Different Stages Of Cervical Cancer And The Available Treatment Options

Cervical cancer is a prevalent type of gynecologic cancer, affecting many women worldwide. It is the primary contributor to cancer-related fatalities in India, comprising17%of all cancer deaths among women aged 30 to 69 years.Regular gynecologic screenings are crucial as they enable doctors to detect cervical cancer at pre cancer stages, increasing the likelihood of successful treatment and recovery.

Explanation Of Cervical Cancer Before /Pre

Cervical cancerbegins in the cervix, which is the lower part of the uterus that connects to the vagina.Certain strains of the human papillomavirus (HPV), a sexually transmitted virus, are primarily responsible for causing cervical cancer.Cervical cancer causes are relatively few and the cancer can develop slowly over time, often without symptoms in the early stages.

Importance Of Knowing Different Stages And Treatment Options

Knowing the different stages and understanding the available cervical cancer treatmentoptions are crucial. Cervical cancer staging helps healthcare professionals determine the appropriate course of action, allows patients to make informed decisions about their care, and provides insight into the expected prognosis and potential outcomes of treatment.

Types of Cervical Cancer

There are Two Main Types of Cervical Cancer
1. Squamous Cell Carcinoma, which accounts for about 80-90% of cases and starts in the squamous cells lining the cervix.
2. Adenocarcinoma, which makes up the remaining 10-20% and begins in the glandular cells of the cervix.

Stages of Cervical Cancer

Cervical cancer staging is determined using the International Federation of Gynecology and Obstetrics (FIGO) system, consisting ofStages 1 to4. Stage 1:Cancer spreads from the cervix lining to deeper tissue but remains within the uterus, with no spread to other parts. Stage 2:Cancer extends beyond the uterus to nearby areas within the pelvic region (e.g., vagina, para-cerical tissue), yet not to other body parts & pelvic side walls. Stage 3:Tumour affects the lower vagina and pelvic wall and causes kidney swelling (hydronephrosis) or involves regional lymph nodes—no distant spread. Stage 4:Cancer metastasises to the bladder, rectum and distant body sites.

What is Stage 1 Cervical Cancer?

Stage 1 cervical cancer refers to early-stage cancer that is confined tocervix cancer. It is further divided into two sub-stages: Stage 1A, where the cancer is microscopic and not visible to the naked eye, and Stage 1B, where the cancer is visible and measures less than 4 cm in size.

Symptoms of Stage 1 Cervical Cancer

Symptoms may be absent or minimal. Some women may experience abnormal vaginal bleeding, particularly after sexual intercourse, between periods, or after menopause. Other symptoms include pelvic pain or discomfort, pain during sexual intercourse (dyspareunia), or unusual vaginal discharge.

Stage 1 Cervical Cancer Treatment Options

The Stage 1 cervical cancer treatment options include surgery,radiation therapy, and sometimes chemotherapy.

Surgery

ConeBiopsy:A cone-shaped portion of the cervix containing the cancerous cells is removed for both diagnosis and treatment. Radical trachelectomy:This surgery removes the cervix and upper part of the vagina while preserving fertility for women who wish to become pregnant in the future. Hysterectomy/ Radical Hysterectomy:This surgery involves the removal of the uterus and cervix, and sometimes the nearby lymph nodes.It is commonly recommended for women who no longer wish to have children.

Radiation Therapy

External Beam Radiation Therapy: High-energy X-rays are directed at the pelvis from outside the body to destroy cancer cells. Brachytherapy (Internal Radiation Therapy): Radioactive implants or sources are placed directly into the cervix to deliver radiation from within the body.

Chemotherapy

Chemotherapy drugs can be combined with radiation therapy to increase treatment effectiveness or administered after surgery. The selection of treatment depends on factors like tumour size, location, patient health, fertility preferences, and healthcare team expertise.

What isStage 2 Cervical Cancer?

Stage 2 cervical cancer has spread beyond the cervix but has not extended to the pelvic sidewall or lower third of the vagina. It is divided into two subcategories: Stage 2A, where cancer involves the upper two-thirds of the vagina, and Stage 2B, where it has spread to nearby tissues but not to the pelvic sidewall.

Symptoms of Stage 2 Cervical Cancer

Common symptoms may include abnormal vaginal bleeding, particularly after sexual intercourse or between periods, pelvic pain or discomfort, pain during sexual intercourse, unusual vaginal discharge, and an increased frequency of urination. These symptoms may be more pronounced compared to earlier stages of the disease.

Stage 2 Cervical Cancer Treatment Options

Stage 2 cervical cancer treatment options typically involvea combination of radiation therapy and chemotherapy, with surgery being considered when deemed necessary.

Surgery

Radical Hysterectomy:This procedure involves the removal of the uterus, cervix, and nearby tissues, such as the upper vagina, parametrium, and pelviclymph nodes.

Radiation Therapy

• External Beam Radiation Therapy
• Brachytherapy

Chemotherapy

Chemotherapy drugs may be used in combination with radiation therapy to enhance the treatment's effectiveness or after surgery. The treatment plan is determined based on the stage, tumour size, lymph node involvement, and other factors unique to the individual.

What is Stage 3 Cervical Cancer?

In Stage 3, the cancer spreads to the lower third of the vagina, pelvic wall, and lymph nodes or has caused kidney problems. This stage is further categorised based on the extent of cancer spread.

Symptoms of Stage 3 Cervical Cancer

In Stage 3 cervical cancer, common symptoms may include pelvic pain or discomfort, pain during sexual intercourse, abnormal vaginal bleeding, including bleeding after intercourse or between periods, leg swelling, weight loss, unusual vaginal discharge, and urinary or bowel problems.

Stage 3 Cervical Cancer Treatments Options

The treatment options for Stage 3 cervical cancer typically involve a combination of surgery, radiation therapy, and chemotherapy.

Surgery

Radical hysterectomy: In some cases, surgery may be considered to remove the uterus, cervix, upper vagina, and nearby lymph nodes. However, surgery alone may not be sufficient for Stage 3 cervical cancer.

Radiation Therapy

• External beam radiation therapy
• Brachytherapy

Chemotherapy

Chemotherapy drugs are often used in combination with radiation therapy to enhance the treatment's effectiveness. This approach includes chemotherapy drugs like cisplatin or other targeted therapies.

Targeted Therapies

Targeted therapiessuch as bevacizumab may be considered in certain cases, especially in combination with chemotherapy, to inhibit the growth of blood vessels that supply nutrients to cancer cells.

What is Stage 4 Cervical Cancer?

Stage 4 cervical cancer refers to advanced cancer that has spread beyond the cervix and uterus to other parts of the body, such as the bladder, rectum or distant organs like the liver, lungs or bones. It is further divided into Stage 4A, involving nearby organs, and Stage 4B, involving distant organs.

Symptoms of Stage 4 Cervical Cancer

The symptoms of advanced cervical cancer may include lethargy, fatigue or weakness, dizziness, bone pain or fractures, vaginal fistula, shortness of breath and spitting up blood.

Stage 4 Cervical Cancer Treatment Options

In Stage 4 cervical cancer, treatment options focus on palliative care to manage symptoms, improve quality of life and extend survival. Curative treatment may not be possible at this advanced stage, but various approaches can be considered:

Chemotherapy

Chemotherapyis often the primary treatment for Stage 4 cervical cancer. It aims to control the spread of cancer, relieve symptoms, and extend survival.

Radiation Therapy

External beam radiation therapy and brachytherapy may be used to shrink tumours and alleviate symptoms, particularly for localised areas of metastasis or for palliation of pain.

Targeted Therapies

Targeted therapies, such as bevacizumab, Pembrolizumab may be considered in combination with chemotherapy to inhibit the growth of blood vessels supplying nutrients to cancer cells. Pelvic Exenteration:In rare cases of extensive disease, this surgery involves the removal of the cervix, uterus, vagina, surrounding lymph nodes and other affected organs, such as the bladder or rectum.

Palliative Surgery

Surgical procedures may be performed to relieve symptoms and improve quality of life.Surgical procedures can involve the removal of obstructing tumours, addressing complications such as bleeding or urinary obstruction and providing relief from pain.

Supportive Care

Supportive care plays a crucial role in managing symptoms, improving quality of life and addressing emotional, physical and practical needs. This includes pain management, nutritional support, psychological support and symptom control.

Conclusion

Cervical cancer is a serious health concern, but regular screenings improve early detection and treatment success. Understanding cervical cancer causes, its stages, and treatment options is vital for informed decisions. Surgery, radiation therapy,chemotherapy,and supportive care are utilised based on stage and individual factors. A comprehensive approach with medical interventions, support, and well-being focus enhances outcomes and quality of life.

Frequently Asked Questions

1) What Are The Potential Side Effects Of Treatment For Cervical Cancer?

Potential side effects of cervical cancer treatment include fatigue, nausea, hair loss, loss of appetite, changes in bowel or bladder function, infertility, early menopause, and emotional distress.

2) What Is The Importance Of Early Detection And Treatment For Cervical Cancer?

Early detection and treatment of cervical cancer are crucial as they significantly improve the chances of successful outcomes, minimise the need for aggressive treatments and enhance overall prognosis and quality of life.

3) What Can Patients Do To Reduce Their Risk Of Developing Cervical Cancer?

Patients can avoid cervical cancer causes by getting vaccinated against human papillomavirus (HPV), practising safe sex, undergoing regular screenings, and maintaining a healthy lifestyle.

4) What Is Palliative Care, And How Does It Apply To Cervical Cancer Treatment?

Palliative care focuses on improving the quality of life for patients with serious illnesses, including cervical cancer. It aims to relieve symptoms,manage pain, address emotional needs and provide support throughout the treatment process.

5) What Is The Follow-Up Care After Cervical Cancer Treatment?

Follow-up care after cervical cancer treatment typically involves regular check-ups, including physical examinations, imaging tests and blood tests, to monitor for any signs of recurrence or complications and ensure the patient's well-being.