Cervical cancer is a type of cancer that develops in the cells of the cervix, which is the lower portion of the uterus that connects to the vagina. Globally, cervical cancer is the most common cancer among women and is usually diagnosed in patients between the ages of 35 and 44 years. The primary cause of 50% of high-grade cervical cancers is the persistent infection of high-risk subtypes of human papillomavirus (HPV 16 and HPV 18). 

Symptoms

Cervical cancer at its early stages may not cause any symptoms, however, as the disease progresses, symptoms may include:

• Vaginal bleeding after sexual contact.

• Pelvic pain or pain during intercourse.

• Unusual vaginal discharge.

Further, the symptoms which indicate the spread of cancer to the adjacent tissues or organs include:

• Difficult or painful urination, occasionally with blood in the urine.

• Diarrhea, bleeding in the poop.

• Fatigue and loss of appetite.

• Loss of weight.

• Dull backache or swelling in the legs.

• Pelvic or abdominal pain.

Diagnosis

There are various tests used for diagnosing and planning the treatment for cervical cancer. The utilization of diagnostic tests is influenced by the type of cancer suspected, symptoms, age, general health, and outcomes of earlier medical tests. Cervical cancer may be detected using the following tests:

1. Bimanual pelvic examination and sterile speculum examination

This examination is used to check the patient's cervix, uterus, vagina, ovaries, and other adjacent organs for any unusual changes.

2. Pap test

A Pap test involves gently scraping the outer and inner surfaces of the cervix to collect cell samples for analysis. The cervix contains aberrant cells that can be found during a Pap test, including cancerous cells and cells that have alterations that raise the risk of cervical cancer.

3. Human papillomavirus (HPV) typing test

A sample of cervical cells is tested for HPV either at the same time as a Pap test or after abnormal alterations to the cervix are identified in the results of the Pap test. High-risk HPV strains are seen more often in people with cervical cancer and may help confirm a diagnosis.

4. Colposcopy

During colposcopy, the cervix is examined by a clinician using a colposcope, a specialized microscope. The colposcope is made to give a magnified view of the areas so that any abnormal tissue can be seen. The tissue is biopsied if aberrant tissue is found.

5. Biopsy

A biopsy is the removal of a small portion of tissue for microscopic histopathological examination. Other tests are suggestive of the presence of cancer, but only histopathological confirmation of the biopsy sample can make a definite diagnosis.

6. Pelvic examination under anesthesia

If required, for treatment planning, the clinician may perform a second pelvic examination while the patient is under anesthesia to check for signs of cancer spread to any nearby organs, such as the uterus, vagina, bladder, or rectum.

7. Imaging tests

• Computed tomography (CT): A CT scan uses X-rays to provide a detailed, 3-D image of the abdomen and pelvis and is used to locate a tumor prior to surgery, to assess the size of the tumor, any potential organ involvement, and the size of the regional lymph nodes.

• Magnetic resonance imaging (MRI):

  An MRI can be used to determine the size of the tumor. An MRI is used to determine whether the bladder, rectum, or tissues nearby to the cervix are affected by cervical cancer.

• Positron emission tomography (PET) or PET-CT scan:

  During a single imaging session, a PET-CT scan provides information on the structure and function of body tissues and cells. The spread of cervical cancer to adjacent lymph nodes and other organs (metastases), like the lungs or liver, may be revealed with a PET/CT scan.

8. Laboratory tests

Advanced genomic testing of the tumor, which studies a tumor to check for DNA alterations driving cancer growth, is the primary laboratory test for cervical cancer. A better understanding of the behavior of the tumor can be possible by detecting the changes that take place in cancer cells' genomes.

9. Visual examination

A pelvic examination may be combined with the following procedures if there are indications or symptoms of bladder or rectal problems:

• Cystoscopy: It is used to look inside the bladder and urethra to look for any abnormalities.

• Sigmoidoscopy: A sigmoidoscope is used during sigmoidoscopy to search for any abnormalities inside the rectum and sigmoid (lower) colon.

Both procedures allow for the collection of tissue samples by biopsy which are then histopathologically examined under a microscope for indications of malignancy.

Treatment

• Surgery

Cervical cancer is occasionally treated surgically. The location of the tumor will determine the type of surgery. During surgical procedures, the uterus is removed along with or without other tissues or organs. Both the uterus and the cervix are removed during a total hysterectomy. The uterus, cervix, ovaries, both fallopian tubes, and surrounding tissue are all removed during a radical hysterectomy.

• Radiation therapy

Radiation therapy uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing by damaging their DNA. It can be external radiation therapy or internal radiation therapy (also called brachytherapy).

• Chemotherapy

Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy can be administered alone or along with other forms of therapy. Chemotherapeutic drugs used to treat cervical cancer include cisplatin, carboplatin, ifosfamide, gemcitabine, irinotecan, topotecan, paclitaxel, and vinorelbine.

• Targeted therapy

In targeted therapy, certain enzymes, proteins, or other molecules involved in the growth and spread of cancer cells are blocked using drugs or other substances. The targeted treatments bevacizumab and tisotumab vedotin are used to treat cervical cancer.

• Immunotherapy

Immunotherapy aids the immune system's battle against cancer. An immunotherapy drug called pembrolizumab is used to treat some cervical cancer patients who have the biomarker PD-L1.

Furthermore, the course of treatment is determined by the stage of the disease, and a combination of these therapies may be employed. The increased public awareness of the prevention of cervical cancer with a focus on screening and vaccination will lead to better survival and improved quality of life.