CERVICAL CANCER OVERVIEW
WHAT IS CERVICAL CANCER?
Cervical cancer is cancer that starts in the cervix, the narrow opening into the uterus from the vagina. The normal “ectocervix” (the portion of the uterus extending into the vagina) is a healthy pink color and is covered with flat, thin cells called squamous cells. The “endocervix” or cervical canal is made up of another kind of cell called columnar cells. The area where these cells meet is called the “transformation zone” (T-zone) and is the most likely location for abnormal or precancerous cells to develop.
Most cervical cancers (80 to 90 percent) are squamous cell cancers. Adenocarcinoma is the second most common type, accounting for the remaining 10 to 20 percent of cases. Adenocarcinoma develops from the glands that produce mucus in the endocervix. While less common than squamous cell carcinoma, the incidence of adenocarcinoma is on the rise, particularly in younger women.
Anatomy of the Cervix
Cervix as shown during Speculum Exam
WORLDWIDE CANCER BURDEN
According to the Estimates of incidence and mortality of cervical cancer in 2018: A Worldwide Analysis, approximately 570,000 cases and 311,000 deaths from this disease occurred in 2018. Cervical cancer was the fourth most common cancer in women, ranking after breast cancer (2·1 million cases), colorectal cancer (0·8 million) and lung cancer (0·7 million). The estimated age-standardised incidence of was 13.1 per 100 000 women globally and varied widely among countries, with rates ranging from less than 2 to 75 per 100 000 women.
Cervical cancer was the leading cause of cancer-related death in women in eastern, western, middle, and southern Africa. The highest incidence was estimated in Eswatini, with approximately 6.5% of women developing cbefore 75 years of age. China and India together contributed more than a third of the global cervical burden, with 106 000 cases in China and 97 000 cases in India, and 48 000 deaths in China and 60 000 deaths in India.
Globally, the average age at diagnosis of was 53 years, ranging from 44 years (Vanuatu) to 68 years (Singapore). The global average age at death was 59 years, ranging from 45 years (Vanuatu) to 76 years (Martinique). Cervical cancer ranked in the top three cancers affecting women younger than 45 years in 146 (79%) of 185 countries assessed. The high mortality rate globally could be reduced through a comprehensive approach that includes prevention, early diagnosis, effective screening and treatment programmes. There are currently vaccines that protect against common cancer-causing types of human papilloma virus and can significantly reduce the risk of cervical cancer.
In the Philippines, Cervical Cancer is the 2nd leading cancer site among women. An estimated 7,277 new cases, and 3,807 deaths are expected to occur every year.
The high mortality rate from cervical cancer globally could be reduced through a comprehensive approach that includes prevention, early diagnosis, effective screening and treatment programmes. There are currently vaccines that protect against common cancer-causing types of human papilloma virus and can significantly reduce the risk of cervical cancer.
Cervical cancer tends to occur during midlife. It is most frequently diagnosed in women between the ages of 35 and 44. It rarely affects women under age 20, and more than 15 percent of diagnoses are made in women older than 65. But in women over 65, cancer typical occurs in women who were not receiving regular screening.
WHAT CAUSES CERVICAL CANCER?
Human papillomavirus (HPV) is found in about 99% of cervical cancers. There are over 100 different types of HPV, most of which are considered low-risk and do not cause cancer. High-risk HPV types may cause cervical cell abnormalities or cancer. More than 70 percent of cases can be attributed to two types of the virus, HPV-16 and HPV-18, often referred to as high-risk HPV types.
HPV is estimated to be the most common sexually transmitted infection. In fact, by age 50 approximately 80% of women have been infected with some type of HPV. The majority of women infected with the HPV virus do NOT develop cervical cancer. For most women the HPV infection does not last long; 90% of HPV infections resolve on their own within 2 years. A small number of women do not clear the HPV virus and are considered to have “persistent infection. A woman with a persistent HPV infection is at greater risk of developing cervical cell abnormalities and cancer than a woman whose infection resolves on its own. Certain types of this virus are able to transform normal cervical cells into abnormal ones. In a small number of cases and usually over a long period of time (from several years to several decades), some of these abnormal cells may then develop into cervical cancer.
SYMPTOMS OF CERVICAL CANCER
Precancerous cervical cell changes and early cancers of the cervix generally do not cause symptoms. For this reason, regular cervical screening can help catch precancerous cell changes early and prevent the development of this disease.
Possible symptoms of more advanced disease may include abnormal or irregular vaginal bleeding, pain during sex, or vaginal discharge. Notify your healthcare provider if you experience:
- Abnormal bleeding, such as
- Bleeding between regular menstrual periods
- Bleeding after sexual intercourse
- Bleeding after douching
- Bleeding after a pelvic exam
- Bleeding after menopause
- Pelvic pain not related to your menstrual cycle
- Heavy or unusual discharge that may be watery, thick, and possibly have a foul odor
- Increased urinary frequency
- Pain during urination
These symptoms could also be signs of other health problems, not related to cervical cancer. If you experience any of the symptoms above, talk to a healthcare provider.