Cervical cancer is a malignant tumor that grows from the tissue of the cervix uteri. Also known as cervical cancer. The cervix is the lower part of the uterus that narrows and connects the uterine cavity to the vagina (birth canal).
Cervical cancer usually develops slowly, about 12-15 years. Before it becomes cancerous, the cells in the walls of the cervix undergo a behavior change called dysplasia. Later, the cancer cells begin to grow rapidly and spread both into the cervix and surrounding tissues.
Why Can I Get Cervical Cancer?
The exact cause of cervical cancer is difficult to know. Experts can only find a few risk factors for cervical cancer. However, if there are no risk factors, it does not mean that someone is free from cancer.
The main risk factor for cervical cancer is infection with a virus called human papillomavirus (HPV). Not all women who have HPV infection will get cancer, only about 5%, because 95% of HPV infections will disappear on their own.
There are over 150 types of HPV, but only a few can cause cervical cancer, the most common being HPV types 16 and 18. Other types include 31, 33, 35, 45, etc. The group of HPV that causes cervical cancer is called the high-risk type. If a woman is infected with a high-risk type of HPV, there is a chance that the infection will persist, not go away, and cause pre-cancerous changes.
Most sexually active women can be infected with HPV. HPV infection usually causes no symptoms and can go undetected for years. A woman is at higher risk of getting HPV if she has more than one sex partner, or if her sex partner has other sex partners.
Other risk factors for cervical cancer are:
- Frequent childbirth;
- Having sex with multiple partners;
- Having sexual intercourse for the first time at a very young age;
- Smoke;
- Taking birth control pills for a long time (more than 5 years).
- Low body resistance.
What are the Symptoms of Cervical Cancer?
There are no specific symptoms for newly occurring cervical cancer. If it has started to grow, cervical cancer can give symptoms such as:
- Bleeding from the genitals
- Excessive vaginal discharge
- Pain around the genitals
- Pain during intercourse
How Do I Know If I Have Cervical Cancer?
The change of normal cells into malignant or cancerous cells actually occurs gradually. These stages can be seen under a microscope by an experienced pathologist. Therefore, the only way to know if you have cervical cancer is to have an early check-up. There are several ways to detect cervical cancer early. The most recommended examination is a Pap smear or Pap test.
A pap smear is a procedure to collect cells from the surface of the cervix and vagina with a tool (spatula) covered with cotton. The cells that are collected are then placed on a glass object and viewed under a microscope to determine whether they are normal or not.
What Should I Do After I’ve Been Diagnosed with Cervical Cancer?
If you have just been diagnosed with cervical cancer, then you will need to undergo a series of tests to find out how far the cancer has spread in your body, whether it is still in the cervix or has already spread to other parts of the body. For this, you will be asked to undergo the following tests:
Internal examination, which is a physical examination by a gynecologist by inserting a finger into your vagina. The goal is to find out how far the tumor has spread clinically and determine the stage of the disease.
Chest X-ray is an X-ray examination of the chest cavity to see the shadows of organs in the chest, such as the heart and lungs. This examination is done to find out if there are signs of cancer cells spreading to the lungs.
Gynecological ultrasound (USG), is an examination with high-frequency sound waves of the internal reproductive organs, namely the uterus, ovaries, and other surrounding structures, such as the kidneys, urinary tract, bladder, and colon.
This examination can help confirm the stage of the disease that has been determined clinically. Ultrasound can see whether cancer causes urinary tract obstruction and kidney swelling, penetrates the bladder to the front or penetrates the colon to the back.
CT scan or MRI, which is a more detailed imaging examination of the inside of your body and processed by a computer. This examination can detect if there is a spread of cancer cells to organs in your body, such as the liver, spleen, kidneys, and others.
Tumor biopsy, which is taking a small sample of cervical cancer tissue to determine the type of cancer cells.
Cervical Cancer Stages
Stage 1, In stage 1, cancer has formed in the lining of the cervix. Stage I is divided into two, namely stages IA and IB based on the depth of the cancer found.
- Stage IA: A small number of cancer cells are found in the cervical tissue under a microscope. Stage IA is divided into stages IA1 and IA2:
- Stage IA1: the cancer is no more than 3 mm deep and no more than 7 mm wide.
- Stage IA2: the cancer is between 3-5 mm deep and no more than 7 mm wide.
- Stage IB: In stage IB, the cancer can only be seen with a microscope and is more than 5 mm deep or more than 7 mm wide, or can be seen without a microscope. Cancers that can be seen without a microscope are divided into two, IB1 and IB2, based on the size of the tumor.
- Stage IB1: the cancer can be seen without a microscope and is no larger than 4 cm.
- Stage IB2: the cancer can be seen without a microscope and is larger than 4 cm.
Stage II, In stage II, the cancer has spread beyond the cervix but not to the pelvic wall (the tissue that lines the part of the body between the two pelvises) or the lower third of the vagina. Stage II is divided into IIA and IIB, based on how far the cancer has spread.
- Stage IIA: Cancer has spread beyond the cervix to the upper two-thirds of the vagina but not to the tissue around the uterus.
- Stage IIB: Cancer has spread beyond the cervix to the upper two-thirds of the vagina and the tissues around the uterus.
Stage III, In stage III, the cancer has spread to the lower third of the vagina or to the pelvic wall, and/or has caused kidney failure. Stage III is divided into stages IIIA and IIIB, based on how far the cancer has spread.
- Stage IIIA: Cancer has spread to the lower third of the vagina but not to the pelvic wall.
- Stage IIIB: Cancer has spread to the pelvic wall and/or the tumor is large enough to press on and block the ureter (the tube between the kidney and the bladder). This blockage causes the kidney to swell or stop working. Cancer cells may also have spread to the lymph nodes in the pelvis.
Stage IV, In stage IV, the cancer has spread to the bladder, rectum, or other parts of the body. Stage IV is divided into stages IVA and IVB based on where the cancer is found.
- Stage IVA: Cancer has spread to the bladder or rectum (lower large intestine) and may have spread to the lymph nodes in the pelvis.
- Stage IVB: Cancer has spread beyond the pelvis and pelvic lymph nodes to other places in the body, such as the liver, small intestine, or lungs.
Cervical Cancer Treatment
There are several types of treatment for cervical cancer, namely surgery, radiation, and chemotherapy.
Surgery and surgical procedures are performed to remove the tumor. Several procedures can be performed:
- Conization: a procedure to remove cone-shaped tissue from the cervix and cervical canal. This procedure is also called a cone biopsy.
- Total hysterectomy, which is the removal of the entire uterus, including the cervix. When performed through the vagina, it is called a vaginal hysterectomy. When performed through an incision in the abdominal wall, it is called a total abdominal hysterectomy. When performed through a laparoscope, it is called a total laparoscopic hysterectomy. Currently, robotic surgery is the optimal choice for removing diseased tissue precisely, accurately, and safely.
- Radical hysterectomy is the removal of the entire uterus, cervix, part of the vagina, and extensive surrounding tissue, including ligaments, ovaries, fallopian tubes, and surrounding lymph nodes.
- Modified radical hysterectomy, which removes the uterus, cervix, upper part of the vagina, and the veins and tissues closest to these organs. Nearby lymph nodes may also be removed. This type of surgery does not remove as much tissue as a radical hysterectomy.
- Bilateral salpingo-oophorectomy, which is the removal of both ovaries and their tubes.
- Pelvic exenteration is the removal of the lower part of the colon, rectum, and bladder. The cervix, vagina, both ovaries, and nearby lymph nodes are also removed. The patient is made an artificial hole (stoma) for urine and feces to exit the body into a collection bag.
- Cryosurgery, is surgery using a tool to freeze and destroy abnormal tissue, for example for carcinoma in situ. This procedure is also called cryotherapy.
- Laser surgery: A surgical procedure that uses a laser beam as a ‘knife’ to cut tissue without bleeding or to remove tumors.
- Loop electrosurgical excision procedure (LEEP), is a procedure that uses an electric current passed through a thin wire as a knife to remove abnormal or cancerous tissue.
Radiation (Radiation), Radiation therapy is a cancer treatment using high-energy X-rays or other radiation to kill cancer cells or prevent further growth. There are two types of radiation therapy, namely external radiation and internal radiation.
External radiation is done using a machine outside the body that emits radiation toward the cancer. Internal radiation is done using a radioactive substance that is placed directly in or near the cancer site. The type and method of radiation administration depends on the type and stage of cancer being treated.
Chemotherapy, Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cancer cells or preventing them from dividing (reproducing). Chemotherapy is usually given by injecting the drugs into a vein (injection).
Selection of Therapy Based on Cancer StagePre-Cervical Cancer:
Therapy for pre-cancerous cervical lesions can be done by, among other things:
- LEEP
- Laser Surgery
- Conization
- Cryosurgery
- Total hysterectomy for women who can no longer have children or do not want to have children.
- Internal radiation for women who cannot undergo surgery.
Cervical Cancer Stage IA
Therapeutic options for stage IA are:
- Total hysterectomy with or without bilateral salpingo-oophorectomy
- Conization
- Modified radical hysterectomy and lymph node removal
- Internal radiation therapy
Cervical Cancer Stage IB
Therapeutic options for stage IB are:
- Combination of internal and external radiation therapy
- Radical hysterectomy and lymph node removal
- Radical hysterectomy and removal of lymph nodes followed by radiation therapy plus chemotherapy
- Radiation therapy plus chemotherapy
Cervical Cancer Stage IIA
Treatment options for stage IIA are:
- Combination of internal radiation therapy and external radiation plus chemotherapy
- Radical hysterectomy and lymph node removal
- Radical hysterectomy and lymph node removal followed by radiation therapy plus chemotherapy
Cervical Cancer Stage IIB
Treatment for stage IIB cervical cancer may include internal and external radiation combined with chemotherapy.
Cervical Cancer Stage III
Treatment for stage III cervical cancer may include internal and external radiation therapy combined with chemotherapy.
Cervical Cancer Stage IVA
Treatment for stage IVA cervical cancer may include internal and external radiation therapy combined with chemotherapy.
Cervical Cancer Stage IVB
Treatment for stage IVB cervical cancer may include:
- Radiation therapy a palliative therapy to reduce symptoms caused by cancer and improve quality of life.
- Chemotherapy
- Clinical trials of new anticancer drugs and combination drugs.
Cervical Cancer Recurrence
Treatment options for recurrent cervical cancer are:
- Pelvic extraction followed by combined radiation therapy with chemotherapy.
- Chemotherapy is a palliative therapy to reduce symptoms caused by cancer and improve quality of life.
- Clinical trials of new anticancer drugs or combinations of drugs.
What are the chances of recovery (prognosis) for me?
The possibility of recovery depends on several factors, including:
- Your age and general health condition;
- The presence or absence of certain types of HPV;
- Cancer stage;
- Types of cancer cells;
- Tumor size;
- Response to treatment.
