Cervical Cancer

Cervical cancer, also known as cervix cancer or cervical carcinoma, is the abnormal and uncontrolled proliferation of malignant cells in the cervix, the narrow lower portion of the uterus that connects it to the vagina. It is one of the most common cancers of the female reproductive system and has a very good prognosis if detected early.

Depending on the type of cells from which it originates, cervical cancer is classified into two main types:

• Squamous cell carcinoma: Arises from squamous cells, which are thin, flat cells found in the ectocervix, the outermost part of the cervix. This is the most common type.
• Adenocarcinoma: Originates in the glandular cells lining the endocervix, the inner part of the cervix that forms the canal connecting to the vagina. These cells are column-shaped and produce mucus.

Symptoms

In its early stages, cervical cancer usually does not cause symptoms. As it progresses, the following may occur:

• Postcoital vaginal bleeding, bleeding between menstrual periods, or postmenopausal bleeding.
• Heavier and longer-than-normal menstrual bleeding.
• Increased vaginal discharge, which may be bloody and foul-smelling.
• Pelvic pain.
• Pain during sexual intercourse.

If the cancer has spread, additional symptoms may appear:

• Difficulty or pain when urinating or defecating, with blood in the urine or stool.
• Lower back pain.
• Abdominal pain.
• Swelling in the legs.

Causes

The abnormal proliferation of cells is caused by a genetic mutation in the DNA that alters normal cell reproduction and death processes. The excess cells accumulate, forming a tumor that invades surrounding tissues. In cervical cancer, this process is slow and progressive, beginning with cervical intraepithelial neoplasia, a cellular lesion characterized by irreversible DNA modification in the epithelium of the ectocervix. This is a precancerous condition that, if untreated, can evolve into carcinoma.

Both precancerous lesions and cervical cancer are closely related to the human papillomavirus (HPV), which is responsible for most cases of this cancer, especially HPV-16 and HPV-18 serotypes. These viruses contain two proteins, E6 and E7, which deactivate tumor suppressor genes such as p53 and Rb. These genes regulate cell growth and trigger cell death. Their deactivation can lead to uncontrolled cell growth and the formation of cancerous tumors. However, only a small percentage of women with HPV develop cancer.

Risk Factors

The likelihood of developing cervical cancer increases in the following situations:

• Greater exposure to sexually transmitted infections (STIs): Increases the risk of acquiring HPV.
  • Unprotected sexual intercourse.
  • Early onset of sexual activity.
  • Multiple sexual partners.
  • High-risk sexual partners.

• Weakened immune system.
• Presence of other STIs, such as herpes, chlamydia, gonorrhea, syphilis, or HIV.
• Smoking: Tobacco prolongs HPV infection.
• History of cancer or precancerous lesions in the vulva, vagina, or anus.
• Family history of cervical cancer.
• Use of oral contraceptives.
• Three or more full-term pregnancies.
• Exposure to diethylstilbestrol (DES), a medication used until 1971 to prevent miscarriage. A rare type of cervical cancer, clear cell adenocarcinoma, is more common in women whose mothers took this drug.

Complications

The main complication of cancer is metastasis, meaning its spread to other parts of the body. Cervical cancer can spread directly to nearby organs and tissues, such as the rest of the reproductive system or the urinary system, or it can enter the uterine lymphatic vessels and spread to any other part of the body. Metastasis not only damages affected organs but also reduces treatment effectiveness and, consequently, life expectancy.

Prevention

The following measures help prevent cervical cancer:

• HPV vaccination.
• Regular Pap smears (cervical cytology).
• Practicing protected sex.
• Avoiding smoking.

What Specialist Treats Cervical Cancer?

Cervical cancer is diagnosed and treated in gynecology, obstetrics, and oncology departments.