Cervical cancer

Diagnosis

Screening

Cervical cancer and precancerous cells that may potentially grow into cervical cancer in the future can be detected through screening tests.

• Pap test is done by scraping and brushing cells from the cervix. The cells are then sent for examination in the lab. Abnormal cells, cancerous cells, and irregular cells in the cervix will be revealed from Pap test.
• HPV DNA test involves testing cells taken from the cervix to detect high-risk types of HPV infection, which may lead to cervical cancer.

Diagnosing

A thorough examination of the cervix is required if the patient is suspected of having cervical cancer. The abnormal cells will be closely inspected with a colposcope, a piece of special magnifying equipment.

Biopsy will be done during the colposcopic procedure. The tissue samples may be collected through:

• Punch biopsy is the use of a sharp instrument to collect cervical tissue samples with a pinch.
• Endocervical curettage uses a curet to scrape off tissue samples from the cervix.

One of the following tests will be done if the punch biopsy or endocervical curettage is alarming to the patient.

• Electrical wire loop can be used to collect a tissue sample. This step involves a thin, low-voltage electrified wire and is done under local anesthesia.
• Cone biopsy is a procedure that collect cells from the deeper layers of the cervix and sends them for laboratory tests. This may be done under general anesthesia.

Staging

If cervical cancer is detected, further tests are necessary to determine the stage of cancer, as the stage is a contributing factor to the choice of treatment.
Additional tests for staging:

• Imaging tests will help reveal whether cancer has spread from the cervix to other parts of the body.
  • X-ray
  • Computerized tomography (CT) scan
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography (PET)
• Visual examination of bladder and rectum is required. This is done with the help of special scopes.

Treatment

The stage of cancer and other health conditions are factors that determine the right treatment option. Surgery, radiation, chemotherapy or all three could be combined.

Surgery

Early-stage cervical cancer is often treated with surgery. The type of surgical procedure depends on the size, the stage of cancer and if the patient has a plan to conceive in the future.

• Cancer Removal:  Removing  entire cancer with a cone biopsy could be possible if the cancer is small. A cone-shaped cervical tissue is removed from the cervix while the rest of the organ is intact. This leaves the possibility for the patient to conceive in the future.
• Trachelectomy or surgical removal of cervix. Operating the cervix and partial surrounding tissues might be a treatment option for early-stage of cervical cancer. Conceiving may be possible as the uterus will be remained untouched after the surgery.
• Hysterectomy or surgical removal of cervix and uterus. Early-stage cervical cancers can be treated with a radical hysterectomy operation. Early-stage cervical cancer can be cured and prevented from reoccurring by a hysterectomy. However, conceiving will no longer be possible as the uterus will be removed.

Minimally invasive hysterectomy may be an option for early-stage cervical cancer. It is done by a few tiny incisions in the abdomen instead of a large incision. This allows the patient to have a faster recovery and shorter hospital admission.

Radiation

Radiation therapy is the use of high-powered beams of energy, similar to X-rays. The goal of this therapy is to kill cancer cells. Radiation therapy and chemotherapy are usually combined to use as the primary treatment for later stages of cervical cancers. If there is a risk of recurrence after the surgery, the combination of these two therapies could be used.

• External beam radiation therapy is given by exposing the radiation beam to the affected area in the body
• Brachytherapy, the radiation is given internally by inserting a device filled with radioactive material into the vagina. Generally, it is kept for a few minutes.
• Both externally and internally

Radiation therapy has a side effect of causing menopause.  Patients who have not reached menopause and have plans to conceive in the future, are recommended to consult a doctor to discuss the possibilities of preserving eggs before starting the treatment.

Chemotherapy

Chemotherapy is the use of powerful anti-cancer drugs that can be taken both orally or intravenously. The drugs are composed to kill cancer cells. For locally advanced cervical cancer, a combination of low doses of chemotherapy and radiation therapy is used as it can increase the effectiveness of the radiation. Doses of chemotherapy can be increased to manage the symptoms of advanced cervical cancer.

Targeted therapy

Targeted therapy is designed to focus on blocking certain abnormalities that present in the cancer cells. This process kills the cancer cells. Giving targeted therapy in conjunction with chemotherapy could be a treatment option for advanced cervical cancer.

Immunotherapy

Immunotherapy is a type of drug that relies on the function of immune system to fight cancer. The immune system in the body may not naturally fight against cancer because the cancer cells create proteins, which cannot be detected by the immune system. Immunotherapy interferes with this process. When cervical cancer has progressed to later stages and other treatment options are not working well, immunotherapy will then be considered.