BNUR – 315
Prepared By: LaniCervical Cancer is a cancer that exists or noticed in the cervix. This is expected by the abnormal growth of cells that have the power to enter or spread to other parts of the body. At the beginning, there are no symptoms seen. But later on changes have been expected such as Abnormal Vaginal Bleeding, Pelvic Pain or Pain during Sexual Intercourse. At times, bleeding after sex may not be serious, but it may also point out the presence of Cervix Cancer.

Human Papillomavirus (HPV) Infection causes about more than 90% of cases. But most people who had (HPV) infections do not develop Cervical Cancer. Other possibilities that cause this are smoking, weak immune system, contraceptive pills, having sex at young age, and also having more sexual partners. All these are less important. Cervical cancer particularly develops from pre-cancerous changes over 10-20 years. About 90% of Cervical Cancer cases are squamous cell Carcinomas, 10% are Adenocarcinomas, and other types are small in numbers. Diagnosis is particularly by Cervical Screening followed by a Biopsy. This is done to decide whether or not the cancer has spread HPC Vaccines protect against between two and seven high risk strains of this family of Viruses and may prevent up to 90% of Cervical Cancer. As a danger of Cancer still presents, guidelines suitable is continuing regular pap tests. Other methods to stop this from happening by having few or no sexual partners and the use of condoms. Cervical Cancer screening using the Pap test or Acetic Acid can prove precancerous changes in which when treatment of Cervical Cancer may consist of some combination of surgery, chemotherapy and radiation therapy. Five year survival rates in the United States are about 68% however the outcomes depend very much on how early the cancer is detected.

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Worldwide, cervical cancer is the forth-most common cause and the forth-most common death in cancer women. In 2012 an estimated 528,000 cases of Cervical Cancer occurred with 266,000 deaths. This is about 8% of the total cases and total deaths from cancer about 70% of cervical cancers occur in developing countries and in low income countries. It is one of the most common causes of cancer death in developed countries, the widespread use of cervical screenings programs has dramatically reduced rate of cervical cancer. In medical research, the most famous Immortalized cell line, known as Hela. This was developed from cervical cancer cells of a woman named Henrietta Locks.

The early stages of Cervical Cancer may be completely free of symptoms vaginal bleeding, contact bleeding (most commonly after sexual intercourse). A vaginal mass may indicate the presence of malignancy, which also include moderate pain during sexual intercourse and vaginal discharge are symptoms of cervical cancer. In advanced disease, metastases may be present in the abdomen, lungs or elsewhere these may include: loss of appetite, weight loss, fatigue or tiredness, pelvic pain, back pain, leg pain, swollen legs, heavy vaginal bleeding, bone fractures and rarely leakage of urine or feces from the vagina. Bleeding after douching or after a pelvic examination is a common symptom of cervical cancer.
Infection with some types of HPV is the greatest risk factor for cervical cancer. This followed by HIV infection, not all of the causes of cervical cancer are known. But some of the other contributing factors have been implicated.
Human papilloma virus types 16 and 18 are the cause of cervical cancer cases globally, while 31 and 45 are the cause of another 10%. Women who have sex with men who have many other sexual partners or women who have many sexual partners have the great risk. Genital warts, which are a form of Benign – not malignant tumor of epithelial cells, are also caused by various strains of HPV. However, these serotypes are not related to cervical cancer. It is common to have multiple strains at the same time, including those that cause warts. Infection with HPV is generally believed to be required for cervical cancer to occur.
Both active and passive cigarette smoking increases the risk of cervical cancer. Among HPV infected women, current and former smokers have roughly two to three times the rate of involving the introduction of cancer. Passive smoking is also associated with increased risk, but to a lesser extent, smoking is also connected to the development of cervical cancer. It can increase the risk in women in two different ways which is direct and indirect methods of inducing cervical cancer. The direct way of contracting this cancer is by a smoker who has a higher chance on CIN3 which has the potential of forming cervical cancer. Although, smoking has been linked to cervical cancer, it helps in the development of HPV which is the leading cause of this type of cancer, but also if the woman is already HPV – positive, she has the probability of contracting cervical cancer.

Long term use of oral contraceptive is associated with increased risk of cervical cancer. Having many pregnancies is associated with an increased risk of several cancers. Among HPV- infected women who had seven or more full term pregnancies have four times the risk of cancer compared to women who had no pregnancy and two to three times the risk to women who had one or two full term pregnancies.

There are two types of cervical cancer squamous cell cancer and Adenocarcinoma. They are named after the type of cell that becomes cancerous. Squamous cells are the flat skin-like cells that cover the outer surface of the cervix. Between 70 and 80 of every 100 cervical cancers (70-80%) are squamous cell cancers.

Adenocarcinoma is a cancer that starts in the gland cells that produce mucus. the cervix has glandular cells scattered along the inside of the passage that runs from the cervix to the womb (the end cervical canal) this is less common that squamous cell cancer but has become more common in recent years. More than 10 in every 100 cervical cancers (10%) are adenocarcinoma. Adenosquamous is treated in the same way as squamous cell cancer adenosquamous carcinoma
Adenosquamous cancers are tumors that have both squamous and glandular cancer cells. This is a rare type of cervical cancer. Around 5-6 out of 100 cervical cancers (5-6%) are this type. they are threated in a similar way to squamous cell cancer of the cervix.

Every cervical cancer patient is different. The cancer experts at cancer treatment centers of America (CTCA) have extensive experience in properly staging and diagnosing the disease and developing a treatment plan that’s tailored to your specific type of cervical cancer. Cervical cancer starts when the cells that line the cervix begin to develop abnormal changes. These abnormal cells may become cancerous or they may return to normal. The majority of women do not develop cancer from abnormal cells. There are two main type of cervical cancer: squamous cell carcinoma and adenocarcinoma. Each one is distinguish by the appearance of cells under a microscope.

Squamous cell carcinomas begin in the thin, flat cells that line the bottom of the cervix, this type accounts to 80-90% of cervical cancers. Adenocarcinomas develop in the glandular cells that line the upper portion of the cervix, these cancer make up 10-20% of cervical cancer. Sometimes both types of cells are involved in cervical cancer. Other type of cancer can develop in the cervix but these are rare Metastatic cervical cancer is cancer that has spread to other parts of the body.

The treatment of cervical cancer varies worldwide, largely due to access to surgeons skilled in radical pelvic surgery, and the emergence of fertility-sparing therapy in developed nations. Because cervical cancers are radiosensitive, radiation may be used in all stages where surgical options do not exist. Surgical intervention may have better outcomes than radiological approaches. In addition, chemotherapy can be used to treat cervical cancer, and has been found to be more effective than radiation alone.
Microinvasive cancer (stage IA) may be treated by hysterectomy (removal of the whole uterus including part of the vagina). For stage IA2, the lymph nodes are removed, as well. Alternatives include local surgical procedures such as a loop electrical excision procedure or cone biopsy.
If a cone biopsy does not produce clear margins (findings on biopsy showing that the tumor is surrounded by cancer free tissue, suggesting all of the tumor is removed), one more possible treatment option for women who want to preserve their fertility is a trachelectomy. This attempts to surgically remove the cancer while preserving the ovaries and uterus, providing for a more conservative operation than a hysterectomy. It is a viable option for those in stage I cervical cancer which has not spread; however, it is not yet considered a standard of care, as few doctors are skilled in this procedure. Even the most experienced surgeon cannot promise that a trachelectomy can be performed until after surgical microscopic examination, as the extent of the spread of cancer is unknown. If the surgeon is not able to microscopically confirm clear margins of cervical tissue once the woman is under general anesthesia in the operating room, a hysterectomy may still be needed. This can only be done during the same operation if the woman has given prior consent. Due to the possible risk of cancer spread to the lymph nodes in stage 1b cancers and some stage 1a cancers, the surgeon may also need to remove some lymph nodes from around the uterus for pathologic evaluation.
A radical trachelectomy can be performed abdominally or vaginally and opinions are conflicting as to which is better. A radical abdominal trachelectomy with lymphadenectomy usually only requires a two- to three-day hospital stay, and most women recover very quickly (about six weeks). Complications are uncommon, although women who are able to conceive after surgery are susceptible to preterm labor and possible late miscarriage. A wait of at least one year is generally recommended before attempting to become pregnant after surgery. Recurrence in the residual cervix is very rare if the cancer has been cleared with the trachelectomy. Yet, women are recommended to practice vigilant prevention and follow-up care including Pap screenings/colposcopy, with biopsies of the remaining lower uterine segment as needed (every 3–4 months for at least 5 years) to monitor for any recurrence in addition to minimizing any new exposures to HPV through safe sex practices until one is actively trying to conceive.
Early stages (IB1 and IIA less than 4 cm) can be treated with radical hysterectomy with removal of the lymph nodes or radiation therapy. Radiation therapy is given as external beam radiotherapy to the pelvis and brachytherapy (internal radiation). Women treated with surgery who have high-risk features found on pathologic examination are given radiation therapy with or without chemotherapy to reduce the risk of relapse.
Larger early-stage tumors (IB2 and IIA more than 4 cm) may be treated with radiation therapy and cisplatin-based chemotherapy, hysterectomy (which then usually requires adjuvant radiation therapy), or cisplatin chemotherapy followed by hysterectomy. When cisplatin is present, it is thought to be the most active single agent in periodic diseases. Such addition of platinum-based chemotherapy to chemoradiation seems not only to improve survival but also reduces risk of recurrence in women with early stage cervical cancer (IA2-IIA).
Advanced-stage tumors (IIB-IVA) are treated with radiation therapy and cisplatin-based chemotherapy. On June 15, 2006, the US Food and Drug Administration approved the use of a combination of two chemotherapy drugs, hycamtin and cisplatin, for women with late-stage (IVB) cervical cancer treatment. Combination treatment has significant risk of neutropenia, anemia, and thrombocytopenia side effects.
For surgery to be curative, the entire cancer must be removed with no cancer found at the margins of the removed tissue on examination under a microscope. This procedure is known as exenteration.
Drugs which are used for treatment of cervical cancer are Avastin (Bevacizumab), Bevacizumab, Bleomycin, Hycamtin (Topotecan Hydrochloride), Keytruda (Pembrolizumab), Pembrolizumab and Topotecan Hydrochloride.

Drugs which are used for prevention of cervical cancer are Cervarix (Recombinant HPV Bivalent Vaccine), Gardasil (Recombinant HPV Quadrivalent Vaccine), Gardasil 9 (Recombinant HPV Nonavalent Vaccine), Recombinant Human Papillomavirus (HPV) Bivalent Vaccine, Recombinant Human Papillomavirus (HPV) Nonavalent Vaccine and Recombinant Human Papillomavirus (HPV) Quadrivalent Vaccine.



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