanced or recurrent cervical cancer, systemic chemotherapy may be used with drugs like paclitaxel, carboplatin, or topotecan. Treatment is given in cycles to minimize side effects and allow the body to recover between sessions.

Targeted Therapy

Targeted therapies are drugs that focus on specific molecules involved in cancer cell growth and spread, offering a more precise treatment with fewer side effects compared to chemotherapy.

Bevacizumab (Avastin): An anti-angiogenic inhibitor that blocks the formation of new blood vessels, cutting off the blood supply to the tumor and slowing its growth. This drug is often used alongside chemotherapy for advanced or recurrent cervical cancer.

Immunotherapy

Immunotherapy harnesses the body's immune system to identify and attack cancer cells. This is particularly beneficial in cases where the cancer has spread or recurred after other treatment.

Immune Checkpoint Inhibitors: Pembrolizumab (Keytruda) is an example of an immune checkpoint inhibitor approved for advanced cervical cancer. It targets PD-1, a protein on immune cells that, when blocked, allows the immune system to recognize and attack cancer cells more effectively.

Hormonal Therapy

Hormonal treatment is used less frequently for cervical cancer but may be considered in cases where the cancer cells are hormone sensitive. It works by blocking hormones that could potentially fuel cancer growth.

Conclusion

Cervical cancer is largely preventable with regular screenings, HPV vaccinations, and early interventions. Timely diagnosis and a tailored treatment plan, including surgery, radiation, and other targeted therapies, significantly improve survival rates and quality of life for patients.

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Cervical Cancer

Causes

Diagnosis

Treatment

Surgery

Radiation Therapy

Chemotherapy

Targeted Therapy

Immunotherapy

Hormonal Therapy

Conclusion

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